Shoulder Pain In Competitive Swimmers Research Articles

Shoulder Pain in Competitive Swimmers: A Multi-Site Survey Study.

There are 2.8 million youth competitive swimmers in the United States (US), and shoulder pain is the most common complaint among swimmers. To determine prevalence of shoulder pain, disability, and dissatisfaction in youth competitive swimmers. A secondary purpose was to determine influence of age, competitive swimming experience, and previous history of shoulder pain or injury on shoulder pain, disability, and dissatisfaction, and finally to determine if sex, geographic area, and participation in a second sport relate to shoulder pain, disability, and dissatisfaction. Multi-site cross-sectional design. Six-hundred and seventy-one swimmers aged 9-17 years from six states in the US completed surveys which included demographics, the Penn Shoulder Score (PSS), and the Disability of Arm Shoulder Hand (DASH) Sports. Independent t-tests were used to compare pain, disability, dissatisfaction, the influence of age, sex, participation in second sport, geographic region, and history of shoulder pain. Linear regression analyses were performed to determine the interaction of these variables with reported pain and disability. Forty-nine percent of swimmers had shoulder symptoms. Greater shoulder pain and disability were reported in 15 to 17-year-olds compared to 9 to 10-year-olds (pain and disability: p<0.001), in swimmers with greater versus less years of experience (pain and disability: p<0.001), and in swimmers from eastern versus western states (pain: p=0.001, disability: p=0.0014). Swimmers not participating in a second sport had higher shoulder dissatisfaction (p=0.002). History of prior shoulder pain/traumatic injury was the best indicator of increased pain, disability, and dissatisfaction (p<0.001). Almost half of swimmers surveyed had shoulder pain, with a higher prevalence found in older age groups, those with greater experience, and in those with prior shoulder pain or traumatic injury. Further research should investigate shoulder pain prevention programs, and surveillance methods are recommended to identify symptomatic swimmers who may benefit from referral to prevent further pain and disability. III.

The Effect of Exercise Therapy Interventions on Shoulder Pain and Musculoskeletal Risk Factors for Shoulder Pain in Competitive Swimmers: A Scoping Review.

Shoulder pain is the main cause of missed or modified training in competitive swimmers. Exercise therapy can improve the outcomes, yet uncertainty exists regarding the characteristics of these interventions. The primary aim was to describe the evidence base relating to the effectiveness of exercise therapy interventions on shoulder pain and shoulder musculoskeletal risk factors for shoulder pain in swimmers. The secondary aim was to identify gaps in the literature and provide recommendations for future research and practice. A scoping review methodology was applied through the search of MEDLINE, PubMed, Scopus, Web of Science, and CINAHL databases. The authors included any research studies (except clinical commentaries and conference papers) that assess the effect of exercise therapy on shoulder pain and musculoskeletal risk factors for shoulder pain in swimmers. The literature was critically appraised using the Modified Down and Black checklist. From 452 papers identified, 14 studies were included in this review. An exercise program of 6 to 8 weeks, including strengthening exercises (shoulder external rotator and scapula retractor muscles) and stretches (pectoral muscles), can decrease the incidence of shoulder pain in swimmers. Furthermore, a combination of exercises and stretches with manual therapy techniques can help to decrease shoulder pain in injured swimmers. Regarding risk factors, a strengthening program of more than 12weeks increased shoulder external rotation peak force, endurance, and external rotation/internal rotation ratio; however, this was not associated to decreases in pain. Finally, open kinetic chain exercises and a dry-land program are superior to close kinetic exercises and water training for improving shoulder external rotation strength and endurance. Exercise therapy has positive effects on reducing the incidence of shoulder pain, the management of shoulder pain, and improving shoulder musculoskeletal risk factors in competitive swimmers. However, due to methodological limitations of the studies, caution must be used when applying these results in practice. Future research should focus on high-quality randomized controlled trials for prevention and management of shoulder pain in swimmers.

