(2014) did not observe any significant relationship between SP and shoulder joint flexibility. (1992), Bak and Magnusson (1997), and Harrington et al. Several studies investigated the relationship between ROM and SP in swimmers. In addition, demanding training programs (including swimming, strength and dry land conditioning) predisposes the swimmers shoulder to adaptive changes including decreased internal rotation and horizontal adduction ROM, and excessive external rotation with respect to no-athletes ( Hibberd et al., 2016 De Martino and Rodeo, 2018). Swimmers have been observed as having increased thoracic kyphosis, rounded shoulders and a forward head, which can decrease subacromial-space distance ( Hibberd et al., 2016 Struyf et al., 2017). Highly repetitive overhead loading, high volume of training and years of swimming experience places tremendous stress and adaptations on the shoulder girdle musculature and the glenohumeral joint complex adapts to the training demands ( Heinlein and Cosgarea, 2010 Dischler et al., 2017 Higson et al., 2018).
Shoulder extension, adduction and internal rotation movements are relevant and highly reproduced in the swimming technique during the propulsive phases of the different strokes ( Wanivenhaus et al., 2012). Swimming requires several different shoulder motions, most being performed in clockwise and counter-clockwise directions with varying degrees of internal and external rotation and scapular protraction and retraction ( McLaine et al., 2018). The percentage of propulsive power of the stroke comes 70–85% from the pull and 20–30% from the kick and these percentages differ according to the swimming technique ( King, 1995). The shoulders and upper extremities represent nearly 90% of the propulsive power for all four main strokes ( Heinlein and Cosgarea, 2010). With an average stroke count of 10 complete strokes per 25 m lap ( Heinlein and Cosgarea, 2010) this can equate to an average of 16800–44000 rotations of each shoulder per week. international swimmers) ( Bradley et al., 2016). The average swimmer swims approximately 42000 to 110000 m per week depending on the competitive level (recreational swimmers vs. Furthermore, the training intensity during the practices is quite high ( Harrington et al., 2014 Ristolainen et al., 2014). In several cohort studies, SP prevalence in swimmers is high, and may range from 40 to 91% depending on the age group and definition ( McMaster, 1999 Bak, 2010 Sein et al., 2010).Ĭompetitive swimming often train 11 months of the year ( Hibberd et al., 2016) and swin over 20 h per week distributed between 5 and 7 days ( Sein et al., 2010 Tate et al., 2012). Shoulder pain (SP) has been described as the most common musculoskeletal disorder in competitive swimmers ( Wanivenhaus et al., 2012) causing an impact on training, competition and swimming goals ( McLaine et al., 2018). In the studied data, a SHAB range of 39° was found to be the most appropriate cut-off point for prognostic screening. This study clearly shows that low range of SHAB is a risk factor for developing SP in competitive young swimmers. Swimmers with limited ROM (≤39°) have 3.6 times higher risk of developing SP than swimmers with normal ROM (>39°).
Using the coordinates of the curves, the angle of SHAB ROM that most accurately identified individuals at risk of developing SP was determined to be 39° (sensibility 0.656 and 0.375 specificity).
Only reduced SHAB ROM was associated with SP. At the follow-up, 16 swimmers (50%) had developed unilateral SP. The data was analyzed via a binary logistic regression and ROC curves were calculated. SP was prospectively monitored during the subsequent season using questionnaires. Measures of passive maximal shoulder extension (SE), flexion (SF), horizontal abduction (SHAB), abduction (SAB), horizontal adduction (SHADD), external (SER) and internal (SIR) rotation ROMs were taken. 24 competitive young swimmers were measured in the 2016 pre-season. The aims of the present study were: (a): to determine the profile of shoulder flexibility in young swimmers, (b) to analyze whether a restricted range of movement (ROM) could be a predictor of subsequent SP in young swimmers. This prospective cohort study investigated the association between 3 blocks of performance factors (anthropometric characteristics, sport experience and training regimen) and the presence of SP. The prevalence of shoulder pain (SP) among competitive swimmers is high, and may profoundly restrict their ability to compete.
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