Journal of Bodywork & Movement Therapies 27 (2021) 127e133

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Journal of Bodywork & Movement Therapies

journal homepage: www.elsevier.com/jbmt

Prevention and Rehabilitation

Biomechanics of core musculature on upper extremity performance in

basketball players
Chandrakala Arora a, Piyush Singh a, Vicky Varghese b, *
a
Department of Sports Physiotherapy, Indian Spinal Injuries Centre Institute of Rehabilitation Sciences, New Delhi, 110070, India
b
Biomechanics Engineer, Biomechanics Lab, Indian Spinal Injuries Centre, New Delhi, 110070, India

a r t i c l e i n f o a b s t r a c t

Article history: Introduction: Basketball is a dynamic team sport which involves skilled movement and activities.
Received 27 May 2020 Shooting is considered to be an essential part of the game for scoring points. The core strength is an
Received in revised form important preconditioning for the sport, and it influences the performance of the player.
19 January 2021
Method: In this study the subjects included thirty-six male basketball players divided into two groups of
Accepted 28 February 2021
high and low core groups. The subjects performed one arm hop test and modified upper quarter y
balance test (mUQYBT) under with and without core activation condition. The performance of the
Keywords:
subjects was evaluated using one way analysis of variance (ANOVA) with Tukeys HSD. Statistical sig-
Functional performance test
Upper extremity
nificance was set at p  0.05 as significant. Value of confidence interval was set at 95%.
Core stability Results: Based on the study, significant difference (p < 0.05) in performance for one arm hop test was
Basketball observed among all the four groups of core muscles (group 1: high core with core activation, group 2
high core without core activation, group 3 low core with core activation and group 4 low core without
core activation). Whereas, no significant difference (p > 0.05) in performance for mUQYBT was observed
among all four groups.
Discussion: Core training is the basis for many functional movements and has become the norm in
athletic training programs. Broad benefits of core stabilization have been overlooked, from improving
athletic performance to preventing injuries in the sports medicine world.
Conclusion: In the present study, core activation was associated with improved stability and mobility of
basketball players during the upper extremity performance test, and the greatest influence of core
activation was seen in individuals with lower core scores.
© 2021 Elsevier Ltd. All rights reserved.

1. Introduction release speed etc.(Drinkwater et al., 2008; Oudejans et al., 2012;

Basketball is the second most popular sports in the world, and
according to the International Basketball Federation (FIBA), it is
played by more than 450 million people worldwide.(“Interna-
tional Basketball Federation (FIBA) - FIBA.basketball,” n.d.) It in-
volves skilled movement which includes shooting, defense, and
dribbling(Çetin and Muratlı, 2014; Stojanovic et al., 2018; Tsai
et al., 2006). The two-legged jump shot constitutes over 70% of
all the shots during a game, where the athlete jumps to increase
the ball release height(Struzik et al., 2014). Previous studies have
explored different aspects concerning jump shot such as the ef-
fects of fatigue, shooting distance, fitness, release angle and
* Corresponding author.
E-mail address: vicky.varghese@gmail.com (V. Varghese).
Ziv and Lidor, 2009) Shots performed from significant range
require higher impulse to propel the ball towards the basket
because the horizontal virtual target decreases as the shooting
distance increases. Researches have shown an increase in the ball
release velocity when the shooting distance is increased(Okazaki
and Rodacki, 2012). Shoulder goes in a typical range of motion
pattern of excessive external motion and compromised internal
rotation during throwing movement, due to laxity in the domi-
nant glenohumeral joint(Allegrucci et al., 1995). Researchers have
found a nonsignificant difference (5 ) in elbow angle in prepa-
ration for the two-or three-point jump shot along with increased
shoulder and wrist range of motion(Knudson, 1993). Motion at
the lower limbs is required for a connection and coordination to
complete a shooting action. On the other hand strong tensile
muscular forces are also needed at the upper limb during a jump
shot(Struzik et al., 2014).

