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Shoulder pain swimming laps, low back pain treatment - Reviews

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The shoulder joint is comprised of three bones: the scapula (also known as the shoulder blade), the clavicle (or collarbone), and the humerus (upper arm bone).
In overhead athletes, swimmers are the most susceptible to shoulder strain because of the constant motion and arm strength required.
In swimmers with shoulder pain, the subscapularis may fatigue earlier, or diminish function to avoid pain during internal rotation at pull-through.
Greek researchers sought to find the most effective way to train the rotator cuff muscles and restore strength balance around the shoulder joint(3). While studies conclude that any programme to strengthen the shoulder will yield positive results, researchers at Northeastern University in Boston, sought the most specific exercise for the supraspinatus muscle(5).
The shoulder is a ball and socket joint held together by ligaments and tendons connecting the humerus to the scapula and clavicle.
It is the only rotator cuff muscle to be located on the anterior portion of the shoulder joint and resists motion of the humeral head in the forwards direction.
Both tendons pass over the posterior portion of the shoulder joint and insert on the backside of the arm bone. Laxity in the shoulder ligaments means that when the arm moves, the head of the humerus does not stay snugly depressed within the glenoid fossa. Scapular stabilising muscles may also be weak, interrupting the normal scapular-humeral rhythm required for full shoulder range of motion.

After evaluating EMG data from the shoulder muscles of athletes performing 12 different exercises, they concluded that performing seven of the exercises activated all the important muscles for throwing.
Being connected in this way allows the shoulder the greatest mobility of any joint in the body. At that point, the scapula begins to rotate away from the spine, effectively extending the position of the shoulder in space, moving the acromion away from the head of the humerus, and allowing the arm to abduct the remaining 60 degrees(2). This is the position after release in throwing, when the rotator muscles are contracting eccentrically, and at the beginning of pull-through phase in freestyle swimming, when the rotator cuff muscles are working concentrically. While rotator cuff injuries are degenerative in nature and their incidence increases with age, the sustained overuse of the shoulder in athletes seems to speed up the process.
The athlete may complain of a dull ache or tenderness at the very top of the shoulder joint, and experience pain as he moves the arm away from the body. With a painful shoulder, a swimmer may exhibit early hand exit, a dropped elbow during recovery, or a wider hand entry(2).
The aching pain in the shoulder becomes more prevalent, often increasing at night, and inhibiting performance of the offending athletic manoeuvre. Therefore, complete range of motion in the shoulder requires synchronous activation of the rotator cuff with the other shoulder muscles.
This applies particularly to swimmers, who often demonstrate increased shoulder range of motion.

Swimmers with increasing pain may demonstrate an asymmetric pull and have difficulty staying in the centre of the lane. Making the front of the shoulder more mobile only increases the vulnerability of the rotator cuff.
Changes in the beat of kicking or an increase in body roll may be compensatory strategies to avoid pain in the shoulder. In fact, one pair of authors contend that knowing which shoulder stretches not to do is more important than doing any at all(6)! If any of these compensations are noted, a swimmer should be pulled immediately from a workout and tested for shoulder injury.
The wall stretch and the partner stretch (pulling the arm from behind) should be eliminated from every athlete’s programme!

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