Skip Navigation Links.
American Journal of Sports Science and Medicine. 2016, 4(3), 57-73
DOI: 10.12691/AJSSM-4-3-1
Original Research

Review of Shoulder Injuries and Shoulder Problems in Competitive Swimmers

Bradley J1, , Kerr S2, Bowmaker D2 and Gomez J-F3

1Department of Education, University College Cork, Cork, T20 YN60, Republic of Ireland

2LifeFit Physiotherapy, Falkirk, FK1 1RA, Scotland, UK

3Mardyke Arena, University College Cork, Cork, T20 YN60, Republic of Ireland

Pub. Date: June 16, 2016
Full Text PDF

Cite this paper

Bradley J, Kerr S, Bowmaker D and Gomez J-F. Review of Shoulder Injuries and Shoulder Problems in Competitive Swimmers. American Journal of Sports Science and Medicine. 2016; 4(3):57-73. doi: 10.12691/AJSSM-4-3-1

Abstract

Swimming is a popular sport, both recreationally and competitively. The repetitive nature of the swim stroke places unique demands on the body. Competitive swimmers spend a considerable amount of time training for their sport, and can swim 110km or more a week. As a consequence of this amount of swimming and the repetitive nature of the swimming stroke, swimmers can develop injuries, most commonly localised to the shoulder. This manuscript will focus on shoulder problems in swimmers and present a review of the factors that may predispose an individual to injury. The EBCSOhost Research Database was initially searched using the keywords: “(Swimming OR Swimmers”) AND “(Competitive OR Shoulder)” AND “(Injury OR Pain)”. This was supplemented by cross-referencing to publications cited by the authors of the initial literature search. Effect sizes (Cohen’s d) were calculated to compare the different factors associated with shoulder injury. A review of literature split factors associated with shoulder problems into six groups: biomechanics of the shoulder; general swimmer characteristics; injury history; shoulder laxity and range of movement; shoulder strength; general strength. The impact of each factor upon swimming and shoulder injury is discussed and the effect sizes show which factors have the greatest association with shoulder injury in swimmers.

Keywords

swimming, competitive, shoulder, pain, effect size

Copyright

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]  International Olympic Committee. Aquatics: History of swimming at the Olympic Games., 2015. http://www.olympic.org/Assets/OSC%20Section/pdf/QR_sports_summer/Sports_Olympiques_natation_eng.pdf (accessed July 6, 2015).
 
[2]  Sport England. Once a week sport participation factsheet: summary of results, 2013. Sport England - Active People Survey 7. http://archive.sportengland.org/research/active_people_survey/active_people_survey_7.aspx (accessed July 6, 2015).
 
[3]  Lunn, P.; Layte, R. Sporting lives: An analysis of a lifetime of Irish sport; The Economic and Social Research Institute: Dublin, 2008.
 
[4]  USA Swimming. USA Swimming - LSC Statistics, 2014. http://www.usaswimming.org/DesktopDefault.aspx?TabId=1521&Alias=Rainbow&Lang=en (accessed March 2, 2015).
 
[5]  NCAA Publications. 1981-82 to 2012-13 NCAA sports sponsorship and participation rates report, 2013. https://www.ncaapublications.com/p-4334-1981-82-2012-13-ncaa-sports-sponsorship-and-participation-rates-report.aspx (accessed July 6, 2015).
 
[6]  Borsa, P.; Scibek, J.; Jacobson, J.; Meister, K. Sonographic stress measurement of glenohumeral joint laxity in collegiate swimmers and age-matched controls. The American Journal of Sports Medicine 2005, 33 (7), 1077-1084.
 
[7]  Chase, K.; Caine, D.; Goodwiin, B.; Whitehead, J.; Romanick, M. A prospective study of injury affecting collegiate competitive swimmers. Research in Sports Medicine 2013, 21 111-123.
 
[8]  Walker, H.; Gabbe, B.; Wajswelner, H.; Blanch, P.; Bennell, K. Shoulder pain in swimmers: A 12-month prospective cohort study of incidence and risk factors. Physical Therapy in Sport 2012, 13 243-249.
 
