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Published online: 2020-02-12


Functional Adaptations in Isokinetic Performance and Shoulder

Mobility in Elite Ultimate Frisbee Players
Funktionale Anpassungserscheinungen von Schulterkraft
und -beweglichkeit bei Elite-Ultimate-Frisbee-Spielern

Christoph Koeble1, Wolfgang Seiberl1, 2

Affiliations iche von dominanter zu nichtdominanter Körperseite durchge-

1 Department of Biomechanics in Sports, Technical führt. Das maximale Moment der Schulteraußenrotation
University of Munich, Germany. (Arbeit) war auf der dominanten Körperseite höher als auf der

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2 Institute of Sport Science, Bundeswehr University Munich, nichtdominanten Körperseite (8,4 ± 8,4 %; p < 0,01), jedoch wur-
Germany den keine Unterschiede bezüglich des Innenrotationsmoments
festgestellt. Das Bewegungsausmaß der Innenrotation und das
Key words
Gesamt-ROM waren wiederum auf der nichtdominanten Körper-
injury prevention, muscular imbalances, overhead sports,
seite signifikant größer (21 ± 18 %; p < 0,01 und 5 ± 9 %; p < 0,05).
range of motion, shoulder strength, rotator cuff
Unsere Ergebnisse zeigen ähnliche Anpassungsmuster der Schul-
Schlüsselwörter termobilität wie sie in anderen Überkopfsportarten auftreten.
Verletzungsprävention, muskuläre Dysbalancen, Die Ergebnisse in Bezug auf die Schultermomente unterscheiden
Überkopfsportart, Schulterbeweglichkeit, Schulterkraft, sich jedoch von der Literatur. Es wird empfohlen, Dehnübungen
Rotatorenmanschette und regelmäßige Screenings für Ultimate-Frisbee-Spieler einzu-
führen, damit bei dieser noch jungen Sportart bereits in den frü-
Bibliography hen Phasen der Karriere möglichen Spätfolgen präventiv entge-
DOI gengewirkt werden kann.
Sportverl Sportschad
© Georg Thieme Verlag KG, Stuttgart · New York ABSTR AC T
ISSN 0932-0555 Ultimate Frisbee is a team sport where players mainly use
their dominant arm for throwing a flying disc. Little is known
about possible functional adaptations to this unilateral strain.
Dr. Wolfgang Seiberl
The purpose of this study was to investigate shoulder rotation
Bundeswehr University Munich
strength and range of motion (ROM) in elite Ultimate Frisbee
Department of Human Sciences,
players. We were especially interested in possible sport-
Werner-Heisenberg-Weg 39, 85577 Neubiberg, Germany
specific functional adaptations of peak torque and work ratios
as well as the range of motion of agonist and antagonist
Z US A M M E N FA SS U N G shoulder rotators regarding laterality between the dominant
and non-dominant body sides. For this reason, the concentric
Ultimate Frisbee ist ein Teamsport, bei dem die Spieler hauptsä-
external and internal isokinetic (60°/s) shoulder rotation tor-
chlich ihren dominanten Arm für den Wurf einer Frisbee-Scheibe
que and passive glenohumeral rotation ROM were examined
einsetzen, um im Spiel zu passen und zu punkten. Über mögliche
in 15 male subjects (27.5 ± 5.5 yrs; all current or former mem-
funktionelle Anpassungen an diese sehr einseitige Belastung ist
bers of the German National Team) and comparisons of domi-
wenig bekannt. Zweck dieser Studie war es, die Schulterkraft
nant to non-dominant body sides were conducted. Maximum
und -beweglichkeit (ROM) bei national und international hochk-
strength (work) during external shoulder rotation was higher
lassig spielenden Ultimate-Spielern zu untersuchen. Insbeson-
on the dominant body side compared with the non-dominant
dere interessierten wir uns für mögliche sportartspezifische
body side (8.4 ± 8.4 %; p < 0.01). No side-to-side differences
funktionelle Anpassungen von Maximalkraft und Arbeit sowie
were found in maximum internal rotation strength. Internal
dem Bewegungsumfang von Agonisten- und Antagonisten der
rotation ROM and total ROM were smaller on the dominant
Schulterrotation hinsichtlich der Lateralität zwischen dominan-
body side (21 ± 18 %; p < 0.01 and 5 ± 9 %; p < 0.05). Our find-
ter und nichtdominanter Körperseite. Das konzentrische (60°/s)
ings indicate similar adaptation patterns of shoulder rotation
Innen- und Außenrotationsmoment sowie das passive glenohu-
mobility compared to other overhead sports, but differing re-
merale Rotationsausmaß wurde bei 15 männlichen Ultimate-
sults regarding shoulder rotation strength. Stretching exerci-
Spielern (27,5 ± 5,5 Jahre; alles aktuelle oder ehemalige Mitglie-
ses and monitoring programs are recommended for elite Ulti-
der der deutschen Nationalmannschaft) untersucht und Vergle-
mate Frisbee players, starting at the early stages of the career.

