|Year : 2022 | Volume
| Issue : 1 | Page : 38-43
Prevalence of shoulder pain and disability in young Saudi bodybuilders, Riyadh, Saudi Arabia
Mohammad Abdullah Almalki1, Mohammed Talal Alzahrani2, Abdulmalek Abdulrahman Aljulaihim3, Ali Mohammed Mofareh Aseeri1, Mohammed Abdullah Alshehri4, Mohammed Khalid Abuhaimed5, Emad Masuadi5
1 Department Reconstructive Orthopedic, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
2 Department of Surgery, Orthopedic Division, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
3 Deparment of Orthopedic Surgery, Prince Mohammed Bin AbdulAziz Hospital, Riyadh, Kingdom of Saudi Arabia
4 Department Orthopedic, Asir Central Hospital, Abha, Kingdom of Saudi Arabia
5 Department of Basic medical sciences, college of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
|Date of Submission||13-Nov-2021|
|Date of Acceptance||05-Feb-2022|
|Date of Web Publication||4-Apr-2022|
Mohammed Talal Alzahrani
Department of Surgery, Orthopedic Division, King Abdulaziz Medical City, Riyadh
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Background: The shoulder complex has been alluded to as one of the most common regions of sports injury. Bodybuilding is getting more popular among Saudi youth in recent years. A vast number of bodybuilders suffer from pain during bodybuilding training. The aim of the study is to assess the prevalence and risk factors of shoulder pain and disability in young Saudi bodybuilders, Riyadh, Saudi Arabia.
Materials and Methods: this is a cross-sectional study that included subjects from multiple large gyms that offer bodybuilding equipment throughout Riyadh city. All subjects were sampled conveniently. Collected data included demographical data and a disability and pain tools (Disability of the Arm, Shoulder and Hand [DASH], and Penn Shoulder Score [PSS] scales).
Results: A total of 363 subjects participated in this study. the point, last month, last 6 months, last year, and lifetime prevalence of shoulder pain among bodybuilders were 23.4%, 35.5%, 51.4%, 57.6%, and 67.2%, respectively. 111 (30.6%) received treatment because of a shoulder injury and they either received medication, physiotherapy, or surgery with 37%, 57%, and 6%, respectively. Positive DASH sports disability has a significant higher prevalence of shoulder pain of all types (P < 0.001). Using the categorization of the pain score, bodybuilders with a positive PSS have significantly higher prevalence of shoulder pain of all types (P < 0.001).
Conclusions: Shoulder pain and disability are very prevalent in bodybuilding reaching up to 67.2% in lifetime prevalence of bodybuilders.
Keywords: Bodybuilding, Shoulder pain, Sports
|How to cite this article:|
Almalki MA, Alzahrani MT, Aljulaihim AA, Aseeri AM, Alshehri MA, Abuhaimed MK, Masuadi E. Prevalence of shoulder pain and disability in young Saudi bodybuilders, Riyadh, Saudi Arabia. Saudi J Sports Med 2022;22:38-43
|How to cite this URL:|
Almalki MA, Alzahrani MT, Aljulaihim AA, Aseeri AM, Alshehri MA, Abuhaimed MK, Masuadi E. Prevalence of shoulder pain and disability in young Saudi bodybuilders, Riyadh, Saudi Arabia. Saudi J Sports Med [serial online] 2022 [cited 2022 Aug 10];22:38-43. Available from: https://www.sjosm.org/text.asp?2022/22/1/38/342527
| Introduction|| |
Bodybuilding is a sport that aims to increase muscle strength, mass, and define body shape. The popularity of bodybuilding is evident by more than 45 million American who engage in bodybuilding regularly and this signify the increased numbers of musculoskeletal injures in those population. Despite the agreement on fitness and health benefits associated with bodybuilding, participation is not without risk. The shoulder joint in particular has been described as one of the most common body regions that are injured. During bodybuilding, the shoulder joint in particular is exposed to significant amount of stress repetitively, which makes it vulnerable to injury. Moreover, unfavorable positions of the most common shoulder resistance training exercises such as end range of external rotation motion put the shoulder under heavy loads predisposing it to both acute and chronic injuries.,, The combination of repetitive stress with heavyweights, improper training technique, and exercise selection would place the shoulder joint at high risk of injury.,,
There are many types of shoulder injuries which are caused by sports activities especially those that contain repetitive overhead movements. These may include injuries such as labral tear, rotator cuff tears, and biceps lesions which are commonly seen in weight-lifting kinds of sports, while fractures are associated with sports that involve lots of crashes and falls.
