Dolor de hombro en nadadores de competición

Background: shoulder pain is the most common problem among competitive swimmers. However, the prevalence varies widely among different studies and external validity is unknown. Also, the characteristics of pain as well as its relation to anthropometric and sports factors are unclear. Moreover, shoulder pain in swimmers has traditionally been blamed on subacromial syndrome, as a result of a repetitive impingement, due to constant movements of the arm above the head. There have been reported many intrinsic mechanisms such as Scapular Dyskinesis (SD), which could lead to this subacromial syndrome. Also, a recent study described the presence of small muscle contractures in these athletes, called myofascial trigger points (MTPs). The MTPs can cause shoulder pain and SD. However, its presence in competitive swimmers has been poorly evaluated so far. Objectives: 1) to determine the prevalence of shoulder pain in competitive swimmers and find out the characteristics of pain as well as its relation to anthropometric and sports factors. 2) to observe in competitive swimmers with and without shoulder pain the presence of SD, and active and latent MTPs, in 19 muscles which can lead to shoulder pain or SD. Participants and methods: 1) Pilot study of prevalence led to the achievement of the first objective. A hundred forty swimmers from 12 to 24 years completed, during a specific training phase, a questionnaire that collected the following variables: age, sex, weight, height, years of practice, specialty, other sports involving the upper limb, exercises with weights and previous episodes of pain, performing stretching and physiotherapy treatment, severity of pain during activity and at rest using the Visual Analogue Scale, location of pain, pain sensation spread from back or neck, or to arm, time of onset in the session, time of onset in the stroke cycle; style to which it is associated, aggravating factors and implications for training. 2) Cross-sectional pilot study aimed at the achievement of the second objective. Five swimmers with shoulder pain and ten swimmers without shoulder pain underwent a physiotherapy assessment of scapular movements through the Scapular Dyskinesis Test (SDT), and were examined to assess the presence of MTPs in the upper trapezius, middle trapezius, lower trapezius, levator scapulae, rhomboid major and iv minor, supraspinatus, infraspinatus, serratus anterior, posterior deltoid, middle deltoid, anterior deltoid, pectoralis major, pectoralis minor, subscapularis, teres major, teres minor, latissimus dorsi, scalene and long head of triceps brachialis, following Simons, Travell & Simons diagnosis criteria. Results: 25.7% swimmers reported shoulder pain at the time of the study. Statistically significant relationships were found between shoulder pain and: previous episodes of pain (p<0.001), an experience over three years (p= 0.014), the Body Mass Index (p= 0.015) and stroke (p= 0.008) and distance (p= 0.011) specialty. Pain was significantly more intense during the resting activity (p<0.001). SD was observed in swimmers with and without shoulder pain. Swimmers with shoulder pain showed a high frequency of active MTPs, mainly in muscles involved in the propulsive phase of the stroke, such as subscapularis, pectoralis major, teres major and minor and triceps brachialis. The MTPs could be a cause of shoulder pain in competitive swimmer. Further studies are needed with larger sample sizes to substantiate the results obtained in the present work.