Elite and competitive swimmers log between 60,000 and 80,000 meters weekly — swimming the length of an Olympic-sized pool 1,200 times — which places significant stress on their shoulder joints. “The upper body provides 90 percent of the propulsive force to move through the water. Due to the amount of force generated and the range of motion required to swim efficiently, the shoulder needs to have perfect mechanics to avoid injury,” says Dr. Elizabeth Matzkin, lead study author of a literature review in the August issue of Journal of the American Academy of Orthopaedic Surgeons and assistant professor of orthopaedic surgery at Harvard Medical School.
Swimming is an endurance sport but “swimmer’s shoulder” — a broad non-medical term often used to describe a variety of shoulder injuries — can affect swimmers at all levels. According to the literature review authors, many shoulder injuries are preventable with proper technique, training, stretching, and strengthening.
Shoulder pain affects 40 to 91 percent of competitive swimmers. Overuse and poor shoulder mechanics can cause muscle imbalances, decreased range of motion of the shoulder, and less efficient swim strokes, all placing athletes at greater risk for further injury. The most common swimming-related injuries include:
Impingement — As swimmers becomes fatigued, the pectoralis muscles (commonly known as “pecs”) compensate for tired muscles, which can cause the peak of the shoulder blade to rub (impinge) against the rotator cuff (tendon and bursa), stress the anterior (front of the body) ligaments, and create tears in the tissue that holds the top of the arm bone in place.
Scapular dyskinesis — Intense, repetitive rotation of the shoulder blade over the chest wall can overstretch and loosen the upper back muscles that keep the shoulder bones in a healthy position. Abnormal shoulder mechanics (scapula dyskinesis) can cause pain near the collarbone when the upper chest muscles tighten to compensate for the loosened upper back muscles.
Glenohumeral internal rotation deficit (GIRD) — Intense, repetitive rotation of the shoulder blade can cause the front shoulder ligaments to overstretch and loosen. This can cause the soft tissues and muscles in the back to tighten to compensate for the loosened front shoulder muscles while limiting the internal rotation of the shoulders, which puts swimmers at greater risk for rotator cuff tears. Swimmers must maintain some shoulder looseness to remain competitive. However, about 20 percent of competitive swimmers have hyperlaxity — the ability of joints to move beyond the normal range of motion — which increases the likelihood of greater shoulder instability and susceptibility to pain.
Possible and often subtle signs of shoulder injuries among swimmers may include:
A dropped elbow during the recovery phase of the freestyle stroke.
Excessive body roll, which may signify shoulder pain.
Drooping of the affected shoulder.
“Injury prevention is best accomplished by proper training. Most importantly, swimmers need to stretch, especially the posterior shoulder capsule, and avoid muscle imbalance by strengthening both the rotator cuff and the scapular stabilizer muscle groups,” says Dr. Matzkin. When a swimmer experiences shoulder pain, a thorough physical examination is important to diagnose the source of the pain, whether there is atrophy in the shoulder or reduced strength in the shoulder joint.
Treatment may include nonsurgical (e.g., a combination of ice, stretching, and anti-inflammatory medication, focused rehabilitation to reduce pain) or surgical (e.g., for structural injuries to manage pain rather than to enhance athletic performance) options to potentially prevent future injuries.
Elizabeth Matzkin, Kaytelin Suslavich, David Wes. Swimmer’s Shoulder. Journal of the American Academy of Orthopaedic Surgeons, 2016; 24 (8): 527 DOI: 10.5435/JAAOS-D-15-00313
Data from a review of U.S.-based clinical trials published in Mayo Clinic Proceedings suggest that some of the most popular complementary health approaches — such as yoga, tai chi, and acupuncture — appear to be effective tools for helping to manage common pain conditions. The review was conducted by a group of scientists from the National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health.
Millions of Americans suffer from persistent pain that may not be fully relieved by medications. They often turn to complementary health approaches to help, yet primary care providers have lacked a robust evidence base to guide recommendations on complementary approaches as practiced and available in the United States. The new review gives primary care providers — who frequently see patients with chronic pain — tools to inform decision-making on how to help manage that pain.
“For many Americans who suffer from chronic pain, medications may not completely relieve pain and can produce unwanted side effects. As a result, many people may turn to nondrug approaches to help manage their pain,” said Richard L. Nahin, Ph.D., NCCIH’s lead epidemiologist and lead author of the analysis. “Our goal for this study was to provide relevant, high-quality information for primary care providers and for patients who suffer from chronic pain.”
The researchers reviewed 105 U.S.-based randomized controlled trials, from the past 50 years, that were relevant to pain patients in the United States and met inclusion criteria. Although the reporting of safety information was low overall, none of the clinical trials reported significant side effects due to the interventions.
The review focused on U.S.-based trial results on seven approaches used for one or more of five painful conditions — back pain, osteoarthritis, neck pain, fibromyalgia, and severe headaches and migraine — and found promise in the following for safety and effectiveness in treating pain:
Acupuncture and yoga for back pain
Acupuncture and tai chi for osteoarthritis of the knee
Massage therapy for neck pain with adequate doses and for short-term benefit
Relaxation techniques for severe headaches and migraine.
Though the evidence was weaker, the researchers also found that massage therapy, spinal manipulation, and osteopathic manipulation may provide some help for back pain, and relaxation approaches and tai chi might help people with fibromyalgia.
