By Luqman Shaikh - Sports Scientist (UK), Sports Physiotherapist
The prevalence of shoulder pain in sports is quite high, especially in overhead sports that require repetitive overhead use of the shoulder joint. Sports such as swimming, tennis and overhead sports subject the shoulder to go under stress, fatigue, micro-trauma and laxity of static and dynamic stabilizers which alter functioning of the shoulder and predispose it to injury.
In the recent years, large number of sports have been studied in the literature including swimming, tennis and golf activities involving overhead activity. The cause of shoulder pain in athlete is usually due to the repetitive and high-energy forces going through the shoulder, leading to chronic stresses placed on the stabilizing structures of the shoulder.
When the stresses are applied to the shoulder it may lead to progressive damage to stabilizing structures. With continued stress, the static stabilizers (glenoid labrum, joint capsule, glenohumeral ligaments) of the shoulder becomes hyper-elastic, enabling anterior glenohumeral subluxation. Initially the dynamic stabilizers (the rotator cuff muscles, long head of the biceps tendon, scapulo-thoracic motion, and other shoulder girdle muscles such as the pectoralis major, latissimus dorsi, and serratus anterior) can compensate for this mild instability with increased muscle activity. However, with increased activity fatigue results, which in turn leads to overloading of these compensatory mechanisms.
Prevalence of Shoulder Injury in Swimmers
In the swimming population, the shoulder joint is particularly vulnerable with 90% of propulsive forces coming from the upper extremity. The shoulder is the most injured area in swimmers with studies showing different prevalence levels. A study revealed prevalence of shoulder pain in 75% of 1200 competitive swimmers from United States. Another study on high-level swimmers demonstrated a prevalence of interfering pain in 23% of athletes. Signs of impingement with orthopedic evaluation was revealed in 50% of the swimmers with pain.
Prevalence of Shoulder Injury in Tennis
Elite tennis players are highly skilled sports players, but because of the intense practice, week on week tournaments, high intensity training, the repair time is hampered causing overuse shoulder injuries. A recent study investigated shoulder injuries in tennis players and determined a prevalence of 32% for overuse injuries of the shoulder, causing a mean absence from tennis of 2 months plus (9.4 weeks) throughout a competitive year. Shoulder pain represents third most common injury among both female and male tennis players after ankle and knee pain and the second most common overuse-related condition, accounting for 8–20% of all tennis injuries.
Prevalence of Shoulder Injury in Golf
The non-dominant shoulder is particularly vulnerable to injury, with most golf injuries occurring as a result of the golf swing, and mostly at impact of the head of the golf club with the turf. The prevalence of golf-related shoulder pain has been demonstrated at 12%. Rotator cuff injury and subacromial impingement are among the most common problems in golfers. In golf players shoulder pain was reported by 37% of the players and ongoing shoulder pain by 20% of the players. In a professional golfer, the shoulder is the third most commonly injured body area, after the lumbar spine and the wrist or hand.
Conclusion
The most common clinical diagnosis involves dysfunction of the rotator cuff with signs of impingement seen in 74% of shoulder pain sufferers. Therefore, proper diagnosis is important. Injury to the shoulder leads to time lost from training and competition. Risk factors for the development of a shoulder problem can be prevented with biomechanical correction, rotator cuff stability and conditioning. Prevention of further injuries or recurrence of injury depends on providing the athlete with an accurate diagnosis and implementing a structured prehab and rehabilitation program.
We at Prehab 121 Physiotherapy use advanced Prehab 121 BodyScan Athlete Musculoskeletal Assessment to understand in depth analysis to diagnosis and find out the root cause of the pain, dysfunction and plan a specific rehabilitation program.