Scapular Position and Craniovertebral Angle by Playing Position in Professional Iranian Female Volleyball Players: Associations with Playing Experience

Objective

This study aimed to compare scapular position and craniovertebral angle across playing positions, examine their associations with playing experience, and describe the prevalence of musculoskeletal symptoms in professional Iranian female volleyball players.

Methods

This cross-sectional study included 59 right-handed professional female volleyball players aged 18-25 years who were recruited from clubs and teams in Tehran, East Azerbaijan, and Alborz provinces. Scapular position was assessed using the lateral scapular slide test by measuring the distance between the inferior angle of the scapula and the adjacent spinal column at 0°, 45°, and 90° of shoulder abduction. The craniovertebral angle was measured using photographic postural assessment and ImageJ software. Musculoskeletal symptoms were assessed using the Standardised Nordic Musculoskeletal Questionnaire. Paired-samples t-tests were used to compare the right and left sides. One-way analysis of variance followed by Bonferroni post-hoc comparisons was used to assess differences among playing positions, and Pearson's correlation coefficient was used to examine relationships among the study variables. Statistical significance was set at P<0.05.

Results

The distance between the right scapular inferior angle and the spinal column was significantly greater than that on the left side at 0°, 45°, and 90° of shoulder abduction (P<0.05). The mean craniovertebral angle differed significantly among playing positions (P=0.026), with opposite hitters demonstrating a lower craniovertebral angle than middle blockers (P=0.012). Lateral scapular slide test values at 0° also differed significantly among playing positions (P=0.007), with middle blockers showing lower values than outside hitters and liberos. No significant associations were found between playing experience and the craniovertebral angle or scapular position measures. Furthermore, the craniovertebral angle was not significantly correlated with the scapular position measures (P>0.05). Forward head posture and shoulder symptoms were reported in 71.2% and 49.2% of the participants, respectively.

Conclusion

The professional female volleyball players examined in this study demonstrated significant asymmetry between the dominant and non-dominant scapular positions, along with some playing-position-related postural differences. Opposite hitters exhibited a greater degree of forward head posture than middle blockers; however, playing experience was not associated with the measured postural indices. These findings support the use of multidimensional and position-specific screening approaches, while scapular asymmetry should not be interpreted in isolation as evidence of pathology or injury risk.