Diagnosis and Therapies: Complementary and Traditional Medicine

Mini Review

Core Stability and Shoulder Injury in Overhead Athletes: A Mini Review

Teresa Paolucci 1*, Daniele Coraci2, R. Saggini 1, L. Pezzi 1, Fabio Priori3, Valeria Conte3, Valter Santilli1,3 and Luca Padua2,4

1Physical Medicine and Rehabilitation Unit, G. D’Annunzio University of Chieti-Pescara, Department of Medical, Oral and Biotechnological Sciences (DSMOB), Italy

2IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy

3Board of Physical Medicine and Rehabilitation, Department of Orthopaedic Science, “Sapienza” University, Rome, Italy

4Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Rome, Italy

Received: 12 August 2019

Accepted: 27 September 2019

Version of Record Online: 15 October 2019


Paolucci T, Coraci D, Priori F, Conte V, Santilli V, et al. (2019) Core Stability and Shoulder Injury in Overhead Athletes: A Mini Review. Diagn Ther Complement Tradit Med 2019(1): 03-05.

Correspondence should be addressed to
Teresa Paolucci, Italy

E-mail: teresapaolucci@hotmail.com


Copyright © 2019 Teresa Paolucci et al. This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and work is properly cited.


Core stability indicates the strengthening and the solidity of the trunk muscles. Stability of the core muscles should be very important to perform limb movements. Improvement of core stability should be useful in overhead sports to prevent shoulder injury. We have performed a literature review to understand the status of art about core stability exercises and sports. We have considered the following terms: “shoulder AND sport AND core stability”, avoiding the MeSH terms and the use of specific filters. After the evaluation of the found papers, thirteen manuscripts were selected about the topic. Core stability influences the performances in many overhead sports: javelin throwing, volleyball, swimming, handball, soccer. The core and the shoulder functions are linked and have mutual effects. The training programs should include exercises of shoulder mobility, neuromuscular control, scapula and core function. Appropriate programs may ameliorate motor performance and prevent shoulder injury in the overhead sports. The relationship between core stability and sports is object of a few studies, at the moment. Furthermore, small amount of quantification instruments of core stability in sports exists. Further researches should be performed to show more clear evidences and recommendations about the choice of the correct training for each sport.


Core Stability; Literature Review; Rehabilitation; Shoulder; Sport


Core Stability (CS) is a generic physical status characterized by strengthening and solidity of the abdominal and lumbo-pelvic region muscles. This status involves the anatomical body nucleus, allowing limb movements around a stable center [1]. The core can be described as a muscular box with the abdominal muscles in the front, paraspinal and gluteal in the back, the diaphragm as the roof, and the pelvic floor and hip girdle muscles in the bottom [1]. The core is made of two main systems: local and global. The first includes the deepest muscles and controls the real stability, while the latter organizes the movements [2]. Due to this double system, the CS allows the control of trunk motion in all three spatial planes and the transfer of forces to the limbs [3]. The described mechanism and its biomechanical consequences are fundamental in sports, especially during physical activities where the upper limbs are highly used, the so-called overhead sports, like basketball, tennis or volleyball. In these sports, trunk muscles play the role of body stabilization, allowing a correct performance of athletic gesture [4]. For this reason, a lack of CS could cause an incorrect force application to the active limb, with a disadvantageous movement [5]. In this condition, the upper limb involved in the movement could be excessively stressed, with possible following increased risks of shoulder injuries [5]. Considering the important relationship between the CS and the upper limbs, strengthening of trunk muscles and improvement of CS is desirable during the training for overhead athletes. This may allow improvement of performance and prevention of shoulder injuries. At present, no complete agreement exists about CS exercises and rehabilitation programs during overhead sport training and for the recovery after shoulder injury. We performed the current review to present the results and, possibly, the evidences about the impact of CS in shoulder performance and its role to prevent injuries in overhead athletes.

Search Strategy and Selection Criteria

We have performed a literature research using PubMed search engine. The research considered the following terms: “shoulder AND sport AND core stability”. We have avoided the use of MeSH terms in order to obtain a larger amount of results. No strict filtering was used, because the topic of the research represents an uncommon issue. For this reason, only language filter was considered and “English” was selected. The publication date did not represent an exclusion criterion and the search included papers until April 2018. Considering the aforementioned criteria, we have initially found 23 papers. For each article, pertinence, methods, results and references were considered. After studying the found manuscripts, 13 papers were finally selected for the current review [6-18].