[9]  Hibberd, E.; Myers, J. Practice habits and attitudes and behaviors concerning shoulder pain in high school competitive club swimmers. Clinical Journal of Sports Medicine 2013, 23 (6), 450-455.
 
[10]  Sein, M.; Walton, J.; Linklater, J.; Appleyard, R.; Kirkbridge, B.; Kuah, D.; Murrell, G. Shoulder pain in elite swimmers: primarily due to swim-volume-induced supraspinatus tendinopathy. British Journal of Sports Medicine 2010, 44 105-113.
 
[11]  Heinlein, S.; Cosgarea, A. Biomechanical considerations in the competitive swimmer’s shoulder. Sports Health 2010, 2 (6), 519-525.
 
[12]  Harrington, S.; Meisel, C.; Tate, A. A cross-sectional study examining shoulder pain and disability in division I female swimmers. Journal of Sport Rehabilitation 2014, 23 65-75.
 
[13]  Tate, A.; Turner, G.; Knab, S.; Jorgensen, C.; Strittmatter, A.; Michener, L. Risk factors associated with shoulder pain and disability across the lifespan of competitive swimmers. Journal of Athletic Training 2012, 47 (2), 149-158.
 
[14]  Mohseni-Bandpei, M.; Keshavarz, R.; Minoonijhad, H.; Mohsenifar, H.; Shakeri, H. Shoulder pain in iranian elite athletes: the prevalence and risk factors. Journal of Manipulative and Physiological Therapeutics 2012, 35 541-548.
 
[15]  Pink, M.; Edelman, G.; Mark, R.; Rodeo, S. Applied biomechanics of swimming. In Athletic and sport issues in musculoskeletal rehabilitation; Elsevier Saunders: St Louis, Missouri, 2011; Chapter 14, pp 331-349.
 
[16]  Cook, J.; Purdam, C. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British Journal of Sports Medicine 2009, 43 (6), 409-416.
 
[17]  Mackenzie, T.; Herrington, L.; Horsley, I.; Cools, A. An evidence-based review of current perceptions with regard to the subacromial space in shoulder impingement syndromes: Is it important and what influences it? Clinical Biomechanics 2015, 30 (7), 641-648.
 
[18]  Diercks, R.; Bron, C.; Dorrestijn, O.; Meskers, C.; Naber, R.; de Ruiter, T.; Willems, J.; Winters, J.; van der WOude, H. Guideline for diagnosis and treatment of subacromial pain syndrome. Acta Orthopaedica 2014, 85 (3), 314-322.
 
[19]  Yanai, T.; Hay, J. Shoulder impingement in front-crawl swimming: II. analysis of stroking technique. Medicine and Science in Sports and Exercise 2000, 32 (1), 30-40.
 
[20]  Wanivenhaus, F.; Fox, A.; Chaudhury, S.; Rodeo, S. Epidemiology of injuries and prevention strategies in competitive swimmers. Sports Health 2012, 4 (3), 246-251.
 
[21]  Gaunt, T.; Maffulli, N. Soothing suffering swimmers: a systematic review of the epidemiology, diagnosis, treatment and rehabilitation of musculoskeletal injuries in competitive swimmers. British Medical Bulletin 2012, 103 45-88.
 
[22]  Tovin, B. Prevention and treatment of swimmer's shoulder. North American Journal of Sports Physical Therapy 2006, 1 (4), 166-175.
 
[23]  Blanch, P. Conservative management of shoulder pain in swimming. Physical Therapy in Sport 2004, 5 109-124.
 
[24]  Hill, L.; Collins, M.; Posthumus, M. Risk factors for shoulder pain and injury in swimmers: A critical systematic review. The Physician and Sportsmedicine 2015, 43 (4), 412-420.
 
[25]  Thalheimer, W.; Cook, S. How to calculate effect sizes from published research articles: a simplified methodology, 2002. http://www.bwgriffin.com/gsu/courses/edur9131/content/Effect_Sizes_pdf5.pdf (accessed July 22, 2013).
 
[26]  Chinn, S. A simple method for converting an odds ratio to effect size for use in meta-analysis. Statistics in Medicine 2000, 19 3127-3131.
 
