Published online: 2020-02-12

Originalarbeit

Functional Adaptations in Isokinetic Performance and Shoulder

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

Authors
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

2 Institute of Sport Science, Bundeswehr University Munich,
Germany
Key words
injury prevention, muscular imbalances, overhead sports,
range of motion, shoulder strength, rotator cuff
Schlüsselwörter
Verletzungsprävention, muskuläre Dysbalancen,
Überkopfsportart, Schulterbeweglichkeit, Schulterkraft,
Rotatorenmanschette
Bibliography
DOI https://doi.org/10.1055/a-1023-4983
Sportverl Sportschad
© Georg Thieme Verlag KG, Stuttgart · New York
ISSN 0932-0555
Correspondence
Dr. Wolfgang Seiberl
Bundeswehr University Munich
Department of Human Sciences,
Werner-Heisenberg-Weg 39, 85577 Neubiberg, Germany
wolfgang.seiberl@unibw.de
Z US A M M E N FA SS U N G
Ultimate Frisbee ist ein Teamsport, bei dem die Spieler hauptsä-
chlich ihren dominanten Arm für den Wurf einer Frisbee-Scheibe
einsetzen, um im Spiel zu passen und zu punkten. Über mögliche
funktionelle Anpassungen an diese sehr einseitige Belastung ist
wenig bekannt. Zweck dieser Studie war es, die Schulterkraft
und -beweglichkeit (ROM) bei national und international hochk-
lassig spielenden Ultimate-Spielern zu untersuchen. Insbeson-
dere interessierten wir uns für mögliche sportartspezifische
funktionelle Anpassungen von Maximalkraft und Arbeit sowie
dem Bewegungsumfang von Agonisten- und Antagonisten der
Schulterrotation hinsichtlich der Lateralität zwischen dominan-
ter und nichtdominanter Körperseite. Das konzentrische (60°/s)
Innen- und Außenrotationsmoment sowie das passive glenohu-
merale Rotationsausmaß wurde bei 15 männlichen Ultimate-
Spielern (27,5 ± 5,5 Jahre; alles aktuelle oder ehemalige Mitglie-
der der deutschen Nationalmannschaft) untersucht und Vergle-
Downloaded by: State University of New York at Stony Brook. Copyrighted material.
nichtdominanten Körperseite (8,4 ± 8,4 %; p < 0,01), jedoch wur-
den keine Unterschiede bezüglich des Innenrotationsmoments
festgestellt. Das Bewegungsausmaß der Innenrotation und das
Gesamt-ROM waren wiederum auf der nichtdominanten Körper-
seite signifikant größer (21 ± 18 %; p < 0,01 und 5 ± 9 %; p < 0,05).
Unsere Ergebnisse zeigen ähnliche Anpassungsmuster der Schul-
termobilität wie sie in anderen Überkopfsportarten auftreten.
Die Ergebnisse in Bezug auf die Schultermomente unterscheiden
sich jedoch von der Literatur. Es wird empfohlen, Dehnübungen
und regelmäßige Screenings für Ultimate-Frisbee-Spieler einzu-
führen, damit bei dieser noch jungen Sportart bereits in den frü-
hen Phasen der Karriere möglichen Spätfolgen präventiv entge-
gengewirkt werden kann.
ABSTR AC T
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.
The purpose of this study was to investigate shoulder rotation
strength and range of motion (ROM) in elite Ultimate Frisbee
players. We were especially interested in possible sport-
specific functional adaptations of peak torque and work ratios
as well as the range of motion of agonist and antagonist
shoulder rotators regarding laterality between the dominant
and non-dominant body sides. For this reason, the concentric
external and internal isokinetic (60°/s) shoulder rotation tor-
que and passive glenohumeral rotation ROM were examined
in 15 male subjects (27.5 ± 5.5 yrs; all current or former mem-
bers of the German National Team) and comparisons of domi-
nant to non-dominant body sides were conducted. Maximum
strength (work) during external shoulder rotation was higher
on the dominant body side compared with the non-dominant
body side (8.4 ± 8.4 %; p < 0.01). No side-to-side differences
were found in maximum internal rotation strength. Internal
rotation ROM and total ROM were smaller on the dominant
body side (21 ± 18 %; p < 0.01 and 5 ± 9 %; p < 0.05). Our find-
ings indicate similar adaptation patterns of shoulder rotation
mobility compared to other overhead sports, but differing re-
sults regarding shoulder rotation strength. Stretching exerci-
ses and monitoring programs are recommended for elite Ulti-
mate Frisbee players, starting at the early stages of the career.

