Biomechanical Considerations in the Competitive Swimmer's Shoulder

Scott A Heinlein, Andrew J Cosgarea, Scott A Heinlein, Andrew J Cosgarea

Abstract

Context: Competitive swimming has become an increasingly popular sport in the United States. In 2007, more than 250 000 competitive swimmers were registered with USA Swimming, the national governing body. The average competitive swimmer swims approximately 60 000 to 80 000 m per week. With a typical count of 8 to 10 strokes per 25-m lap, each shoulder performs 30 000 rotations each week. This places tremendous stress on the shoulder girdle musculature and glenohumeral joint, and it is why shoulder pain is the most frequent musculoskeletal complaint among competitive swimmers.

Evidence acquisition: Articles were obtained through a variety of medical search sources, including Medline, Google Scholar, and review articles from 1980 through January 2010.

Results: The most common cause of shoulder pain in swimmers is supraspinatus tendinopathy. Glenohumeral instability and labral tears have also been reported, but a paucity of information remains regarding prevalence and treatment in swimmers.

Conclusion: Because of the great number of stroke repetitions and force generated through the upper extremity, the shoulder is uniquely vulnerable to injury in the competitive swimmer. Comprehensive evaluation should include the entire kinetic chain, including trunk strength and core stability.

Keywords: biomechanics; swim strokes; swimmer’s shoulder.

Conflict of interest statement

No potential conflict of interest declared.

Figures

Figure 1.
Figure 1.
Freestyle stroke cycle pull-through and recovery of the right arm during a single stroke. (Used with permission from Colwin CM. Breakthrough Swimming. Champaign, IL: Human Kinetics; 2002:50-70.)
Figure 2.
Figure 2.
Muscle activity of the freestyle stroke based on electromyographic and cinematographic analysis. (Adapted with permission from Colwin CM. Breakthrough Swimming. Champaign, IL: Human Kinetics; 2002:50-70.) Figure copyright Scott Heinlein.
Figure 3.
Figure 3.
Butterfly stroke cycle pull-through and recovery. (Used with permission from Colwin CM. Breakthrough Swimming. Champaign, IL: Human Kinetics; 2002:50-70.)
Figure 4.
Figure 4.
Backstroke cycle pull-through and recovery of the right arm. (Used with permission from Colwin CM. Breakthrough Swimming. Champaign, IL: Human Kinetics; 2002:50-70.)
Figure 5.
Figure 5.
Breaststroke cycle pull-through and recovery of the right side during a single stroke. (Used with permission from Colwin CM. Breakthrough Swimming. Champaign, IL: Human Kinetics; 2002:50-70.)

