Effect of Swim Training on the Physical Characteristics of Competitive Adolescent Swimmers

Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review

Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.

Shoulder structures and strength in competitive preadolescent swimmers: A longitudinal ultrasonographic study

BACKGROUND

Repetitive shoulder movements during competitive training may cause changes in the strength of periarticular shoulder structures in preadolescent swimmers.

OBJECTIVE

To prospectively determine the effects of training on shoulder periarticular structures and muscle strength in preadolescent swimmers.

DESIGN

Prospective cohort study.

SETTING

Community-based natatorium.

PARTICIPANTS

Twenty-four preadolescent swimmers aged 10-12 years.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Measurements were repeated in three periods as preseason, midseason, and postseason. Ultrasonographic measurements (supraspinatus tendon thickness, humeral head cartilage thickness, deltoid muscle thickness, and acromiohumeral distance) were performed using a portable device and a linear probe. Shoulder (flexion, extension, abduction, internal and external rotation) and back (serratus anterior, lower, and middle trapezius) isometric muscle strength were measured with a handheld dynamometer.

RESULTS

Supraspinatus tendon thickness and acromiohumeral distance were similar in all periods (all p > .05); however, deltoid muscle and humeral head cartilage thicknesses increased throughout the season (p = .002, p = .008, respectively). Likewise, whereas shoulder muscle strength increased (all p < .05), back muscle strength was similar in all periods (all p > .05).

CONCLUSIONS

In preadolescent swimmers, acromiohumeral distance and supraspinatus tendon thickness seem to not change; but humeral head cartilage and deltoid muscle thicknesses as well as shoulder muscle strength increase throughout the season.

The effect of swimming on the body posture, range of motion and musculoskeletal pain in elite para and able-bodied swimmers

BACKGROUND

Elite swimmers may be predisposed to disturbances in the range of motion (ROM) of hip joints and spinal curvatures, which are a factor that induces body's compensatory mechanisms that may have an impact on sports training, athletic performance and health. This study aimed to identify compensatory mechanisms in body posture of elite Para and able-bodied swimmers (spinal curvatures, ROM), to indicate the dominant locations of the compensatory mechanisms in the groups of Para and able-bodied athletes, and to identify and compare the prevalence and location of musculoskeletal pain from the last week and the last six months in the context of compensatory mechanisms.

METHODS

Thirty-five (nF = 8; nM = 27; age = 20.51 ± 4.24) elite Para and able-bodied swimmers from the Polish national team took part in the study and were divided into: study group (SG) of Para swimmers and control group (CG) of able-bodied swimmers. Depth of the anteroposterior spinal curvatures and sagittal spinal mobility testing were evaluated with a Medi Mouse device. The prevalence and locations of musculoskeletal pain were assessed with a Nordic Musculoskeletal Questionnaire for the last seven days (NMQ-7) and the last six months (NMQ-6).

RESULTS

In both groups lumbar hypolordosis, anterior pelvic tilt and pain in the shoulders, lower back and hips/thighs (NMQ-7) were reported the most frequent. In SG several significant relationships were found between duration of sport-specific training experience (years) and depth of angle the lumbar lordosis, the depth of the angle of pelvic inclination the ROM in the lumbar spine and thoracic spine, what was not reported in CG.

CONCLUSIONS

Extrinsic compensatory mechanism was identified in both study groups, however only in SG it occurred as structural (depth of the angle of lumbar lordosis and pelvic inclination) and functional changes (ROM in the thoracic and lumbar spine) in the body posture. Internal compensatory mechanism was identified in SG, however external compensation showed only partially suppressive character regarding to internal compensation. The locations of the musculoskeletal complaints seems to result from both internal compensatory mechanism (SG) and continuous overload of the anatomy trains as a result of swimming training (SG, CG).

Preseason shoulder screening in volleyball players: is there any change during season?

Background

Volleyball players sollicit their shoulder with high velocity and high ranges of motion. Musculoskeletal adaptations have been described after some years of practice but have not been explored after some months of practice. The objective of this study was to analyze the short-term evolution of shoulder clinical measures and functional performance in youth competitive volleyball players.

Methods

Sixty-one volleyball players were assessed twice, at preseason and at midseason. Shoulder internal and external rotation range of motion as well as forward shoulder posture and scapular upward rotation were measured in all players. Two functional tests were also performed: the upper quarter Y-balance test and the Single-arm medicine ball throw. The results obtained at midseason were compared to those measured at preseason.

