Page 7 - Summer 2020

● Dropped elbow during the pull-through laxity and multi-directional instability Knee Injuries and Conditions
and recovery phases over time due to repetitive use. The Knee pain is the second most commonly
● Eyes-forward head-carrying angle potential for shoulder pain and instability reported musculoskeletal problem among
in swimmers rises as the dynamic
● Incorrect hand entry or hand swimmers with an incidence of 34–86
entry angle stabilizers fatigue and the static stabilizers percent. The mechanics of a swimmer’s
23
become increasingly laxed. Joint laxity in
11
● Incorrect pull-through pattern kick influence the rate of knee injury as
swimmers is often due to a combination altered kicking kinematics are commonly
These errors place the upper extremity of underlying anatomic, genetic, and present in swimmers with medial knee
musculotendinous units at a mechanical mechanical factors as well as from the pain. 24,25 A recent study of MRI findings in
disadvantage and can lead to rotator cuff repetitive overhead activity required for the knees of elite swimmers showed a 69.2
impingement and superior labral strain. 1,10 the four competitive strokes. 12,16 Excessive percent rate of structural abnormalities
laxity then decreases static shoulder in swimmers compared to 31.1 percent
Shoulder Injuries stability leading to rotator cuff overload, in age-matched controls. The most
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and Conditions fatigue, and increased translation of the commonly identified MRI findings were
humeral head within the glenoid. 1,16
Swimmer’s Shoulder edema of the infrapatellar fat pad and
bone marrow edema. 5,26
The shoulder is the most common Risk Factors, Evaluation, and Treatment
location of pain and injury in swimmers. Clinical joint laxity and instability, Breaststroker’s Knee
Up to 91 percent of swimmers have internal and external rotation deficits,
reported shoulder pain during their previous history of injury, and competitive The greatest incidence of swimming-
11
lifetime. Swimmer’s shoulder is a general level have all been shown to influence the related knee pain has been shown to
term for chronic shoulder pain and/ risk of developing swimmer’s shoulder. A occur among breaststrokers. Breaststroke,
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or instability brought on by swimming. variety of provocative tests to determine which requires a “frog kick,” produces
This condition was first described in the range of motion, strength, atrophy, and high velocities at the hips and knees with
1970s and was thought to be due to the ligamentous laxity should be used to increased external rotation of the tibia
repetitive shoulder abduction and forward evaluate swimmers with shoulder pain. as the knees extend, and high valgus
12
flexion required for freestyle and butterfly The majority of swimmers loads during the adduction phase. 5,11,28,29
swimming strokes. 12,13 with shoulder pain can be treated Effects of repetitive stress to the medial
Several pathologies have been described symptomatically with rest, ice, anti- compartment during breaststroke include
as potential causes of swimmer’s inflammatory medications, and a home synovitis, symptomatic synovial plicae,
shoulder including suprascapular strengthening program. Off-seasons, pes anserine tendinitis or bursitis,
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neuropathy and glenohumeral internal rest periods, and participation in alternate and sprains of the medial
rotation deficit (GIRD), though the sports (other than water polo) have been collateral ligament. 25,28
most common etiologies include rotator shown to be factors that reduce the risk
cuff tendinopathy and impingement, of injury in swimmers. 21,22 Athletes with
subacromial bursitis, labral tears, and persistent pain or instability and those
tenosynovitis of the proximal biceps with positive findings on imaging require
longhead tendon. 12-16 During freestyle a more aggressive approach. Physical
stroke entry with the glenohumeral therapy programs that include video
joint in a forward flexed and internally swim stroke analysis can be especially
rotated position, the hydrodynamic helpful in balancing muscle groups,
force on the hand elevates the arm into a reducing in-season symptoms, and Risk factors for overuse
position allowing potential subacromial potentially preventing future injuries. If injuries in swimmers
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impingement. This impingement pain from impingement fails to improve
1,11
can eventually lead to tendonitis and with physical therapy, or if a labral tear is ● Glenohumeral instability
degenerative tears of the rotator cuff in present on imaging, shoulder arthroscopy ● Generalized ligamentous laxity
those who swim greater than 20 hours may be required. When multidirectional ● Single stroke specialization
per week for more than 500,000 strokes. 17 (especially breaststroke)
instability persists and begins to affect
activities of daily living, a capsular ● Swimming for more than
Glenohumeral Instability
plication or inferior capsular shift may 20 hours per week
Generalized ligamentous laxity has be considered. Though training volume ● Poor or abnormal stroke
been demonstrated to be present in the may need to be reduced following surgery, mechanics
majority of competitive swimmers. 15,16 This return to sport rates of 75–80 percent
group may develop increased shoulder have been reported in swimmers. 12

Summer 2020, Issue 3 | sportsmed.org 5 