References

    1. Allegrucci M, Whitney SL, Irrgang JJ. Clinical implications of secondary impingement of the shoulder in freestyle swimmers. J Orthop Sports Phys Ther. 1994;20(6):307-318
    1. Bak K. Nontraumatic glenohumeral instability and coracoacromial impingement in swimmers. Scand J Med Sci Sports. 1996;6(3):132-144
    1. Baril B, Bivens B, Brown L, Travis J. The effects of generalized joint laxity and shoulder joint laxity on shoulder joint ROM in swimmers. In Proceedings of the Fourth Annual GRASP Symposium. Wichita, KS: Wichita State University; 2008. Accessed October 15, 2008
    1. Beach ML, Whitney SL, Dickoff-Hoffman SA. Relationship of shoulder flexibility, strength, and endurance to shoulder pain in competitive swimmers. J Orthop Sports Phys Ther. 1992;16(6):262-268
    1. Bedi A, Rodeo SA. Os acromiale as a cause for shoulder pain in a competitive swimmer: a case report. Sports Health. 2009;1(2):121-124
    1. Borsa PA, Scibek JS, Jacobson JA, Meister K. Sonographic stress measurement of glenohumeral joint laxity in collegiate swimmers and age-matched controls. Am J Sports Med. 2005;33(7):1077-1084
    1. Brushøj C, Bak K, Johannsen HV, Faunø P. Swimmers’ painful shoulder arthroscopic findings and return rate to sports [published online ahead of print June 28, 2006]. Scand J Med Sci Sports. 2007;17(4):373-377
    1. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology. Part III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy. 2003;19(6):641-661
    1. Colwin CM. Breakthrough Swimming. Champaign, IL: Human Kinetics; 2002:50-70
    1. Cools AM, Witvrouw EE, Declercq GA, Danneels LA, Cambier DC. Scapular muscle recruitment patterns: trapezius muscle latency with and without impingement symptoms. Am J Sports Med. 2003;31(4):542-549
    1. Fu FH, Harner CD, Klein AH. Shoulder impingement syndrome: a critical review. Clin Orthop Relat Res. 1991;269:162-173
    1. Greipp JF. Swimmer’s shoulder: the influence of flexibility and weight training. Phys Sportsmed. 1985;13(8):92-105
    1. Guerrero P, Busconi B, Deangelis N, Powers G. Congenital instability of the shoulder joint: assessment and treatment options. J Orthop Sports Phys Ther. 2009;39(2):124-134
    1. Jansson A, Saartok T, Werner S, Renström P. Evaluation of general joint laxity, shoulder laxity and mobility in competitive swimmers during growth and in normal controls. Scand J Med Sci Sports. 2005;15(3):169-176
    1. Jobe CM, Coen MJ, Screnar P. Evaluation of impingement syndromes in the overhead-throwing athlete. J Athl Train. 2000;35(3):293-299
    1. Kennedy JC, Hawkins R, Krissoff WB. Orthopeaedic manifestations of swimming. Am J Sports Med. 1978;6:309-322
    1. Kibler WB, Press J, Sciascia A. The role of core stability in athletic function. Sports Med. 2006;36(3):189-198
    1. McMaster WC, Roberts A, Stoddard T. A correlation between shoulder laxity and interfering shoulder pain in competitive swimmers. Am J Sports Med. 1998;26(10):83-86
    1. McMaster WC, Troup J. A survey of interfering shoulder pain in United States competitive swimmers. Am J Sports Med. 1993;21(1):67-70
    1. Membership demographics for the 2007 membership year. USA Swimming. Accessed March 2, 2008
    1. Pink M, Jobe FW, Perry J, Browne A, Scovazzo ML, Kerrigan J. The painful shoulder during the butterfly stroke: an electromyographic and cinematographic analysis of twelve muscles. Clin Orthop Relat Res. 1993;288:60-72
    1. Pink M, Jobe FW, Perry J, Kerrigan J, Browne A, Scovazzo ML. The normal shoulder during the butterfly swim stroke: an electromyographic and cinematographic analysis of twelve muscles. Clin Orthop Relat Res. 1993;288:48-59
    1. Pink M, Perry J, Browne A, Scovazzo ML, Kerrigan J. The normal shoulder during freestyle swimming: an electromyographic and cinematographic analysis of twelve muscles. Am J Sports Med. 1991;19:569-576
    1. Pink MM, Tibone JE. The painful shoulder in the swimming athlete. Orthop Clin North Am. 2000;31(2):247-261
    1. Richardson AB, Jobe FW, Collins HR. The shoulder in competitive swimming. Am J Sports Med. 1980;8(3):159-163
    1. Ruwe PA, Pink M, Jobe FW, Perry J, Scovazzo ML. The normal and the painful shoulders during the breaststroke: electromyographic and cinematographic analysis of twelve muscles. Am J Sports Med. 1994;22(6):789-796
    1. Sciascia A, Kibler WB. The pediatric overhead athlete: what is the real problem? Clin J Sport Med. 2006;16(6):471-477
    1. Scovazzo ML, Browne A, Pink M, Jobe FW, Kerrigan J. The painful shoulder during freestyle swimming: an electromyographic cinematographic analysis of twelve muscles. Am J Sports Med. 1991;19:577-582
    1. Sein ML, Walton J, Linklater J, et al. Reliability of MRI assessment of supraspinatus tendinopathy [published online ahead of print February 8, 2007]. Br J Sports Med. 2007;41(8):e9.
    1. Sein ML, Walton J, Linklater J, et al. Shoulder pain in elite swimmers: primarily due to swim-volume-induced supraspinatus tendinopathy [published online ahead of print May 7, 2008]. Br J Sports Med.
    1. Woertler K, Waldt S. MR imaging in sports-related glenohumeral instability [published online ahead of print April 22, 2006]. Eur Radiol. 2006;16(12):2622-2636
    1. Yanai T, Hay JG. Shoulder impingement in front-crawl swimming: II. Analysis of stroking technique. Med Sci Sports Exerc. 2000;32(1):30-40
    1. Yanai T, Hay JG, Miller GF. Shoulder impingement in front-crawl swimming: I. A method to identify impingement. Med Sci Sports Exerc. 2000;32(1):21-29
    1. Zemek MJ, Magee DJ. Comparison of glenohumeral joint laxity in elite and recreational swimmers. Clin J Sport Med. 1996;6(1):40-47

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