Overuse shoulder injuries among competitive male volleyball players in Kuwait

Overuse shoulder injuries are common in overhead sports including volleyball. The development of injury prevention programs requires a holistic understanding of the multiple risk factors involved in their occurrence. In addition, performance-driven contexts and other contextual determinants contribute to the complexity of overuse shoulder injuries. To our knowledge, no study investigated overuse shoulder injuries of male competitive volleyball players in Kuwait. Therefore, this thesis aimed to investigate overuse shoulder injuries in a population of male sub-elite volleyball players in Kuwait. This research adopted a pragmatic, mixed methods research design and a revised “Sequence of Prevention” framework that considers context. This involved three studies: 1. one-season prospective cohort study, 2. cross-sectional study, and 3. qualitative study. In line of the first step of the “Sequence of Prevention”, the extent of the overuse shoulder injury problem has been established through the first study which includes: the prevalence of overuse shoulder injuries which was high (39%; 95% CI 37.45% to 40.3%), the incidence of overuse shoulder injuries that were 2.46/1000 hours (95% Cl: 2.1, 2.8), as well as severe impacts on performance (U = 297), pain (U =159), training volume (U = 228), and task difficulty (U = 290.5) (P ≤ 0.001). As v the second step of the “Sequence of Prevention”, the multiple risk factors were investigated via study one (personal and training-related risk factors) and study two (physical risk factors). Although, there were no significant personal or training-related risk factors (RR=0-4%), rotator cuff muscle weakness (IER=10, IIR=13.5, EER=13.6) and glenohumeral range of motion deficiencies (ER=6.4°, IR, U = 149.5) of external rotation and internal rotation were indicated as a significant physical risk factors of overuse shoulder injuries (P ≤ 0.05). In a way to retrieve step one and two of “Sequence of Prevention” model, a qualitative study (study three) was conducted using semi-structured interviews with injured volleyball players. Contextual determinants of injury were perceived at multiple stakeholder levels: individual (e.g., lifestyle), interpersonal (e.g., unsupportive coaches), organizational (e.g., too many games), and at the policymaker level (lack of professionalization). This research is the first which provides an evidence-based, and context-driven understanding of overuse shoulder injuries in a population of male sub-elite volleyball players in Kuwait. Therefore, our data can be used as a reference for many regional countries. Further research with larger sample size and gender variation are needed. The findings are a call to action for translating this research into injury prevention programs that take into consideration the context and levels of the socioecological framework. Guidelines and recommendations may be produced for the different stakeholders to help prevent these injuries in volleyball players.