{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T15:09:56Z","timestamp":1790176196868,"version":"4.1.0"},"reference-count":45,"publisher":"International Journal of Sports Physical Therapy","issue":"3","license":[{"start":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T00:00:00Z","timestamp":1740787200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec id=\"introduction\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>There is a high incidence of shoulder injuries among overhead athletes. Identifying and understanding risk factors for these injuries, particularly those that can be modified, is a necessary step towards being able to effectively develop and implement shoulder specific injury prevention programs. Therefore, the purpose of this systematic review was to identify risk factors associated with a new onset of shoulder pain and injury among the athletic population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"design\">\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic Review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review of the literature was performed within PubMed, Embase, AMED, CINAHL, and EmCare databases. Studies were screened utilizing the following inclusion criteria; (a) athletes currently pain free or no history of pain at baseline, (b) athletes with shoulder and or arm pain originating from a musculoskeletal shoulder problem (c) risk factors captured prospectively (d) pathoanatomy and biomechanics in isolation or in addition to personal characteristics, etc. (e) reporting relative risk, odds ratios, and\/or hazard ratios and (f) follow up \u2265 6 months. Due to data heterogeneity, only a descriptive data synthesis was performed. Data were extracted and underwent risk of bias assessment utilizing the Quality in Prognosis Studies (QUIPS) tool. PRISMA guidelines were utilized throughout.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nineteen papers were included. A total of four studies investigated baseball, five handball, three swimming, two tennis, two military, one cricket, one American football, and one with multiple sports, totaling 7,802 athletes. The risk of bias among the included studies was rated from moderate to low overall with no single study being identified as high risk of bias. All studies designs were a level of evidence of II except for two studies that were level III. The most significant risk factors included range of motion, reduced strength, history of local\/regional musculoskeletal pain, previous injury, and training load. There are inconsistencies in how injury and pain are defined within studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"conclusion\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Many risk factors are easily objectifiable and modifiable which may help in developing shoulder injury mitigation strategies. Three of the five significant risk factors for injury can be identified by objective pre-screening measures. While previous pain and injury cannot be mitigated, training loads should be closely monitored and adapted according to other risk factors and the athlete\u2019s response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"level-of-evidence\">\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>2<\/jats:p>\n                  <\/jats:sec>","DOI":"10.26603\/001c.129462","type":"journal-article","created":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T20:14:26Z","timestamp":1740773666000},"source":"Crossref","is-referenced-by-count":8,"title":["Risk Factors Associated with New Onset of Shoulder Pain and Injury Among the Athletic Population: A Systematic Review of the Literature"],"prefix":"10.26603","volume":"20","author":[{"given":"Paul","family":"Salamh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garrett","family":"Bullock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Chester","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Daniell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chad","family":"Cook","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"DeLang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah-Rose","family":"Tucker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Walker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Lewis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"11140","published-online":{"date-parts":[[2025,3,1]]},"reference":[{"issue":"6","key":"ref1","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1177\/1941738116672161","article-title":"Anterior shoulder instability in the military athlete","volume":"8","author":"B. Waterman","year":"2016","journal-title":"Sports Health"},{"issue":"5-6","key":"ref2","doi-asserted-by":"publisher","first-page":"e158","DOI":"10.1093\/milmed\/usx086","article-title":"A