FEATURE: SWIMMER’S SHOULDER SWIMMER’S SHOULDER sense is adversely affected. Increased4. Rotator cuff strength imbalancemay cumulatively increase glenohumeral supraspinatus tendon thickness post- joint laxity over time, however, it is swim training has been demonstratedSwimmers develop imbalances of uncommon for swimmers to present with in preliminary research, using real-timeshoulder internal rotation to externaldistinct shoulder instability symptoms. ultrasound measurement within the rotation strength, with stronger internal subacromial space. The time course rotation strength due to its dominance6. Flexibility requirements to recovery for these acute trainingduring the pull through. An ideal ratio of effects is unknown. internal to external rotation strength is beDuring all swim strokes, swimmers utilise IR:ER= 1.46. Swimmers with generalisedthe unique ‘high elbow catch position’ 3. Potential long-term effects of swimjoint hypermobility may demonstrateto generate propulsive and lift forces and training on the shoulder shoulder internal rotation strength the ‘streamline’ to minimise hydrodynamic deficits. Hand-held dynamometry is anform drag. The high elbow ‘catch’ Imaging studies point towards swim excellent tool for prescribing targetedcomprises by shoulder elevation and near training induced rotator cuff tendonstrengthening programs for the shouldermaximal internal rotation. Most swimmers changes over the long-term. An MRI external and/or internal rotators. presenting with shoulder pain describe study of elite swimmers reported symptoms at the ‘catch’. During freestyle that 86.2% of symptomatic participants5. Shoulder Laxity arm recovery, shoulder external rotation had abnormal shoulder changes. The and thoracic rotation mobility is critical most common MRI finding in competitiveCompetitive swimmers commonly to avoid hyperextension of the shoulder. swimmers’ shoulders is supraspinatusdemonstrate generalised joint Similarly, during backstroke, thoracic tendinopathy (69%), believed to be hypermobility. This hypermobility rotation is necessary and required during swim volume induced. Other reportedis beneficial, allowing swimmers the the pull. All strokes require full shoulder findings include subscapularis tendinosis,necessary range of motion for a long,elevation at hand entry. Biomechanical subacromial, subdeltoid fluid and ACefficient stroke. Generalised shoulderanalysis of freestyle swimming revealed joint changes. Ultrasound studies reportjoint laxity is a common, normal findingshoulder ROM approaching ‘impingement similar findings with supraspinatus tendonin competitive swimmers’ shoulders withpositions’ during arm recovery, hand changes significantly correlated withup to 62% incidence. When investigatedentry and the pull through. Importantly, shoulder pain in marathon swimmers.prospectively, laxity is not associated withincorrect body alignment and an the development of swimming shoulderinefficient kick will increase the pain. It is hypothesised that swim trainingwork of swimming at the shoulder. 8 VOLUME 36 • ISSUE 3 2018