In Germany, a study conducted by Siewe et al. showed 45.1% of bodybuilding athletes reported shoulder symptoms while training. Kolber et al. collected epidemiological reports in the USA for shoulder joint injuries with prevalence rates ranging from 22% to 36%.
In Saudi Arabia, it has been noticed for the last decade that there is increasing numbers of youngsters who are engaged in different sports activities to optimize their physical appearance. This increase in numbers is directly related to the dramatic increase in numbers of Gym centers in Saudi Arabia. As bodybuilding is getting more popular among Saudi youth in recent years, a high percentage of Saudis started to travel abroad to participate in sport and bodybuilding competitions.,
It is common for the bodybuilders to sustain injuries during resistance and weight training, these injuries vary from site and severity depending on the type and form of training and training positions.,, Injuries can present as acute injuries including strains, sprains, compartment syndrome, and tendon avulsions., This can also present as chronic injuries such as the cases of rotator cuff tears, fractures, stress injuries, and tendinopathies., In addition, nerve injuries can be sustained due to wrong technique and muscle hypertrophy.,
In general, bodybuilding in both recreational form and competitive form shows a low number of injury rates compared to other types of sports.,, It is estimated that the rate of injury in competitive bodybuilding is 0.12 injuries per athlete per year and 0.24 injuries per 1000 h of training, however, in recreational bodybuilding, it shows some increase in the rate of injury (0.42) injuries per bodybuilder per year and 1.0 injuries per 1000 training hours.
Due to bodybuilders' goals to achieve a total body physique and a symmetry of the entire body, Bodybuilders train mostly all parts of body including back and chest and upper extremities, and lower extremities, thus Injuries in bodybuilding can occur in multiple sites and locations with a wide variety of symptoms. Spine injuries including cervical spine (36.6%), thoracic spine (21%), and lumbar spine (39.4%) are very common. Other injuries can affect upper extremities as with hand and wrist (14.1%), elbow (33.8%), and shoulders (36.6%). Lower extremities are commonly affected as the case with hip (5.6%), knee (31%), and ankle and foot (11.3%).
Pain during training is a very common issue in bodybuilding and can hinder the progression and performance of bodybuilders., A vast number of bodybuilders suffer from pain during bodybuilding training with the estimation of 45% affected. Pain attacks bodybuilders on different and diverse patterns during training. Upper extremities account for 24% of pain, with shoulders (12.7%), and hands (12.7%) are the most common sites for upper extremities pain. Back pain (12.7%) and lower extremities pain (15.5) are also reported.
| Materials and Methods|| |
Study, design population, and setting
This is a cross-sectional study that aimed to assess the prevalence and risk factors of shoulder pain and disability in young Saudi bodybuilders, Riyadh, Saudi Arabia. Subjects were collected from different sports gyms in Riyadh city with a convenient sampling. Collected data included demographical data and a well-known disability and pain tools.
Sampling technique and sample size
A convenient sampling technique was used by including those bodybuilders who were available at the selected sports club at the time of data collection.
For an estimated prevalence of shoulder pain and disability in bodybuilders around 36% and with a confidence level of 95% and a margin of error (0.05), the required sample size using the Raosoft is 348 bodybuilders. Available from: http://www.raosoft.com/samplesize.html.
Data collection form was designed to include demographical data such as date of birth, weight, and height. In addition, two well-known tools were included to assess the shoulder pain and disability which are the Disability of the Arm, Shoulder and Hand (DASH) and Penn Shoulder Score (PSS) scales.
