Recognizing Swimmer’s Shoulder : Causes, Treatments, & Return to Endurance Sports Following Injury Steve Reece, MD Moose Herring, MD Sports Medicine Division Advanced Orthopedics Advanced Orthopedics February 1, 2014

Recognizing Swimmer’s Shoulder : Causes, Treatments, & Return to Endurance Sports Following Injury Anatomy reviewAnatomy review Swimmer’s shoulder injury etiologySwimmer’s shoulder injury etiology DiagnosisDiagnosis Treatment planTreatment plan Reece, MD

Shoulder Anatomy Reece, MD

What goes wrong in swimmers? Shoulder is highly mobile jointShoulder is highly mobile joint OvertrainingOvertraining FatigueFatigue HypermobilityHypermobility Stroke techniqueStroke technique WeaknessWeakness TightnessTightness Previous injuryPrevious injury

Diagnosis Swimmer’s shoulder not really a diagnosisSwimmer’s shoulder not really a diagnosis Rotator cuff tendinitisRotator cuff tendinitis Overuse injuryOveruse injury Rotator cuff impingement ? + instabilityRotator cuff impingement ? + instability Entrapment of cuff/bursa with overhead activityEntrapment of cuff/bursa with overhead activity Labral pathologyLabral pathology Tear of cartilage on socket side of jointTear of cartilage on socket side of joint

Treatment Summary 1.Pain relief  NSAIDs, cortisone injection, avoid painful action 2.Cross train to ensure fitness  Don’t let CV fitness restrict the RTP 3.Regain full range of motion 4.Restore scapular control/function 5.Restore rotator cuff strength 6.Restore technique 7.Return to swimming

Swimming Mechanics Body rotationBody rotation Symmetric body rotation via bilateral breathing techniqueSymmetric body rotation via bilateral breathing technique Flat spine axis yields arms swinging around side w recoveryFlat spine axis yields arms swinging around side w recovery Excess IR causes cuff injury, impingementExcess IR causes cuff injury, impingement

Swimming Mechanics Hand position into waterHand position into water Hand pitch outward, thumb first entryHand pitch outward, thumb first entry Excessive IR again leading to cuff overuse/impingementExcessive IR again leading to cuff overuse/impingement

Swimming Mechanics Swimming postureSwimming posture Often poor posture from daily activityOften poor posture from daily activity Leads to severe cross at the front of the stroke and impingementLeads to severe cross at the front of the stroke and impingement Stretch anteriorly, strengthen posteriorylyStretch anteriorly, strengthen posterioryly Think shoulders back, chest outThink shoulders back, chest out YTWLYTWL

Swimming Mechanics Catch and pull throughCatch and pull through Dropped elbow and/or straight arm leads to significant increase in shoulder loadDropped elbow and/or straight arm leads to significant increase in shoulder load This high elbow catch and pull uses the larger chest/back muscles instead of solely shoulderThis high elbow catch and pull uses the larger chest/back muscles instead of solely shoulder

Technique Summary A good swimming technique will have the following factors in place, consistently: 1. Bilateral breathing for at least 80% of your training sessions. There are many times (especially in the open water) when unilateral breathing is the better option, but for a healthy, balanced freestyle stroke technique, bilateral breathing is the way to go in training. 2. Good, symmetrical body rotation. This can be worked upon through a range of different body rotation drills, often employing fins for support. 3. Hand entry into the water is finger tip first, not thumb first despite what you may have been taught when you learnt to swim! 4. Avoiding midline cross over at the front of the stroke. 5. Developing and maintaining of good upper body posture. 6. Targeting a high elbow (bent arm) catch and pull through.