Koeble C et al. Functional Adaptations in… Sportverl Sportschad


Introduction range of motion (ΔTROM) of the glenohumeral joint towards more

external rotation ROM without necessarily reducing the ΔTROM
Ultimate Frisbee is a non-contact team sport played 7 vs. 7. The significantly (negative values of GIRD, ERG or ΔTROM indicate a
main goal is to throw a flying disc between players in order to suc- deficit on the dominant body side when compared to the contra-
cessfully overcome a certain playing field distance against an op- lateral side). These patterns are synonymous with a lateral mobility
ponent team. With currently ~165 000 active players registered in deficit, which in turn is an accepted risk factor for injuries and over-
the world flying disc federation (wfdf), Ultimate Frisbee is one of use syndromes especially in the glenohumeral joint [8, 14–16].
the fastest growing team sports worldwide [1]. Most players par- Although literature evidence of other overhead sports sug-
ticipate in the United States with over 57 000 active players, gests important adaptations due to the highly asymmetric load-
whereas there are about 5600 in Germany. Due to the fast ing towards the dominant shoulder of Ultimate Frisbee players,
growth, the importance of athleticism increased constantly over there is a lack of proof based experimental data. Thus, the pur-
the past ten years. However, scientific data about the physical de- pose of this study was to investigate possible functional adapta-
mands on Ultimate Frisbee players are rare, although injuries in tions in shoulder rotation strength and glenohumeral rotation
this team sport are reported to be among the highest incidence ROM. With regard to the high eccentric forces between wind-up
of all team sports in the United States [2]. Injuries are typically and acceleration phase and during the follow-through phase in
reported by players for the knee or ankle joint, but also for the the throwing motion, we hypothesized an increase in internal

