Análise dos aspectos funcionais do complexo do ombro, core e quadril em atletas de arremesso com e sem dor no ombro

Abstract

Introduction: Overhead sports overload the shoulder complex mainly due to the repetition of throwing movements at high speeds, which may cause some adaptations in the athlete’s shoulder, and might increase the risk of developing shoulder pain. Moreover, it has been considered nowadays the influence of alterations throughout the kinetic chain as risk factor to injuries in the shoulder complex. Objective: to compare alterations in osseous, muscular and joint system and the function of shoulder complex, core and hip in overhead athletes with and without shoulder pain. Methods: This is an observational study, in which 41 handball and volleyball athletes were assessed. The athletes were assigned to two groups according to their shoulder pain: no pain group (NPG) (n: 20, age: 21,2±3,1 years and BMI: 23,3±3,2 kg/m2 ) and pain group (PG) (n: 21; age: 23,6±3,7 years and BMI: 25,02±3,9 kg/m2 ), based on pain and function self-reported through the Penn Shoulder Score (PSS) and Disabilities of the arm, shoulder, and hand (DASH) questionnaires. The individuals underwent an assessment of range of motion (ROM) of shoulder (rotation, horizontal adduction, low flexion, and humeral retroversion), hip (rotation) and trunk (flexion, extension, and lateral flexion), strength of glenohumeral (rotators), scapular (lower trapezius and serratus anterior), hip (abductors and extensors) and trunk (rotators, extensors and lateral flexors) muscles, besides endurance of the trunk (flexors, extensors and lateral flexors) and functional performance of lower and upper limbs through the Y balance test. Data were analyzed in a descriptive and inferential manner through SPSS 20.0, with a 95% confidence interval and a p<0,05 was considered statistically different. Results: Athletes from the pain group showed smaller external rotation (ER) (p<0,01) and total rotation (p<0,01) ROM in the dominant shoulder, smaller horizontal adduction (p<0,01) in non-dominant shoulder, smaller hip internal rotation (IR) in dominant and non-dominant hips (p<0,01), and less trunk flexion ROM (p<0,01). PG also showed less strength of trunk extension (p=0,01), short endurance time for trunk extensors (p=0,02) and flexors (p<0,01), decreased reach distance for both lower limbs in the anterior direction (p<0,05), decreased reach distance in the posteromedial direction(p=0,04) for the dominant lower limb, as well as smaller composite score for both limbs (p<0,05). Moreover, for limbs comparison, the dominant limb of the PG showed smaller ROMs of shoulder IR(p<0,01) and total ROM (p<0,01), of horizontal adduction (p=0,04) and low flexion(p=0,01), besides decreased reach distance in the superolateral direction in the upper quarter Y balance test. As for the NPG the dominant limb showed higher shoulder ER ROM (p=0,03), and smaller values for shoulder IR ROM (p=0,02), horizontal adduction (p=0,01) and low flexion (p<0,01). Conclusion: Overhead athletes with shoulder pain show changes in ROM throughout the kinetic chain, besides lower core endurance, and decreased functional performance in the lower limbs.