steve reece, md moose herring, md sports medicine division advanced orthopedics

Recognizing Swimmer’s Shoulder:

Causes, Treatments, & Return to Endurance Sports Following Injury

Steve Reece, MD Moose Herring, MDSports Medicine Division Advanced Orthopedics

February 1, 2014

Recognizing Swimmer’s Shoulder:

Causes, Treatments, & Return to Endurance Sports Following Injury

• Anatomy review• Swimmer’s shoulder injury etiology• Diagnosis• Treatment plan

Reece, MD

Shoulder Anatomy

Reece, MD

What goes wrong in swimmers?

• Shoulder is highly mobile joint• Overtraining• Fatigue• Hypermobility• Stroke technique• Weakness• Tightness• Previous injury

Diagnosis• Swimmer’s shoulder not really a diagnosis

• Rotator cuff tendinitis• Overuse injury

• Rotator cuff impingement ? + instability• Entrapment of cuff/bursa with overhead activity

• Labral pathology• Tear of cartilage on socket side of joint

Treatment Summary

1. Pain relief NSAIDs, cortisone injection, avoid painful

action2. Cross train to ensure fitness

Don’t let CV fitness restrict the RTP3. Regain full range of motion4. Restore scapular control/function5. Restore rotator cuff strength6. Restore technique7. Return to swimming

Swimming Mechanics• Body rotation

• Symmetric body rotation via bilateral breathing technique

• Flat spine axis yields arms swinging around side w recovery

• Excess IR causes cuff injury, impingement

Swimming Mechanics• Hand position

into water

• Hand pitch outward, thumb first entry

• Excessive IR again leading to cuff overuse/impingement

Swimming Mechanics• Swimming posture

• Often poor posture from daily activity

• Leads to severe cross at the front of the stroke and impingement

• Stretch anteriorly, strengthen posterioryly

• Think shoulders back, chest out

• YTWL

Swimming Mechanics• Catch and pull through

• Dropped elbow and/or straight arm leads to significant increase in shoulder load

• This high elbow catch and pull uses the larger chest/back muscles instead of solely shoulder

Technique Summary• A good swimming technique will have the following factors in place,

consistently:

1. Bilateral breathing for at least 80% of your training sessions. There are many times (especially in the open water) when unilateral breathing is the better option, but for a healthy, balanced freestyle stroke technique, bilateral breathing is the way to go in training.

2. Good, symmetrical body rotation. This can be worked upon through a range of different body rotation drills, often employing fins for support.

3. Hand entry into the water is finger tip first, not thumb first despite what you may have been taught when you learnt to swim!

4. Avoiding midline cross over at the front of the stroke.

5. Developing and maintaining of good upper body posture.

6. Targeting a high elbow (bent arm) catch and pull through.

 http://www.swimsmooth.com/injury.php#ixzz2qlnyEEmP