Risk Factors for Shoulder Injuries in Female Athletes Playing Overhead Sports: A Systematic Review.

Overhead sports like volleyball, softball, and swimming place repeated, high-demand stress on the shoulder, and researchers wanted to pull together what is known about why female athletes in these sports get shoulder injuries. This systematic review gathered 23 studies published between 2000 and 2021 looking at shoulder injury risk factors in female athletes aged 15 to 35. Across these studies, six recurring risk factors emerged, with using the dominant shoulder and high training volume or overuse being the most frequently cited. Volleyball, softball, and swimming were the sports most often studied.

Because this is a review of existing observational research rather than a controlled trial, it describes associations rather than proving that these factors directly cause injury, and the studies varied in sport, methods, and quality, which limits how confidently the findings can be generalized.

If you're a female athlete who plays an overhead sport like volleyball, softball, swimming, gymnastics, or tennis, you may wonder what puts your shoulder at risk. This review looked across 23 existing studies to find common patterns in shoulder injuries among female athletes aged 15 to 35.

The researchers found that using your dominant shoulder repeatedly and having a high volume of training or overuse were the factors most often linked to shoulder injury, along with other factors like time spent in the sport, age at injury, past injury history, and shoulder instability in multiple directions. It's important to understand that this review combines findings from many different studies rather than testing a new treatment directly, so it shows patterns of association rather than proof that any one factor causes injury. The studies also varied in design and sport, which means these patterns may not apply the same way to every athlete or every sport.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

For clinicians working with female overhead athletes, a recurring question is which modifiable or non-modifiable factors should inform injury-prevention conversations and return-to-sport reasoning. This systematic review synthesizes 23 studies (2000-2021, ages 15-35) across volleyball, softball, swimming, gymnastics, tennis, water polo, and basketball, identifying six recurring risk factors: dominant shoulder, training volume/overuse, time in sport, older age at injury, prior injury, and multidirectional instability. The most consistently cited factors were dominant-shoulder involvement (reported in 9 of 23 studies, mean risk ratio 2.04) and volume/overuse (6 of 23 studies, mean risk ratio 1.45).

These figures represent averaged risk ratios across heterogeneous studies rather than a single pooled analysis, so they should be treated as indicative of frequently reported associations rather than precise, generalizable effect sizes. The abstract does not specify the individual study designs included, note formal heterogeneity or risk-of-bias assessment, or report on adverse events, and prevention strategies mentioned are described qualitatively without effectiveness data reported here. This limits the ability to draw firm conclusions about which interventions reduce injury risk, even though the review identifies consistent risk-factor themes worth factoring into clinical reasoning about overhead athletes.