In this research, disability and pain were measured using two tools which are DASH sports module score and PSS. The DASH Outcome Measure, which is abbreviated by DASH, the questionnaire helps patients to describe their symptoms better and assess the changing of functioning over time. DASH tool is considered as a valid and reliable instrument for both clinicians and researchers to assess all joints in the upper extremities and used for research purposes. The Penn Shoulder Score which is abbreviated by PSS is another tool that was used in this research to measure the pain of shoulder. PSS, which was applied for the first time in 1999, is a condition-specific and self-report measure with 10 points scale to measure pain. According to a study that measured the reliability and validity of PSS, this measurement is considered reliable, valid and can be used confidently to assess people with shoulder complaints.
Data management and statistical analysis
Participants were classified as positive for pain and disability when the following 2 criteria were met: The DASH sports module score >6/20 points and the PSS strenuous pain score ≥4/10.
- All data collected were coded in an Excel sheet. IBMStatistical Package for the Social Sciences® (IBM SPSS®) Version 23.0. USA
- Categorical variables were described by frequencies and percentages such as disability, while numerical variables such as age were presented as mean standard deviation (SD)
- Chi-square test was used to assess the risk factors associated with shoulder pain. A test is considered statistically significant when P < 0.05.
The research proposal was submitted to the ethics board in King Abdullah international medical Research center and was approved.
All subjects were deidentified and all data were accessible only by investigators.
| Results|| |
[Table 1] shows the baseline characteristics and level of training of 363 young Saudi bodybuilders included in this study. The mean age was 25.9 years and almost half of them have normal weight and 41% are overweight. For bodybuilders, smoking was relatively high, there was 138 (38%) smokers. In terms of their practice, the mean of practice duration was around (23 ± 29) (Mean + SD) months with average of (5 ± 1) days per week, with a daily practice duration of (71 ± 34) minutes.
[Table 2] shows the point, last month, last 6 months, last year, and lifetime prevalence of shoulder pain among bodybuilders were 23.4%, 35.5%, 51.4%, 57.6%, and 67.2%, respectively. However, 111 (30.6%) receive treatment because of shoulder injury and they either received medication, physiotherapy, or surgery with 37%, 57%, and 6%, respectively.
[Table 3] summarizes the prevalence of shoulder pain among bodybuilders by the baseline characteristics. There is a significant difference in the lifetime pain prevalence between age groups (P = 0.02) with the highest of 80% for 26–30-year-old and lowest 57% among. However, age has no significant effect on other types prevalence of shoulder pain. Body mass index has no significant effect on any type of prevalence of shoulder pain, while smoking has only significance effect on the lifetime prevalence of shoulder pain (P = 0.01) where smokers tend to have a higher prevalence than nonsmokers 76% compare to 62%. In general, bodybuilders with a history of shoulder injury tend to have a higher prevalence of shoulder pain of all types and it is significant for 6 months, annual and lifetime prevalence (P < 0.001). Stretching exercise and warming up before you participate in playing does not have a significant effect on any type of shoulder pain prevalence. For those with positive DASH sports disability have a significant higher prevalence of shoulder pain of all types (P < 0.001). Using the categorization of the pain score, bodybuilders with positive PSS have significantly higher prevalence of shoulder pain of all types (P < 0.001).
|Table 3: Shoulder pain prevalence among bodybuilder by baseline characteristics|
Click here to view
A stepwise binary logistics regression was used to assess the factors associated with the shoulder pain and presented in [Table 4]. Using the pain score categories (positive vs. negative), only three factors have a significant effect on the presence of shoulder pain, namely, stretching exercise and warming up, Smoking, and positive DASH sports disability P = 0.049, P = 0.011, and P < 0.001, respectively. Bodybuilders who do practice stretching exercise and warming up before you participate in playing have 2.1 times chance of shoulder pain as those who do not. Smokers have 1.8 times higher chance of shoulder pain by compared to nonsmokers. Bodybuilders who are regarded as positive DASH sports disability have five times change of shoulder pain.
|Table 4: Stepwise binary logistic regression of pain score (positive vs. negative)|
Click here to view
| Discussion|| |
Shoulder pain and disabilities are common in bodybuilders. Bodybuilding sport is becoming popular among Saudi youth., We hypothesize that the number of bodybuilders who complain of shoulder pain and disabilities would be high in our population due to high popularity among youth. The aim of the study was to assess the prevalence and risk factors of shoulder pain and disability in young Saudi bodybuilders, Riyadh, Saudi Arabia. The significance of this research is in identifying the size of the problem to reduce it and avoid the significant risk factors. Our hypothesis was that lifting weights in bodybuilders does correlate with the shoulder pain that shares similar results with other studies in literature.