history of shoulder instability in the military: where we have been and what we have learned","volume":"183","author":"J. A. Wolfe","year":"2018","journal-title":"Mil Med"},{"issue":"7","key":"ref3","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1136\/bjsports-2022-105674","article-title":"Diagnosis, prevention and treatment of common shoulder injuries in sport: grading the evidence - a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF)","volume":"57","author":"B. Liaghat","year":"2023","journal-title":"Br J Sports Med"},{"issue":"5","key":"ref4","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1177\/1941738120931764","article-title":"Risk factors of overuse shoulder injuries in overhead athletes: a systematic review","volume":"12","author":"C. Tooth","year":"2020","journal-title":"Sports Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"M. J. Page","year":"2021","journal-title":"Br Med J"},{"issue":"7","key":"ref6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2519\/jospt.2023.11773","article-title":"Description, prediction, and causation in sport and exercise medicine research: resolving the confusion to improve research quality and patient outcomes","volume":"0","author":"J. M. Losciale","year":"2023","journal-title":"J Orthop Sports Phys Ther"},{"issue":"4","key":"ref7","doi-asserted-by":"publisher","first-page":"280","DOI":"10.7326\/0003-4819-158-4-201302190-00009","article-title":"Assessing bias in studies of prognostic factors","volume":"158","author":"J. A. Hayden","year":"2013","journal-title":"Ann Intern Med"},{"issue":"9","key":"ref8","doi-asserted-by":"publisher","first-page":"1773","DOI":"10.1016\/j.jse.2022.04.016","article-title":"Initial kinematic chain injuries increase hazard of subsequent arm injuries in professional baseball pitchers","volume":"31","author":"G. S. Bullock","year":"2022","journal-title":"J Shoulder Elbow Surg"},{"issue":"2","key":"ref9","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1080\/00913847.2017.1300505","article-title":"Risk factors for shoulder and elbow pain in youth baseball players","volume":"45","author":"T. Matsuura","year":"2017","journal-title":"Phys Sportsmed"},{"issue":"2","key":"ref10","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1177\/19417381221078830","article-title":"Hip abductor strength asymmetry: relationship to upper extremity injury in professional baseball players","volume":"15","author":"H. A. Plummer","year":"2023","journal-title":"Sports Health"},{"issue":"20","key":"ref11","doi-asserted-by":"publisher","first-page":"1312","DOI":"10.1136\/bjsports-2017-098254","article-title":"Risk factors for, and prevention of, shoulder injuries in overhead sports: a systematic review with best-evidence synthesis","volume":"52","author":"M. Asker","year":"2018","journal-title":"Br J Sports Med"},{"issue":"4","key":"ref12","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1007\/s00167-019-05493-4","article-title":"Decreased external rotation strength is a risk factor for overuse shoulder injury in youth elite handball athletes","volume":"28","author":"L. Achenbach","year":"2020","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"1","key":"ref13","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1186\/s40798-022-00478-z","article-title":"The effect of shoulder and knee exercise programmes on the risk of shoulder and knee injuries in adolescent elite handball players: a three-armed cluster randomised controlled trial","volume":"8","author":"M. Asker","year":"2022","journal-title":"Sports Med Open"},{"issue":"2","key":"ref14","doi-asserted-by":"crossref","first-page":"67","DOI":"10.2519\/jospt.2020.9044","article-title":"Preseason clinical shoulder test results and shoulder injury rate in adolescent elite handball players: a prospective study","volume":"50","author":"M. Asker","year":"2020","journal-title":"J Orthop Sports Phys Ther"},{"issue":"7","key":"ref15","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1055\/s-0032-1312587","article-title":"Shoulder strength imbalances as injury risk in handball","volume":"34","author":"P. Edouard","year":"2013","journal-title":"Int J Sports Med"},{"issue":"4","key":"ref16","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1136\/bjsports-2016-096927","article-title":"Handball load and shoulder injury rate: a 31-week cohort study of 679 elite youth handball players","volume":"51","author":"M. M\u00f8ller","year":"2017","journal-title":"Br J Sports Med"},{"issue":"1","key":"ref17","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1177\/0363546520969913","article-title":"Prediction of shoulder pain in youth competitive swimmers: the development and internal validation of a prognostic prediction