Transcript Swimmer’s Shoulder - Aetiology,Treatment & Prevention

Injury
Prevention
in Swimming
Mr Kevin Boyd
FRCS(Tr&Orth) FFSEM (UK) DipSportsMed
Consultant Trauma & Orthopaedic Surgeon
Chairman British Swimming Medical Advisory Committee
Swimming is Unique !
• Outside of man’s natural environment
• Specific actions to allow breathing
• No firm surface against which to
generate forces
• Propulsion by the upper limbs
• Negative effect of water drag
Injuries in Sport and Exercise
Survey of 29 000 in England & Wales
• 19.3 million new sporting injuries/year
• 9.8 million substantive injuries/year
Injury risks:
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Rugby
Soccer
Hiking
Swimming
57.7/1000 occasions
19.3/1000 occasions
4.2/1000 occasions
2.3/1000 occasions
Nichol et al BJSM 1991
Human Performance Continuum
HEALTH
SUBOPTIMAL
HEALTH
OPTIMISED
PERFORMANCE
OPTIMISED
UK Swimming
Population:
4.5 million
Causes of Sports Injuries
INTRINSIC
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Age, sex, body composition
Muscle weakness/imbalance
Flexibility
Malalignment
Poor nutritional state
Causes of Sports Injuries
EXTRINSIC
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Training methods
Surfaces
Equipment
Environment
Nature/rules of sport
Training
Load
Training Load
POOL WORK
• 70 km/week = 1400 lengths/week
• 36 strokes/length
• 48-50 weeks/year
1.25 million strokes per arm per year
Duration 8-10 years
Training Load
Training Load
LAND WORK
• Weights
• Swimbench / pulleys
• Flexibility
• Cross-training
– Circuits / Running / Cycling
Training Cycle
Training
Remodelling
Adaptation
Recovery
Tissue Breakdown
INJURY
Acute
Injuries
Overuse
Injuries
Acute Injuries
TRAUMATIC
• Head & C-Spine
– Diving
– Correct technique
• Fingers / Feet
• Falls
– Wet Environment
• Drowning
Education & Discipline
Shoulder Problems
Aetiology
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Tendinopathy
Impingement
Instability
Fatigue
Secondary Impingement Syndrome
due to functional instability
Research - Impingement
Impingement 25% stroke
time (range 4-56%)
Increased impingement
with:
- reduced shoulder tilt at
catch ‘breathing side’
- late initiation of ER in
recovery
- large IR in insweep
Yansai & Hay MSSE 2000
Research – Muscle Imbalance
Prospective, controlled trial
31 elite age group swimmers/20 controls
Initial
2/12
18/12
ER/IR ratio 1:1.96
1:1.78
1:1.47
Controls 1:1.47
Pain
16
1
Instability
22
8
Holz Biomech Med Swim VII 1996
Research – Joint laxity/Pain
40 elite swimmers
Laxity Score ± Apprehension
- Pain group 15/16 cf No Pain group
9.8/10.7
Significant correlation (p<0.05)
between shoulder laxity and
interfering shoulder pain
McMaster AJSM 1998
Shoulder Instability
• Spectrum of Instability
– Acute traumatic v Multi-directional
• Functional/Dynamic instability
– Imbalance
– Fatigue
– +/- Generalised Joint Laxity
Knee Problems
• Chronic MCL sprain
– external rotation of ‘whip’ kick
• Patellofemoral
– Maltracking
– CMP
– Instability
• Plica syndrome
• Meniscal tears
Back Problems
• Postural
• Ligament strains /
Muscle sprains
• Spondylolysis
– Pars stress injury
– Butterfly /
Breaststroke
Prevention
• Education
– Athlete / Coach
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Progressive training loads
In-build Recovery periods
Limit non-sport demands
Minimise psychological stressors
Ensure optimal nutritional status
Responsive to Change
Prevention
• Correct postural / muscular
imbalances
– Muscle / Ligament Length
– Endurance
• Optimise Core Stability
• Attention to technique /
biomechanics
• Stretching *BEWARE*
Summary
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Swimming is a safe sport
Demands of elite Swimming are large
Individual ability to cope
Primary prevention is the priority
Swimmer, Coach and Therapist working
together in the pool
Thank You