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STROKE MECHANICS
Breakdown in stroke mechanics can predispose swimmers to injury, so it is important for the clinician and coach to focus attention on fundamental stoke mechanics. Some older masters swimmers were taught to swim “flat” and with one-sided breathing. By clarifying old-style stroke mechanics and adjusting mechanical stressors, athletes can limit repetitive injury.
Regardless of the swimmer’s chosen stroke event, most training is done in freestyle or drills alternating with freestyle such as freestyle/backstroke combos.
Freestyle stroke phases include a catch, pull-through, and recovery period. During the out-of-water phase, the torso rotates on the body’s longitudinal axis as the shoulder exits the water in an abducted and externally rotated position. The elbow should remain high above the hand until the hand enters the water fingers first in front and just outside the line of the shoulder. At the water entry point, the swimmer extends his or her arm to its maximum length. To keep the elbow high, the swimmer must roll the body approximately 45 degrees on the swimmer’s long axis. In mechanical studies, the body roll angle can vary due to the athlete’s fatigue or breathing side (3). This indicates that physiologic changes attributed to aging alone may be more due to disuse than age.
Masters swimmers age rules include athletes 25 years old and older (4). Individual events include athletes in 5-year age intervals (e.g., 25-29, 30-34). Relay events are based on total age of team members in whole years (e.g., 100-119, 120-159, 160-199) continued in 40-year increments as high as is necessary.
The majority of injuries in swimming are due to overuse, with the most frequently injured body part being the shoulder. A study of competitive U.S. swimmers demonstrated that 47% of 13- and 14-year-old swimmers, 66% of 15- and 16-year-old swimmers, and 73% of elite swimmers had a history of interfering shoulder pain (8). A recent study of National Collegiate Athletic Association (NCAA) I-A swimmers showed that shoulder and upper arm injuries accounted for 31% of injuries in males and 36% in females. Back and neck injuries were the second most frequent areas injured (6).
When stroke mechanics need correction, the use of an underwater video can help clarify the errors. Working with a qualified coach is important.
UPPER EXTREMITY INJURIES
Swimmer’s Shoulder
Shoulder pain is the most common complaint in competitive swimmers. Nearly 50% of collegiate and masters swimmers report shoulder pain lasting at least 3 weeks (13).
Swimmer’s shoulder refers to shoulder tendinopathy or impingement. Typically, the swimmer feels maximum pain at the beginning of the pull-through phase. Often, the swimmer will swim through this pain for weeks until the pain is present throughout the entire freestyle stroke.
Fatigue, muscle imbalance, and shoulder laxity contribute to the development of swimmer’s shoulder. Land and in-water training can each play a factor in injury development.
Typical treatment includes ice, training regimen modification, anti-inflammatory medication, and occasionally subacromial corticosteroid injection. Rarely is surgery necessary.
The swimmer should li not clear whether altering this angle could enhance performance or reduce injury. During the underwater phase, the shoulder internally rotates and adducts as the arm follows an S-shaped path to propel the body forward (9). The elbow should point toward the sidewall during this phase. The upper trapezius, rhomboids, supraspinatus, and deltoid all function in combination to position the scapula and humerus for hand entry and exit. It is important that the neck be extended around 30-45 degrees to decrease drag and reduce cervical strain. The athlete looks forward with the hairline just cresting the water surface. Some have advocated that the athlete look straight down without much cervical extension at all.
The flutter kick helps stabilize the swimmer’s trunk. This kick starts at the hip and simulates a motion similar to kicking off a loose shoe. The knees should flex only 30-40 degrees. Flexion at the hip is minimal.
The swimmer must focus on the coordinated motion of both the upper and lower extremity. If the swimmer fails to kick throughout the stroke, the body will lose some of its buoyancy, and more drag is created. The upper extremity will then compensate, placing more stress at the shoulders.
Bilateral breathing helps the swimmer develop equal pulling strength in both arms and helps ensure equal body roll on each side (<A onclick="if (window.scroll_to_id) { scroll_to_id(event,'R6-105'); return false; }" class=LK href="#R6-105" name=to-R6-105 xpath="/CT{06b9ee1beed59419fa2bedb37ace85f4ef50397bb3c2ea48f132154d6696ac7a4193a8d1e1ebf50ad49ba55b042ff138}/fatigue. The level of training in duration and intensity is typically much greater than most of these athletes are used to at a club or high school level.-
Prevention of future injury includes correcting stroke mechanic problems by working with a swimming coach while strengthening the rotator cuff and scapular stabilizing muscles. The article “Shoulder Injury Prevention” reviews exercises for the uninjured athlete (14).
SHOULDER INSTABILITY
In the swimmer, excessive shoulder mobility can functionally allow the athlete to have a more powerful stroke, but it is just this excessive motion that could also lead to overstretch of the supporting shoulder structures, ultimately resulting in pain and decreased performance. It is a fine balance. A stretched shoulder capsule can lead to subluxation and repeat injury, keeping the athlete poolside.
Instability can be anterior, posterior, inferior, or a combination. The more unstable the glenohumeral joint, the greater is the risk of developing a labral tear, a Hill-Sachs lesion, or a Bankart lesion. Radiographs, including an axillary view, should be obtained. If a labral tear is suspected, a magnetic resonance imaging (MRI) arthrogram can be ordered, but some of the newer MRI machines can identify labral injury without an injection.
The mainstay of treatment is rotator cuff muscle strengthening and scapular stabilization.Related posts:
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