The Effect of Exercise Therapy Interventions on Shoulder Pain and Musculoskeletal Risk Factors for Shoulder Pain in Competitive Swimmers: A Scoping Review

Abstract

Context: Shoulder pain is the main cause of missed or modified training in competitive swimmers. Exercise therapy can improve the outcomes, yet uncertainty exists regarding the characteristics of these interventions. Objectives: The primary aim was to describe the evidence base relating to the effectiveness of exercise therapy interventions on shoulder pain and shoulder musculoskeletal risk factors for shoulder pain in swimmers. The secondary aim was to identify gaps in the literature and provide recommendations for future research and practice. Evidence Acquisition: A scoping review methodology was applied through the search of MEDLINE, PubMed, Scopus, Web of Science, and CINAHL databases. The authors included any research studies (except clinical commentaries and conference papers) that assess the effect of exercise therapy on shoulder pain and musculoskeletal risk factors for shoulder pain in swimmers. The literature was critically appraised using the Modified Down and Black checklist. Evidence Synthesis: From 452 papers identified, 14 studies were included in this review. An exercise program of 6 to 8 weeks, including strengthening exercises (shoulder external rotator and scapula retractor muscles) and stretches (pectoral muscles), can decrease the incidence of shoulder pain in swimmers. Furthermore, a combination of exercises and stretches with manual therapy techniques can help to decrease shoulder pain in injured swimmers. Regarding risk factors, a strengthening program of more than 12 weeks increased shoulder external rotation peak force, endurance, and external rotation/internal rotation ratio; however, this was not associated to decreases in pain. Finally, open kinetic chain exercises and a dry-land program are superior to close kinetic exercises and water training for improving shoulder external rotation strength and endurance. Conclusions: Exercise therapy has positive effects on reducing the incidence of shoulder pain, the management of shoulder pain, and improving shoulder musculoskeletal risk factors in competitive swimmers. However, due to methodological limitations of the studies, caution must be used when applying these results in practice. Future research should focus on high-quality randomized controlled trials for prevention and management of shoulder pain in swimmers.

Effects of a dry-land strengthening exercise program with elastic bands following the Kabat D2 diagonal flexion pattern for the prevention of shoulder injuries in swimmers

“…In the present study, the inclusion of this risk factor as an inclusion criterion may have provided meaningful results in the study population, as altered scapular kinematics has also been shown to be a potential risk factor (Su et al, 2004). In contrast, there is no consensus on which of the therapeutic approaches developed to date to control the agonist-antagonist ratio is the most appropriate (Yoma et al, 2022). The present study did not obtain the expected results in terms of muscle strength and shoulder ROM.…”

Shoulder pain and injury risk factors in competitive swimmers: A systematic review

“…Due to the impact of shoulder fatigue during swimming, it is possible that increased endurance of the posterior rotator cuff can enhance the stability of the humeral head in the glenoid. In turn, this may help mitigate the shoulders tendency for functional impingement, particularly during longer swimming sets 51 . Future studies should reappraise shoulder strength‐endurance, particularly the posterior shoulder test, to confirm its association with shoulder pain or injury, and whether any such association is causal or consequent.…”

“…Currently, it is not known if altering any risk factor will decrease injury incidence. Preliminary evidence suggests exercise‐based programs in swimmers could reduce shoulder injury incidence 48,51,60,61 . Nevertheless, before meaningful conclusions can be drawn, subsequent investigations should include the following methodological improvements, larger samples, refined pain definitions, and longer monitoring periods.…”

“…In turn, this may help mitigate the shoulders tendency for functional impingement, particularly during longer swimming sets. 51 Future studies should reappraise shoulder strengthendurance, particularly the posterior shoulder test, to confirm its association with shoulder pain or injury, and whether any such association is causal or consequent.…”

“…Preliminary evidence suggests exercise-based programs in swimmers could reduce shoulder injury incidence. 48,51,60,61 Nevertheless, meaningful conclusions can be drawn, subsequent investigations should include the following methodological improvements, larger samples, refined pain definitions, and longer monitoring periods. For swimming practitioners looking to use the presented evidence for their athlete monitoring or injury prevention programs, we highlight the following areas for consideration: (i) A swimmer's ROM is not likely a predictor of injury.…”