Shoulder Problems in High Level Swimmers - Impingement, Anterior Instability, Muscular Imbalance?

Abstract

The objective was to study prevalence and underlying pathology of "swimmer's shoulder". Twenty-two competitive swimmers of national "D-Kader" (elite development swimmers) were evaluated by means of questionnaire, clinical examination and isokinetic testing of external rotation and internal rotation. At the examination current interfering pain necessitating a cessation or reduction of practice was found in 5 (23%) athletes. At isokinetic testing 8 (36%) athletes complained of shoulder pain. Any history of pain was seen in 14 (64%) swimmers. A positive impingement sign was noted in 11 (50%) athletes. Apprehension sign which is indicative of anterior instability was found in 11 (50%) swimmers. Clinical equivalents of dysfunction of scapulothoracic muscles such as scapular winging (5 athletes) and shoulder protraction (12 athletes) were noted. For comparison of results of isokinetic testing a control group of non-swimmers was selected matching the group of swimmers exactly in terms of age, sex and dominant side. External rotation/internal rotation ratio of peak torque and total work at 60 deg/sec and 180 deg/sec was significantly lower in swimmers than in controls. The ratio was independent of sex, dominant side, history of pain and pain at examination. During internal rotation competitive swimmers produced significantly higher peak torques and total work than controls. There was no significant difference in external rotation. In conclusion there are several different abnormalities of function contributing to the pathology of "swimmer's shoulder":--Laxity of anterior-inferior capsuloligamentous structures with atruamatic anterior instability due to repetitive overload.--Impingement with rotator cuff tendinitis.--Muscular imbalance of the rotator cuff muscles and scapulothoracic dysfunction.

Lesões desportivas na natação

“…As razões abordadas para ocorrência de tal lesão são relacionadas comumente ao excesso de repetições associados ao desequilíbrio de força muscular (12,13,19,25) . As lesões musculares também foram referidas de maneira significante e, segundo alguns autores (13,25) , estão associadas com o mesmo fator causal das tendinopatias, reiterando repetição e desequilíbrio muscular.…”

Prevalence of Shoulder Pain in Competitive Archery

“…Fatigue of rotator cuff associated with increased workload allows anterosuperior humeral head translation and secondary impingement of the subacromial structures (3). High Prevalence of shoulder overuse injuries is reported in swimming (4,5), tennis (6) and other overhead sports such as badminton (7) volleyball (8) and handball (9).…”

Scapular taping alters kinematics in asymptomatic subjects

“…Overhead athletes and other 44 professionals that require use of the arm in a predominant overhead position are at a 45 high risk of developing associated shoulder pains and injuries. A number of studies 46 have reported high prevalence of shoulder pain and injury in swimmers [Lo et al,47 1990, Rupp et al, 1995, Su et al, 2004, tennis players [Cools et al, 2008], baseball 48 players [Hsu et al, 2009] and other overhead throwing athletes [Laudner et al, 2006, 49 Lo et al, 1990, Wilk et al, 2002. Shoulder impingement accounts for the majority of 50 the reported complaints [Michener et al, 2003].…”