Introduction: “Swimmer’s shoulder” is the colloquial phrase describing pain and injury in the anterolateral region of the shoulder and is reported by 40-91% of adolescent competitive swimmers (1-3). Early detection of shoulder pain is beneficial to long-term health of athletes across similar sports requiring repetitive overhead shoulder motions as shoulder pain can signal imminent overuse injury (4). However, prior studies indicate that 86% of athletes implicitly or explicitly endorse swimming through practice pain, and 84% express reluctance towards the idea of taking time off (5). Such normalization is likely derived from theories that relate attitudes towards pain to external circumstances and social mores (6, 7). As such, we sought to better understand adolescent competitive swimmers’ outlooks and perceptions related to shoulder pain. In doing so, injury prevention protocols can be better designed to address behavioral elements contributing to the ubiquity, and potential delay in treatment, of swimmer’s shoulder. Methods: Questionnaires were developed for swimmers (ages 13-18). Information regarding demographics, practice programs, medication, injury reporting and detection, and psychosocial beliefs about swimmer’s shoulder was solicited. The surveys were distributed electronically to coaches listed in the California Interscholastic Federation (CIF) Swimming database. Surveys were subsequently distributed to swimmers after receiving parental consent as necessary. Results Of the 150 participants, 76.7% of swimmers reported experiencing shoulder pain within the last 12 months. Agreement with statements concerning shoulder pain perception between swimmers with and without shoulder pain is represented in Figure 1. Swimmers generally agree with the statement “shoulder pain is normal among competitive swimmers,” although the difference between those with and without shoulder pain was insignificant (p = 0.083) (Figure 1). Swimmers who only swim on a seasonal high school team and swimmers who swim on both club and high school teams did not significantly differ in their agreement to the same statement (4.0 vs. 4.1, p = 0.455). The majority of swimmers agree that “mild shoulder pain should be tolerated” if they want to become successful swimmers (66.0%) and that “taking time off from swimming is not ideal” if they want to become successful swimmers (61.0%) (Figure 2). Conclusion As noted in previous research, it is common for swimmers to normalize swimmer shoulder pain (5). Regardless of swim organization type (high school vs. high school and club), the surveyed cohort generally perceived shoulder pain as normal, suggesting that both elite and non-elite swimmers normalize pain. Furthermore, perceptions of the normality of shoulder pain did not differ significantly between swimmers with shoulder pain and swimmers without shoulder pain, suggesting that normalization of shoulder pain can contribute to the development of shoulder pain. Understanding perceptions towards shoulder pain will allow coaches, trainers, and parents to optimize injury prevention and treatment of swimmer’s shoulder.
No Pain, No Gain: Normalizing Attitudes Associated with Shoulder Pain in Adolescent Swimmers
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Eli M. Cahan, Shin Mei Chan, Nicole A. Segovia, Charles Chan; No Pain, No Gain: Normalizing Attitudes Associated with Shoulder Pain in Adolescent Swimmers. Pediatrics July 2020; 146 (1_MeetingAbstract): 60–63. 10.1542/peds.146.1MA1.60
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