| Competitive swimmers train an average of ten to | | | | crossover, which increase the risks of impingement. |
| twenty thousand yards per day. At eight to ten arm | | | | Proper, symmetrical body roll decreases most |
| cycles per twenty-five yards, this leads to nearly one | | | | impingement risks. Other technique contributors are |
| million shoulder rotations per week. It’s no | | | | improper head position, forward shoulders, and |
| wonder studies have shown the lifetime incidence of | | | | scapular instability (see Strengthening section). |
| shoulder injury in competitive swimmers is over 70%. | | | | Stretching, proper warm-up, and preventive |
| The most common shoulder injury incurred in | | | | strengthening must also be incorporated into practices. |
| swimmers is “swimmer’s shoulder.” | | | | Prevention and Rehabilitation: |
| This syndrome is a combination of any of the following: | | | | StrengtheningStrengthening, both for injury prevention |
| rotator cuff or bicipital tendonitis, subacromial bursitis, | | | | and rehabilitation, must focus on stretching the strong |
| shoulder impingement, and glenohumeral joint instability. | | | | groups of muscles and strengthening the weak ones. |
| It is not simply a condition of overuse; the repetitive use | | | | Shoulder injury is prevented first by core stabilization |
| must be combined with some other aggravating factor, | | | | and then by scapular stabilization. Strengthening should |
| such as supraspinatus or biceps avascular tendinosis, | | | | focus on endurance of the serratus anterior, lower |
| impingement syndrome, labral injury, or instability due to | | | | trapezius, and subscapularis, as well as taking into |
| ligamentous laxity or muscular dysfunction. | | | | account the strength ratio of the internal and external |
| Muscle Imbalances and Scapular DysfunctionThe most | | | | rotators. Stretching should focus on the pectoralis |
| common problem leading to swimmer’s shoulder | | | | major and minor, the posterior shoulder capsule, and |
| is a weak serratus anterior. This increases the | | | | the latissimus dorsi. Core strengthening should focus on |
| rhomboid activity, which leads to anterior impingement | | | | the lower abdominals and increased pelvic control. |
| of the biceps and supraspinatus tendons. The serratus | | | | Exercises to include in a swimmer’s routine |
| anterior also attaches to the scapula, which is the link in | | | | include: scapular elevation with the thumbs up and |
| the kinetic chain from the legs and trunk to the | | | | arms thirty degrees forward; push-up plus; rowing with |
| shoulder. In fact, scapular dysfunction is present in 68% | | | | scapular retraction and palms rotated up; reverse |
| of all rotator cuff problems. For every two degrees | | | | push-ups; unilateral shoulder shrugs; horizontal |
| the glenohumeral joint moves, the scapula should move | | | | abduction; and shoulder abduction. Sport-specific |
| one degree. | | | | exercises include ball throws with a rebounder, |
| ImpingementImpingement occurs when the soft tissues | | | | punching, and PNF 2 maneuvers. Athletes can also use |
| of the subacromial space (supraspinatus tendon, | | | | an ergometer to work these muscles. These |
| tendon of the long head of the biceps, and the | | | | exercises should be done with low weights, 1-3 sets |
| subacromial bursa) are compressed between the | | | | with 25-30 repetitions, or to fatigue. When these |
| head of the humerus, the coracoacromial arch, and the | | | | exercises can be done without pain, gradually increase |
| anterior acromion. Inflammation of these tissues | | | | the weight in one-pound increments. This routine should |
| worsens the impingement. Impingement is common in | | | | be done either after swimming, or as an isolated |
| swimmers, volleyball players, baseball pitchers, and | | | | workout session, to decrease injury risk. Core |
| tennis players, due to increased overhead movements. | | | | strengthening exercises can be done any time. |
| Poor flexibility in the shoulders can lead to increased | | | | For the internal and external shoulder rotators, isolated |
| impingement symptoms. It is also caused by prolonged | | | | exercises have been shown to emphasize better |
| postural stresses, such as sitting at a computer for | | | | muscular recruitment. If the external: internal rotation |
| work. | | | | strength ratio is 70-80%, focus on internal rotation |
| Shoulder LaxityThe rotator cuff holds the humeral | | | | strengthening. If it is less than 70%, focus on the |
| head, preventing anterior and superior movement. | | | | external rotators. When the ratio is 60-65%, replace |
| Common causes of instability are shoulder | | | | the isolated movement with dynamic exercises, such |
| hypermobility, increased internal rotation and adduction | | | | as pull-ups, latissimus dorsi pull downs, overhead |
| strengths, overuse, overuse of hand paddles while | | | | presses, reverse pull-ups, and push-ups. All of these |
| swimming, technique flaws, and decreased core | | | | exercises will enhance glenohumeral stability. They |
| strength. Instability leads to subluxation, and, combined | | | | should be done with 3-7 sets of 8-15 repetitions, with |
| with repetition, leads to inflammation and pain, which | | | | 2-4 minutes of rest between sets. |
| leads to scarring, which leads to more inflammation, | | | | ConclusionApproaches to prevention and active |
| pain, and dysfunction. | | | | rehabilitation of swimmer’s shoulder are |
| Prevention and Rehabilitation: Technique | | | | essentially the same: correct improper technique; |
| ChangesSwimming technique needs to incorporate | | | | stretch the tight musculature of the chest and anterior |
| body rotation with core strength, early catch, early exit, | | | | shoulder; strengthen the core musculature and the |
| and straight-through arm pulls. Thumb-first hand entry | | | | scapular stabilizers; and reduce strength imbalances in |
| stresses the biceps attachment to the labrum, leading | | | | the shoulder rotators. Coaches and rehabilitation |
| to impingement. Hand entry that crosses the midline | | | | providers need to work together with these athletes in |
| leads to anterior impingement. Asymmetric body roll | | | | order to prevent future injury and correct problems |
| and unilateral breathing both cause a compensatory | | | | that may already be present. |