“These data can equip providers and patients with the information they need to have informed conversations regarding non-drug approaches for treatment of specific pain conditions,” said David Shurtleff, Ph.D., deputy director of NCCIH. “It’s important that continued research explore how these approaches actually work and whether these findings apply broadly in diverse clinical settings and patient populations.”
Nahin RL, Boineau R, Khalsa PS, Stussman BJ, Weber WJ. Evidence-based evaluation of complementary health approaches for pain management in the United States. Mayo Clinic Proceedings, 2016;91(9):1292-1306 DOI: 10.1016/j.mayocp.2016.06.007
Hip strengthening exercises performed by female runners not only significantly reduced patellofemoral pain — a common knee pain experienced by runners — but they also improved the runners’ gaits, according to Indiana University motion analysis expert Tracy Dierks.
“The results indicate that the strengthening intervention was successful in reducing pain, which corresponded to improved mechanics,” said Dierks, associate professor of physical therapy in the School of Health and Rehabilitation Sciences at Indiana University-Purdue University Indianapolis. “The leg was going through more motion, suggesting that the (pain) guarding mechanism was reduced, and coordination or control of many of these peak or maximum angles in the leg were improved in that they were getting closer to occurring at the same time.”
Only in recent years have researchers begun studying the hips as a possible contributor to patellofemoral pain (PFP). This study is the first to focus on hip strength and gait changes during prolonged running. Dierks, director of the Motion Analysis Research Laboratory at IUPUI, discussed his findings at the American College of Sports Medicine annual meeting in Denver.
The runners in Dierks’ study received no training or coaching on proper running form, which makes the improvements more notable. The improvements in mechanics resembled those of uninjured runners, when muscles, joints and limbs move economically and in synch with each other.
About the study
The study involved four runners and a control group comprising another four runners. Hip strength measurements and kinematic data — minute measurements of how the women’s hips, knees and shin bones moved and rotated while they ran — were taken before and after the runners in the control group maintained their normal running schedule for six weeks. The measurements were repeated for all of the runners before and after the next six-week period in which they all performed the hip-strengthening exercises.
The exercises, performed twice a week for around 30 to 45 minutes, involved single-leg squats and exercises with a resistance band, all exercises that can be performed at home. This study is part of an ongoing study involving hip exercises and PFP pain, with 10 runners successfully using the intervention.
After the six-week program, the movement of the hips and knees in relation to each other improved for both groups of runners, demonstrating increases in joint angles between the foot, shin and thigh.
The study used a pain scale of zero to 10, with 3 representing the onset of pain and 7 representing very strong pain — the point at which the runners normally stop running because the pain is too great. The injured runners began the six-week trial registering pain of 7 when they ran on a treadmill and finished the study period registering pain levels of 2 or lower; i.e. no onset of pain.
PFP, one of the most common running injuries, is caused when the thigh bone rubs against the back of the knee cap. Runners with PFP typically do not feel pain when they begin running, but once the pain begins, it gets increasingly worse. Once they stop running, the pain goes away almost immediately. Dierks said studies indicate PFP essentially wears away cartilage and can have the same effect as osteoarthritis. His study participants showed many of the classic signs of PFP, the most prominent being their knees collapsing inward when running or doing a squat exercise move.
Co-authors of “The Effect Of Hip Muscle Strengthening On Pain and Running Mechanics In Females With Patellofemoral Pain” are Rebecca L. Phipps, Ryan E. Cardinal, Peter A. Altenburger, IUPUI.
The above post is reprinted from materials provided by Indiana University.
Lower back pain is a complaint that most people will experience to some degree during their lives. Sitting, standing and running posture in combination with muscular imbalances and weakness in the lumbo-pelvic or “core” region have long been widely accepted factors.
The success of mobility, coordination and strength based treatment is evident in the growing popularity of Physiotherapy exercise prescription over the past 5-10 years.
But…….. Is it possible that your unassuming feet are playing havoc with the rest of your body??
First, let me fill you in on the engineering brilliance of the human foot; 26 bones, 33 joints, 20 muscles within the foot and 13 muscles acting on the foot via the leg, all of which harmoniously work together to perform coordinated, powerful movements step after step.
The foot is designed to absorb initial impact via rolling inward (pronation) and lowering through the arch, maintain a stable base of support then act as rigid lever to propel the body-weight forward.
Unfortunately the foot and its components do not always cooperate. Due to mainly genetic factors, the foot can exhibit varying degrees of mobility resulting in either too much “rolling in” or not enough, ultimately we are left with an impaired ability of the foot to absorb, support and propel.
A rigid high arch foot structure is notoriously deficient at absorbing shock resulting in excessive jarring forces transmitted through the lower leg, pelvis and lumbar spine.
An overly flexible foot with subsequent excess pronation and arch collapse has the tendency to “slap” the ground at initial contact, immediately zapping its powers of shock absorption and setting off a chain of biomechanical events that put your precious lower back in a vulnerable position…..
Excess rear-foot pronation will increase internal rotation of the lower-leg (tibia/fibula). This excessive inward “twist” of the leg progresses all the way through the upper leg, the pelvis and stress on the vertebral column.
The human body can be extremely resilient and adaptable. Therefore, even with a less efficient foot type some individuals remain functional without a hint of discomfort. For others it may be the underlying factor to years of chronic, debilitating back pain.
There are many ways to improve the function of your marvellous feet. They are a musculo-skeletal structure just like any other part of the body ie. “the core”.
The mobility, strength and overall function can be improved with tailored exercise. In some cases additional assistance through specific footwear, with or without foot orthotics may be required to further enhance their function, improve their capacity to absorb shock and protect your back from harm.