Enter your details:
Thank you for subscribing.
Subscribe to our newsletter!

Tengku Fadilah Tengku Kamalden1, Qais Gasibat1, Shamsulariffin Samsudin1, Jacklyn Anak Joseph1

1University Putra Malaysia, Department of Sport Studies, Kuala Lumpur, Malaysia

Occurrence of Muscle Imbalance and Risk of Injuries in Athletes using Overhead Movements: A Systematic Review

Sport Mont 2021, 19(3), 115-122 | DOI: 10.26773/smj.211012


The purpose of this study was to examine injuries attributed to muscle imbalance in sports with overhead move- ments. Available sources in the period between 2010 and 2020 that provide an overview of the occurrence of muscle imbalance and the risk of injuries in overhead sports were evaluated. A comprehensive search of relevant sources was conducted using Google Scholar, PubMed databases, and other databases, including Science Direct, Research Gate, Web of Science, and Psyc Info. Eleven articles met the criteria to be included in the systematic re- view. Muscle imbalance significantly impacted overhead athletes and was responsible for injuries of the shoulder, lower back, elbow, and wrist. Based on the findings of the review, further study on muscle imbalance should be carried out. More importantly, future research should investigate the muscle imbalance in the non-dominant side and identify relevant exercises that can reduce the imbalance and increase the stability and strength of the muscles on the non-dominant side. Researchers have identified muscle imbalance as a cause of the injuries, but detailed information on the prevalence of muscle imbalance and its impact on athletes remains lacking.


dominant and non-dominant limbs, overhead sports, injuries, muscle imbalance

View full article
(PDF – 478KB)


Andrade, M.D.S., Fleury, A.M., de Lira, C.A.B., Dubas, J.P., & da Silva, A.C. (2010). Profile of isokinetic eccentric-to-concentric strength ratios of shoulder rotator muscles in elite female team handball players. Journal of Sports Sciences, 28(7), 743-749.

Andrade, M.S., de Carvalho Koffes, F., Benedito-Silva, A.A., da Silva, A.C., & de Lira, C.A.B. (2016). Effect of fatigue caused by a simulated handball game on ball throwing velocity, shoulder muscle strength and balance ratio: a prospective study. BMC Sports Science, Medicine and Rehabilitation, 8(1), 13.

Atan, T, Yüceloğlu Keskin, D, Çamlidağ, İ, & Derebaşi, D. (2019). Analysis of dominant and non-dominant biceps and deltoid muscle volumes of badminton players. Turkish Journal of Sport and Exercise, 21(2), 323-327. https://doi.org/10.15314/tsed.496133

Bahr, R., Andersen, S. O., Løken, S., Fossan, B., Hansen, T., & Holme, I. (2004). Low back pain among endurance athletes with and without specific back loading—a cross-sectional survey of cross country skiers, rowers, orienteers, and nonathletic controls. Spine, 29(4), 449-454.

Baranto, A., Hellström, M., Cederlund, C.G., Nyman, R., & Swärd, L. (2009). Back pain and MRI changes in the thoraco-lumbar spine of top athletes in four different sports: a 15 year follow-up study. Knee Surgery, Sports Traumatology, Arthroscopy, 17(9), 1125 1134.

Betchol, C.O. (1954). Grip test: the use of a dynamometer with adjustable handle spacing. J Bone Jt Surg AM, 36, 820-4.

Borsa, P.A., Laudner, K.G., & Sauers, E.L. (2008). Mobility and stability adaptations in the shoulder of the overhead athlete. Sports Medicine, 38(1), 17-36.

Burkhart, S.S., Morgan, C.D., & Kibler, W.B. (2003). The disabled throwing shoulder: spectrum of pathology Part III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy, 19(6), 641-661.

Challoumas, D., Artemiou, A., & Dimitrakakis, G. (2017). Dominant vs. non-dominant shoulder morphology in volleyball players and associations with shoulder pain and spike speed. Journal of Sports Sciences, 35(1), 65-73.

Codine, P., Bernard, P.L., Pocholle, M., Benaim, C., & Brun, V. (1997). Influence of sports discipline on shoulder rotator cuff balance. Medicine & Science in Sports & Exercise, 29(11), 1400-1405.

Correia, J.P., Oliveira, R., Vaz, J.R., Silva, L., & Pezarat-Correia, P. (2016). Trunk muscle activation, fatigue and low back pain in tennis players. Journal of Science and Medicine in Sport, 19(4), 311-316.

Couppe, C., Thorborg, K., Hansen, M., Fahlström, M., Bjordal, J.M., Nielsen, D., & Magnusson, SP. (2014). Shoulder rotational profiles in young healthy elite female and male badminton players. Scandinavian Journal of Medicine & Science in Sports, 24(1), 122-128.

Edmonds, E.W., & Dengerink, D.D. (2014). Common conditions in the overhead athlete. American Family Physician, 89(7), 537-541.

