Swimmer’s injuries and treatment

Subscapularis tendinopathy

A July 2022 paper (1) examined the prevalence of an MRI documented injury in elite swimmers’ shoulders compared to non-swimmer’s shoulders. Sixty (aged 16-36 years) elite Australian swimmers and 22 healthy active, age and gender matched controls (aged 16-34 years) entered the study. All participants completed a demographic, and training load and shoulder pain questionnaire and underwent shoulder MRI.

  • Subscapularis and supraspinatus tendinopathy was the most common tendon abnormality identified in swimming participants, being reported in at least one shoulder in 48/60 (73 %) and 46/60 (70 %) swimmers, respectively. There was no significant difference between dominant and non-dominant shoulders for either tendinopathy, however, grade 3 tendinopathy was significantly more prevalent in subscapularis than in supraspinatus
  • Compared with controls, significantly more abnormalities were reported in swimmers’ shoulders in both subscapularis and supraspinatus tendons along with the labrum and acromioclavicular joint.

Conclusions: “This data confirms that tendon abnormality is the most common finding in elite swimmers’ shoulders. Furthermore, that subscapularis tendinopathy is not only as common as supraspinatus but has a greater prevalence of grade 3 tendinopathy.” Next the researchers of this stuyd suggested, the MRI is a tool to help assess the swimmer’s shoulder, but not be the sole tooil of assessment. Here the researchers wrote: “With significant varied abnormalities including tendinopathy being so common in both symptomatic and asymptomatic shoulders of swimming athletes’, clinicians should consider imaging findings alongside patient history, symptom presentation and clinical examination in determining their relevance in the presenting condition.”

Therapy for Swimmer’s Shoulder

A June 2022 study wrote (4): “Therapeutic exercise seems to minimize musculoskeletal risk factors related to swimmer’s shoulder. However, there is an absence of a qualitative evaluation of these programs and a great variability regarding the characteristics of exercises.”

Orthostatic intolerance

A July 2022 paper (2) looked at orthostatic intolerance (lightheadedness, fainting or feeling faint, increased heart beat when arising to a standing position) as a potential contributor to prolonged fatigue and inconsistent performance in elite swimmers.

In this paper, the authors described five elite swimmers with prolonged fatigue and athletic underperformance. Based on (previous) work in myalgic encephalomyelitis /chronic fatigue syndrome, we focused on orthostatic intolerance as a possible contributor to symptoms.

  • Participants were referred for evaluation of fatigue and underperformance to the Chronic Fatigue Clinic at the Johns Hopkins Children’s Center. All patients were evaluated for overtraining syndrome, as well as for features commonly seen in myalgic encephalomyelitis/chronic fatigue syndrome. The latter included joint hypermobility, orthostatic intolerance, and non-IgE mediated milk protein intolerance. Orthostatic intolerance was tested by performing a ten-minute passive standing test or a head-up tilt table test.

Orthostatic testing provoked fatigue and other symptoms in all five swimmers, two of whom met heart rate criteria for postural tachycardia syndrome. Treatment was individualized, primarily consisting of an increased intake of sodium chloride and fluids to address orthostasis. All patients experienced a relatively prompt improvement in fatigue and other orthostatic symptoms and were able to either return to their expected level of performance or improve their practice consistency.

The author’s concluded: “We suggest that passive standing tests or formal tilt table tests be incorporated into the clinical evaluation of athletes with fatigue and underperformance as well as into scientific studies of this topic. Recognition and treatment of orthostatic intolerance provides a new avenue for improving outcomes in underperforming athletes.”

A 2022 update to the pulication STATPERALS writes about Surfer’s Ear: “Surfer’s ear, or exostoses of the external auditory canal, is a slowly progressive disease from benign bone growth as a result of chronic cold water exposure. It is a condition most commonly associated with surfing but can be seen in anyone repeatedly exposed to cold water such as swimmers, divers, kayakers, and participants of other maritime activities. Although usually asymptomatic and benign, external auditory exostoses (EAE) can cause conductive hearing loss, recurrent otitis externa, otalgia, otorrhea, cerumen impaction, and water trapping.”

1 Holt K, Delbridge A, Josey L, Dhupelia S, Livingston Jr G, Waddington G, Boettcher C. Subscapularis tendinopathy is highly prevalent in elite swimmer’s shoulders: an MRI study. Journal of Science and Medicine in Sport. 2022 Jul 14.
2 Petracek LS, Eastin EF, Rowe IR, Rowe PC. Orthostatic Intolerance as a Potential Contributor to Prolonged Fatigue and Inconsistent Performance in Elite Swimmers.
3 Landefeld K, Bart RM, Lau H, Cooper JS. Surfer’s Ear. InStatPearls [Internet] 2022 May 8. StatPearls Publishing.
4 Tavares N, Dias G, Carvalho P, Vilas-Boas JP, Castro MA. Effectiveness of Therapeutic Exercise in Musculoskeletal Risk Factors Related to Swimmer’s Shoulder. European Journal of Investigation in Health, Psychology and Education. 2022 Jun;12(6):601-15.

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