Association of trunk and lower limb factors with shoulder complaints and sport performance in overhead athletes: A systematic review including GRADE recommendations and meta-analysis

To identify the association of trunk and lower limb factors with shoulder complaints and sport performance in overhead athletes. Search performed at PubMed/Medline, Embase, CINAHL, LILACS, Cochrane, Web of Science and SPORTDiscus for observational studies. Methodological quality and strength of the evidence was assessed with the Newcastle-Ottawa Scale and GRADE. Meta-analysis and effects sizes analysis were calculated when possible. Sixty-five studies were included. Low to very-low evidence suggests no association of trunk/lower limb strength, endurance, power, jump or balance with shoulder complaints and/or throwing performance. Athletes with shoulder complaints performed worse in trunk stability and endurance tests (mean difference: −6.83 (95%CI: −8.78, −4.88)). Athletes with high throwing performance presented better results in CMJ, horizontal jump, power measures and knee extension strength. For swimmers, there was no association of trunk/lower limb endurance with shoulder complaints (moderate evidence) and no association of balance and swimming performance (low evidence). Better trunk/lower limb strength, power and vertical jumps measures were associated with better swimming performance. In methodologically similar studies, some trunk/lower limb outcomes are associated with shoulder complaint or sport/swimming performance. Results should be considered with caution and future studies should use better methodologies. •The association of trunk/lower limb and shoulder complaints/sport performance is still unclear.•In overhead athletes, shoulder complaints are related with trunk stability/endurance.•In overhead athletes, throwing performance is related with lower limb power/strength.•In swimmers, performance is related with trunk/lower limb strength and power.•Trunk stability/endurance, and lower limb strength/power should be considered.