LAND BASED EXERCISES VERSUS POOL BASED EXERCISES FOR SWIMMER’S SHOULDER IN COMPETITIVE SWIMMERS: RANDOMIZED CLINICAL TRIAL

To compare the effect of Land based exercises and Pool based exercises for shoulder strength to reduce shoulder pain in competitive swimmers using Shoulder Pain Disability Index (SPADI) score, Hand-Held dynamometer (HHD), Randomized Clinical trial.29 competitive swimmers with age group between 8 to 18 years were evaluated for shoulder pain using Shoulder Pain Disability Index Score [SPADI] and shoulder strength was evaluated using Hand Held Dynamometer [HHD] before and after the study. Then all the subjects were divided into 2 groups, for Group A Pool based exercises were given and for Group B Land based exercises were given. Statistically there is significant difference in values of outcome measures after the study in both groups but there is more significant difference in Group A than Group B. Pool based exercises showed more significant effect on shoulder pain than land based exercises in swimmer’s shoulder.

Ultrasonographic Evaluation of the Shoulders and Its Associations with Shoulder Pain, Age, and Swim Training in Masters Swimmers.

Background and objectives: The long head of the biceps (LHB) and rotator cuff tendinopathy is the major cause of shoulder pain in competitive swimmers. The risk of tendinopathy increases with aging; however, the structural changes of LHB and rotator cuff in populations of masters swimmers have not been well examined. The purpose of this study was to investigate the prevalence of ultrasonographic abnormalities of the shoulders in masters swimmers, and the association of pain, age, and swim training with structural changes in this population. Materials and Methods: A total of 60 subjects participated in this study, with 20 masters swimmers with shoulder pain, 20 asymptomatic masters swimmers, and 20 sex- and age-matched controls. All swimmers completed a self-reported questionnaire for shoulder pain, their history of competition, and training volume. Each subject underwent ultrasonographic examination of both shoulders for pathologic findings in the LHB tendon, rotator cuff (supraspinatus (SSP) and subscapularis (SSC)) tendons, and subacromial bursa (SAB) of both shoulders and had thickness measured. Results: The prevalence of tendinosis (LHB, 48.8%; SSP, 17.5%; SSC, 15.9%), partial tear (SSP, 35.0%), and calcification (SSC, 10.0%) were higher in swimmers than in controls. LHB and SSP tendinosis were associated with shoulder pain. Older age and later start of competition were associated with an increased risk of LHB tendinosis and SSC calcification. Earlier initiation of swimming and longer history of competition were associated with an increased risk of SSP and SSC tendinosis. The thicker SSP tendon significantly increased the risk of tendinosis and partial tear. Conclusions: A high prevalence of structural changes in the rotator cuff and biceps tendons in masters swimmers reflects the effect of shoulder symptoms, aging, and swim training.

Swim-Training Volume and Shoulder Pain Across the Life Span of the Competitive Swimmer: A Systematic Review.

Competitive swimmers are exposed to enormous volumes of swim training that may overload the soft tissue structures and contribute to shoulder pain. An understanding of training factors associated with the injury is needed before practice guidelines can be developed. To investigate the relationship between swim-training volume and shoulder pain and to determine swim-training volume and shoulder pain prevalence across the life span of the competitive swimmer. Relevant studies within PubMed, Web of Science, and MEDLINE. Studies that assessed the relationship between a defined amount of swim training and shoulder pain in competitive swimmers. Twelve studies (N = 1460 participants) met the criteria. Swimmers were grouped by age for analysis: young (<15 years), adolescent (15-17 years), adult (18-22 years), and masters (23-77 years). Adolescent swimmers showed the highest rates of shoulder pain (91.3%) compared with other age groups (range = 19.4%-70.3%). The greatest swim-training volumes were reported in adolescent (17.27 ± 5.25 h/wk) and adult (26.8 ± 4.8 h/wk) swimmers. Differences in exposure were present between swimmers with and those without shoulder pain in both the adolescent (P = .01) and masters (P = .02) groups. In adolescent swimmers, the weekly swim-training volume (P < .005, P = .01) and years active in competitive swimming (P < .01) correlated significantly with supraspinatus tendon thickness, and all swimmers with tendon thickening experienced shoulder pain. Evidence suggests that swim-training volume was associated with shoulder pain in adolescent competitive swimmers (level II conclusion). Year-round monitoring of the athlete's swim training is encouraged to maintain a well-balanced program. Developing athletes should be aware of and avoid a sudden and large increase in swimming volume. However, additional high-quality studies are needed to determine cutoff values in order to make data-based decisions regarding the influence of swim training.

