pathology: swimmer’s shoulder

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swimmer’s shoulder

Definition of

Syndrome of disorders in the shoulder area caused by swimming styles with overhead movement of the arms: crawl, dolphin, backstroke. As a rule, this is not an acute condition, but rather a chronic change. Basically, all disorders of the muscles and their tendons, the ligaments, bursae and bones of the shoulder joint that are associated with regular practice of this sport are referred to as swimmer’s shoulder. After all, a competitive swimmer completes between 500,000 and 800,000 arm cycles per year in training and competition. An overweight of the endorotators with too weak exorotators and the adductors compared to the abductors of the shoulder joint as well as an impingement tendency are often part of the disorder pattern, crawl and dolphin are the most important triggers. In principle, competitive swimmers are affected more frequently than recreational athletes, as the occurrence of the disorder depends on the acquired strengths and imbalances. Both sexes are affected about equally often. The disorder pattern is similar to the disorders acquired by other people who work a lot overhead. In both cases, the side of the dominant arm is affected more frequently and usually first. Initially (stage 1), the pain is only felt after swimming, in stage 2 during and after swimming. In stage 3, it is so pronounced during swimming that it impairs performance. In stage 4, performance is no longer possible due to the pain.

30-50% of all competitive swimmers and triathletes are affected at least for the first time. In a study of competitive swimmers, 100% of participants who swam at least 60 kilometers per week or 20 hours had problems with the supraspinatus tendon.

For the sport of swimming, see also the corresponding article in Exercise Physiology

Cause

  1. more extensive practice of swimming, especially in the disciplines of crawl, dolphin, butterfly, backstroke

Predisposing

  1. Technical defects
  2. Too rapid an increase in the performance requirement or training volume
  3. Lack of compensatory training
  4. Pre-existing muscular imbalances, especially overweight endorotators
  5. ligamentous or muscular instability of the shoulder joint
  6. Use of paddles, the bigger the more

Diagnosis

  1. If a SLAP lesion is suspected: MRI

Symptoms

  1. Subacromial events such as primary and secondary impingement (mostly internal)
  2. Imbalances with shortened endorotators with less sufficient exorotators, which also predisposes to impingement syndrome
  3. Cervical spine disorders, which can arise for two reasons, on the one hand due to the head being held in reclination during breaststroke, and on the other hand due to the iterated traction of the trapezius pars descendens on the cervical spine
  4. Insertional tendinopathy of the trapezius, especially at the clavicle
  5. Irritation of the tendons of the supraspinatus, secondarily also of the infraspinatus and teres major

Complications

  1. Recurrence, especially when resuming intensive training or neglecting compensatory training
  2. Overstretching of the joint capsule of the shoulder joint and the glenohumeral ligaments, resulting in instability of the shoulder joint and labrum damage up to tearing or shearing. SLAP lesion
  3. Bursitis
  4. Tendinitis of the supraspinatus
  5. Tendency to subluxate
  6. Tears of the rotator cuff muscles

Therapy

Usually conservative, only if conservative therapy fails is an attempt made to enlarge the subacromial space surgically and, if necessary, to repair other existing disorders.

  1. Depending on the extent of the disorder, abstinence, reduction or adaptation of training
  2. Working through muscular imbalances, appropriate strengthening training (especially deltoid pars spinalis, teres minor, infraspinatus) and stretching training (especially endorotators)
  3. NSAIDs if necessary
  4. If necessary, local infiltrations (local anesthetics, cortisone)
  5. Recurrence prevention: limit paddle training to 20% of the training volume and reweight the strength training: less strengthening of the endorotatory muscles (including the pectoralis major) and increased training of the exorotatory antagonists, additional stretching training
  6. If conservative treatment fails, arthroscopy with tightening of the capsule if necessary, repair of the labrum

On the biomechanics of swimming, see also this article on Sportaerzte.com

Asana practice

In the case of a swimmer’s shoulder, the strength and tone of the endorotators of the shoulder joint must be counterbalanced by the antagonistic group of exorotators of the shoulder joint. To do this, the endorotators must be stretched on the one hand and the exorotators, which are generally weaker in humans anyway, must be strengthened on the other. As the latissimus dorsi and the pectoralis major, two powerful adductor muscles, are part of the endorotators, wide frontal abductions of the shoulder joint are also recommended, especially those with a widely exorotated arm such as the postures derived from the elbow pose, the shoulder opening on the chair, dvi pada viparita dandasana and also the headstand. Exercises with powerful transverse abduction such as jathara parivartanasana and retroversion also help to balance the muscles of the shoulder joint.

Asanas

Asanas in 272: Strengthening the exorotators of the shoulder joint
Asanas in 271: Stretch for exorotation of the shoulder joint
Asanas in 501: Stretching the latissimus dorsi
Asanas in 511: Stretching the pectoralis major
Asanas in 247: Strengthening the retroverters of the shoulder joint Asanas in 257: Strengthening the transverse adductors of the shoulder joint