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shoulder and the back [3]. Especially interesting for shoulder rotation strength, laterality in the functional ratios, and a gleno-
lesions, comparable injuries are reported for disc golf, where humeral internal rotation deficit on the dominant body side.
similar throwing techniques are used [4].
Players mainly use two throws in game situations. The back-
hand throw is similar to a one-handed backhand stroke in tennis Methods
and is typically thrown with a lot of power. The forehand throw is 15 healthy, male elite Ultimate Frisbee players, all current or for-
comparable to a low hip throw in handball and used as a more mer members of the German National Team, volunteered for this
finely tuned technical throw. Functional adaptations in the gleno- study (age: 27.5 ± 5.5 yrs; height 183.6 ± 5.4 cm; weight 78.8 ±
humeral joint, especially changes in range of motion (ROM) or 6.6 kg, duration of sport-specific career 11.5 ± 5.0 yrs). All experi-
strength parameters of internal and external rotation, are well ments were conducted according to the Declaration of Helsinki.
documented for athletes in throwing, pitching or striking sports Informed written consent was obtained from all participants prior
like tennis, baseball or volleyball [5–8]. Although data is rare, it to testing and all methods were used in accordance to ethical
might be reasonably assumed that also in Ultimate Frisbee the standards of the Department of Sports and Health Sciences, Tech-
asymmetrical loading of the dominant shoulder joint regarding nical University of Munich.
agonist-antagonist motion can result in laterality between the Mobility was assessed passively in supine position with the
dominant and the non-dominant body side. shoulder abducted at 90° and the elbow flexed at 90° (90/90-po-
Overloading of musculotendinous structures in overhead sition). Internal (IR), external rotation (ER) and total range of mo-
sports can cause injuries and overuse syndromes in the dominant tion was measured three times in a randomized order using a
shoulder joint. Additionally, muscular imbalances resulting from standard 2D-goniometer. Isokinetic maximum strength of should-
continuous asymmetrical loading may lead to functional adapta- er rotation was assessed in concentric mode at 60°/s using a com-
tions in strength and mobility of overhead athletes [9]. In fact, puter driven dynamometer (Isomed 2000, D&R Ferstl GmbH, He-
muscular imbalances like ratios of dominant to non-dominant mau, GER). Subjects were tested in supine 90/90-position with a
external rotation strength, are considered to be one of the main total range of motion of 100°, ranging from 50° of ER to 50° of IR
risk factors for injuries of the rotator cuff [8]. during IR testing and vice versa. 3 submaximal repetitions were
As already mentioned above, changes and adaptions of muscu- performed as standardized local warm-up, followed by 5 repeti-
lar strength are usually expressed in functional ratios, like indicat- tions of IR and ER on each shoulder side. Each repetition was com-
ing the relationship of agonistic and antagonistic muscle strength. posed of an IR followed by an ER, with 10 seconds of rest in-
In overhead athletes, typically an increase of the internal rotation between. The rest between subsequent repetitions was set at
peak torque at the dominant compared to the non-dominant 30 seconds, the order of body side was chosen randomly.
body side is reported, with no difference or a decrease of external Passive shoulder rotation mobility (IR, ER, TROM) was calculat-
rotation strength [10–13]. The concentric/concentric functional ed using the mean out of the three ROM tests. Peak torque (PT),
ratio of shoulder rotation strength is defined as the external rota- work (W) and angle of peak torque was assessed at individual
tion strength divided by the internal rotation strength. trials and the mean of the 2nd to 4th trial was chosen for statistical
Besides shoulder strength, adaptation can also be found in analysis of the strength parameters. Data was tested for normality
shoulder mobility. One of the most typical pattern of adaptation in (Kolmogorow-Smirnow-Test) and paired t-tests were used to ana-
overhead sports is the glenohumeral internal rotation deficit lyze differences between dominant (dom) and non-dominant
(GIRD). The GIRD is defined as a loss of internal rotation ROM of (n-dom) body sides. Pearson correlation coefficients (r) served
the dominant body side, when compared to the non-dominant for the identification of relationships between the analyzed
side. Another typical pattern of mobility adaptation can be found parameters. The level of significance was set to p ≤ 0.05.
as external rotation gain (ERG) on the dominant compared to the
non-dominant body side. Both patterns result in a shift of the total

Koeble C et al. Functional Adaptations in… Sportverl Sportschad

Results ▶ Table 1 Isokinetic strength of internal and external shoulder rota-
Data resulted in n = 13 subjects as two subjects were excluded from tors of male elite Ultimate Frisbee players at 60°/s for the dominant
and non-dominant body side (mean ± standard deviation).
the analysis due to pain which occurred during the measurements.
No side-to-side differences for internal rotation strength could be
peak torque [Nm] work [J]
found. External rotation work was significantly higher (8.4 ± 8.4 %;
p < 0.01) for the dominant, compared to the contralateral body side IR ER IR ER
(▶ Table 1). The angle at which PT occurred did not show significant
side-to-side differences neither in IR (dom: 0.3 ± 22.2° of ER; n‑dom: dom 47.7 ± 9.6 33.4 ± 6.1 68.7 ± 10.1 56.5 ± 8.4**
10.7 ± 17.7° of ER; p = 0.21) nor in ER (dom: 20.1 ± 4.1° of ER; n-dom: n-dom 43.1 ± 6.4 33.8 ± 6.3 65.7 ± 9.0 52.2 ± 7.5**
18.7 ± 14.8° of ER; p = 0.47). There were no side-to-side differences
Abbreviations: IR, internal rotation; ER, external rotation; dom, domi-
between functional ratios (PT and W), however PT-ratios were smal-
nant body side; n-dom, non-dominant body side. ** p < 0.01.
ler than work ratios on the dominant (PT: 0.73 ± 0.20 vs. W: 0.83
± 0.10; p < 0.05) and non-dominant body side (PT: 0.74 ± 0.12 vs.
W: 0.80 ± 0.12; p < 0.01).
IR ROM was smaller (dom: 41 ± 10°; n-dom: 53 ± 12°; laterality:

