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The Swimmer’s Shoulder
Corey Kunzer PT, DPT, SCS ATC, CSCS Becca Gsumer, PT, DPT
Mayo Clinic 26th Annual Symposium on Sports Medicine
November 12th, 2016
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Disclosures • No relevant financial relationships or conflicts of
interest exist
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Objectives • Understand the epidemiology and etiology of
swimmer’s shoulder • Understand the mechanics of the freestyle swim
stroke • Be able to develop an effective rehabilitation
plan to enable your patient to return to swimming pain-free
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Swimmer’s Shoulder Epidemiology • 90% of propulsive power comes from upper
extremities in swimming • Swimmers average
• Practice 2x/day 5-7 days/week • 10 strokes / 25 m lap • 10,000 m/day = 4,000 rev/shoulder/day
Allegrucci et al, 1994; Heinlein et al, 2010; Waivenhaus et al, 2012
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Swimmer’s Shoulder Epidemiology • Overall incidence of shoulder pain: 40-69%
• Non-Elite: 27% • Division I Collegiate: 67% • Elite: 52-57%
• Prevalence: 40-91% • 10-18 year old: 47% • Senior developmental: 66% • Elite: 73%
Allegrucci et al, 1994; Heinlein et al, 2010; Spigelman et al, 2014; Waivenhaus et al, 2012
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• Greater swimming exposure
• Previous traumatic injury
• Subjective report of shoulder instability
• Reduced participation in another sport
• Muscular imbalances
• Correlated with more hours swum per week
• Higher weekly mileage
• More arm revolutions per lap
• Decreased core endurance
Kerr et al, 2016, Sein et al, 2010, Tate et al, 2012
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Heinlein et al, 2010
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Swimmer’s Shoulder Etiology
1. Overuse and muscular fatigue 2. Glenohumeral laxity with subsequent shoulder
instability leading to impingement 3. Stroke biomechanics
Sein et al, 2008, Waivenhaus et al, 2012
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Swimmer’s Shoulder Etiology 1. Muscle overuse and fatigue
• Glenohumeral joint is inherently unstable • Greatest ROM with most DOF • Humerus curvature exceeds shallow glenoid • Muscles
• Stability, motion, function
Wanivenhaus et al, 2012
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Swimmer’s Shoulder Etiology 2. Excessive glenohumeral laxity
• Repetitive stress adaptations • Disrupted static stabilizers • Fatigued / weak dynamic Stabilizers • Microinstabiltiy
• Secondary impingement
Heinlein et al, 2010
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Swimmer’s Shoulder Etiology 3. Stroke Mechanics • Duration of impingement in stroke: 24.8%
• Pulling Phase: 14.4% • Recovery Phase: 10.4%
• Stroke • Entry • Early pull-through • Late pull-through • Recovery Wanivenhaus et al, 2012, Spigelman et al, 2014, Heinlein et al, 2010
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Swimmer’s Shoulder Etiology
Intrinsic Factors
• Stroke biomechanics
• ROM: ↑ ER with ↓ IR
• Acquired joint laxity
• Muscular imbalances
• Fatigue (↓ endurance) • Changes mechanics • Decreases stability
Extrinsic Factors
• Lack muscular strength and endurance
• Overuse: Frequency
• Misuse: Improper form / equipment
• Abuse: Excessive forces
• Disuse: Time off
Tovin, 2006
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How to Treat • Education • Rest • Ice • Posture Education • Strengthening of the Rotator Cuff • Strengthening of the Scapula Stabilizers • Swimming Biomechanics, Technique, and
Specific Drills
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Swimming Technique • Body position • Lack of rotation • Elbow drops • Cross over the middle
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References Allegrucci M, Whitney SL, Irrgang JJ. Clinical Implications of Secondary Impingement of the Shoulder in Freestyle Swimmers. J Orthop Sports Phys Ther Journal of Orthopaedic & Sports Physical Therapy. 1994;20(6):307-318. doi:10.2519/jospt.1994.20.6.307.
Heinlein SA, Cosgarea AJ. Biomechanical Considerations in the Competitive Swimmer's Shoulder. Sports Health: A Multidisciplinary Approach. 2010;2(6):519-525. doi:10.1177/1941738110377611.
Kerr ZY, Baugh CM, Hibberd EE, Snook EM, Hayden R, Dompier TP. Epidemiology of National Collegiate Athletic Association men's and women's swimming and diving injuries from 2009/2010 to 2013/2014. British Journal of Sports Medicine Br J Sports Med. 2015;49(7):465-471. doi:10.1136/bjsports-2014-094423
Sein ML, Walton J, Linklater J, et al. Shoulder pain in elite swimmers: primarily due to swim-volume-induced supraspinatus tendinopathy. British Journal of Sports Medicine. 2008;44(2):105-113. doi:10.1136/bjsm.2008.047282.
Spigelman T, Sciascia A, Uhl T. RETURN TO SWIMMING PROTOCOL FOR COMPETITIVE SWIMMERS: A POST‐OPERATIVE CASE STUDY AND FUNDAMENTALS. International Journal of Sports Physical Therapy. 2014;9(5):712-725.
Tovin BJ. Prevention and Treatment of Swimmer’s Shoulder. North American Journal of Sports Physical Therapy : NAJSPT. 2006;1(4):166-175.
Wanivenhaus F, Fox AJS, Chaudhury S, Rodeo SA. Epidemiology of Injuries and Prevention Strategies in Competitive Swimmers. Sports Health: A Multidisciplinary Approach. 2012;4(3):246-251. doi:10.1177/1941738112442132.
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Corey Kunzer, PT, DPT, SCS, ATC, CSCS Supervisor and Sports Physical Therapy Residency Coordinator
Mayo Clinic Sports Medicine Email: [email protected]
_______________________________ Mayo Clinic Sports Medicine Center Dan Abraham Healthy Living Center 200 First Street SW Rochester, MN 55905 Phone: 507-266-9100
_______________________________ Mayo Clinic Sports Medicine Center
Mayo Clinic Square 600 Hennepin Ave
Minneapolis, MN 55403 Phone: 612-313-0520
Questions
sportsmedicine.mayoclinic.org