Koeble C et al. Functional Adaptations in… Sportverl Sportschad

 Originalarbeit
Introduction
Ultimate Frisbee is a non-contact team sport played 7 vs. 7. The
main goal is to throw a flying disc between players in order to suc-
cessfully overcome a certain playing field distance against an op-
ponent team. With currently ~165 000 active players registered in
the world flying disc federation (wfdf), Ultimate Frisbee is one of
the fastest growing team sports worldwide [1]. Most players par-
ticipate in the United States with over 57 000 active players,
whereas there are about 5600 in Germany. Due to the fast
growth, the importance of athleticism increased constantly over
the past ten years. However, scientific data about the physical de-
mands on Ultimate Frisbee players are rare, although injuries in
this team sport are reported to be among the highest incidence
of all team sports in the United States [2]. Injuries are typically
reported by players for the knee or ankle joint, but also for the
shoulder and the back [3]. Especially interesting for shoulder
lesions, comparable injuries are reported for disc golf, where
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
and is typically thrown with a lot of power. The forehand throw is
comparable to a low hip throw in handball and used as a more
finely tuned technical throw. Functional adaptations in the gleno-
humeral joint, especially changes in range of motion (ROM) or
strength parameters of internal and external rotation, are well
documented for athletes in throwing, pitching or striking sports
like tennis, baseball or volleyball [5–8]. Although data is rare, it
might be reasonably assumed that also in Ultimate Frisbee the
asymmetrical loading of the dominant shoulder joint regarding
agonist-antagonist motion can result in laterality between the
dominant and the non-dominant body side.
Overloading of musculotendinous structures in overhead
sports can cause injuries and overuse syndromes in the dominant
shoulder joint. Additionally, muscular imbalances resulting from
continuous asymmetrical loading may lead to functional adapta-
tions in strength and mobility of overhead athletes [9]. In fact,
muscular imbalances like ratios of dominant to non-dominant
external rotation strength, are considered to be one of the main
risk factors for injuries of the rotator cuff [8].
As already mentioned above, changes and adaptions of muscu-
lar strength are usually expressed in functional ratios, like indicat-
ing the relationship of agonistic and antagonistic muscle strength.
In overhead athletes, typically an increase of the internal rotation
peak torque at the dominant compared to the non-dominant
body side is reported, with no difference or a decrease of external
rotation strength [10–13]. The concentric/concentric functional
ratio of shoulder rotation strength is defined as the external rota-
tion strength divided by the internal rotation strength.
Besides shoulder strength, adaptation can also be found in
shoulder mobility. One of the most typical pattern of adaptation in
overhead sports is the glenohumeral internal rotation deficit
(GIRD). The GIRD is defined as a loss of internal rotation ROM of
the dominant body side, when compared to the non-dominant
side. Another typical pattern of mobility adaptation can be found
as external rotation gain (ERG) on the dominant compared to the
non-dominant body side. Both patterns result in a shift of the total
range of motion (ΔTROM) of the glenohumeral joint towards more
external rotation ROM without necessarily reducing the ΔTROM
significantly (negative values of GIRD, ERG or ΔTROM indicate a
deficit on the dominant body side when compared to the contra-
lateral side). These patterns are synonymous with a lateral mobility
deficit, which in turn is an accepted risk factor for injuries and over-
use syndromes especially in the glenohumeral joint [8, 14–16].
Although literature evidence of other overhead sports sug-
gests important adaptations due to the highly asymmetric load-
ing towards the dominant shoulder of Ultimate Frisbee players,
there is a lack of proof based experimental data. Thus, the pur-
pose of this study was to investigate possible functional adapta-
tions in shoulder rotation strength and glenohumeral rotation
ROM. With regard to the high eccentric forces between wind-up
and acceleration phase and during the follow-through phase in
the throwing motion, we hypothesized an increase in internal
Downloaded by: State University of New York at Stony Brook. Copyrighted material.
rotation strength, laterality in the functional ratios, and a gleno-
humeral internal rotation deficit on the dominant body side.
Methods
15 healthy, male elite Ultimate Frisbee players, all current or for-
mer members of the German National Team, volunteered for this
study (age: 27.5 ± 5.5 yrs; height 183.6 ± 5.4 cm; weight 78.8 ±
6.6 kg, duration of sport-specific career 11.5 ± 5.0 yrs). All experi-
ments were conducted according to the Declaration of Helsinki.
Informed written consent was obtained from all participants prior
to testing and all methods were used in accordance to ethical
standards of the Department of Sports and Health Sciences, Tech-
nical University of Munich.
Mobility was assessed passively in supine position with the
shoulder abducted at 90° and the elbow flexed at 90° (90/90-po-
sition). Internal (IR), external rotation (ER) and total range of mo-
tion was measured three times in a randomized order using a
standard 2D-goniometer. Isokinetic maximum strength of should-
er rotation was assessed in concentric mode at 60°/s using a com-
puter driven dynamometer (Isomed 2000, D&R Ferstl GmbH, He-
mau, GER). Subjects were tested in supine 90/90-position with a
total range of motion of 100°, ranging from 50° of ER to 50° of IR
during IR testing and vice versa. 3 submaximal repetitions were
performed as standardized local warm-up, followed by 5 repeti-
tions of IR and ER on each shoulder side. Each repetition was com-
posed of an IR followed by an ER, with 10 seconds of rest in-
between. The rest between subsequent repetitions was set at
30 seconds, the order of body side was chosen randomly.
Passive shoulder rotation mobility (IR, ER, TROM) was calculat-
ed using the mean out of the three ROM tests. Peak torque (PT),
work (W) and angle of peak torque was assessed at individual
trials and the mean of the 2nd to 4th trial was chosen for statistical
analysis of the strength parameters. Data was tested for normality
(Kolmogorow-Smirnow-Test) and paired t-tests were used to ana-
lyze differences between dominant (dom) and non-dominant
(n-dom) body sides. Pearson correlation coefficients (r) served
for the identification of relationships between the analyzed
parameters. The level of significance was set to p ≤ 0.05.
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:

Downloaded by: State University of New York at Stony Brook. Copyrighted material.
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.

Discussion
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

 Originalarbeit
body side may result from repetitive eccentric-concentric internal
rotation overload during the forehand throw [20, 22]. However,
the magnitude of these adaptations was smaller compared to
other overhead athletes, which could be due to a lower weight of
the thrown object, a smaller angle of abduction, the number of
repetitions performed in competition and training, and differing
throwing mechanics compared to striking and pitching in tennis,
baseball or volleyball. The combination of these factors likely
results in smaller distraction forces acting on the shoulder joint
during the throwing motions in Ultimate Frisbee.
As a limitation of our study it needs to be acknowledged that
the sample of subjects was heterogeneous with regard to age and
the duration of sport-specific career. However, no correlation in
our analysis indicated any connection of functional/strength
adaptations to sport-specific career. As this sport is relatively
young, and competition as well as training is getting more and
more professional, future studies might lead to different results.
Conclusion
This study is the first to investigate shoulder rotation strength and
mobility of elite Ultimate Frisbee players. Compared to other over-
head athletes, it could be shown that Ultimate Frisbee players have
similar functional adaptations regarding mobility. Functional ratios
of strength were not affected by sport-specific loading, however
there was laterality between dominant and non-dominant body
side concerning external rotation maximum strength. These first re-
sults might not provide evidence for important pathologic sport-
specific adaptations, however, as Ultimate Frisbee is a young but
fast growing sport, regular screenings and diagnostics are suggested
to assess possible imbalances in strength and mobility of the should-
er joint at an early stage. Rehabilitative and preventive training pro-
grams should be introduced to the athletes who suffer from muscu-
lar imbalances with focus on strengthening and stretching exercises.
Conflict of Interest
The authors declare that they have no conflict of interest.
References
[1] World Flying Disc Federation. 2018 Annual Census. Online: http://www.
wfdf.org/downloads/doc_download/705-2017-member-association-cen
sus-information-; accessed: July 2019
[2] Akinbola M, Logerstedt D, Hunter-Giordano A et al. Ultimate Frisbee
injuries in a collegiate setting. Int J Sports Phys Ther 2015; 10 (1): 75–84
[3] Reynolds KH, Halsmer SE. Injuries from Ultimate Frisbee. WMJ 2006;
105 (6): 46–49
[4] Nelson JT, Jones RE, Runstrom M et al. Disc Golf, a Growing Sport:
Description and Epidemiology of Injuries. Orthop J Sports Med 2015.
doi:10.1177/2325967115589076
[5] Ellenbecker TS, Roetert EP. Testing isokinetic muscular fatigue of
shoulder internal and external rotation in elite junior tennis players.
J Orthop Sports Phys Ther 1999; 29 (5): 275–281. doi:10.2519/
jospt.1999.29.5.275
[6] Hadzic V, Sattler T, Veselko M et al. Strength asymmetry of the shoulders
