Swimmer’s Shoulder

Triathletes and competitive swimmers may typically employ one of four different strokes: front crawl (freestyle), butterfly, backstroke, and breaststroke. The biomechanics of the four strokes, with respect to the arm action, are quite similar. Each swimming stroke goes through four common phases: reach, catch, pull, (these three are often combined and called the pull-through phase) and the recovery. In simplified terms, the pull-through involves adduction and internal rotation of the shoulder with simultaneous flexion and extension of the elbow. The recovery phase involves abduction and external rotation of the shoulder, also with simultaneous flexion and extension of the elbow. Freestyle, butterfly, and backstroke all rely on the arms for 75 percent of the propulsion forward, while in the breaststroke the legs and arms contribute equally.

Shoulder pain is the most common pain complaint in swimmers. Studies have shown that between 47 and 73 percent of the musculoskeletal problems in swimmers relate to their shoulders. (Stocker, D. Comparison of shoulder injury in collegiate and master's level swimmers. Clinical Journal of Sports Medicine. 1995; 5:4-8./Richardson, A. The shoulder in competitive swimming. The American Journal of Sports Medicine. 1980; 8:159.)

Several factors, such as intensity of training, overwork, impingement, stroke mechanics, shoulder joint laxity, shoulder instability, acromial shape, and hypovascularity, are implicated in what is typically known as "swimmer's shoulder," the term introduced to the clinical literature by Kennedy and Hawkins in 1974. (Kennedy, J. Swimmer's shoulder. Physician and Sportsmedicine. 1974; 2:35.) This entity referred to what was thought to be a tendonitis of the rotator cuff, but because inflammation has not been noted histologically or under direct vision (during surgery), the term "tendinopathy" is a more appropriate description of this disorder. (Fowler, P. Swimming. In Reider, B. (ed.), Sports Medicine: The School-Age Athlete. Philadelphia, PA: W.B. Saunders Company, 1996, pp. 471-489.)

In other words, the rotator cuff tendons of swimmers are not inflamed but degenerated, when viewed under a microscope and during surgery. There are no inflammatory cells present, but evidence of degeneration, including a loss of cells, fragmentation, and disorganization of the collagen fibers.

Continue  [ 1 | 2 | 3 | 4 ]