1. Injury Prevention Kevin Marberry, M.D. Assistant Professor Sports Medicine Team Physician, University of Missouri Swimming and Diving Kevin Marberry, M.D. Assistant Professor Sports Medicine Team Physician, University of Missouri Swimming and Diving

2. Who Swims Anyway? 100 million participants One of the most popular sports internationally Becoming more popular locally

3. Who Gets Hurt? 150,000 swimming/diving related injuries annually. 1 40-70% of competitive swimmers reports shoulder pain. 1.American Academy of Orthopaedic Surgeons, 2002.

4. What are the most common injuries? Most are minor “bumps and bruises”. Injuries that interfere with ability to compete are musculoskeletal. Classified as overuse injuries.

5. Overuse Injuries Swimmer’s Shoulder Butterfly Swimmer’s Back Breaststroker’s Knee

6. Swimmer’s Shoulder Shoulder Anatomy

7. Swimmer’s Shoulder What is it exactly? –Term coined in 1970 to describe anterior shoulder pain during and after workouts. –Rotator cuff tendinopathy –Current understanding: combination of subacromial impingement and glenohumal instability

8. Impingement?

9. What Causes It? Overuse. 2 hour sessions (4000-8000 yards), twice daily, 5 days a week, plus dry- land work 500,000 shoulder revolutions per year

10. When to get it evaluated? May start as an irritation during exercise. Swimmer may change mechanics. Progresses to pain after exercise and then pain at rest.

11. Medical Evaluation Rotator Cuff Strength Shoulder Range of Motion Subtle Anterior Instability

12. How Is It Prevented? Avoid overuse. Achieve balanced muscle strength. Maintain flexibility. www.usaswimming.org

13. Strengthening Recommendations Rotator Cuff Muscles that stabilize the shoulder blade Muscles of the low back, abdominal, and pelvis that make up the “core” of the body – the abdominal and lower back muscles.

14. How Is It Treated? Avoid aggravating motion Rest Ice Anti-inflammatory medications Rarely surgery

15. Shoulder Arthroscopy

16. Conclusions Swimmers are unfortunately prone to overuse injuries Swimmer’s Shoulder is common in competitive swimmers Prevention is the key to treatment

17. THANK YOU