in elite volleyball players. J Athl Train 2014; 49 (3): 338–344.
doi:10.4085/1062-6050-49.2.05
[7] Kibler WB, Kuhn JE, Wilk K et al. The disabled throwing shoulder: spec-
trum of pathology-10-year update. Arthroscopy 2013; 29 (1): 141–161.
e26. doi:10.1016/j.arthro.2012.10.009
[8] Shitara H, Kobayashi T, Yamamoto A et al. Prospective multifactorial
analysis of preseason risk factors for shoulder and elbow injuries in high
school baseball pitchers. Knee Surg Sports Traumatol Arthrosc 2017;
25 (10): 3303–3310. doi:10.1007/s00167-015-3731-4
[9] Ellenbecker TS, Davies GJ. The application of isokinetics in testing and
rehabilitation of the shoulder complex. J Athl Train 2000; 35 (3): 338–350
[10] Saccol MF, Gracitelli GC, da Silva RT et al. Shoulder functional ratio in
elite junior tennis players. Phys Ther Sport 2010; 11 (1): 8–11.
Downloaded by: State University of New York at Stony Brook. Copyrighted material.
doi:10.1016/j.ptsp.2009.11.002
[11] Stanley A, McGann R, Hall J et al. Shoulder strength and range of motion
in female amateur-league tennis players. J Orthop Sports Phys Ther
2004; 34 (7): 402–409. doi:10.2519/jospt.2004.34.7.402
[12] Wang HK, Cochrane T. Mobility impairment, muscle imbalance, muscle
weakness, scapular asymmetry and shoulder injury in elite volleyball
athletes. J Sports Med Phys Fitness 2001; 41 (3): 403–410
[13] Codine P, Bernard PL, Pocholle M et al. Influence of sports discipline on
shoulder rotator cuff balance. Med Sci Sports Exerc 1997; 29 (11):
1400–1405
[14] Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder:
spectrum of pathology Part III: The SICK scapula, scapular dyskinesis, the
kinetic chain, and rehabilitation. Arthroscopy 2003; 19 (6): 641–661
[15] Kibler WB, Wilkes T, Sciascia A. Mechanics and pathomechanics in the
overhead athlete. Clin Sports Med 2013; 32 (4): 637–651. doi:10.1016/
j.csm.2013.07.003
[16] Moreno-Pérez V, Moreside J, Barbado D et al. Comparison of shoulder
rotation range of motion in professional tennis players with and without
history of shoulder pain. Man Ther 2015; 20 (2): 313–318. doi:10.1016/
j.math.2014.10.008
[17] Ellenbecker TS, Mattalino AJ. Concentric isokinetic shoulder internal and
external rotation strength in professional baseball pitchers. J Orthop
Sports Phys Ther 1997; 25 (5): 323–328. doi:10.2519/jospt.1997.25.5.323
[18] Ng GYF, Lam PCW. A study of antagonist/agonist isokinetic work ratios
of shoulder rotators in men who play badminton. J Orthop Sports Phys
Ther 2002; 32 (8): 399–404. doi:10.2519/jospt.2002.32.8.399
[19] Wilk KE, Obma P, Simpson CD et al. Shoulder injuries in the overhead
athlete. J Orthop Sports Phys Ther 2009; 39 (2): 38–54. doi:10.2519/
jospt.2009.2929
[20] Sasakawa K, Sakurai S. Biomechanical analysis of the sidearm throwing
motion for distance of a flying disc: a comparison of skilled and unskilled
ultimate players. Sports Biomech 2008; 7 (3): 311–321. doi:10.1080/
14763140802270936
[21] Hummel SA. Frisbee flight simulation and throw biomechanics. 2003
[22] Myklebust G, Hasslan L, Bahr R et al. High prevalence of shoulder pain
among elite Norwegian female handball players. Scand J Med Sci Sports
2013; 23 (3): 288–294. doi:10.1111/j.1600-0838.2011.01398.x
Koeble C et al. Functional Adaptations in… Sportverl Sportschad