The Swimmer's Shoulder: Multi-directional Instability.

Swimmer's shoulder is the term used to describe the problem of shoulder pain in swimmers. Originally described as supraspinatus tendon impingement under the coracoacromial arch, it is now understood that several different pathologies can cause shoulder pain in competitive swimmers, including subacromial impingement syndrome, overuse and subsequent muscle fatigue, scapular dyskinesis, and laxity and instability. Swimmers may develop increased shoulder laxity over time due to repetitive use. Such excessive laxity can decrease passive shoulder stability and lead to rotator cuff muscle overload, fatigue, and subsequent injury in order to properly control the translation of the humeral head. Generalized laxity can be present up to 62% of swimmers, while a moderate degree of multi-directional instability can be present in the majority. Laxity in swimmers can be due to a combination of underlying inherent anatomical factors as well as from repetitive overhead activity. The role of excessive laxity and muscle imbalance are crucial in the swimmer's shoulder and should be well understood since they are the primary target of the training and rehabilitation program.

Intra- and interrater reliability of the ‘lumbar-locked thoracic rotation test’ in competitive swimmers ages 10 through 18 years

ObjectivesMeasuring thoracic spine mobility can be of interest to competitive swimmers as it has been associated with shoulder girdle function and scapular position in subjects with and without shoulder pain. At present, no reliability data of thoracic spine mobility measurements are available in the swimming population. This study aims to evaluate the within-session intra- and interrater reliability of the “lumbar-locked rotation test” for thoracic spine rotation in competitive swimmers aged 10 to 18 years. This reliability study is part of a larger prospective cohort study investigating potential risk factors for the development of shoulder pain in competitive swimmers. DesignWithin-session, intra- and inter-rater reliability. SettingCompetitive swimming clubs in Belgium. Participants21 competitive swimmers. Main outcome measuresIntra- and inter-rater reliability of the lumbar-locked thoracic rotation test. ResultsIntraclass correlation coefficients (ICCs) ranged from 0.91 (95% CI 0.78 to 0.96) to 0.96 (0.89–0.98) for intra-rater reliability. Results for inter-rater reliability ranged from 0.89 (0.72–0.95) to 0.86 (0.65–0.94) respectively for right and left thoracic rotation. ConclusionResults suggest good to excellent reliability of the lumbar-locked thoracic rotation test, indicating this test can be used reliably in clinical practice.

Shoulder pain in swimmers: A 12-month prospective cohort study of incidence and risk factors

ObjectiveTo investigate shoulder pain incidence rates and selected risk factors for shoulder pain in competitive swimmers. Design12-month prospective cohort study. SettingFive swimming clubs in Melbourne, Australia. Participants74 (37 M, 37 F) competitive swimmers ranging in age from 11 to 27 years and performing at least five swim sessions per week. Assessment of risk factorsSwimmers completed a baseline questionnaire regarding demographics, anthropometric features, swimming characteristics and training and injury history. Active shoulder internal (IR) and external rotation (ER) range of motion and passive joint laxity were measured. Main outcome measurementsShoulder pain was self-reported over 12 months with significant interfering shoulder pain (SIP) defined as pain interfering (causing cessation or modification) with training or competition, or progression in training. A significant shoulder injury (SSI) was any SIP episode lasting for at least 2 weeks. Results28/74 (38%) participants reported SIP while 17/74 (23%) reported SSI. Exposure-adjusted incidence rates were 0.3 injuries and 0.2 injuries per 1000 swim km for SIP and SSI, respectively. Swimmers with both high and low ER range were at 8.1 (1.5, 42.0) and 12.5 (2.5, 62.4) times greater risk of sustaining a subsequent SIP, respectively and 35.4 (2.8, 441.4) and 32.5 (2.7, 389.6) times greater risk of sustaining a SSI, respectively than those with mid-range ER. Similarly swimmers with a history of shoulder pain were 4.1 (95% CI: 1.3, 13.3) and 11.3 (95% CI: 2.6, 48. 4) times more likely to sustain a SIP and SSI, respectively. ConclusionShoulder pain is common in competitive swimmers. Preventative programs should be particularly directed at those swimmers identified as being at risk of shoulder pain.

