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Shoulder Pain in Elite Swimmers: Primarily Due to Swim-volume-induced Supraspinatus Tendinopathy
  1. Mya Lay Sein (mlsein{at}
  1. Orthopaedic Research Institute, Australia
    1. Judie Walton (j.walton{at}
    1. Orthopaedic Research Institute, Australia
      1. James Linklater (linklj{at}
      1. Castlereagh Imaging, Australia
        1. Richard Appleyard
        1. Orthopaedic Research Institute, Australia
          1. Brent Kirkbride
          1. New South Wales Institute of Sport, Australia
            1. Donald Kuah
            1. New South Wales Institute of Sport, Australia
              1. George AC Murrell (murrell.g{at}
              1. Orthopaedic Research Institute, Australia


                Background/Hypothesis: Shoulder pain in elite swimmers is common and its pathogenesis is uncertain.

                Hypothesis/Study Design: We used a cross-sectional study design to test Jobe’s hypothesis that repetitive forceful swimming leads to shoulder laxity which in turn leads to impingement pain.

                Methods: Eighty young elite swimmers (13-25 years of age) completed questionnaires on their swimming training, pain, and shoulder function. They were given a standardized clinical shoulder examination, and tested for glenohumeral joint laxity using a non-invasive electronic laxometer. 52/80 swimmers also attended for shoulder magnetic resonance imaging (MRI).

                Results: 73/80 (91%) swimmers reported shoulder pain. Most (84%) had a positive impingement sign and 69% of those examined with MRI had supraspinatus tendinopathy. The impingement sign and MRI-determined supraspinatus tendinopathy correlated strongly (rs=0.49, p<0.00001). Increased tendon thickness correlated with supraspinatus tendinopathy (rs=0.37, p<0.01). Laxity correlated weakly with impingement pain (rs=0.23, p<0.05) and was not associated with supraspinatus tendinopathy (rs=0.14, p=0.32). The number of hours swum/week (rs=0.39, p<0.005) and weekly mileage (rs=0.34, p=0.01) both correlated significantly with supraspinatus tendinopathy. Swimming stroke preference did not.

                Conclusions: These data indicate: (1) supraspinatus tendinopathy is the major cause of shoulder pain in elite swimmers; (2) this tendinopathy is induced by large amounts of swimming training; and (3) shoulder laxity per se has only a minimal association with shoulder impingement in elite swimmers. These findings are consistent with animal and tissue culture findings which support an alternate hypothesis: the intensity and duration of load to tendon fibers and cells causes tendinopathy, impingement, and shoulder pain.

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