Auctores Publishing – Volume 2(1)-018 www.auctoresonline.org Page - 1 J Orthopaedics and Surgical Sports Medicine Shoulder Pain in Swimmers Gomaa M. Othman Dept. Of Theories and Applications of Aquatic sports, Faculty of Physical Education, Zagazig university, zagazig, Egypt Corresponding Author: Gomaa M. Othman, Dept. Of Theories and Applications of Aquatic sports, Faculty of Physical Education, Zagazig university,zagazig, Egypt E-mail: Dr.gomaaothman@yahoo.com. Received date: November 11, 2019; Accepted date: December 04, 2019; published date: December 09, 2019 Citation: Gomaa M. Othman, (2019) Shoulder Pain in Swimmers.J. Orthopaedics and Surgical Sports Medicine, 2(1): Doi:10.31579/2641- 0427/018. Copyright: © 2019 Gomaa M. Othman. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Shoulder pain is the most important symptom that affects competitive swimmers, with a prevalence between 40 – 91% [1-2], and it constitutes a special syndrome called the “swimmer’s shoulder”. This syndrome, described by Kennedy and Hawkins in 1974 [2] consists in discomfort after swimming activities in a first step. This may progress to pain during and after training. Finally, the pain affects the pro23wsq2wgress of the athlete [3]. Keywords: pain; biomechanics; shoulder Introduction Shoulder pain is the most important symptom that affects competitive swimmers, with a prevalence between 40 – 91% [1-2], and it constitutes a special syndrome called the “swimmer’s shoulder”. This syndrome, described by Kennedy and Hawkins in 1974 [2] consists in discomfort after swimming activities in a first step. This may progress to pain during and after training. Finally, the pain affects the progress of the athlete [3]. Some researchers have demonstrated that an important proportion of competitive swimmers have shoulder pain that interferes with training and progress of their abilities. The percentage of athletes with swimmer’s shoulder is proportional to the age, the years of practice and the level of competition. Swimmers with interfering pain might not progress in training and thus will not compete as effectively [4]. One of the first reports of this problem was in the 1972 Olympic Games in Munich; Kennedy noticed a high incidence of shoulder pain among swimmers of Canadian group: of 35 competitive swimmers, there were 43 orthopaedic consultations, with 16 specific-related to shoulder (37%), being the most frequent problem [3]. Kennedy had performed a cross-Canada survey involving all competitive swimmers (5000 yards per day). A total of 2496 swimmers were included, reporting a 3% (81 swimmers) shoulder complaints, caused primarily by the freestyle and butterfly strokes and occasionally by the backstroke [3]. Shoulder Biomechanics in Swimming Swimming requires several different shoulder motions, most being performed during circumduction in clockwise and counter-clockwise directions with varying degrees of internal and external rotation and scapular protraction and retraction [5]. Competitive swimmers used four types of strokes: freestyle or front crawl stroke, breaststroke, backstroke, and butterfly stroke. The fastest, most popular and most widely used stroke for training is the freestyle stroke [6]. The power for this stroke comes 80% from the pull and 20% from the kick [6]. The freestyle stroke pull-cycle can be divided in four phases [7]: 1. Early pull-through: beginning with the hand entry into the water and ending when the humerus is perpendicular to the axis of the torso. 2. Late pull-through: beginning at the completion of early pull- through and ending as the hand leaves the water. 3. Early recovery: beginning at hand exit and ending when the humerus is perpendicular to the water surface. 4. Late recovery: beginning at the completion of early recovery and ending at hand entry. During the entry and beginning of the pull phases, the glenohumeral joint is in forward flexion, and the humerus is in abduction and internal rotation [6]. During the end of the pull, the joint is extended and the humerus is in adduction and internal rotation [6]. During the recovery period, the arm is in abduction and internal rotation, moving from extension to flexion above the water [6]. The backstroke is considered the complement to the freestyle stroke, and the arm actions involve the same four phases; however, power comes 25% from the kick and 75% from the pull [6]. The butterfly stroke is performed with the arms in the same phase of the stroke at one time. During the entry, both shoulders are flexed, abducted, and internally rotated. During the pull-through phase, the shoulders move into extension, and in the recovery, the arms are brought above the water from extension to flexion while abducted and internally rotated. The power for this stroke comes 30% from the kick and 70% from the pull [6]. The breaststroke has a fifty-fifty split from where the power is initiated. In the pull phase, the arms move into adduction, internally rotated, and are always below the water surface. During the recovery, the arms return in a circular pattern, always under the water surface [6]. In 1991 Marilyn Pink performed the most detailed electromyographic and cinematographic analysis of freestyle stroke [7]. In the pull-through phase, they recognized three different phases: the first phase was Open Access Mini Review Journal of Orthopaedics and Surgical Sports Medicine Gomaa M. Othman AUCTORES Globalize your Research