Transcript PowerPoint Presentation - Swimmers Shoulder

Identifying, treatment, and PREVENTION
Sara Kraft DPT, NCS, ATP
What is Swimmers Shoulder
 The pain swimmers feel in or around the shoulder that
is related to the activity of Swimming.
Statistics
 90% of swimmers complaints are about shoulder pain
 66% of swimmers develop shoulder pain
 Shoulder pain is the number 1 cause of missed
practices or slower times
 The average collegiate swimmer performs more than 1
million strokes annually with each arm
Causes of Shoulder pain in Swimmers
 Most likely causes of shoulder pain are due to the
demands of the sport including
 Increased shoulder Range Of Motion (ROM)
 Increased shoulder internal rotator and adductor
strength
 Prolonged 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 ADD
 Most 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 motion
 Swimmers 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 Fatigue
 Main muscles of the shoulder-rotator cuff muscles
 Scapular or shoulder blade stabilizers
 Swimmers 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 demand
 Freestyle-Most common stroke in practice
 The 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.
Stroke analysis and muscle demand
 Recovery Phase
 Mid 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.
Early Signs
 Dropped elbow during the recovery phase of freestyle
 Wider hand entry
 Difficulty staying in the center of the lane
 Early hand exit in recovery phase
 Excessive Body roll
 Note: 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 injuries
 Stretch both the front and back of the shoulder
capsule equally
 Shoulder blade positioning exercises specifically
retraction and upward rotation
 Rotator cuff exercises emphasizing external rotation
Treatment of swimmers shoulder
 Reduce inflamation with ice/anti-inflammatories ( at least







2 weeks worth)
Cease activities that cause the pain
Kick but without a kick board!!
Stop anterior capsule stretching and increase posterior
capsule stretching
Do rotator cuff exercises especially ER
Scapular 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!!!
Exercises
All 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 2
Ex 1
Ex 3
Ex 4