In sports, the CS seems to influence the strength and the realization of shoulder movement. In particular, after a fatiguing protocol finalized to obtain a core tiredness, the strength of shoulder muscles was reduced, at frontal and sagittal planes [13]. Indeed, the core and the shoulder function appear to be linked and influence each other [18]. The lacking of CS can be a risk factor for shoulder dysfunction development in sports requiring high usage of this joint [6]. In these overhead sports, the shoulder efficiency, with correct muscle balance and coordination, is essential. A rehabilitation program to treat the shoulder impairment, throughout exercises aimed to ameliorate balance and stability, is fundamental because of the relationship between shoulder dysfunction, balance and CS [11]. A training program just focused on shoulder should not be enough, because of this strict association between the joint and the core. A possible strategy should consider exercises based on appropriate shoulder motility, neuromuscular control, scapula and core function [14].

Among the overhead sports requiring a particular attention to CS, javelin throwing represents a typical example. A specific training, including exercises finalized to enhance CS, is shown to prevent shoulder injury in this sport and improve athletes’ results [12]. Even considering the volleyball, exercises aimed to develop the CS are linked to shoulder injury prevention [16]. Another example is represented by swimming. In this sport, shoulder pain is a common musculoskeletal disorder [8]. The most frequent cause is supraspinatus tendinopathy, followed by glenohumeral instability and labral tears. However, the shoulder dysfunction should be considered as part of a more complex apparatus. In particular, core weakness may play a very important role and patient’s management should consider trunk strength and CS [8].

The significant impact of core stability in motor performance has been recently showed in handball athletes. The subjects with instability presented significantly slower speed of different body segments, including the upper limb, during some typical sport gestures [17].

Even the goalkeepers are exposed to shoulder disorders, hence, for this type of players, appropriate prevention programs are desirable. In particular, based on our literature research, a single study assessed the potentiality of CS exercises to prevent shoulder disorders in soccer goalkeepers. The authors presented a sport training finalized to warming-up, strength and balance improvement of upper limb muscles, CS and motor control. The exercises were performed at high-velocity and consisted of ball throwing tasks, jumping and walking with hands in prone position and movements by the use of an elastic [15].

Considering the possibility to obtain objective measurements and appropriate quantification of stability of the shoulder and the core, Gorman and colleagues developed a test to simultaneously study these two body components [10]. The Upper Quarter Y Balance Test is able to quantify the capability of an athlete to reach with a free hand, while maintaining, with the other hand, a push-up position. This exercise reveals a high usefulness to depict alteration in balance and limitation in shoulder movement and, hence, it should be added in athlete evaluation to estimate injury risks [10]. Another tool to assess the CS is McGill’s trunk muscle endurance test. It evaluates trunk flexor, back extensor, right and left lateral trunk muscles [9]. Trunk flexion likely correlates with instability level, but the assessment of static CS is not enough to understand athlete’s performance during dynamic and more complex tasks [7].


CS is a sport rehabilitation topic that has been considered in the last ten years. CS exercises may influence the posture and the movement throughout a trunk stabilization. On the basis of the literature, CS exercises show high potentiality for prevention and rehabilitation of sport injuries [11,12]. The sports where the shoulder is may obtain benefits from CS exercises [15]. At the moment, however, defined evidences about CS and sports are not available. Furthermore, more studies, for each overhead sport, should be performed to understand the CS exercises specific for each discipline. Another critical point, is the presence of evaluation tools and outcome measures [7,9,10]. A small amount of quantification instruments of CS in sports exists. They are useful, but far for a complete evaluation of the athletes.

CS and overhead sports relationship is an object of few studies. For this reason, further researches are desirable, especially Randomized Controlled Trials. These may provide clear evidences and recommendations about the choice of the appropriate training exercises. The use of rigid study designs, appropriate subject selection and specific objective outcome measurements, like imaging and motion analysis, should be considered for the aim.

Conflicts of Interest

Authors declare no conflict of interest.


Authors’ contributions Teresa Paolucci and Daniele Coraci manuscript writing; Fabio Priori and Valeria Conte literature research; Valter Santilli draft correction; Luca Padua draft correction and final approval of the manuscript.


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