Results

Compared to preseason, an increase in absolute value of shoulder external rotation, total rotation range of motion and forward shoulder posture were observed at midseason (P < .001). An increase in side-to-side difference for shoulder internal rotation range of motion was also observed during the season. As for scapular kinematics, scapular upward rotation was significantly decreased at 45° and increased at 120° of abduction at midseason. Concerning functional tests, an increase in throwing distance in the single-arm medicine ball throw was observed at midseason while no change was noted for the upper quarter Y-balance test.

Conclusion

Significant changes in clinical measures and functional performance were observed after some months of practice. Since some variables have been suggested to be correlated to a higher risk of shoulder injuries, the current study emphasizes the importance of regular screening in order to highlight injury risk profiles throughout the season.

Upper crossed syndrome in secondary school students: A mixed-method study

Objective

The study objectives were to identify the prevalence of upper crossed syndrome (UCS) and its associated factors in a population of Spanish adolescents, and to explore these associations through focus groups.

Methods

The study used a sequential explanatory mixed method design. The quantitative phase consisted of a cross-sectional study in which 45 students underwent photogrammetry measurements and evaluations with the Kiddo-KINDL and VISA-TEEN questionnaires. Subsequently, several focus groups were conducted to discuss the quantitative results.

Results

The results indicated a 37.8% prevalence of UCS, a 48.9% prevalence of forward head posture (FHP) and an 80% prevalence of forward shoulder posture (FSP). A positive FSP was indicated by an angle represented by the intersection of the line between the midpoint of the humerus and the spinous process of C7 of <52°. FSP was significantly higher in boys (mean [M] = 43.59, standard deviation [SD] = 6.9) than in girls (M = 47.98, SD = 6.33; p < 0.05). Boys showed significant moderate associations of FSP with body mass index (BMI) (r = -0.48, p < 0.05) and hygiene habits (r = -0.46, p < 0.05), and of FHP with worse use of technology (r = 0.53, p < 0.05). Those with UCS showed significant differences in school performance (M = 47.22, SD = 8.33, p < 0.05). Analysis of the qualitative results led to the identification of 33 codes and five categories.

Conclusions

UCS was associated with factors such as BMI, school performance, use of technology and physical activity. Correcting posture in adolescence was generally believed to be necessary. Physical exercise and postural health were considered highly important among adolescents.

Traumatology and functional recovery of the shoulder specific to the game of Volleyball

Abstract: Worldwide, the game of volleyball is a very popular sport regardless of the demographic categories analyzed. In recent years, the dynamics of the game of volleyball is continuously increasing, notable increases being observed among the female gender. Shoulder injuries are common among athletes, for example in baseball, 12% to 19% of injuries encountered are located in the shoulder, while in swimming, the percentage of shoulder injuries is estimated to be between 23% and 38%. The research is based on the case study carried out on a 28-year-old male subject, with 15 years of sports experience, a volleyball player, with a previous history of shoulder joint through the presence of bicipital tendinitis, contractures in the trapezius muscle, as well as in the the sternocleidomastoid muscle. The analysis of the dynamics of the evolution of the subject included in the research and the interpretation of the results led to the confirmation of the hypothesis, so that, reaching all the well-established recovery objectives, we can conclude that the symptomatology, in our case, rotator cuff muscle injury, can be combated by using kinetotherapeutic methods , which demonstrated the highest level of success achieved, when the subject can be taken even from the immobilization stage. Also, a much faster progress was observed from the point of view of socio-professional reintegration. Keywords: Volleyball, Shoulder, Recovery.

Bilateral Comparison of Anterior Shoulder Position in Elite Tennis Players

Background

In elite tennis players, musculoskeletal adaptations in the dominant upper extremity have been reported for range of motion, strength, and scapular biomechanics. In addition to scapular dysfunction, tightness and inflexibility of the pectoral musculature have been identified as risk factors for the development of overuse shoulder injury in overhead athletes.

Hypothesis

Differences in anterior shoulder position will be identified between the dominant and non-dominant extremity in elite tennis players. The purpose of this study was to examine bilateral differences in anterior shoulder posture measured using a double square in elite tennis players without shoulder injury.

Study Design

Descriptive Laboratory Study.

