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Treating swimmers and their shoulder injuries

Treating Swimmers: Tips for Physios

“Keep Australia on your left” is the title of a book by Eric Stiller, about his kayaking adventure circumnavigating Australia. Eric and a friend paddled counterclockwise around the coastline, keeping Australia on their left! They ultimately failed in their endeavour, but the book is a fascinating read on the hardships they encountered on their adventure. The biggest hurdle they faced was the sheer size of Australia and its coastline, as well as the treacherous currents and hefty swells of water. To put it simply, Australia is a vast country filled with many things that are willing to kill you if you allow them. Most Australians live near the coast so being able to swim is a useful skill! Every third or fourth “backyard” has a swimming pool and almost every council has an outdoor 50m pool. Now, my particular passion is for the gladiatorial combat sports, like rugby, so I can't say that I am an absolute expert at managing an injured swimmer and their shoulders. But I am an Australian physiotherapist, which means I've seen my fair share of swimming injuries. I've also worked alongside physios who have formed part of the Olympic medical team devoted to swimmers. So, if I don't know the answer, I know another expert who does. If you want to learn more about swimming injuries, I recommend you take a look at the upcoming issue of the Sports Injury Bulletin, published at the end of the month. In this issue, Andrew Hamilton provides a fantastic insight into the aetiology of the swimmers shoulder. He also provides some coalface advice on technical matters that relate to stroke modification and considerations for the coaches to avoid swimmers shoulder injuries. In the meantime, read on for some extra tips passed on to me by Victor Popov, a physio who was part of the medical team for Australian swimmers at a few Olympic games. For any therapist that has to deal with the swimmer with a painful and impinged shoulder, my advice would be to focus on three of Victor's “pearls of wisdom” listed below. Improve thoracic spine extension The upper thoracic spine is required to extend as the shoulder approaches a fully flexed position. This is the position the swimmer has to achieve when they reach for the water at the start of the stroke in the water. The primary reason for the thoracic spine extension is to allow the scapula to fully posterior tilt in order to clear space for the humeral head to not impinge against the acromian process. If the thoracic spine is stuck and cannot fully extend then the scapula also gets stuck and the acromian process cannot get out of the way of the humeral head. If this happens then the humeral head will impinge. Solution: mobilise, manipulate, foam roll the thoracic spine to improve the extension. Infraspinatus trigger points The infraspinatus at the back of the shoulder is a muscle that does get overly tight and overactive in swimmers. When it gets tight, it creates a mechanical effect on the shoulder whereby it pushes the humeral head forward in relation to the glenoid fossa or socket of the shoulder joint. This can create an anterior shoulder impingement. Solution: massage, trigger and stretch the infraspinatus. Pec minor tightness The pec minor is the evil player in shoulder problems. When it is tight it works to drag the scapula down into a downward rotation, anterior tilt and depressed position. This is the complete opposite of what the scapula has to do at the top of the stroke as the hand enters the water. It has to upwardly rotate, posterior tilt and elevate. A tight pec minor will stop this and possibly create a scapular position that allows the acromian process to hit the humeral head and cause an impingement. Solution: massage, stretch and self release the pec minor muscle. There are many other interventions and prevention strategies that can be employed to manage a swimmers shoulder and many of these are explained in great detail in Andrew's article in issue 139 of Sports Injury Bulletin at the end of this month.

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Treating swimmers and their shoulder injuries