https://doi.org/10.1016/j.jbmt.2021.02.023
1360-8592/© 2021 Elsevier Ltd. All rights reserved.
C. Arora, P. Singh and V. Varghese
The main muscle groups of the upper limb that intervenes
during the action of the shooting are the flexors of the arm (anterior
deltoid, biceps, coracobrachialis), forearm(brachialis) and hand
during the handling phase, along with extensors (triceps) and
pronators (pronator teres) of the forearm during the finishing stage
of the shot. The muscles of the lower limb contracts isometrically
until the player does not bend and works concentrically (knee
flexors) during the step of bending. The muscles (knee extensors)
work eccentrically, and the force applied on the ground increases
after bending when the player stretches the lower limbs to perform
a jump. During the release phase of the ball, the muscles of the
lower limbs work concentrically, thereby pushing strong on the
ground and increasing the forces(Raiola and D'isanto, 2016). The
proper function of these active muscles and the velocity at which
the ball is released is crucial in determining a shot success(Knud-
son, 1993). Muscular strength and endurance are required around
the lumbar spine to maintain functional stability during both upper
and lower limb movements. This region includes the abdominal
muscles anteriorly, the paraspinals and gluteus posteriorly, the
diaphragm superiorly, and the pelvic floor and hip girdle muscu-
lature inferiorly are referred as “core”(Radwan et al. (2014)). The
proximal core muscles stabilize the spinal and its poor function is
associated with dysfunctional movement pattern. The Core has the
purpose of controlling and stabilizing the lumbosacral region and
allows as a connection between the upper and lower part of the
body and aids in distribution of forces generated by upper and
lower limbs.(Sannicandro and Cofano, 2017).
In sports, core becomes particularly important as it provides
‘proximal stability for distal mobility’(Akuthota et al., 2008). Core
stability proves to be an essential component of biomechanical
efficiency as it leads to maximum force production thereby
reducing the loads over peripheral joints (Radwan et al., 2014). The
core muscles of the trunk and pelvis are responsible for main-
taining the stability of the spine and pelvis and are critical for the
transfer of energy from larger torso to smaller extremities during
many sports activities (Sharrock et al., 2011).
Despite the current interest surrounding core stability, a limited
body of evidence exists to support the relationship of core stability
strength and performance enhancement amongst athletes. The
purpose of the current study is to examine the influence of different
level of core musculature strength on the athlete's upper extremity
performance measures in basketball players.
2. Methods
2.1. Subjects
The subjects were thirty-six male basketball players from Delhi
University College and Army Headquarters. The average age was
21.11 years (17e25 years), the average height of 1.83 ± 0.07 m
(range-1.7e2.08 m), weight 75.77 ± 7.48 kg (range 58e88 kg), BMI
22.72 ± 1.86 kg/m2 (19.44e25.71 kg/m2). Only healthy male sub-
jects were included to avoid the confounding effect of health status
and gender. The inclusion criteria included subjects with normal
ROM at lumbar spine, shoulder, elbow and wrist joints and were
comprehensive in speaking and understanding English and Hindi.
The measurement to determine normal ROM was done using a
universal goniometer and an active range of motion (the arc of
motion attained by a subject during unassisted voluntary joint
motion) was assessed as per the definition of American Academy of
Orthopedic Surgeons (AAOS). Subjects were excluded if they had
any history of injury or surgery in upper extremity or spine in the
last six months, the complaint of any pain in upper extremity or
spine, vestibular problems (example-vertigo), visual disturbances
or any associated neurological problems, hip flexor musculature
128
Journal of Bodywork & Movement Therapies 27 (2021) 127e133
tightness and systemic disease. Each subject signed a statement of
informed consent before participation. Before testing, participants
age, dominant throwing arm, and upper limb length were recorded.
Upper limb length of a participant was measured in an upright
standing position with the shoulder abducted to ninety degrees,
the elbow fully extended, and the participant's hand in a neutral
position. The tester measured the participant's upper limb length