Methods

Three hundred and six uninjured elite tennis players were measured in the supine position using a double square method to measure anterior shoulder position. The distance from the surface of the table to the anterior most position of the shoulder (in millimeters) was measured bilaterally and compared. A dependent t-test was used to test for significant differences in anterior shoulder position between the dominant and non-dominant extremity.

Results

One hundred thirty-three males and 173 females were included in this study with a mean age of 16.58 years. The mean difference between extremities indicates increased anterior shoulder positioning on the dominant shoulder of 7.65 mm in females, and 8.72 in males. Significantly greater (p<.001) anterior shoulder position measures were documented on the dominant shoulder as compared to the non-dominant shoulder.

Conclusions

The results of this study showed significantly (p<.001) greater anterior shoulder position on the dominant extremity of elite male and female tennis players. The differences of 7-8mm between extremities has clinical application for interpreting anterior shoulder position test results in this population.

Level of Evidence

3.

Changes in clinical measures and tissue adaptations in collegiate swimmers across a competitive season

BACKGROUND

Competitive swimmers incur shoulder pain and injury. Physical characteristics such as shoulder range of motion (ROM) and endurance and tissue adaptations such as posterior capsule thickness (PCT) may be risk factors in addition to high training volume.

HYPOTHESIS/PURPOSE

1) To identify the most provocative special test and prevalence of positive special tests for shoulder impingement tests in a group of collegiate swimmers, (2) to assess shoulder pain and disability, internal rotation (IR) and external rotation, and horizontal adduction (HADD) ROM and posterior shoulder endurance longitudinally over a competitive collegiate season, and (3) determine if there is a relationship between swimming yardage, supraspinatus tendon organization, and PCT.

METHODS

Thirty Division III swimmers were tested poolside at the beginning (T1), middle (T2), and end (T3) of their season. Dependent variables included pain and disability, shoulder ROM, Posterior Shoulder Endurance Test (PSET) value, and PCT. Analyses of variance with follow-up t tests compared measures over time, and Pearson correlation coefficients were performed.

RESULTS

Despite increased swimming yardage, disability was reduced from T1 to T3 (P = .003). There was a reduction in bilateral IR and HADD ROM from T1 to T3. PSET values increased on the right from T1 to T3 (P = .014). There was a significant positive correlation between swimming yardage at T1 and T2 and PCT at T3 (P = .034, P = .028).

CONCLUSION

A loss of shoulder IR and HADD was observed across the season concurrent with less swimming-related disability, which may indicate a favorable adaptation. Improved PSET scores over the season is consistent with prior research linking endurance and less pain and disability.

Risk Factors of Overuse Shoulder Injuries in Overhead Athletes: A Systematic Review

CONTEXT

Shoulder injuries are highly prevalent in sports involving the upper extremity. Some risk factors have been identified in the literature, but consensus is still lacking.

OBJECTIVES

To identify risk factors of overuse shoulder injury in overhead athletes, as described in the literature.

DATA SOURCES

A systematic review of the literature from the years 1970 to 2018 was performed using 2 electronic databases: PubMed and Scopus.

STUDY SELECTION

Prospective studies, written in English, that described at least 1 risk factor associated with overuse shoulder injuries in overhead sports (volleyball, handball, basketball, swimming, water polo, badminton, baseball, and tennis) were considered for analysis.

STUDY DESIGN

Systematic review.

LEVEL OF EVIDENCE

Level 3.

DATA EXTRACTION

Data were extracted from 25 studies. Study methodology quality was evaluated using the Modified Coleman Methodology Score.

RESULTS

Intrinsic factors, previous injury, range of motion (lack or excess), and rotator cuff weakness (isometric and isokinetic) highly increase the risk of future injuries. Additionally, years of athletic practice, body mass index, sex, age, and level of play seem to have modest influence. As for the effect of scapular dysfunction on shoulder injuries, it is still controversial, though these are typically linked. Extrinsic factors, field position, condition of practice (match/training), time of season, and training load also have influence on the occurrence of shoulder injuries.

CONCLUSION

Range of motion, rotator cuff muscle weakness, and training load are important modifiable factors associated with shoulder injuries. Scapular dysfunction may also have influence. The preventive approach for shoulder injury should focus on these factors.

Clinical Evaluation Techniques for Injury Risk Assessment in Elite Swimmers: A Systematic Review

CONTEXT

Evidence concerning a systematic, comprehensive injury risk assessment in the elite swimming population is scarce.