model","volume":"49","author":"S. Feijen","year":"2021","journal-title":"Am J Sports Med"},{"issue":"16","key":"ref18","doi-asserted-by":"publisher","first-page":"1767","DOI":"10.1080\/02640414.2012.718092","article-title":"Can scapular and humeral head position predict shoulder pain in adolescent swimmers and non-swimmers?","volume":"30","author":"L. McKenna","year":"2012","journal-title":"J Sports Sci"},{"issue":"4","key":"ref19","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1016\/j.ptsp.2012.01.001","article-title":"Shoulder pain in swimmers: a 12-month prospective cohort study of incidence and risk factors","volume":"13","author":"H. Walker","year":"2012","journal-title":"Phys Ther Sport"},{"issue":"1","key":"ref20","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1177\/19417381211051643","article-title":"Association between spikes in external training load and shoulder injuries in competitive adolescent tennis players: the SMASH cohort study","volume":"14","author":"F. Johansson","year":"2022","journal-title":"Sports Health"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"940934","DOI":"10.3389\/fspor.2022.940934","article-title":"Athletic identity and shoulder overuse injury in competitive adolescent tennis players: the SMASH cohort study","volume":"4","author":"F. Johansson","year":"2022","journal-title":"Front Sports Act Living"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1002\/9781444316872","article-title":"Epidemiology of injury in olympic sports","author":"D. J. Caine","year":"2009"},{"issue":"11","key":"ref23","doi-asserted-by":"publisher","first-page":"2645","DOI":"10.1177\/0363546513501508","article-title":"Risk factors for posterior shoulder instability in young athletes","volume":"41","author":"B. D. Owens","year":"2013","journal-title":"Am J Sports Med"},{"issue":"11","key":"ref24","doi-asserted-by":"publisher","first-page":"2591","DOI":"10.1177\/0363546514551149","article-title":"Risk factors for anterior glenohumeral instability","volume":"42","author":"B. D. Owens","year":"2014","journal-title":"Am J Sports Med"},{"issue":"5","key":"ref25","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1002\/tsm2.158","article-title":"Risk factors for dominant-shoulder injury in elite female Australian cricket players: A prospective study","volume":"3","author":"M. C. Murphy","year":"2020","journal-title":"Transl Sports Med"},{"issue":"3","key":"ref26","doi-asserted-by":"publisher","first-page":"2325967116639222","DOI":"10.1177\/2325967116639222","article-title":"Influence of extrinsic risk factors on national football league injury rates","volume":"4","author":"D. W. Lawrence","year":"2016","journal-title":"Orthop J Sports Med"},{"issue":"1","key":"ref27","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1055\/s-0033-1343409","article-title":"Does scapular positioning predict shoulder pain in recreational overhead athletes?","volume":"35","author":"F. Struyf","year":"2014","journal-title":"Int J Sports Med"},{"issue":"7","key":"ref28","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1136\/bjsports-2019-101969","article-title":"International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020 (including STROBE Extension for Sport Injury and Illness Surveillance (STROBE-SIIS))","volume":"54","author":"R. Bahr","year":"2020","journal-title":"Br J Sports Med"},{"issue":"9","key":"ref29","doi-asserted-by":"publisher","first-page":"2075","DOI":"10.1177\/0363546514538391","article-title":"Deficits in glenohumeral passive range of motion increase risk of elbow injury in professional baseball pitchers: a prospective study","volume":"42","author":"K. E. Wilk","year":"2014","journal-title":"Am J Sports Med"},{"issue":"2","key":"ref30","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1177\/0363546510384223","article-title":"Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers","volume":"39","author":"K. E. Wilk","year":"2011","journal-title":"Am J Sports Med"},{"issue":"1","key":"ref31","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.jsams.2020.06.015","article-title":"Baseball pitching biomechanics in relation to pain, injury, and surgery: A systematic review","volume":"24","author":"G. S. Bullock","year":"2021","journal-title":"J Sci Med Sport"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/00913847.2017.1300505","article-title":"Risk factors for shoulder and elbow pain in youth baseball players","author":"T. Matsuura","year":"2017","journal-title":"Phys Sportsmedicine"},{"issue":"10","key":"ref33","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1136\/bjsports-2016-096847","article-title":"Musculoskeletal dysfunctions associated with swimmers' shoulder","volume":"51","author":"F. Struyf","year":"2017","journal-title":"Br J Sports