Edouard, P., Damotte, A., Lance, G., Degache, F., & Calmels, P. (2013). Static and dynamic shoulder stabilizer adaptations in javelin throwers: a preliminary study. Isokinetics and Exercise Science, 21(1), 47-55.

Escamilla, R.F., Fleisig, G.S., Barrentine, S.W., Zheng, N., & Andrews, J.R. (1998). Kinematic comparisons of throwing different types of baseball pitches. Journal of Applied Biomechanics, 14(1), 1-23.

Fahlström, M., & Söderman, K. (2007). Decreased shoulder function and pain common in recreational badminton players. Scandinavian Journal of Medicine & Science in Sports, 17(3), 246-251.

Fahlström, M., Yeap, J. S., Alfredson, H., & Söderman, K. (2006). Shoulder pain–a common problem in world‐class badminton players. Scandinavian Journal of Medicine & Science in Sports, 16(3), 168-173.

Fett, D., Trompeter, K., & Platen, P. (s2019). Prevalence of back pain in a group of elite athletes exposed to repetitive overhead activity. PloS one, 14(1), e0210429. https://doi.org/10.1371/journal.pone.0210429

Fleisig, G.S., Escamilla, R.F., Andrews, J.R., Matsuo, T., Satterwhite, Y., & Barrentine, S.W. (1996). Kinematic and kinetic comparison between baseball pitching and football passing. Journal of Applied Biomechanics, 12(2), 207-224.

Gedela, R.K., Kirby, A., & Huhtala, H. (2008). Does the dominant hand possess 10% greater grip strength than the non-dominant hand. Indian Journal of Physiotherapy, 45(2), 116 121.

Gil, J.A., & Kakar, S. (2019). Hand and wrist injuries in tennis players. Current Reviews in Musculoskeletal Medicine, 12(2), 87-97.

Hootman, J.M., Dick, R., & Agel, J. (2007). Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. Journal of Athletic Training, 42(2), 311.

Hosseinimehr, S.H., Anbarian, M., Norasteh, A.A., Fardmal, J., & Khosravi, M.T. (2015). The comparison of scapular upward rotation and scapulohumeral rhythm between dominant and non-dominant shoulder in male overhead athletes and non-athletes. Manual Therapy, 20(6), 758-762.

Kaplan, D.Ö. (2016). Evaluating the relation between dominant and non-dominant hand perimeters and handgrip strength of basketball, volleyball, badminton and handball athletes. International Journal of Environmental and Science Education, 11(10), 3297 3309.

Kibler, W.B. (1998). The role of the scapula in athletic shoulder function. The American Journal of Sports Medicine, 26(2), 325-337.

Koh, J., & Dietz, J. (2005). Osteoarthritis in other joints (hip, elbow, foot, ankle, toes, wrist) after sports injuries. Clinics in Sports Medicine, 24(1), 57-70.

Kraan, R.B., de Nobel, D., Eygendaal, D., Daams, J.G., Kuijer, P.P.F., & Maas, M. (2019). Incidence, prevalence, and risk factors for elbow and shoulder overuse injuries in youth athletes: A systematic review. Translational Sports Medicine, 2(4), 186-195.

Lam, K.Y., & Siow, H.M. (2012). Conservative treatment for juvenile osteochondritis dissecans of the talus. Journal of Orthopaedic Surgery, 20(2), 176-180.

Lantz, J., & McNamara, S. (2003). Modifying the latissimus pull-down exercise for athletes with shoulder injury. Strength & Conditioning Journal, 25(6), 67-69.

Laudner, K., & Sipes, R. (2009). The incidence of shoulder injury among collegiate overhead athletes. Journal of Intercollegiate Sport, 2(2), 260-268.

Lee, K.S., Tuite, M.J., & Rosas, H.G. (2010). Elbow Injuries. In Essential Radiology for Sports Medicine(127-141). Springer, New York, NY.

Lin, J.J., Wu, Y.T., Wang, S.F., & Chen, S.Y. (2005). Trapezius muscle imbalance in individuals suffering from frozen shoulder syndrome. Clinical Rheumatology, 24(6), 569 575.

Lupo, C., Capranica, L., Cugliari, G., Gomez, M. A., & Tessitore, A. (2016). Tactical swimming activity and heart rate aspects of youth water polo game. The Journal of Sports Medicine and Physical Fitness, 56(9), 997-1006.

Murray, I.R., Goudie, E.B., Petrigliano, F.A., & Robinson, C.M. (2013). Functional anatomy and biomechanics of shoulder stability in the athlete. Clinics in Sports Medicine, 32(4), 607 624.

Nekooei, P., Tengku-Fadilah, T.K., Amri, S., Baki, R.B., Majlesi, S., & Nekouei, P. (2019). Anatomical shoulder movement strength imbalance among water polo overhead athletes. International Journal of Kinesiology and Sports Science, 7(2), 15-20.

