1. Identifying, treatment, and PREVENTION Sara Kraft DPT, NCS, ATP

2. What is Swimmers Shoulder The pain swimmers feel in or around the shoulder that is related to the activity of Swimming.

3. Statistics 90% of swimmers complaints are about shoulder pain 66% of swimmers develop shoulder pain Shoulder pain is the number 1 cause of missed practices or slower times The average collegiate swimmer performs more than 1 million strokes annually with each arm

4. Causes of Shoulder pain in Swimmers Most likely causes of shoulder pain are due to the demands of the sport including Increased shoulder Range Of Motion (ROM) Increased shoulder internal rotator and adductor strength Prolonged repetitive, shoulder intensive training which causes muscle fatigue **All 3 can lead to instability which can lead to impingement and pain

5. Increased Strength in the IR and ADD Most of the propulsive force of swimming is performed by these 2 muscle groups the Pect Major (chest muscle)and Latissimus Dorsi ( large back muscle) There is a large imbalance between these 2 muscle groups and the external rotators and abductors which causes joint instability

6. Increased Range of motion Swimmers have increased Range of motion (ROM) in extension, External Rotation (ER), and Abduction (ABD) Decreased ROM in Internal Rotation (IR) These 2 things can lead to a very unstable joint with increased movement in the front of the shoulder joint and tightness in the back of the shoulder joint which leads to an inequality and potential for injury.

7. Muscle Fatigue Main muscles of the shoulder-rotator cuff muscles Scapular or shoulder blade stabilizers Swimmers have to increase endurance by repetitive movements which lead to shoulder instability due to fatigue of the muscles. When the muscles fatigue the shoulder is at risk for injury.

8. Stroke analysis and muscle demand Freestyle-Most common stroke in practice The first ½ of the pull-this is when the arm is unilaterally producing the most force to propel the swimmer through the water-70% of swimmers with pain have pain at this phase of the cycle. The Adductors and internal rotators are responsible for the majority of the force production.

9. Recovery Phase Mid recovery phase the upper arm is in shoulder hyperextension and max external rotation-( equivalent to the wind up pitcher arm in baseball) This is a position that leads the swimmer to have increased force on the front portion of the shoulder. Stroke analysis and muscle demand

10. Early Signs Dropped elbow during the recovery phase of freestyle Wider hand entry Difficulty staying in the center of the lane Early hand exit in recovery phase Excessive Body roll Note: when in the workout does this happen and if it is consistent then test with Hawkins test

11. Hawkins Test Have the swimmer lift their shoulder and turn their elbow, wrist and hand down and then add resistance. If positive will have pain at the front of the shoulder.

12. Prevention of Shoulder injuries Stretch both the front and back of the shoulder capsule equally Shoulder blade positioning exercises specifically retraction and upward rotation Rotator cuff exercises emphasizing external rotation

13. Treatment of swimmers shoulder Reduce inflamation with ice/anti-inflammatories ( at least 2 weeks worth) Cease activities that cause the pain Kick but without a kick board!! Stop anterior capsule stretching and increase posterior capsule stretching Do rotator cuff exercises especially ER Scapular positioning exs- retraction and increase body roll. Have swimmers do alternate aerobic exercise until acute phase is over. THERE IS NOT SUCH THING AS NO PAIN NO GAIN!!!

14. Exercises All exercises should be performed for 3 sets of 10 reps. Can start with bands for ex 1 and 4 and no resistance for exercise 2 and 4 Ex 1 Ex 2 Ex 3 Ex 4