Transcript Upper Extremity Overuse Injuries in Swimming

Recognizing Swimmer’s Shoulder:
Causes, Treatments, & Return to Endurance
Sports Following Injury
Steve Reece, MD
Moose Herring, MD
Sports 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.
2.
3.
4.
5.
6.
7.
Pain relief

NSAIDs, cortisone injection, avoid painful action
Cross train to ensure fitness

Don’t let CV fitness restrict the RTP
Regain full range of motion
Restore scapular control/function
Restore rotator cuff strength
Restore technique
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