Noguchi, T., Demura, S., Takahashi, K., Demura, G., & Mori, Y. (2014). Differences in muscle power between the dominant and non-dominant upper limbs of baseball players. The Journal of Strength & Conditioning Research, 28(1), 82-86.

Noormohammadpour, P., Rostami, M., Mansournia, M.A., Farahbakhsh, F., Shahi, M.H.P., & Kordi, R. (2016). Low back pain status of female university students in relation to different sport activities. European Spine Journal, 25(4), 1196-1203.

Oleksy, L., Czarny, W., Bajorek, W., Król, P., & Mika, A. (2018). The evaluation of shoulder muscle fatigue in volleyball players. Journal of Novel Physiotherapies, 8(388), 2.

Olivier, N., & Daussin, F. (2019). Isokinetic torque imbalances of shoulder of the French women’s national water polo team. Science & Sports, 34(2), 82-87.

Page, P. (2011). Shoulder muscle imbalance and subacromial impingement syndrome in overhead athletes. International Journal of Sports Physical Therapy, 6(1), 51.

Page, P., Frank, C., & Lardner, R. (2011). Assessment and treatment of muscle imbalance: the Janda approach. J Orthop Sports Phys Ther, 41(10), 799-800.

Parikh, H., Case, A.L., Hogarth, D.A., & Abzug, J. M. (2020). Pediatric Sports Injuries: Little League Elbow, Osteochondritis Dissecans of the Elbow, Gymnast Wrist. In Pediatric Hand Therapy (pp. 331-357). Elsevier.

Pennock, A.T., Dwek, J., Levy, E., Stearns, P., Manning, J., Dennis, M.M., & Taylor, K.S. (2018). Shoulder MRI abnormalities in asymptomatic little league baseball players. Orthopaedic Journal of Sports Medicine, 6(2), 2325967118756825.

Putty, B.B. (2010). Upper limb injuries in sports. British Journal of Sports Medicine, 44(Suppl 1), i3.

Roos, K.G., Marshall, S.W., Kerr, Z.Y., Golightly, Y.M., Kucera, K.L., Myers, J.B., ... & Comstock, R. D. (2015). Epidemiology of overuse injuries in collegiate and high school athletics in the United States. The American Journal of Sports Medicine, 43(7), 1790 1797.

Sirota, S.C., Malanga, G.A., Eischen, J.J., & Laskowski, E.R. (1997). An eccentric-and concentric strength profile of shoulder external and internal rotator muscles in professional baseball pitchers. The American Journal of Sports Medicine, 25(1), 59-64.

Sung, D.J., Park, S.J., Kim, S., Kwon, M.S., & Lim, Y.T. (2016). Effects of core and non- dominant arm strength training on drive distance in elite golfers. Journal of Sport and Health Science, 5(2), 219-225.

Tonin, K., Stražar, K., Burger, H., & Vidmar, G. (2013). Adaptive changes in the dominant shoulders of female professional overhead athletes: mutual association and relation to shoulder injury. International Journal of Rehabilitation Research, 36(3), 228-235

Trompeter, K., Fett, D., & Platen, P. (2017). Prevalence of back pain in sports: a systematic review of the literature. Sports Medicine, 47(6), 1183-1207.

Tunås, P., Nilstad, A., & Myklebust, G. (2015). Low back pain in female elite football and handball players compared with an active control group. Knee Surgery, Sports Traumatology, Arthroscopy, 23(9), 2540-2547.

Wang, H.K., Macfarlane, A., & Cochrane, T. (2000). Isokinetic performance and shoulder mobility in elite volleyball athletes from the United Kingdom. British Journal of Sports Medicine, 34(1), 39-43.

Wilk, K.E., Ellenbecker, T.S., & Macrina, L.C. (2015). Rehabilitation of the overhead athlete’s elbow. In Elbow Ulnar Collateral Ligament Injury(pp. 227-259). Springer, Boston, MA.

Wilk, K.E., Obma, P., Simpson, C.D., Cain, E.L., Dugas, J., & Andrews, J.R. (2009). Shoulder injuries in the overhead athlete. Journal of Orthopaedic & Sports Physical Therapy, 39(2), 38-54.

Wright, A.A., Hegedus, E.J., Tarara, D.T., Ray, S.C., & Dischiavi, S.L. (2018). Exercise prescription for overhead athletes with shoulder pathology: a systematic review with best evidence synthesis. British Journal Sports Medicine, 52(4), 231-237.

Zellner, B., & May, M.M. (2013). Elbow injuries in the young athlete—an orthopedic perspective. Pediatric Radiology, 43(1), 129-134.

Zuzgina, O., & Wdowski, M.M. (2019). Asymmetry of dominant and non-dominant shoulders in university level men and women volleyball players. Human Movement, 20(2), 19-27.