from C7 to the tip of their middle finger with a measuring tape.
Participants performed the testing procedures barefoot to elimi-
nate any stability and balance issues from footwear. The testing
procedure was approved by the Institutional Review Board of the
Indian Spinal Injuries Centre at New Delhi, India (Ref ISIC/IIRS/RP/
2018/153).
2.2. Testing procedure
Core assessment of selected basketball players was performed
using Sahrmann core testing progression.(Akuthota and Nadler,
2004; Faries and Greenwood, 2007). The Sahrmann protocol aims
to assess the ability of the core musculature to stabilize the spine
and includes five levels of testing each designed to make it
increasingly challenging to maintain a neutral spinal position using
the core stabilizers involved. Subjects were grouped according to
their core stabilization scores (Sahrmann scores) into LOW core
strength (Sahrmann score 0) and HIGH core strength (Sahrmann
score 1 to 5).
The subjects from each group were then randomly assigned and
instructed to perform upper extremity performance tests with core
activation and without core activation. Subjects in the category of
core activation were instructed to engage their abdominal muscles
while performing the upper extremity performance tests.
Group 1- High core group with core activation
Group 2- High core group without core activation
Group 3- Low core group with core activation
Group 4- Low core group without core activation.
The test procedure has been is depicted in the form of a flow-
chart (Fig. 1).
Prior to commencement, players performed their general warm
up and practice trials of the upper extremity performance tests to
ensure that they were comfortable with the study procedures. The
subject first watched an instructional video depicting the test
protocols. The current study used to two performance tests to
assess the upper extremity performance: One arm hop test and
modified upper quarter Y balance test. One arm hop test is a closed
kinetic chain movement, but it requires both concentric and
eccentric muscle strength and control with an external load on the
upper extremity, similar to the shot performance of basketball.
Modified Y balance test challenges the proprioception, balance,
strength, and range of motion of upper extremity and trunk and
thus allowing the assessment of mobility and stability of scapular
and thoracic movement outside base of support. Although modified
Y balance test is a closed kinetic chain test as compared to shot
performance in basketball which is an open kinetic chain activity, it
is the only reliable measure available for assessing the dynamic
balance of upper limb in athletes.
 One arm Hop test:
For testing, subjects assumed a one-arm push-up position with
his back flat, his feet and shoulders apart, and his dominant weight-
bearing upper extremity positioned perpendicular to the floor. The
participant placed his non-weight bearing hand on the posterior
lower back. A 10.2-cm step (Aerobic stepper, De Jure Fitness, New
Delhi, India) was immediately placed laterally to the test hand of
the subject. Upon reaching the position, the subject used the
C. Arora, P. Singh and V. Varghese
Fig. 1. Flowchart of test procedure protocol.
weight-bearing arm to hop on the step and land with the entire
hand on the step. Then participant used the weight-bearing arm to
hop off to the step and return his hand to the starting position.(-
Fig. 2) This movement was repeated five times as quickly as
possible by the participant. One trial was performed during the test
with acceptable technique and if the test was performed with an
improper technique, 1 min rest was given to the subject before
performing another trial. An acceptable test was defined as a test in
which the participant hopped entirely onto the step, did not use the
other hand, did not touch down with a knee, and kept his back flat
and his feet in the same position. Time taken was recorded as the
participant completes one set of hop with the weight-bearing arm.
 Modified Y e Balance Test
A modified upper quarter Y balance test (mUQYBT) is con-
structed (as shown in Fig. 3). It consisting of three wooden blocks
measuring 2  4x8 inches and three cloth measuring tapes affixed
129
Journal of Bodywork & Movement Therapies 27 (2021) 127e133
to the floor using athletic tape matching the angles (90 and two
135 ) of the upper quarter Y balance test (UQYBT). Before starting
each participant was provided with a demonstration of the pro-