[27]  Borenstein, M.; Hedges, L.; Higgins, J.; Rothstein, H. Converting among effect sizes. In Introduction to Meta-Analysis; John Wiley & Sons Ltd.: Chichester, West Sussex, UK, 2009; Chapter 7, pp 45-50.
 
[28]  Cohen, J. Statistical power analysis for the behavioural sciences.; Lawrence Erlbaum Associates: USA, 1988; pp 19-74.
 
[29]  Yanai, T.; Hay, J.; Miller, G. Shoulder impingement in front-crawl swimming: I. a method to identify impingement. Medicine and Science in Sports and Exercise 2000, 32 (1), 21-29.
 
[30]  Gill, T.; Shanahan, E.; Allison, D.; Alcorn, D.; Hill, C. Prevalence of abnormalities on shoulder MRI in symptomatic and asymptomatic older adults. International Journal of Rheumatic Diseases 2014, 17 863-871.
 
[31]  Miniaci, A.; Mascia, A.; Salonen, D.; Becker, E. Magnetic Resonance Imaging of the Shoulder in Asymptomatic Professional Baseball Pitchers. The American Journal of Sports Medicine 2002, 30 (1), 66-73.
 
[32]  Virag, B.; Hibberd, E.; Oyama, S.; Padua, D.; Myers, J. Prevalence of freestyle biomechanical errors in elite competitive swimmers. Sports Health 2014, 6 (3), 218-224.
 
[33]  Becker, T.; Havriluk, R. Quantitative data supplements qualitative evaluations of butterfly swimming. Proceedings of the XIth International Suymposium for Biomechanics and Medicine in Swimming., Oslo, 2010; pp 314-316.
 
[34]  Richardson, A.; Jobe, F.; Collins, H. The shoulder in competitive swimming. American Journal of Sports Medicine 1980, 8 159-163.
 
[35]  Abgarov, A.; Fraser-Thomas, J.; Baker, J. Understanding trends and risk factors of swimming-related injuries in varsity swimmers. Clinical Kinesiology 2012, 66 (2), 24-28.
 
[36]  Guskiewicz, K. Physical education curriculum priorities: “safe” exercise is medicine. Quest 2011, 63 66-72.
 
[37]  Bahr, R.; Holme, I. Risk factors for sports injuries—a methodological approach. Britisj Journal of Sports Medicine 2003, 37 384-392.
 
[38]  Engebretsen, A.; Myklebust, G.; Holme, I.; Engebretsen, L.; Bahr, R. Prevention of inuries aong male soccer players. The American Journal of Sports Medicine 2008, 36 (6), 1052-1060.
 
[39]  Cook, G. Movement; On Target Publications: Aptos, California, USA, 2010; pp 15-33.
 
[40]  Zemek, M.; Magee, D. Comparison of glenuhumeral joint laxity in elite and recreational swimmers. Clinical Journal of Sports Medicine 1996, 6 40-47.
 
[41]  Beach, M.; Whitney, S.; Dickoff-Hoffman, S. Relationship of shoulder flexibility, strength, and endurance to shoulder pain in competitive swimmers. The Journal of Orthopaedic and Sports Physical Therapy 1992, 16 (6), 262-268.
 
[42]  Deschodt, V.; Arsac, L.; Rouard, A. Relative contribution of arms and legs in humans to propulsion in 25-m sprint front-crawl swimming. European Journal of Applied Physiology 1999, 80 192-199.
 
[43]  McMaster, W.; Roberts, A.; Stoddard, T. A correlation between shoulder laxity and interfering pain in competitive swimmers. American Journal of Sports Medicine 1998, 26 (1), 83-86.
 
[44]  Jansson, A.; Saartok, T.; Werner, S.; Renstrom, P. Evaluation of general joint laxity, shoulder laxity and mobility in competitive swimmers during growth and in normal controls. Scandinavian Journal of Medicine and Science in Sports 2005, 15 169-176.
 
[45]  Bak, K.; Fauno, P. Clinical findings in competitive swimmers with shoulder pain. American Journal of Sports Medicine 1997, 25 (2), 254-260.
 
[46]  Bak, K. The practical management of swimmer’s painful shoulder: etiology, diagnosis, and treatment. Clinical Journal of Sports Medicine 2010, 20 386-390.
 