OBJECTIVE

To evaluate the quality of current literature regarding clinical assessment techniques used to evaluate the presence and/or development of pain/injury in elite swimmers and to categorize objective clinical assessment tools into relevant predictors (constructs) that should consistently be evaluated in injury risk screens of elite swimmers.

DATA SOURCES

PubMed, Embase, Scopus, CINAHL, SPORTDiscus, PEDro, and the Cochrane Library Reviews were searched through September 2018.

STUDY SELECTION

Studies were included for review if they assessed a correlation between clinic-based objective measures and the presence and/or development of acute or chronic pain/injury in elite swimmers. All body regions were included. Elite swimmers were defined as National Collegiate Athletic Association, collegiate, and junior-, senior-, or national-level swimmers. Only cohort and cross-sectional studies were included (both prospective and retrospective); randomized controlled trials, expert opinion, and case reports were excluded, along with studies that focused on interventions, performance, or specific swim-stroke equipment or technology.

STUDY DESIGN

Systematic review and qualitative analysis.

LEVEL OF EVIDENCE

Level 3.

DATA EXTRACTION

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were utilized at each phase of review by 2 reviewers; a third reviewer was utilized for tie breaking purposes. Qualitative analysis was performed using the Methodological Items for Non-Randomized Studies (MINORS) assessment tool.

RESULTS

A total of 21 studies assessed the presence and/or development of injury/pain in 3 different body regions: upper extremity, lower extremity, and spine. Calculated average MINORS scores for comparative (n = 17) and noncomparative (n = 4) studies were 18.1 of 24 and 10.5 of 16, respectively. Modifiable, objectively measurable injury risk factors in elite swimmers were categorized into 4 constructs: (1) strength/endurance, (2) mobility, (3) static/dynamic posture, and (4) patient-report regardless of body region.

CONCLUSION

Limited evidence exists to draw specific correlations between identified clinical objective measures and the development of pain and/or injury in elite swimmers.

Activation Profile of Scapular Stabilizing Muscles in Asymptomatic People: Does Scapular Dyskinesis Have an Impact on It?

OBJECTIVE

The aim of the study was to assess the activation profile of scapular stabilizing muscles in dyskinetic asymptomatic people.

DESIGN

This is a noninterventional observational study. Two groups of 20 people were included in the study. The first group involved asymptomatic athletes with scapular dyskinesis. The second one included athletes without scapular dysfunction. Muscle activation of upper trapezius, lower trapezius, and serratus anterior were recorded by a surface electromyography during shoulder flexion and shoulder abduction, in unloaded and loaded conditions.

RESULTS

A significant increase of the activity of the upper trapezius (between 23% and 31%) and a significant decrease of the activity of the lower trapezius (between 32% and 65%) were observed in the dyskinetic group in comparison with the nondyskinetic group in asymptomatic athletes. A significant increase between 17% and 31% of the activity of the serratus anterior was also observed in dyskinetic people. Likewise, a significant increase approximately 24%-61% and 23%-70% was noted respectively in upper trapezius/lower trapezius and upper trapezius/serratus anterior ratio's in the dyskinetic group.

CONCLUSIONS

An alteration of periscapular muscular activation exists in dyskinetic asymptomatic people. Future studies will be needed to know whether those alterations increase the risk of shoulder injuries.

Quantifying acromiohumeral distance in elite male field hockey players compared to a non-athletic population

BACKGROUND

Shoulders of elite field hockey players are loaded continuously during play. Frequent high shoulder loading is known to influence certain shoulder variables, such as acromiohumeral distance. However, the influence of elite field hockey play on acromiohumeral distance is not examined yet.

OBJECTIVE

To examine the acromiohumeral distance in elite male field hockey players compared to a non-athletic control group.

DESIGN

Cross-sectional study.

METHODS

Fifty male participants were included; 25 elite field hockey players (age: 24.0±2.72 years; weight: 77.2±5.29kg; height; 180.5±5.37cm) and 25 age- and gender matched non-athletes (23.0±2.29 years; weight: 75.7±9.53kg; height: 181.8±5.52cm). A Telemed-Colormaster-128 EXT-IZ device was used to bilaterally obtain ultrasound acromiohumeral distance images at 3 different angles of shoulder abduction in the frontal plane.