cedures and standardized instructions. The starting position was
defined as the feet placed shoulder-width apart in a pushup posi-
tion with the tested hand on the stance platform and the thumb
adducted. With the free hand the participant pushes the wooden
box along the tape, by contacting only the side of the wooden box.
Three trials for the mUQYBT were recorded for the dominant upper
limb (superolateral, medial, inferolateral) in the standardized order.
The maximum reach distance was measured at the point where the
most distal part of the hand reached by reading the tape measure at
the edge of the reach indicator.
A performance trial was not accepted if the following occurred:
a) The participant failed to maintain unilateral stability
(participant fell over or placed their free hand on the ground
for support/stability),
C. Arora, P. Singh and V. Varghese
Fig. 2. Subject positioned for one-arm hop test.
Fig. 3. Subjects positioned for Modified Upper Quarter Y e Balance test.
b) Participant did not maintain contact with the block,
c) Participant had improper hand placement on the block
(placed hand on top of block instead of fingertips on closest
side),
d) Participant lifted a foot off the floor.
130
Journal of Bodywork & Movement Therapies 27 (2021) 127e133
2.3. Data analysis
The subject demographics (age, height, weight,BMI), the time to
perform the One Arm Hop Test and the maximum reach distance in
the Modified Upper Quarter Y- Balance Test (mUQYBT) were
separately compared between the four groups using One way
Analysis of variance which was performed with Tukeys HSD to
analyze the difference in mean using R (Rstudio, Version .3.1043,
RStudio: Integrated Development for R. RStudio, PBC, Boston, MA
URL http://www.rstudio.com/). Statistical significance was set at
p  0.05 as significant. Value of confidence interval was set at 95%.
3. Results
The distribution of descriptive statistics of age, height, weight,
and BMI for the four groups namely high core with core activation
(Group 1), high core without core activation (Group 2), low core
with core activation (Group 3) and low core without core activation
(Group 4) is shown in Table 1. There is no significant difference
(p < 0.05) among the subjects participating in the groups.
3.1. One arm hop test
The results of one arm hop test are presented in Fig. 4. Time was
highest for group 4 at 7.72 ± 0.75 s, whereas it was lowest for group
1 at 5.03 ± 0.67 s. In both high and low core groups, the time was
highest for groups 2 and 4 (5.86 ± 0.70 and 7.72 ± 0.75 s respec-
tively). Based on statistical analysis (Table 2), in high core group
there is a significant difference in one arm hop test at (p  0.05)
between group 1 and group 2. Similarly, in case of low core group
there is a significant difference (p  0.05) between group 3 and
group 4. In case of core activation group there is a significant dif-
ference (p  0.05) between group 1 and group 3, similarly in case of
without core activation, there is a significant difference (p < 0.05)
group 2 and group 4. The difference was not significant (p > 0.05)
between group 2 and group 3.
3.2. Modified upper quarter Y balance test (mUQYBT)
The results of mUQYBT are presented in Fig. 5. The highest
composite score was obtained in group 3 at 89.99 ± 4.93% whereas
it was lowest in group 4 at 88.97 ± 6.42%. Based on statistical
analysis (Table 2), in case of the high core group, there was no
significant difference (p > 0.05) between group 1 (89.36 ± 3.10%)
and group 2 (89.39 ± 6.94%). Similarly, in the case of the low core
group, there was no significant difference (p > 0.05) between group
3 (89.99 ± 4.93%) and group 4 (88.97 ± 6.42%). Similar no significant
difference was observed for other combinations (group 1 vs group
3, group 4 vs group 1, group 3 vs group 2, and group 4 vs group 2).
4. Discussion
Core training is the basis for many functional movements and
has become the norm in athletic training programs. Broad benefits
of core stabilization have been overlooked, from improving athletic
performance to preventing injuries in the sports medicine world.
Core training found to be an essential precondition for many high
impact sports such as football, basketball and in track and field
events. The results of the current study match with the studies in
the literature. In a study by Falsone et al. (2002) using one arm hop
test by male collegiate wrestlers and football players had the
C. Arora, P. Singh and V. Varghese Journal of Bodywork & Movement Therapies 27 (2021) 127e133

