Objective To examine the association between preseason kinetic chain-related postural alignment, neuromuscular control and functional performance and non-contact upper extremity injuries in overhead athletes. Design Prospective cohort study. Setting Field-based preseason screening with in-season injury surveillance. Participants 143 overhead athletes from 11 teams. Main outcome measures Preseason assessments comprised spinal postural alignment, shoulder range of motion, the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), the Single-Leg Squat Test (SLST) and weekly training volume. Non-contact upper extremity injuries were recorded throughout the season. Methods Group comparisons used parametric and non-parametric tests; independent variables were identified with multivariable logistic regression. Results Forty-five athletes (31.5%) sustained an upper extremity injury, 73.3% non-contact. Higher weekly training volume (OR 1.20, 95% CI 1.03-1.40), lower CKCUEST performance (OR 0.86, 95% CI 0.76-0.98) and poorer SLST performance (good vs. poor: OR 0.08, 95% CI 0.010-0.622; moderate vs. poor: OR 0.17, 95% CI 0.047-0.596) were independently associated with risk. Sex, shoulder rotational asymmetry and static spinal alignment were not. Conclusions Non-contact upper extremity injuries are linked to modifiable kinetic chain factors. Integrating CKCUEST and SLST with training-load monitoring into preseason screening may improve early risk identification.
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