Effects of 6-Week Sling-Based Training of the External-Rotator Muscles on the Shoulder Profile in Elite Female High School Handball Players

in Journal of Sport Rehabilitation
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In women's handball, the large numbers of throws and passes make the shoulder region vulnerable to overuse injuries. Repetitive throwing motions generate imbalance between shoulder internal- and external-rotator muscles. It has not yet been established whether sling-based training can improve shoulder external-rotator muscle strength.


This study investigated the effectiveness of a 6-wk strengthening program in improving shoulder functional profile in elite female high school handball players.


Crossover study.


National elite handball training center.


25 elite female high school handball players.


The program, completed twice per week for 6 wk, included sling-based strengthening exercises using a suspension trainer for external rotation with scapular retraction and scapular retraction alone.

Main Outcomes:

Maximal shoulder external- and internal-rotation strength, shoulder external- and internal-rotation range of motion (ROM), and maximal throwing velocity were assessed preintervention and postintervention for dominant and nondominant sides.


After sling training, external- and internal-rotation strength increased significantly for both sides (P ≤ .001, and P = .004, respectively), with the result that there was no significant change in external- and internal-rotation strength ratios for either the dominant or the nondominant shoulder. No significant differences were observed for external-rotation ROM, while internal-rotation ROM decreased moderately, in particular in the dominant shoulder (P = .005). Maximal throwing velocity remained constant for the dominant arm, whereas a significant increase was found for the nondominant arm (P = .017).


This 6-wk strengthening program was effective in improving shoulder external-rotator muscle strength but resulted in a decrease in the ROM in shoulder internal rotation, while throwing velocity remained stable. Adding a stretching program to this type of sling-based training program might help avoid potential detrimental effects on shoulder ROM.

Genevois, Berthier, Guidou, and Rogowski are with the Center for Research and Innovation in Sport, University of Lyon, Villerurbanne, France. Muller and Thiebault are with the girls' handball team, Lycée Jean Perrin, Lyon, France. Address author correspondence to Isabelle Rogowski at isabelle.rogowski@univ-lyon1.fr.