Table 1
Descriptive statistics of age, height, weight, BMI of the subjects in different groups.

Parameters Group 1 (HCCA) Group 2 (HCWCA) Group 3 (LCCA) Group 4 (LCWCA)

N 9 9 9 9
AGE Minimum 20 19 17 18
(years) Maximum 25 24 23 23
Mean (SD) 22.22 (1.78) 21.67 (1.80) 20.33 (1.87) 20.22 (1.71)
HEIGHT Minimum 1.75 1.73 1.70 1.75
(m) Maximum 1.87 2.08 1.94 1.90
Mean (SD) 1.82 (0.04) 1.85 (0.10) 1.83 (0.07) 1.79 (0.05)
WEIGHT Minimum 63 69 58 70
(kg) Maximum 88 88 88 81
Mean (SD) 73.78 (7.85) 78.89 (6.43) 75.22 (10.59) 75.22 (3.73)
BMI Minimum 19.44 19.60 19.70 21.60
(kg/m2) Maximum 25.71 25.46 25.71 25.46
Mean (SD) 22.12 (2.13) 23.12 (1.90) 22.27 (2.14) 23.37 (1.08)

Fig. 4. Comparing the effects of all four groups on one arm hop test. Fig. 5. Comparing the effects of all four groups on modified upper quarter Y balance
test.

Table 2
One way Anova results for One Arm Hop test and Modified Y balance Test between assessment of joint stability and mobility of the upper quarter and
the different groups. trunk as suggested in the literature(Gorman et al., 2012). One arm
hop test is a closed kinetic chain movement, but it requires both
Confidence interval
concentric and eccentric muscle strength and control with an
One arm hop test Mean difference Lower limit Upper limit p value external load on the upper extremity, similar to the shot perfor-
group 2 vs group 1 0.83 0.03 1.63 0.04
group 3 vs group 1 1.44 0.64 2.24 <0.01
mance of basketball. Modified Y balance test challenges the pro-
group 4 vs group 1 2.69 1.89 3.49 <0.01 prioception, balance, strength, and range of motion of upper
group 3 vs group 2 0.61 0.19 1.41 0.18 extremity and trunk and thus allowing the assessment of mobility
group 4 vs group 2 1.86 1.06 2.66 <0.01 and stability of scapular and thoracic movement outside base of
group 4 vs group 3 1.25 0.45 2.05 <0.01
support. Although modified Y balance test is a closed kinetic chain
modified Y Balance test test as compared to shot performance in basketball which is an
group 2 vs group 1 0.03 7.07 7.12 >0.99 open kinetic chain activity, it is the only reliable measure available
group 3 vs group 1 0.63 6.47 7.72 >0.99 for assessing the dynamic balance of upper limb in athletes. Sahr-
group 4 vs group 1 0.39 7.48 6.71 >0.99 mann core testing protocol, is one of the most practical and
group 3 vs group 2 0.60 6.49 7.70 >0.99
group 4 vs group 2 0.42 7.51 6.68 >0.99
objective methods to evaluate core stability in the athletic popu-
group 4 vs group 3 1.02 8.11 6.08 >0.99 lation. Aggarwal et al. (2011) found Sahrmann core testing protocol
as more reliable measure in evaluating function of deep abdominal
muscles. Shirley et al. (Shirey et al. (2012)) in their research
performance in the range of (2.95e7.07 s) and 3.24e9.95 s mentioned that Sahrmann is the only core testing protocol which
respectively. Similarly, in a study by Cramer et al. (2017) for requires low level of abdominal muscle activation during the initial
modified y balance test the results were in the range of values level and becomes increasingly difficult with the progression of
(composite score 60e98). Sannicandro et al. (Sannicandro and levels, similar to most of the athletic activities.
Cofano, 2017) tested the effect of core stability and jump perfor- The novelty of the study is that results demonstrated an increase
mance and concluded that jumping performance was improved in upper extremity performance in subjects with greater core
with core stability training in young basketball players.In a study by activation(Niewolna and Zwierko, 2015; Shirey et al., 2012). There
Xie (Xie, 2014) concluded that the core strength training could was a significant improvement in the performance scores of one
improve the shooting average and stability of basketball athletes. arm hop test and modified upper quarter Y balance with intentional
The current study used one arm hop test and modified Y balance core activation as compared to no core activity. This might be
test as it represents dynamic movement testing, which involves attributed due to the effect of core muscles on spinal loading.

