Identifying, treatment, and PREVENTION Sara Kraft DPT, NCS, ATP.

Identifying, treatment, and PREVENTION

Sara Kraft DPT, NCS, ATP

What is Swimmers ShoulderThe pain swimmers feel in or around the

shoulder that is related to the activity of Swimming.

Statistics90% of swimmers complaints are about

shoulder pain66% of swimmers develop shoulder painShoulder pain is the number 1 cause of

missed practices or slower timesThe average collegiate swimmer performs

more than 1 million strokes annually with each arm

Causes of Shoulder pain in SwimmersMost likely causes of shoulder pain are due to

the demands of the sport includingIncreased shoulder Range Of Motion (ROM)Increased shoulder internal rotator and

adductor strengthProlonged repetitive, shoulder intensive

training which causes muscle fatigue**All 3 can lead to instability which can lead to

impingement and pain

Increased Strength in the IR and ADDMost of the propulsive force of swimming is

performed by these 2 muscle groups the Pect Major (chest muscle)and Latissimus Dorsi ( large back muscle)

There is a large imbalance between these 2 muscle groups and the external rotators and abductors which causes joint instability

Increased Range of motionSwimmers have increased Range of motion

(ROM) in extension, External Rotation (ER), and Abduction (ABD)

Decreased ROM in Internal Rotation (IR)

These 2 things can lead to a very unstable joint with increased movement in the front of the shoulder joint and tightness in the back of the shoulder joint which leads to an inequality and potential for injury.

Muscle FatigueMain muscles of the shoulder-rotator cuff

musclesScapular or shoulder blade stabilizersSwimmers have to increase endurance by

repetitive movements which lead to shoulder instability due to fatigue of the muscles.

When the muscles fatigue the shoulder is at risk for injury.

Stroke analysis and muscle demandFreestyle-Most common stroke in practiceThe first ½ of the pull-this is when the arm is

unilaterally producing the most force to propel the swimmer through the water-70% of swimmers with pain have pain at this phase of the cycle. The Adductors and internal rotators are responsible for the majority of the force production.

Recovery PhaseMid recovery phase the upper arm is in

shoulder hyperextension and max external rotation-( equivalent to the wind up pitcher arm in baseball) This is a position that leads the swimmer to have increased force on the front portion of the shoulder.

Stroke analysis and muscle demand

Early SignsDropped elbow during the recovery phase of

freestyleWider hand entryDifficulty staying in the center of the laneEarly hand exit in recovery phaseExcessive Body rollNote: when in the workout does this happen

and if it is consistent then test with Hawkins test

Hawkins Test

Have the swimmer lift their shoulder and turn their elbow, wrist and hand down and then add resistance. If positive will have pain at the front of the shoulder.

Prevention of Shoulder injuriesStretch both the front and back of the

shoulder capsule equallyShoulder blade positioning exercises

specifically retraction and upward rotationRotator cuff exercises emphasizing external

rotation

Treatment of swimmers shoulderReduce inflamation with ice/anti-inflammatories ( at

least 2 weeks worth)Cease activities that cause the painKick but without a kick board!!Stop anterior capsule stretching and increase

posterior capsule stretchingDo rotator cuff exercises especially ERScapular positioning ex’s- retraction and increase

body roll. Have swimmers do alternate aerobic exercise until

acute phase is over. THERE IS NOT SUCH THING AS NO PAIN NO

GAIN!!!

ExercisesAll exercises should be performed for 3 sets of 10 reps. Can start with bands for ex 1 and 4 and no resistance for exercise 2 and 4

Ex 1

Ex 2

Ex 3

Ex 4