Background 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. Objectives 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. Data Sources Relevant studies within PubMed, Web of Science, and MEDLINE. Study Selection Studies that assessed the relationship between a defined amount of swim training and shoulder pain in competitive swimmers. Data Extraction 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). Data Synthesis 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. Conclusions 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.
Shoulder pain is the most reported area of orthopaedic injury in swimmers. The so-called 'swimmers' shoulder' has been applied to a variety of complaints involving shoulder pain in swimmers without specific reference to contributing mechanisms or structures. Knowledge of dysfunctions associated with swimmers' shoulder can assist clinicians in developing rehabilitation strategies. This literature review aims at providing clinicians insight into the musculoskeletal mechanisms and impairments associated with swimmers' shoulder that could aid them in developing rehabilitation strategies. The following musculoskeletal dysfunctions will be discussed: muscle activity, strength, endurance, muscle control, range of motion, glenohumeral laxity, glenohumeral instability, shoulder posture and scapular dyskinesis. The findings in this review may have implications for swimmers, their coaches, and rehabilitation specialists working with swimmers.
Background: Disorders of the rotator cuff are a common musculoskeletal pain presentation in the general population, and treatment by a physiotherapist is often prescribed. In 2011 and 2016, surveys of physiotherapy practice in the United Kingdom (UK) were performed, which reported that advice and exercise were the most common treatment strategies used. The aim of this current survey was to examine current physiotherapy practice in Belgium andThe Netherlands, with consideration of differences between physiotherapists who were members of a shoulder network and physiotherapists who were not. Methods: During February / March 2018, a cross-sectional online survey was conducted in Belgium and The Netherlands. Results: 505 physiotherapists completed the survey. Advice (n=362/505), isotonic exercises (n=302/505) and scapular stabilisation exercises (n=359/505) were the most common treatment modalities for patients with rotator cuff disorders. Physiotherapists not part of a shoulder network group more commonly integrated mobilization (n=66/254 SN, n=125/251 N-SN), electrotherapy (n=1/254 SN, n=19/251 N-SN) and massage (n=48/254 SN, n=89/251 N-SN) compared to those who were member of the group. Conclusion:Advice and exercise were the most common treatment prescriptions, which aligns with recommendations from current research evidence. Practice differs between physiotherapists involved with a shoulder network group compared to those who are not.
Background: Knowledge of predictors for shoulder pain in swimmers can assist professionals working with the athlete in developing optimal prevention strategies. However, study methodology and limited available data have constrained a comprehensive understanding of which factors cause shoulder pain. Purpose: To investigate risk factors and develop and internally validate a multivariable prognostic model for the prediction of shoulder pain in swimmers. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 201 pain-free club- to international-level competitive swimmers were followed for 2 consecutive seasons. The cohort consisted of 96 male (mean ± SD age, 13.9 ± 2.2 years) and 105 female (13.9 ± 2.2 years) swimmers. Demographic, sport-specific, and musculoskeletal characteristics were assessed every 6 months. Swim-training exposure was observed prospectively. Shoulder pain interfering with training was the primary outcome. Multiple imputation was used to cope with missing data. The final model was estimated using multivariable logistic regression. We applied bootstrapping to internally validate the model and correct for overoptimism. Results: A total of 42 new cases of shoulder pain were recorded during the study. Average duration of follow-up was 1.1 years. Predictors included in the final model were acute:chronic workload ratio (odds ratio [OR], 4.31; 95% CI, 1.00-18.54), competitive level (OR, 0.19; 95% CI, 0.06-0.63), shoulder flexion range of motion, posterior shoulder muscle endurance (OR, 0.96; 95% CI, 0.92-0.99), and hand entry position error (OR, 0.37; 95% CI, 0.16-0.91). After internal validation, this model maintained good calibration and discriminative power (area under the receiver operating characteristic curve, 0.71; 95% CI, 0.60-0.94). Conclusion: Our model consists of parameters that are readily measurable in a swimming setting, allowing the identification of swimmers at risk for shoulder pain. Multivariable logistic regression showed the strongest predictors for shoulder pain were regional competitive swimming level, acute:chronic workload ratio, posterior shoulder muscle endurance, and hand entry error.
Since the establishment of the Olympic Games in 1896, competitive swimming has grown to become one of its largest disciplines. 1 As a result, its competitive level has increased accordingly but this requires the swimmers to prepare differently for major swimming events. Modern swim-training programs are now characterized by year-round swimming with little time for off-season recovery. 2,3 In fact, these training programs seem inherently volume dependent, with elite athletes swimming up to 57.1 km/wk. 4 Swim-training programs primarily aim to induce adaptations to the body that allow the swimmer to perform better in competition 5 but this requires a carefully predetermined combination of training intensity, volume, and rest. 6 However, researchers have suggested that swimmers train too much according to their capabilities 3,4,7 and that they restrain their body from sufficient rest and recovery that is required for optimal adaptation. 8 During their 10-to 15-year careers, swimmers frequently practise up to seven days per week, 3 logging between 10 000 and 14 000 meters. 2 This excessive exposure to swimming has been linked to overtraining 9 and increases the risk of
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