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21 ± 18 %; p < 0.01) on the dominant body side, as well as TROM
(dom: 138 ± 14°; n-dom 146 ± 11°; laterality: 5 ± 9 %; p < 0.05). No
differences were found in ER ROM. This led to a GIRD of ‑12 ± 11°,
an ERG of 4 ± 10° and a ΔTROM of ‑8 ± 13° (▶ Fig. 1).
The duration of the sport-specific career did not show correla-
tions with any strength or mobility parameter of the dominant
shoulder joint or with side-to-side differences.

This investigation focused on analyzing the balance of shoulder
internal and external maximum rotation strength and mobility,
regarding laterality in first place. Secondly, possible correlations
between maximum strength and mobility were of specific inter-
est. Significantly higher maximum strength was found for external ▶ Fig. 1 Side-to-side differences in glenohumeral rotation ROM in
rotation on the dominant body side while there were no signifi- supine 90/90-position (mean ± standard deviation; GIRD: gleno-
cant differences for maximum internal rotation strength. This is humeral internal rotation deficit; ERG: external rotation gain;
in contrast to findings in other overhead sports [10–12]. ΔTROM: side-to-side difference in total range of motion; negative
values indicate less ROM on the dominant body side).
Although peak torques for internal and external rotation strength
did not show laterality in our study, we found significant side-to-side
differences for the analyzed external rotation work values. This can
ing between 0.66 and 0.75 [9], we found higher functional ratios
be interpreted as an adaptation to higher sport-specific loading on
when analyzing the produced work. To the author’s knowledge
the dominant body side. This adaption might be due to the enor-
there is no study that discussed differences between peak torque
mous loads that the shoulder rotation muscles of the throwing arm
ratios and work ratios. As work is the product of generated forces
are exposed to during the backhand throw, especially during the
over a certain distance (or rotational range), this indicates that a
transition from the wind-up to the acceleration phase and during
mismatch of internal and external shoulder strength gets more ob-
the follow-through phase (referring to end-ROM positions). Typically
vious, when not only considering a single maximum, but full range
these end-ROM positions are those that put the greatest loading on
strength. As end-ROM positions of passive mobility identified in this
active and passive structures within the shoulder joint [10–12, 17,
study were not fully covered by the test range of motion in the iso-
18]. At the same time the angles at which peak torques occurred dif-
kinetic tests, it might be of interest for future studies to evaluate
fered from these end-ROM positions. This could be the reason for
ratios within these end-ROM positions. This would require calculat-
the differing results regarding peak torque and work values in this
ing angle-specific ratios within the mentioned phases and these ra-
study. Unexpectedly, no laterality was found in functional ratios of
tios should be work-specific at the same time. Work-specific in the
peak torque and work, what might be explained by the smaller angle
transition phase of the backhand throw would mean a ratio be-
of abduction during throwing in Ultimate Frisbee, compared to
tween concentric internal rotation and eccentric external rotation
other overhead throwing movements [9, 19–21].
strength, and a ratio between concentric external rotation and
Our results indicate that most of our sample of tested Ultimate
eccentric internal rotation strength for the follow-through phase.
Frisbee players do not suffer from negative sport-specific adapta-
Adaptations of shoulder rotation mobility in this study showed
tions in related functional ratios, and kept good (in terms of healthy
similar findings compared to other overhead athletes [7, 16]. The
and preventive) peak torque ratios. However, in contrast to peak
reported glenohumeral internal rotation deficit on the dominant
torque ratios that largely stayed within recommended values rang-

Koeble C et al. Functional Adaptations in… Sportverl Sportschad


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Koeble C et al. Functional Adaptations in… Sportverl Sportschad

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