FEATURE: SWIMMER’S SHOULDER SWIMMER’S SHOULDER Streamlined position and long axis body rotation to keep the hips & shoulders “connected” during Freestyle considering potential pain generation.isometric exercises (low range) areIn summary, management of swimmer’s The supraspinatus tendon (animal well tolerated and may assist with painshoulder is complex and an exact studies), subacromial bursa and themodulation. Later, eccentric, low-range‘diagnosis’ is often elusive. Despite this, connective, fat and bursal tissue ER and IR exercises embedded within knowledge of the specific demands of adjacent to the coracoclavicular dryland programming, are equally the swim strokes and implementation ligament, are potential drivers of well-tolerated and may improve tendonof targeted rehabilitation and load pain, given the distribution of load tolerance. Swimmers may find management strategies will lead nociceptors in these structures. regular post-session icing helpful forto resolution of pain in the majority Importantly, the subacromial bursa pain relief. Dynamic control problems ofof cases. is more densely innervated than shoulder-hip connection or the ‘catch’ the cuff and biceps tendons. The should be rectified with sensorimotorReferences available on request by glenohumeral joint capsule and re-training exercises. Finally, swim emailing sport.health@sma.org.au labrum has mechanoreceptors and technique should be corrected in free nerve endings densely located inconsultation with the coach. areas consistent with their protective role. Whilst understanding in this area is still developing, the rotator cuff tendons and subacromial bursa are key structures to consider when ABOUT THE AUTHORS planning rehabilitation strategies. Dr Helen Walker is a Sports Kylie Holt is a Sports Physiotherapist REHABILITATION FOR Physiotherapist at Physio4athletes,with Swimming Australia and has SWIMMER’S SHOULDER Melbourne and consults to Melbourneworked with the Australian Swim Vicentre Swimming Club, a SwimmingTeam for the past 10 years. She Rehabilitation should consider both Australia High Performance Centre.is currently completing her PhD intrinsic (ROM, strength) and extrinsicShe completed her PhD investigatinglooking at the pathoanatomy of variables (training loads/technique). risk factors for shoulder pain inan elite swimmer’s shoulder on MRI. Load modification may include reducingAustralian swimmers in 2010. HelenKylie has also attended the London swim distance or intensity, using finshas consulted to the Australian 2012/Rio 2016 Olympic Games and or performing ‘kick only’ for several Swim team at the Montreal 2005 Delhi 2010/Glasgow 2014/Gold sessions. Gradual return to full trainingWorld Champs, Melbourne 2006 Coast 2018 Commonwealth Games should be well-planned in terms of Commonwealth Games and worked as as a Sports Physiotherapist with the distance and intensity. a sports physiotherapist at the SydneyAustralian Headquarters Medical Team. 2000 Olympic Games and the 2018 Where primary rotator cuff tendon painGold Coast Commonwealth Games. is suspected, moderately high load 10 VOLUME 36 • ISSUE 3 2018