[47]  Bak, K.; Magnusson, S. Shoulder strength and range of motion in symptomatic and pain-free elite swimmers. American Journal of Sports Medicine 1997, 25 (4), 454-459.
 
[48]  Bansal, S.; Sinha, A.; Sandhu, J. Shoulder impingement syndrome among competitive swimmers in India - prevalence, evaluation and risk factors. Journal of Exercise Science and Fitness 2007, 5 (2), 102-108.
 
[49]  Solem-Bertoft, E.; Thuomas, K.; Westerberg, C. The influence of scapula retraction and protraction on the width of the subacromial space: an MRI study. Clinical Orthopaedics and Related Research 1993, 296 99-103.
 
[50]  Su, K.; Johnson, M.; Gracely, E.; Karduna, A. Scapular Rotation in Swimmers with and without Impingement Syndrome: Practice Effects. Medicine & Science in Sports & Exercise 2004, 36 (7), 1117-1123.
 
[51]  Magnusson, S.; Glelm, G.; Nicholas, J. Subject variability of shoulder abduction strength testing. The American Journal of Sports Medicine 1990, 18 (4), 349-353.
 
[52]  Kelln, B.; McKeon, P.; Gontkof, L.; Hertel, J. Hand-held dynamometry: Reliability of lower extremity muscle testing in healthy, physically active, young adults. Journal of Sport Rehabilitation 2008, 17 160-170.
 
[53]  Ellenbecker, T.; Davies, G. The application of isokinetics in testing and rehabilitation of the shoulder complex. Journal of Athletic Training 2000, 35 (3), 338-350.
 
[54]  Aagaard, P.; Simonsen, E.; Magnusson, S.; Larsson, B.; Dyhre-Poulsen, P. A new concept for isokinetic hamstring: quadriceps muscle strength ratio. American Journal of Sports Medicine 1998, 26 (2), 231-237.
 
[55]  Scoville, C.; Arciero, R.; Taylor, D.; Stoneman, P. End Range Eccentric Antagonist/Concentric Agonist Strength Ratios: A New Perspective in Shoulder Strength Assessment. Journal of Orthopaedic & Sports Physical Therapy 1997, 25 (3), 203-207.
 
[56]  Noffal, G. Isokinetic Eccentric-to-Concentric Strength Ratios of the Shoulder Rotator Muscles in Throwers and Nonthrowers. The American Journal of Sports Medicine 2003, 31 (4), 537-541.
 
[57]  Marberry, K.; Schisler, D. Swimming & Diving Injuries. In Sports Medicine & Rehabilitation - A Sport-Specific Approach; Lipincott, Williams & Wilkins: Philadelphia, 2009; pp 93-108.
 
[58]  Edelman, G. Sjoulder stretching for swimmers: Helpful or harmful?, 2007. Edelman Soine and Orthopaedic Physical Therapy. http://www.esopt.com/site/1/docs/stretcharticlefull.pdf.
 
[59]  Flatow, E.; Soslowsky, L.; Ticker, J.; Pawluk, R.; Hepler, M.; Ark, J.; Mow, V.; Bigliani, L. Excursion of the Rotator Cuff Under the Acromion. The American Journal of Sports Medicine 1994, 22 (6), 779-788.
 
[60]  Goldbeck, T.; Davies, G. Test-retest reliability of the closed kinetic chain upper extremity stability test: a clinical field test. Journal of Sport Rehabilitation 2000, 9 35-45.
 
[61]  Gomoll, A.; Hatch, G.; Millett, P. Shoulder injuries in throwing athletes. In Sports Medicine; Lippincott, Williams & Wilkins: Baltimore, Maryland, 2006; Chapter 16, pp 200-213.
 
[62]  Maglischo, E. Increasing Propulsion. In Swimming Fastest; Human Kinetics: Champaign, Illinois, USA, 2003; pp 5-42.
 
[63]  Neer II, C. Anterior acromioplasty for the chronic impingement syndrome in the shoulder. The Journal of Bone and Joint Surgery 1972, 54 (1), 41-50.
 
[64]  Ozcaldiran, B. A relation between static flexibility and shoulder pain in competitive age-group swimmers. The Pain Clinic 2002, 14 (2), 159-163.