In our research, the mean age was 25.9 years with 56 (15.4%) <20-year-old, 181 (49.9%) 21–25-year-old, 75 (20.7%) 2–30-year-old, 51 (14.0%) more than 31 years which is similar to another research was done by Nakhaee MR et al., studying the prevalence of use of anabolic steroids by in Iran, that enrolled 298 male athletes in the final analysis. Mean ± SD age of subjects was 25.9 ± 8.4. The weight of the 33 bodybuilders included in the study was as accordingly: only 9 of them (2.5%) were underweight, 186 (51.2%) were normal weight, 150 (41.3%) were overweight, 18 (5.0%) were obese. The number of overweight bodybuilders was surprisingly high with 41.3% while only half of them were normal weight (51.2%). The number of bodybuilders smokers was very high with 138 (38%) in comparison to another study by Schwingel et al., discussing the influence of concomitant use of alcohol, tobacco, cocaine, and anabolic steroids on lipid profiles of Brazilian recreational bodybuilders. Found that 27 out of 145 (18%) bodybuilders are smokers. This increased number of bodybuilder smokers we found in our research might be due to the increased number of smoking in Saudi Arabia especially in youths which is found to be 28.6% among college students and total average of 26.5% in males.,
As stated in our study, smokers have a 1.8 higher chance of having shoulder pain compared to nonsmokers. It is well established in large amount of clinical and experimental researches that smoking has a harmful effect on musculoskeletal system. It is known that smoking can cause loss of muscle mass and strength.
As our results state, stretching and warming up can play a significant role in shoulder injuries and pain. Comparing to the literature, there is a great conflict weather stretching or warming up can really prevent further injuries. One review research that combined multiple studies concluded that preexercise and postexercise stretching as an intervention play no role in muscle injury compared to no stretching. On the other hand, another review study was done in Australia showed the opposite. It concluded with stretching or warming up does not reduce muscle soreness or tenderness.
Our study showed that a positive DASH sports disability can have five times the risk of a negative DASH. One suggestion we can make based on our result is that using this method as a predictor and screening for shoulder pain or even as a preventive measure to stop it before it happens. In addition, when you look in the literature you can find many researches and studies that support the idea that a positive DASH score is a predictive for shoulder pain.
Our study showed a high prevalence of shoulder pain among bodybuilders, which might be lowered by modifying risk factors such as smoking habit, level of physical activity, obesity, and unhealthy sports style. The awareness of these risk factors is important among bodybuilders and it can be achieved by dedicated injury prevention campaigns and couching beginners in bodybuilding by professional mentors.
The outcome of this study has important indicators for health interventions that can improve the prevalence of shoulder pain among bodybuilders. However, this study has some limitations; First, based on this study design (cross-sectional), it was not possible to detect all risk factors. Second, a systemic bias which is a result of using self-filled questionnaire.
| Conclusions|| |
Shoulder pain and disability are very prevalent in bodybuilding reaching up to 67.2% in lifetime prevalence of bodybuilders. Intervention program may help improving the musculoskeletal health of the medical students and hence improving their quality of life.
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Siewe J, Marx G, Knöll P, Eysel P, Zarghooni K, Graf M, et al.
Injuries and overuse syndromes in competitive and elite bodybuilding. Int J Sports Med 2014;35:943-8.
Kolber MJ, Beekhuizen KS, Cheng MS, Hellman MA. Shoulder injuries attributed to resistance training: A brief review. J Strength Cond Res 2010;24:1696-704.
Reeves RK, Laskowski ER, Smith J. Weight training injuries: Part 1: Diagnosing and managing acute conditions. Phys Sportsmed 1998;26:67-96.
Reeves RK, Laskowski ER, Smith J. Weight training injuries: Part 2: Diagnosing and managing chronic conditions. Phys Sportsmed 1998;26:54-73.
