Background Biomechanical alterations, including changes in shoulder mechanics, lower limb function, and visual-motor coordination, play a crucial role in influencing both performance and injury risk among table tennis players. Understanding these adaptations is essential for developing effective training protocols and injury prevention strategies. Methods A systematic search was conducted across three electronic databases—PubMed, PEDro, and Scopus—covering studies published between January 2000 and September 2024. The search strategy combined biomechanical and sport-specific keywords related to table tennis. After removing 262 duplicates, 3160 records were screened by title and abstract, and 145 full-text articles were assessed for eligibility. Fourteen studies met the inclusion criteria and were included in the final review, comprising a total of 489 participants with sample sizes ranging from 8 to 143 and participant ages spanning from 8 to 30 years. The study designs included nine cross-sectional studies, four randomized controlled trials (RCTs), and one comparative study. Methodological quality was assessed using the PEDro scale for RCTs (average score: 5.75) and the NIH Quality Assessment Tool for cross-sectional studies (average score: 9.5). Results The review identified consistent biomechanical asymmetries in table tennis players, particularly concerning shoulder mechanics. Dominant shoulders commonly exhibited glenohumeral internal rotation deficits (GIRD) and impaired scapular upward rotation (ISUR), both of which are associated with an elevated risk of injury. Alterations in foot load distribution during forehand strokes were found to significantly impact stroke power and postural stability. Additionally, elite players demonstrated superior visual-motor coordination, characterized by enhanced eye tracking and spatial accuracy, which positively influenced performance outcomes. Conclusion The biomechanical alterations in shoulder function, lower limb mechanics, and visual-motor coordination are critical factors influencing performance and injury risk in table tennis players. Structured training programs emphasizing shoulder mobility, lower limb strength, and visual-motor skill development are essential for optimizing athletic performance and minimizing injury potential.
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