Risk factors for shoulder pain and injury in swimmers: A critical systematic review

Abstract

Swimming is one of the most popular recreational and competitive sporting activities. In the 2013/2014 swimming season, 9630 men and 12,333 women were registered with the National Collegiate Athletics Association in the USA. The repetitive nature of the swimming stroke and demanding training programs of its athletes raises a number of concerns regarding incidence and severity of injuries that a swimmer might experience during a competitive season. A number of risk factors have previously been identified but the level of evidence from individual studies, as well as the level of certainty that these factors predispose a swimmer to pain and injury, to our knowledge has yet to be critically evaluated in a systematic review. Therefore, the primary objective of this review is to conduct a systematic review to critically assess the published evidence for risk factors that may predispose a swimmer to shoulder pain and injury. Three electronic databases, ScienceDirect, PubMed and SpringerLink, were searched using keywords "(Injury OR pain) AND (Swim*)" and "(Shoulder) AND (Swim*)". Based on the inclusion and exclusion criteria, 2731 unique titles were identified and were analyzed to a final 29 articles. Only articles with a level of evidence of I, II and III were included according to robust study design and data analysis. The level of certainty for each risk factor was determined. No studies were determined to have a high level of certainty, clinical joint laxity and instability, internal/external rotation, previous history of pain and injury and competitive level were determined to have a moderate level of certainty. All other risk factors were evaluated as having a low level of certainty. Although several risk factors were identified from the reviewed studies, prospective cohort studies, larger sample sizes, consistent and robust measures of risk should be employed in future research.

Musculoskeletal dysfunctions associated with swimmers’ shoulder

“…ROM was assessed using an inclinometer, with the participant lying supine 6. These findings are confirmed by the systematic review of Hill et al 13 who demonstrated with moderate certainty that there is sufficient evidence that reduced shoulder IR ROM and either increased or decreased ER ROM (measured with either a goniometer or inclinometer) is a risk factor for shoulder pain in swimmers. However, recent studies in an overhead athlete population have highlighted that different methods exist for analyzing shoulder ROM for the classification of a shoulder at risk 27 28.…”

“…The latter did relate to the incidence of supraspinatus tendinopathy on MRI. Current evidence suggests uncertainty regarding GH laxity or instability being a risk factor for shoulder pain in swimmers 13. Although frequently identified in swimmers, it is unclear whether laxity predisposes swimmers to pain or if it occurs in symptomatic swimmers as a result of cumulative microtrauma.…”

“…However, based on their scapular assessment technique, a fatiguing exercise protocol failed to demonstrate significant changes in scapular position. With regard to its predisposing role, there is insufficient evidence that scapular dyskinesis is a risk factor for shoulder pain in swimmers 13. Swimming may alter scapular position, but it is unclear if these changes are related to the development of shoulder pain.…”

Prevalence of Pain and Psychological Distress in High‐Performance Swimmers: Job Stress and Associated Factors – A Cross-Sectional Study

“…Studies have shown that, in general population, similar patterns of pain occurrence can be observed between men and women(1). Prospective population-based surveys (Germany and Nederland) found sex difference: prevalence of pain was systematically higher in women than in men (22). In swimming context, literature is not consistent on sex differences in pain (23).…”

A comparative study of aquatic training exercises over free exercise technique on shoulder function among periarthritis shoulder patients

“…The primary role of mobilization is to restore joint play and facilitate joint movement by restoring arthrokinematics. The biomechanical effect manifests itself when forces are directed towards resistance but within limit of patient's tolerance 10,11 .…”