PRACTICAL SPORTS MEDICINE

Title: Biomechanical aspects of injury in specific sports

Introduction

The biomechanical aspects of shoulder and medial knee pain leading to injury in swimmers are

of paramount importance due to the high prevalence of these issues in the swimming population.

Shoulder pain, often referred to as "swimmer's shoulder," is a common complaint among

swimmers, with a prevalence ranging from 40% to 91% (Othman, 2019). The repetitive forceful

nature of swimming has been linked to shoulder laxity, impingement pain, and tendinopathy,

particularly in the supraspinatus tendon (Sein et al., 2008). Additionally, intrinsic factors such as

joint laxity, postural deficits, and muscle strength imbalances have been identified as

contributors to swimmer shoulder pain (Nichols, 2015). Furthermore, the thickness of the

supraspinatus tendon has been associated with years and hours of training, highlighting the

biomechanical impact of swim training volume on shoulder health (Feijen et al., 2020).

In the case of medial knee pain, breaststroke swimmers are particularly susceptible, with 47%

experiencing thickened and tender medial plica, leading to pain and dysfunction (Wanivenhaus

et al., 2012). Biomechanical studies have also emphasized the role of muscle activity, especially

scapular stabilizers and shoulder rotators, in the development of shoulder problems in overhead

athletes, including swimmers (Sousa et al., 2019). Moreover, the altered stroke biomechanics

resulting from muscle stiffness may predispose swimmers to shoulder pain (Feijen et al., 2020).

The importance of addressing these biomechanical aspects is underscored by the need for
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preventive measures, such as exposure reduction, cross-training, and specific stretching and

strengthening programs, to mitigate shoulder injury and pain in swimmers (Tate et al., 2012).

The biomechanical aspects of shoulder and medial knee pain in swimmers are multifaceted,

involving factors such as training volume, muscle imbalances, and stroke biomechanics.

Understanding and addressing these biomechanical factors are crucial for injury prevention and

the overall well-being of competitive swimmers.

A conceptual approach to injury prevention

Injury prevention in swimmers requires a comprehensive approach that addresses the specific

risk factors associated with shoulder and knee pain. A conceptual approach to injury prevention

should involve a multifaceted strategy based on the identified risk factors. Firstly, understanding

the epidemiology of injuries in swimmers, particularly shoulder and knee injuries, is crucial

(Wanivenhaus et al., 2012). This knowledge provides the foundation for targeted prevention

strategies. For instance, dry-land strength training programs focusing on shoulder rotator muscles

have shown effectiveness in preventing shoulder injuries in competitive swimmers (Batalha et

al., 2020). Additionally, addressing muscle imbalances, particularly in the shoulder, through

targeted training programs can mitigate the risk of shoulder injuries, especially in elite adolescent

swimmers (Drigny et al., 2020).

Furthermore, core stability training has been highlighted as a crucial component in the

rehabilitation plan for swimmers with shoulder injuries, emphasizing the importance of proximal

stability for safe distal mobility across the shoulder joint (Abdelmohsen et al., 2021). It is
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essential to consider the long-term impact of injuries, as evidenced by an 11-year follow-up

study on artistic swimmers, which emphasizes the need for better knowledge and prevention of

shoulder hyper-solicitation injuries (Vignaud et al., 2023). Additionally, a mixed-methods

approach to injury prevention in para swimming underscores the necessity of incorporating

strengthening, stretching, and endurance training in injury prevention programs for swimmers

(Salerno et al., 2022).

Biomechanical assessments have been suggested as beneficial in the management and prevention

of injuries and pain in swimmers' vulnerable joints (Haghpanah et al., 2022). Moreover,

understanding the musculoskeletal dysfunctions associated with swimmers' shoulder is crucial

for developing rehabilitation strategies and injury prevention programs (Struyf et al., 2017).

Finally, injury surveillance and potential prevention strategies should focus on the shoulder for

in-pool activities and the axial spine for cross-training activities, highlighting the importance of a

comprehensive approach to injury prevention (Wolf et al., 2009).

In conclusion, a conceptual approach to injury prevention in swimmers should encompass

targeted strength training, addressing muscle imbalances, core stability training, long-term injury

impact assessment, biomechanical assessments, and comprehensive injury surveillance. By

integrating these elements, a holistic and effective injury prevention program can be developed

to mitigate the risk of shoulder and knee injuries in swimmers.

Summary
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Biomechanical analysis of shoulder and medial knee pain in swimmers is crucial for

understanding and addressing the injuries prevalent in this athletic population. Shoulder pain is a

common musculoskeletal complaint among swimmers, with a reported prevalence between 40%

and 91% (Wanivenhaus et al., 2012; Johnson et al., 1987). The differential diagnosis for

swimmer shoulder pain includes back pain, rotator cuff injuries, and cumulative trauma disorders

(Nichols, 2015). The scapula's involvement in shoulder injuries has been highlighted,

emphasizing the clinical implications for evaluation and treatment (Kibler et al., 2013). In

addition, shoulder pain resulting from glenohumeral instability is common among competitive

swimmers (O’Donnell et al., 2005). Furthermore, stroke errors have been identified as potential

risk factors for shoulder pain in swimmers (Virag et al., 2014). Regarding medial knee pain, it is

essential to consider the biomechanical risk factors and their implications for injury progression.

Lateral wedge insoles have been studied for their effects on reducing biomechanical risk factors

for medial knee osteoarthritis progression, with the first meta-analysis showing their impact on

relevant parameters (Arnold et al., 2016). Similarly, valgus knee bracing has been found to

decrease measures of medial knee compressive force and alter the distribution of load across the

knee, indicating its potential in mitigating medial knee pain (Moyer et al., 2015). Furthermore,

the relationship between reductions in knee loading and immediate pain response while wearing

lateral wedged insoles in knee osteoarthritis has been examined, suggesting a potential link

between biomechanical interventions and pain reduction (Jones et al., 2014). Additionally, the

use of a lightweight medial unloader orthosis has been shown to effectively reduce external knee

adduction moment and pain sensation during daily activities in patients with medial knee

osteoarthritis (Brand et al., 2017). Understanding the biomechanical aspects of shoulder and

medial knee pain in swimmers has broader implications for injury prevention and performance
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enhancement. By identifying the biomechanical determinants related to swimming performance,

it is possible to implement training adaptations for swimmers with shoulder pain, thereby

improving their overall performance and reducing the risk of injuries (Barbosa et al., 2010;

Kreulen et al., 2022). Moreover, the interplay between dry-land strength and conditioning and

stroke biomechanics in young swimmers has been studied, highlighting the potential for strength

and conditioning programs to influence stroke biomechanics and, consequently, injury risk

(Morais et al., 2018). Therefore, a comprehensive understanding of the biomechanical aspects of

shoulder and medial knee pain in swimmers not only aids in injury prevention and management

but also contributes to optimizing athletic performance.

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