Screening tests for the overhead athlete: why, when and how?

Ann Cools, Events / Wednesday, October 9th, 2019

On October 4-5th  2019, sports physiotherapists from all over the world gathered for the 3rd World Congress of Sports Physiotherapists ( A major topic of discussion was the value of screening (ROM, strength, functional tests…) for injury prevention and return to play after injury. The world experts agree that at this moment, there is not enough evidence to claim that we may predict (re)-injury performing screening tests, but that does not mean that screening is useless (Bahr 2016) . The goal of screening is to identify existing problems, have baseline measures for future follow up, create a database of “normal” values within the specific population of athletes you work with, and to assess the capacity (physical performance) of the athlete when returning to play compared to his/her fellow athletes (Ardern et al. 2016).

For the upper limb, reliable tests are available for ROM, strength, and upper limb performance (like the Seated Medicine Ball Throw (SMBT), the Y-balance test Upper Quadrant (YBT-UQ) or the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), however the validity is unclear (Cools et al. 2014, Borms et al. 2016) . As an example, the SMBT highly correlates with shoulder and elbow strength, and is a valuable alternative for strength testing “on the field”, however the YBT-UQ does not correlate with strength. So we don’t know (yet) what we test with the YBT-UQ, but definitely not strength only (Borms et al. 2016).

Criteria for RTP criteria may be found in 3 categories of research papers: 1/ studies analyzing risk factors for shoulder pain in different shoulder loading sports (Asker et al. 2018), 2/ descriptive analyses of ROM, strength and functional performance in elite athletes (Cools et al. 2014, Vanderstukken et al. 2019), and 3/ references values from larger populations (not always elite) (Cools et al. 2016, Borms et al. 2018). The future of screening lies in developing a test-battery rather than individual tests, in order to assess as many aspects of shoulder performance as possible (Olds et al. 2019).

Ann Cools


Asker M, Brooke HL, Waldén M, Tranaeus U, Johansson F, Skillgate E, Holm LW. Risk factors for, and prevention of, shoulder injuries in overhead sports: a systematic review with best-evidence synthesis. Br J Sports Med. 2018 Oct;52(20):1312-1319

Ardern CL, Glasgow P, Schneiders A, Witvrouw E, Clarsen B, Cools A, Gojanovic B, Griffin S, Khan KM, Moksnes H, Mutch SA, Phillips N, Reurink G, Sadler R, Silbernagel KG, Thorborg K, Wangensteen A, Wilk KE, Bizzini M. 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med. 2016 Jul;50(14):853-64.

Bahr R. Why screening tests to predict injury do not work-and probably never will…: a critical review. Br J Sports Med. 2016 Jul;50(13):776-80. doi: 10.1136/bjsports-2016-096256.

Borms D, Maenhout A, Cools AM. Upper Quadrant Field Tests and Isokinetic Upper Limb Strength in Overhead Athletes. J Athl Train. 2016 Oct;51(10):789-796

Borms D, Cools A. Upper-Extremity Functional Performance Tests: Reference Values for Overhead Athletes. Int J Sports Med. 2018 Jun;39(6):433-441

Cools AM, Palmans T, Johansson FR. Age-related, sport-specific adaptions of the shoulder girdle in elite adolescent tennis players. J Athl Train. 2014 Sep-Oct;49(5):647-53

Cools AM, De Wilde L, Van Tongel A, Ceyssens C, Ryckewaert R, Cambier DC. Measuring shoulder external and internal rotation strength and range of motion: comprehensive intra-rater and inter-rater reliability study of several testing protocols. J Shoulder Elbow Surg. 2014 Oct;23(10):1454-61

Cools AM, Vanderstukken F, Vereecken F, Duprez M, Heyman K, Goethals N, Johansson F. Eccentric and isometric shoulder rotator cuff strength testing using a hand-held dynamometer: reference values for overhead athletes. Knee Surg Sports Traumatol Arthrosc. 2016 Dec;24(12):3838-384

Olds M, Coulter C, Marant D, Uhl T. Reliability of a shoulder arm return to sport test battery. Phys Ther Sport. 2019 Sep;39:16-22

Vanderstukken F, Jansen N, Mertens T, Cools AM. Elite male field hockey players have symmetric isokinetic glenohumeral strength profiles, but show asymmetry in scapular muscle strength. J Sports Sci. 2019 Mar;37(5):484-491

Leave a Reply