Shoulder pain in archers: Kaur Grover 2017 study

At the Indian inter-university archery championship in Amritsar in February 2013, 156 archers (91 men and 65 women, mean age 20.27, on average 4.33 years of practice) were interviewed and examined by a sports physiotherapist. At the time of the survey 85 had pain in a shoulder, 54.4%; counting past episodes, 82.69% had had shoulder pain at least once, and 64.74% reported pain that kept coming back.

Among those with current pain, 41.18% felt it in the drawing shoulder; according to the chart, 36% in the bow shoulder and 22% in both; the phase named most often was the draw (45.88%). For 80% the pain appeared only during certain activities and went away between sessions; for 20% it persisted and got in the way of their sport. Of those with pain, 40% thought it was costing them points. In the clinical tests of this group the commonest findings were a positive Hawkins-Kennedy test (80.00%), a positive Speed's test (60.00%), the lift-off test (51.76%) and painful isometric contraction of supraspinatus (51.76%). Current pain was associated with previous episodes (odds ratio 2.57) and with age, being more common from 20 upwards (odds ratio 2.13); it was not associated with sex, bow type, training hours, arrows shot per day, warming up or gym strengthening.

It is a cross-sectional survey in two parts: a structured interview of 76 questions, drawn up after a literature review and talks with coaches and piloted on 40 archers, and a clinical examination of both shoulders. The questions covered personal details, training, current and past pain, treatment and effects on performance; an archer was classed as having current or past pain on answering yes to the direct question. The examination included inspection, palpation of the usual tender points and a battery of tests: Neer, Hawkins-Kennedy, apprehension-relocation for anterior instability, sulcus sign, painful arc, Speed's test for the long head of biceps, lift-off for subscapularis and resisted isometric contraction of supraspinatus.

Archers with at least a year of training and competition were included. Three bow types were represented: 40 compound archers, 37 recurve and 79 shooting the wooden bow ("wooden" in the paper). The two groups, with and without current pain, were compared with chi-square, odds ratios and t-tests.

Clinical shoulder tests are not a diagnosis: they point to possible involvement of a structure and often come out positive in people who do not have the problem. The study itself shows this, since the Hawkins test was positive in 38.02% of those without pain as well. The idea that most cases are impingement involving supraspinatus, the long head of biceps and subscapularis is therefore the authors' interpretation, without imaging. One examiner did all the assessments, and there is no measure of agreement.

Past pain and training data were recalled by the archers, and the question on current pain was yes or no, with no intensity scale: "pain" can mean very different things. The sample is Indian university archers gathered at one tournament, where anyone with pain bad enough to stop them competing may well have been absent. There are inconsistencies: the abstract names young age as a risk factor while the results and table say the opposite; painful supraspinatus contraction is 58.1% in the abstract and 51.76% in the table; the minimum age is 15, although the authors say they excluded those under 16. The lack of association with training hours or arrow counts should be read with caution, because these are self-reported and widely spread values.

The study shows that in a group of young university archers with only a few years of practice, shoulder pain was very common: more than one in two had it on the day of the competition, and four in five had had it at least once. The pain was more often in the drawing shoulder and linked to the draw, but a third of cases involved the bow shoulder, which tends to be forgotten. Mostly it appeared only while shooting and eased between sessions, which is why many archers ignored it; the authors also note that several athletes with positive tests did not report pain.

It does not show what causes it or what prevents it: training hours, arrows shot, warming up and gym strengthening did not differ between archers with and without pain, but the study was not designed to find that out. For an archer whose pain keeps returning, the useful point is that this is a common and often underrated problem, and that assessing it is a job for a doctor or physiotherapist.