Arthroscopic Capsular Plication in the Treatment of Shoulder Pain in Competitive Swimmers

Shoulder pain is a common and difficult problem in competitive swimmers due to cumulative loads from repetitive overhead motion. Capsular laxity has been implicated as a potential etiology for shoulder pain in competitive swimmers. No study has examined the role of capsular plication in addressing recurrent shoulder pain in competitive swimmers. The purpose of this study is to retrospectively describe our series of competitive swimmers treated with arthroscopic capsular plication with a primary outcome of return to competitive swimming. Eighteen shoulders in 15 patients underwent arthroscopic capsular plication from 2003 to 2007. Patients were contacted at an average follow-up of 29months (range, 8-42) and a swimming history, American Shoulder and Elbow (ASES) scores, and L'Insalata scores were obtained. At time of surgery, all patients demonstrated laxity under examination under anesthesia. All patients had a positive drive-through sign. Eighty percent (12/15) of patients returned to competitive swimming although only 20% (3/15) were able to return to their pre-injury training regimen volume. All patients subjectively reported improved pain after surgery. The average ASES score was 78 ± 16 (average, standard deviation). The average L'Insalata score was 82 ± 11. Although our results demonstrate that arthroscopic capsular plication has utility in the treatment of shoulder pain in swimmers who have failed non-operative treatment, the inability of some athletes to return to pre-injury training volume illustrates the difficult nature of shoulder pain in swimmers. Retrospective case series, Level IV.

Relationship of Shoulder Flexibility, Strength, and Endurance to Shoulder Pain in Competitive Swimmers

This study was supported in part by the School of Health Related Professions Research and Development Fund, University of Pittsburgh, Pittsburgh, PA A common complaint of competitive swimmers is shoulder pain. The purposes of this study were to: 1) provide normative data on shoulder flexibility in swimmers, 2) determine if a correlation exists between flexibility and shoulder pain, and 3) determine the correlation between strength and endurance ratios to shoulder pain. The subjects were 28 Division I collegiate swimmers and four club swimmers. Shoulder flexibility measurements were obtained bilaterally using a universal goniometer. Strength and endurance ratios were obtained bilaterally using the Cybex II(R) isokinetic dynamometer and the Upper Body Exercise Table(R). The swimmers completed a questionnaire that included a shoulder pain performance scale. The Pearson product moment correlation coefficient and multiple regression (R) analysis were the applied statistics. The results demonstrated that no significant correlation (p > 0.001) existed between shoulder flexibility, strength ratios, and shoulder pain. There was a significant (p </= 0.001) negative Pearson's correlation between endurance ratios of external rotation, abduction, and shoulder pain in competitive swimmers. A multiple R of 0.78 was obtained for the combination of external rotation and abduction endurance ratios to shoulder pain, which was significant (p </= 0.001). Clinical implications suggest that when evaluating swimmers, clinicians need to be aware of the importance of assessing the endurance ratios of the shoulder abductors and the external rotators at faster speeds. With decreased endurance ratios, competitive swimmers may be more likely to develop shoulder pain. J Orthop Sports Phys Ther 1992;16(6):262-268.