Med"},{"issue":"14","key":"ref34","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.1136\/bjsports-2016-096226","article-title":"Preventing overuse shoulder injuries among throwing athletes: a cluster-randomised controlled trial in 660 elite handball players","volume":"51","author":"S. H. Andersson","year":"2017","journal-title":"Br J Sports Med"},{"issue":"7-8","key":"ref35","first-page":"761","article-title":"Effects of a strength-training program for shoulder complaint prevention in female team handball athletes. A pilot study","volume":"55","author":"H. \u00d8ster\u00e5s","year":"2015","journal-title":"J Sports Med Phys Fitness"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"45304","DOI":"10.1038\/srep45304","article-title":"Shoulder stretching intervention reduces the incidence of shoulder and elbow injuries in high school baseball players: a time-to-event analysis","volume":"7","author":"H. Shitara","year":"2017","journal-title":"Sci Rep"},{"issue":"9","key":"ref37","doi-asserted-by":"publisher","first-page":"893","DOI":"10.4085\/1062-6050-501-19","article-title":"Training load and its role in injury prevention, part 2: conceptual and methodologic pitfalls","volume":"55","author":"F. M. Impellizzeri","year":"2020","journal-title":"J Athl Train"},{"issue":"9","key":"ref38","doi-asserted-by":"publisher","first-page":"885","DOI":"10.4085\/1062-6050-500-19","article-title":"Training load and its role in injury prevention, part I: back to the future","volume":"55","author":"F. M. Impellizzeri","year":"2020","journal-title":"J Athl Train"},{"issue":"9","key":"ref39","doi-asserted-by":"publisher","first-page":"1667","DOI":"10.1007\/s40279-023-01833-0","article-title":"Understanding training load as exposure and dose","volume":"53","author":"F. M. Impellizzeri","year":"2023","journal-title":"Sports Med"},{"issue":"1","key":"ref40","doi-asserted-by":"publisher","first-page":"11","DOI":"10.2519\/jospt.2022.10952","article-title":"2022 Bern Consensus statement on shoulder injury prevention, rehabilitation, and return to sport for athletes at all participation levels","volume":"52","author":"A. Schwank","year":"2022","journal-title":"J Orthop Sports Phys Ther"},{"issue":"10","key":"ref41","doi-asserted-by":"publisher","first-page":"2379","DOI":"10.1177\/0363546515594380","article-title":"Deficits in glenohumeral passive range of motion increase risk of shoulder injury in professional baseball pitchers: a prospective study","volume":"43","author":"K. E. Wilk","year":"2015","journal-title":"Am J Sports Med"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/j.ptsp.2021.09.004","article-title":"Effectiveness of shoulder injury prevention programs in an overhead athletic population: A systematic review","volume":"52","author":"A. A. Wright","year":"2021","journal-title":"Phys Ther Sport"},{"issue":"8","key":"ref43","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1136\/bjsports-2012-091524","article-title":"Development and validation of a new method for the registration of overuse injuries in sports injury epidemiology: the Oslo Sports Trauma Research Centre (OSTRC) overuse injury questionnaire","volume":"47","author":"B. Clarsen","year":"2013","journal-title":"Br J Sports Med"},{"issue":"7","key":"ref44","doi-asserted-by":"publisher","first-page":"569","DOI":"10.2165\/00007256-200939070-00004","article-title":"Shoulder muscle recruitment patterns and related biomechanics during upper extremity sports","volume":"39","author":"R. F. Escamilla","year":"2009","journal-title":"Sports Med"},{"issue":"2","key":"ref45","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1177\/1941738110362656","article-title":"The kinetic chain in overhand pitching: its potential role for performance enhancement and injury prevention","volume":"2","author":"S. T. Seroyer","year":"2010","journal-title":"Sports Health"}],"container-title":["International Journal of Sports Physical Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ijspt.scholasticahq.com\/article\/129462-risk-factors-associated-with-new-onset-of-shoulder-pain-and-injury-among-the-athletic-population-a-systematic-review-of-the-literature","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T14:49:58Z","timestamp":1790174998000},"score":1,"resource":{"primary":{"URL":"https:\/\/ijspt.scholasticahq.com\/article\/129462-risk-factors-associated-with-new-onset-of-shoulder-pain-and-injury-among-the-athletic-population-a-systematic-review-of-the-literature"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,1]]},"references-count":45,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.26603\/001c.129462","relation":{},"ISSN":["2159-2896"],"issn-type":[{"value":"2159-2896","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,1]]}}}