Low Range of Shoulders Horizontal Abduction Predisposes for Shoulder Pain in Competitive Young Swimmers.

Antonio Cejudo,Fernando Santonja-Medina,Pilar Sainz De Baranda,Sheila Sánchez-Castillo,Juan Carlos Gámez

doi:10.3389/fpsyg.2019.00478

Abstract

The prevalence of shoulder pain (SP) among competitive swimmers is high, and may profoundly restrict their ability to compete. This prospective cohort study investigated the association between 3 blocks of performance factors (anthropometric characteristics, sport experience and training regimen) and the presence of SP. The aims of the present study were: (a): to determine the profile of shoulder flexibility in young swimmers, (b) to analyze whether a restricted range of movement (ROM) could be a predictor of subsequent SP in young swimmers. 24 competitive young swimmers were measured in the 2016 pre-season. Measures of passive maximal shoulder extension (SE), flexion (SF), horizontal abduction (SHAB), abduction (SAB), horizontal adduction (SHADD), external (SER) and internal (SIR) rotation ROMs were taken. SP was prospectively monitored during the subsequent season using questionnaires. The data was analyzed via a binary logistic regression and ROC curves were calculated. At the follow-up, 16 swimmers (50%) had developed unilateral SP. Only reduced SHAB ROM was associated with SP [SP group 36.6° vs. pain-free group 41.5°; p = 0.005, d = -0.96 (moderate effect sizes)]. Using the coordinates of the curves, the angle of SHAB ROM that most accurately identified individuals at risk of developing SP was determined to be 39° (sensibility 0.656 and 0.375 specificity). Swimmers with limited ROM (≤39°) have 3.6 times higher risk of developing SP than swimmers with normal ROM (>39°). This study clearly shows that low range of SHAB is a risk factor for developing SP in competitive young swimmers. In the studied data, a SHAB range of 39° was found to be the most appropriate cut-off point for prognostic screening.

Highlights

Shoulder pain (SP) has been described as the most common musculoskeletal disorder in competitive swimmers (Wanivenhaus et al, 2012) causing an impact on training, competition and swimming goals (McLaine et al, 2018)
Among the variables that were assessed before the beginning of the study, the only significant difference detected between the groups (SP vs. pain-free at follow-up) was in SHAB range of movement (ROM)
Possible Clinical Implications and Conclusion. These findings suggest that coaches and professionals in sport sciences should pay great attention to the regular assessment of ROM during the sport season, and consequent prescriptive measures should be taken and in order to correct the marked reduced ROM

Summary

Introduction

Shoulder pain (SP) has been described as the most common musculoskeletal disorder in competitive swimmers (Wanivenhaus et al, 2012) causing an impact on training, competition and swimming goals (McLaine et al, 2018). SP prevalence in swimmers is high, and may range from 40 to 91% depending on the age group and definition (McMaster, 1999; Bak, 2010; Sein et al, 2010). Competitive swimming often train 11 months of the year (Hibberd et al, 2016) and swin over 20 h per week distributed between 5 and 7 days (Sein et al, 2010; Tate et al, 2012). With an average stroke count of 10 complete strokes per 25 m lap (Heinlein and Cosgarea, 2010) this can equate to an average of 16800–44000 rotations of each shoulder per week

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