Intrinsic Risk Factors for Noncontact Musculoskeletal Injury in Collegiate Swimmers: A Prospective Cohort Study

Abstract

Context: Shoulder pain is pervasive in swimmers of all ages. Yet due to a limited number of prospective studies, risk factors for injury in swimmers remain uncertain. Objective: To determine the extent to which the risk factors of previous injury, poor movement competency, erroneous freestyle swimming technique, and low perceived susceptibility to sport injury were associated with non-contact musculoskeletal injury in college swimmers. We hypothesized each risk factor would be associated with increased odds of injury. Design: Prospective cohort study. Setting: College natatorium. Patients or Other Participants: Thirty-seven Division III college swimmers. Main Outcome Measures: Participants completed preseason questionnaires on previous injuries and perceived susceptibility to sport injury. At the beginning of the season, they completed the Movement System Screening Tool and Freestyle Swimming Technique Assessment. Logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals for the association between each risk factor and injury. Results: Eleven of the 37 participants (29.7%) sustained an injury. Univariate analyses identified two risk factors: previous injury (OR = 8.89 [95% CI = 1.78, 44.48]) and cross-over hand positions during the freestyle entry phase (OR = 8.50 [95% CI = 1.50, 48.05]). After adjusting for previous injury, higher perceived percentage chance of injury (one item from the perceived susceptibility to sport injury questionnaire) decreased injury odds (adjusted OR = 0.11 [95% CI = 0.02, 0.82). Poor movement competency was not associated with injury (P > 0.05). Conclusions: Previous injury, a cross-over hand entry position in freestyle, and low perceived percentage chance of injury were associated with increased injury odds. Ascertaining injury histories and assessing for cross-over may help identify swimmers with elevated injury risk and inform injury prevention strategies.

Sink or Swim? Clinical Objective Tests and Measures Associated with Shoulder Pain in Swimmers of Varied Age Levels of Competition: A Systematic Review

“…There is limited evidence from only a single study of youth swimmers demonstrating greater shoulder pain with swimming if they did not have a neutral position of the scapula with the Kibler Test. 35 In conflict with this finding is limited evidence from one study using Kibler Test 44 and one using visual inspection 41 which both describe no relationship between scapular position/dyskinesia and shoulder pain for youth swimmers. Moderate evidence for no relationship between scapular position and shoulder pain was determined from two studies across age groups, 10,36 one including youth and adolescent/adult swimmers employed digital inclinometry for assessing the scapula at various intervals of elevation 36 and the other 10 used visual inspection for swimmers across all age levels (age 8-77).…”

“…Five studies utilized various methods for analyzing core stability and endurance as a risk factor for developing shoulder pain. 11, 26,32,33,41,42 the timed side bridge, timed prone plank, timed ball bridge, and isokinetic peak torque testing for trunk flexion/extension. One study reported on youth swimmers, three were on adolescent/adult swimmers, and one included various age groups There is moderate evidence from two studies in youth swimmers that decreased trunk endurance is associated with the development of shoulder pain.…”

“…42 In contrast, three studies on adolescent/adult swimmers demonstrated moderate evidence that there was no relationship between core endurance and the development of shoulder pain. 32,33,41 THORACIC MOBILITY Two studies assessed the impact of trunk mobility including thoracic rotation 44 and trunk flexion/extension 41 on the development of shoulder pain in adolescent/adult swimmers. These studies demonstrated limited evidence regarding the impact of trunk mobility as a risk factor for developing shoulder pain.…”

“…The most widely studied objective variable as a risk factor for shoulder pain was shoulder internal and external range of motion which was reported in 11 studies. 3,10,24,25,30,32,34,[40][41][42][43] One of the studies reports on youth swimmers, six report on adolescent/adult swimmers, one on masters, and three on swimmers of various ages. All of the studies except one used goniometry, and measured rotation at 90 degrees of abduction, while one study reported the presence or absence of glenohumeral internal rotation deficiency as "yes or no."…”

“…In the adolescent/adult competition level, six studies demonstrated moderate evidence that there was not a relationship between shoulder rotation measures and the development of shoulder pain. 24,30,32,34,41,42 Moderate level evidence for having excessive mobility associated with shoulder pain was described in two studies of youth swimmers using novel range of motion methods: one used a total ROM index and found that pain was associated with higher summation of mobility 45 ; the other used a shoulder rotation width index which was associated with shoulder pain if it was decreased in males, and increased in females. 40 This index is purported to be an index of comprehensive shoulder motion combining glenohumeral and scapulothoracic movements; it is a measure of the minimal distance between the two hands that are holding a dowel while raising the arms as high overhead as possible without elbow flexion.…”