SWIMMERS

SHOULDER
Ivana Lovric, BSC Sports Therapy
CASE STUDY:
- Male professional freestyle
swimmer

- grade 2 shoulder impingement

-Mechanism of injury: repetitive

trauma on rotator cuff tendons
 >50-80%
prevalence
among
competitive
swimmers

> More than

50% linked with
rotator cuff
tendonitis

McMaster WC, Troup J (1993) (A survey of

interfering shoulder pain in US
competitive swimmers; Am J Sports Med
2:67-70)
 • Compression of
subacromial
structures
against
coracoacromial
ligament and
anterior inferior
acromion

C.S Neer (2005) Anterior acromioplasty

for the chronic impingement syndrome
in the shoulder( J Bone Joint Surg Am
pg 1399)
• Stages of subacromial impingement:
Neer’s classification
•
Stage 1: oedema and haemorrhage
Stage 2: fibrosis and tendinitis
Stage 3: bone spurs and tendon rupture
Rehabilitation process (ROM)
Phase 1
90° Shoulder flexion
-patient standing
-raise straight arm to 90°, externally rotated
-3 sets/6 reps/holding 5 seconds/10 sec rest
between sets

Progression: increasing of reps and holding

time
Regression: decrease of reps, no holding
time, decrease to 45°
Rehabilitation process
(ROM)
Phase 2

Shoulder internal rotation stretch

-hold a towel with affected arm
behind back and use other arm to
pull affected arm
- 3 sets/3 reps/10 sec hold between
sets/ 15 sec rest between sets

Progression: add 5 second hold

between reps
Regression: decrease sets and reps
or remove holding time
Rehabilitation process –
Motor Control Excercises
Phase 1

Scapular rolling
-lying sideways on non injured side
-place pillow to support head and affected
arm
-roll scapula toward centre of the back
- 3 sets/2 reps/5 sec hold each rep/ 10 sec
rest between sets

Progression: 10 sec hold each rep

Regression: slight roll
Rehabilitation process –
Motor Control Excercises

Phase 2

Scapular roll, arms addes

- sitting position, straight back
- elbows at 90°, roll shoulder blades
toward centre and hold, move arms
back and forth

3 sets/5 reps/each rep 5 second

hold/ 10 sec rest between sets

Regression: no holding on reps

Progression: adding minimum
weigths
Rehabilitation process
(Strength and endurance
excercises)

Phase 1
Wall push
- 90° flexion, place hand on the
wall
- Slightly push for 3 seconds
- 4 sets/2 reps/ 10 sec rest
between sets
Progression: prolongate push time
to 5 seconds
Regression: decrease number of
sets
Rehabilitation process
(Strength and endurance
excercises)
Phase 2
Pendulum with added weights
- Bend and hold on to something with
non injured hand, do 5 circle motions
for each rep
3 stes/3 reps/10 second rest between
sets

Progression: adding more circle

movements, adding more weight
Regression: remove weights
Outcome measurements
Numeric Pain Rating Scale (NPRS)
 Outcome
measurements:
Goniometer
THANK YOU FOR YOUR ATTENTION