for coaches?. swimmers’ blessing swimmers’ curse steven kalandiak, md, shoulder and elbow...
TRANSCRIPT
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For coaches?
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Swimmers’ Blessing
Swimmers’ Curse
Steven Kalandiak, MD, Shoulder and Elbow SurgeryUniversity of Miami, Miller School of Medicine
ASCA Conference Fort Lauderdale, FL, September 2009
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Yahoo
Scott Rodeo, MD
Chair – USA Swimming Sports Medicine
George T. Edelman, MPT, OCS, MTC
http://www.usaswimming.org/USASWeb/DesktopDefault.aspx?TabId=451&Alias=Rainbow&Lang=en
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Elite competitive swimmers put their shoulders through millions of stroke cycles over the course of their careers.
Michael Phelps – 80K/wk20 lap/K x 80K/wk x 50wk/yr = 80,000lap/yr
80K x 13-14cycles/lap = approx 1M cycles/yr
Ouch!
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The Problem
The same hypermobile joints that allow elite swimmers to compete at the level they do also predispose them to overuse injuries.
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Proper mechanics, appropriate therapeutic exercises, and rest and rehabilitation are not only essential to fast swimming, but are also important to maintaining shoulder health.
This talk reviews the structure and inner workings of the shoulder joint, the injuries swimmers are likely to suffer, and the prevention and treatment of these problems.
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McMaster and Troup - 1993 - 1262 US swimmers
Prevalence of interfering shoulder pain varied between 10% (age group) to 26% (national team) at any given time and increased with time in the sport.
50 to 80% have training interrupted at some point in their careers.
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Wolf et al, 2009 - Injury data for University of Iowa swimming and diving team 2002-07
94 swimmers
71% injury rate, 37% resulted in missed time
Shoulder/upper arm was the most frequently injured, followed by the neck/back
Increased number and risk of injuries in freshman
Conclusion: Give particular attention to swimmers making the transition to a higher level of training
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Impingement/tendonitis
Internal impingement
SLAP tear
Anteroinferior instability
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Multifactorial
Impingement, laxity, instability and labral pathology can all coexist in the same shoulder
Maladaptive movement patterns (scapula) can also coexist
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Brushøj, Bak et al, 2006
Eighteen competitive Danish swimmers had arthroscopy fortherapy-resistant shoulder pain.
Most common findings at arthroscopy was labral pathology in 11 (61%) and subacromial impingement in 5 (28%).
Nine swimmers (56%) returned to preinjury competition level.Findings suggest that ‘‘Swimmer’s shoulder’’ covers a variety of
pathologies including labral wearing and subacromial impingement.
Arthroscopic debridement of labral tears or bursectomy has a low success rate with regard to return to sport.
Scapular dyskinesias were common in this patient group.
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Training (yardage/intensity)
Repetitive microtrauma“acquired capsular laxity”
?? Incorrect stretching ??
Muscle imbalance
Flaws in technique
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Rapid increase in training distance, intensity or frequency problematic
Pressing on past the point where technique fails either reinforces poor mechanics or causes injury (or both)
Go slow – increase only one per week
Elite athletes need months to years to achieve full fitness
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“acquired capsular laxity”
when baseline laxity increases, it can become pathologic
?? Can incorrect stretching contribute??
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1,000,000 stroke cycles a year!
Repeatedly moving through unbalanced shoulder positions can further stretch already loose tissue, creating pathologic instability
Improper mechanics (poor technique or technique breakdown due to fatigue) can worsen this
Could inappropriate (capsular) stretching also contribute to excess laxity?
(Edelman at USA Swimming)
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Tradition, emulate others
Injury prevention (little real proof)
Relieve muscle soreness
Loosen tight muscle groups
(correct unbalanced joints)
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Doorframe stretches (Pectoralis)
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Flexibility – Pectoralis and Latissimus tight >
external rotation difficult
Strength – large propulsive adductors and internal rotators vs. abductors and external rotators
Endurance – serratus and subscapularis prone to fatigue > scapular dyskinesia
rotator cuff fatigues faster than large muscle groups > instability > worsening laxity
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Poor body roll
Crossing midline
Too straight elbow during pull
Persisting in the face of failing mechanics
?? Unilateral Breathing ??
?? Hand Paddles ??
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Scapular plane swimming
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Also fingertips not toward bottom, arm timing wrong
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Reinforces poor, rather than excellent technique
Puts joints at risk of injury
fatigue accentuates muscle imbalances
scapular control and joint stability decline
Switch stroke, drill, or kick instead
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Bilateral breathe to improve stroke symmetry
? increase body roll ?
An error in and of themselves, or do they just aggravate existing flaws ?
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First, second and third line treatment
“You can always operate –
you can never un-operate”
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DO NOT swim through the pain
(But ok to swim with it if mild)
relative rest - vary strokes,
decrease intensity and yardage
NSAIDS, ice when aggravated
gradually re-increase workouts
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Moderate to severe pain
Minimal swimming
aerobic fitness (legs), and core
technique evaluation by coach
evaluation for muscle imbalance by therapist
transition to home “preventive” exercises
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My office phone # is …….
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Repair/reattach torn structures
Tighten stretched tissue
Debride (smooth) irreparable tears or rough surfaces (Masters)
Lengthy rehabilitation
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Shoulder muscle development
but not too much
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Strength, Endurance, Balance, Flexibility
Of the muscles in the shoulder
and thoughout the body
Do after practice or several hours before
Each set 2 or 3 times per week
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Rotator cuff
Scapular stabilizers
Core
Stretching
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One second on, one second off
Three sets of two minutes or until lose form
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One second up, one second down
Three sets of two minutes or until lose form
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15 sec clockwise, 15 sec counterclockwise
Three sets of two minutes or until lose form
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One second on, one second off
Three sets of two minutes or until lose form
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One second on, one second off
Three sets of two minutes or until lose form
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One up, hold “plus” for two, one down
Three sets of two minutes or until lose form
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Flat back
2 minute flutter kick or until lose form
advanced
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Flat back, then bird dog
Alternate sides – 2 minutes or until lose form
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Two 30 second stretched each leg
Don’t lock knee
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Two 30 second stretches
Breathe!
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Can do on ball
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Can stretch, work abs, back or back of shoulders
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The hypermobile joints that allow swimmers to compete also predispose them to injuries.
A controlled increase in yardage and intensity, attention to proper mechanics, and preventive exercises are key to good shoulder health.
If problems arise, prompt recognition, relative rest, and an appropriate search for the underlying cause(s) are vital to returning the swimmer to competition.
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Questions?