Gross ML, Brenner SL, Esformes I, Sonzogni JJ. Anterior shoulder instability in weight lifters. Am J Sports Med 1993;21:599-603.
Kolber MJ, Beekhuizen KS, Cheng MS, Hellman MA. Shoulder joint and muscle characteristics in the recreational weight training population. J Strength Cond Res 2009;23:148-57.
Doyscher R, Kraus K, Finke B, Scheibel M. Acute and overuse injuries of the shoulder in sports. Orthopade 2014;43:202-8.
Al-Harbi F, Gamaleddin I, Alsubaie E, Al-Surimi K. Prevalence and Risk Factors Associated with Anabolic-androgenic Steroid Use: A Cross-sectional Study among Gym Users in Riyadh, Saudi Arabia. Oman Medical Journal 2020;35:e110.
Jabari M, Al-Shehri H, Al-Faris A, Al-Sayed M, Algaeed F, Al-Sobaie N, et al.
The prevalence of anabolic androgenic steroid use amongst athletes in Riyadh (Saudi Arabia). Electron Physician 2016;8:3343-7.
Raske A, Norlin R. Injury incidence and prevalence among elite weight and power lifters. Am J Sports Med 2002;30:248-56.
Siewe J, Rudat J, Röllinghoff M, Schlegel UJ, Eysel P, Michael JW. Injuries and overuse syndromes in powerlifting. Int J Sports Med 2011;32:703-11.
Winwood PW, Hume PA, Cronin JB, Keogh JW. Retrospective injury epidemiology of strongman athletes. J Strength Cond Res 2014;28:28-42.
Lavallee ME, Balam T. An overview of strength training injuries: Acute and chronic. Curr Sports Med Rep 2010;9:307-13.
Eberhardt A, Dzbanski P, Fabirkiewicz K, Iwan'ski A, Ronge P. Frequency of injuries in recreational bodybuilding. Phys Educ Sport 2007;51:40-4.
Peters MA, Phelps L. Body image dissatisfaction and distortion, steroid use, and sex differences in college age bodybuilders. Psychol Sch 2001;38:283-9.
Hsu JE, Nacke E, Park MJ, Sennett BJ, Huffman GR. The disabilities of the arm, shoulder, and hand questionnaire in intercollegiate athletes: Validity limited by ceiling effect. J Shoulder Elbow Surg 2010;19:349-54.
Leggin BG, Michener LA, Shaffer MA, Brenneman SK, Iannotti JP, Williams GR Jr. The Penn shoulder score: Reliability and validity. J Orthop Sports Phys Ther 2006;36:138-51.
Harrington S, Meisel C, Tate A. A cross-sectional study examining shoulder pain and disability in Division I female swimmers. J Sport Rehabil 2014;23:65-75.
Nakhaee MR, Pakravan F, Nakhaee N. Prevalence of use of anabolic steroids by bodybuilders using three methods in a city of Iran. Addict Health 2013;5:77-82.
Schwingel PA, Zoppi CC, Cotrim HP. The influence of concomitant use of alcohol, tobacco, cocaine, and anabolic steroids on lipid profiles of Brazilian recreational bodybuilders. Subst Use Misuse 2014;49:1115-25.
Al Nohair SF. Prevalence of smoking and its related behaviors and beliefs among secondary school students in Riyadh, Saudi Arabia. Int J Health Sci (Qassim) 2011;5:51-7.
Bassiony MM. Smoking in Saudi Arabia. Saudi Med J 2009;30:876-81.
Andersen JC. Stretching before and after exercise: Effect on muscle soreness and injury risk. J Athl Train 2005;40:218-20.
Herbert RD, de Noronha M. Stretching to prevent or reduce muscle soreness after exercise. Cochrane Database Syst Rev 2007;17-4:CD004577.
Dixon D, Johnston M, McQueen M, Court-Brown C. The Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) can measure the impairment, activity limitations and participation restriction constructs from the International Classification of Functioning, Disability and Health (ICF). BMC Musculoskelet Disord 2008;9:114.
[Table 1], [Table 2], [Table 3], [Table 4]