RESULTS

Field hockey players showed a bilateral larger acromiohumeral distance at 45° (mean difference: 1.46mm [95% CI 0.46; 2.46]; p=0.005) and 60° (mean difference: 1.07mm [95% CI 0.21; 1.93]; p=0.016) compared to controls. In both groups, a significant but clinically less relevant, side difference was established for the acromiohumeral distance at 60° (mean difference: 0.79mm [95% CI 0.21; 1.34]; p=0.009).

CONCLUSION

With active shoulder abduction, elite field hockey players show a larger acromiohumeral distance in comparison to non-athletic participants. This may be a protective sport-specific adaptation, to better guard the shoulder from injury. Thus, acromiohumeral distance measurement may help physical therapists/coaches decide which athletes could benefit from specific, additional exercises aimed at enlarging the subacromial space.

Swimming Practice and Scapular Kinematics, Scapulothoracic Muscle Activity, and the Pressure-Pain Threshold in Young Swimmers

CONTEXT

Whereas alterations in scapular kinematics, scapulothoracic muscle activity, and pain sensitivity have been described in adult swimmers, no researchers have examined these outcomes in young swimmers.

OBJECTIVES

To compare scapular kinematics, scapulothoracic muscle activation, and the pressure-pain threshold (PPT) of the shoulder muscles among young nonpractitioners (those who were not involved in sports involving the upper limbs), amateur swimmers, and competitive swimmers.

DESIGN

Cross-sectional study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 90 individuals (age = 11.63 ± 0.61 years) in 3 groups: nonpractitioners, amateur swimmers, and competitive swimmers.

INTERVENTION(S)

Scapular kinematics and activity of the upper trapezius, lower trapezius, and serratus anterior (SA) were measured during upper extremity elevation in the scapular plane. The PPT was assessed in the upper trapezius, infraspinatus, supraspinatus, middle deltoid, and tibialis anterior.

MAIN OUTCOME MEASURE(S)

Scapular kinematics, scapulothoracic muscle activation, and PPT. We conducted a 2-way mixed-model analysis of variance and a 1-way analysis of variance for scapular rotation and PPT, respectively. A Kruskal-Wallis test was used to assess muscle activity. The α level was set at .05.

RESULTS

Competitive swimmers presented more internal rotation at 90° ( P = .03) and 120° ( P = .047) and more anterior tilt at 90° ( P = .03) than nonpractitioners. Amateur swimmers demonstrated more anterior tilt at 90° ( P = .004) and 120° ( P = .005) than nonpractitioners. Competitive swimmers had greater SA activation in the intervals from 60° to 90° ( P = .02) and 90° to 120° ( P = .01) than amateur swimmers. They also displayed more SA activation in the interval from 90° to 120° than nonpractitioners ( P = .04). No differences were found in any of the muscles for the PPT ( P > .05).

CONCLUSIONS

Young competitive swimmers presented alterations in scapular kinematics and scapulothoracic muscle activation during upper extremity elevation that may be due to sport practice. Mechanical pain sensitivity was not altered in young swimmers.

Scapular dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic athletes: a systematic review and meta-analysis

Background

It is unclear whether the presence of scapular dyskinesis increases the risk of developing shoulder pain in asymptomatic athletes.

Objectives

To determine whether the presence of scapular dyskinesis in asymptomatic athletes increases the risk of developing shoulder pain by systematic review and meta-analysis.

Methods

A systematic search was conducted in the Cochrane Library, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database and SPORTDiscus. Prospective studies that assessed athletes for scapular dyskinesis and recorded incidents of shoulder pain were included. Study quality was assessed using the Downs and Black checklist. Meta-analysis was conducted to derive a pooled risk ratio (RR) for the development of shoulder pain in athletes with scapular dyskinesis compared with those without scapular dyskinesis.

Results

Five studies were included with a total of 419 athletes. Of the athletes with scapular dyskinesis, 35% (56/160) experienced shoulder pain during the follow-up, whereas 25% (65/259) of athletes without scapular dyskinesis experienced symptoms. The presence of scapular dyskinesis at baseline indicated a 43% increased risk of a shoulder pain event over a 9 to 24 months follow-up (RR=1.43, 95% CI 1.05 to 1.93).

Conclusions

Athletes with scapular dyskinesis have 43% greater risk of developing shoulder pain than those without scapular dyskinesis.