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©2016 MFMER | slide-1

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


Disclosures • No relevant financial relationships or conflicts of

interest exist


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


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


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


• 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


Heinlein et al, 2010


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


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


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


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


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


How to Treat • Education • Rest • Ice • Posture Education • Strengthening of the Rotator Cuff • Strengthening of the Scapula Stabilizers • Swimming Biomechanics, Technique, and

Specific Drills


Swimming Technique • Body position • Lack of rotation • Elbow drops • Cross over the middle


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.


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

https://sportsmedicine.mayoclinic.org/locations/minneapolis-mn.php

https://sportsmedicine.mayoclinic.org/locations/rochester-mn.php

mailto:[email protected]

https://sportsmedicine.mayoclinic.org/

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