131
C. Arora, P. Singh and V. Varghese
Results of our research are consistent with Shirey et al., 2012, where
they concluded that core activation influenced hip and knee kine-
matics during single-leg squats with more significant positive effect
noted in the individuals with poor core stability. The results suggest
that subjects with higher core score and core activation showed
higher scores in physical performance measure. This phenomenon
can be attributed to the core musculature which gets activated
involuntarily during functional activities. This fact is already sup-
ported by Radwan et al., 2014, Brumitt et al. (Brumitt and Dale,
2009) and Willardson et al. (Willardson, 2007) which states that
trunk musculature becomes activated in a feed-forward manner
during the upper or lower limb movements in individuals with
competent core strength. The study done by Hodges and
Richardson (1997) concludes that trunk muscle activity, specif-
ically the transversus abdominis and multifidus gets activated
before the arm motion to contribute to the stability of the adjacent
joints and control the position within the base of support.
Likewise, statistical estimation between individuals of lower
core scores with core activation has shown better performance
than the individuals without core activation. This possible outcome
suggests that with core activation, the trunk stability increases in
lower core scores individuals during the performance activities. In a
study by Sannicandro et al. (Sannicandro and Cofano, 2017) on pre-
pubertal basketball players demonstrates enhancement in the
jumping performance after four weeks of core stability training.
Similarly, the performance scores of LOW core individuals with core
activation in our study has shown a greater increase than in-
dividuals with HIGH core group with core activation on modified
upper quarter Y balance test. This possible finding could attribute
towards the concept of relative flexibility or stiffness proposed by
Sahrmann (Sahrmann et al., n.d.), which explains that if multi
articular muscles lack extensibility or generate excessive tension,
the normal motion becomes restricted causing monoarticular
muscles to essential lengthen during the functional movement
leading to excessive or uncontrolled motion at the joint.(Comerford
and Mottram, 2001).
Findings of our research suggest that individuals acquiring a
good core strength and better core stability will have better athletic
performance scores than individuals with poor core stability. Also,
an individual to gain good core strength, it is required that core
training is incorporated for a stipulated duration to have an
improvement/effect in the athletic performance measures. Results
of our research also recommend incorporating core strength
training for improving synchronicity in basketball performance by
improving proprioception and coordination.
The limitations of the current study include a small sample of
subjects with similar demographics. Another limitation of the
present study is that quantification of core musculature engage-
ment during the performance test was not assessed. Currently,
there are no standard methods to evaluate the same while per-
forming the tests and hence couldn't be performed in the current
study. Upper extremities strength and neuromuscular control
before the commencement of upper-performance test were not
evaluated. Based on these limitations, the future work would
include quantification of core musculature engagement using EMG
analysis during the upper extremity performance tests and
including larger sample size.
5. Conclusion
In the present study, core activation was associated with
improved stability and mobility of basketball players during the
upper extremity performance test, and the greatest influence of
core activation was seen in individuals with lower core scores.
132
Journal of Bodywork & Movement Therapies 27 (2021) 127e133
Funding
This study was non funded.
Ethical approval
All procedures performed in studies involving human partici-
pants were in accordance with the ethical standards of the insti-
tutional research committee (Indian Spinal Injuries Centre at New
Delhi, India (Ref ISIC/IIRS/RP/2018/153)) and with the 1964 Helsinki
declaration and its later amendments or comparable ethical
standards.
Informed consent
Informed consent was obtained from all individual participants
included in the study.
Declaration of competing interest
All authors have no conflict of interest.
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