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Classification System for Treatment of the Painful Shoulder in the Swimming Athlete

For decades, health care providers have been searching for the Holy Grail in terms of the single variable or single high risk factor as the cause for shoulder pain in the swimming athlete.  Recent research by Hill et. al. revealed what we have been observing clinically for over 20 years.  They conducted a systematic review to critically assess the published evidence for risk factors that may predispose a swimmer to shoulder pain and injury.  Here's what they found: "No studies were determined to have a high level of certainty. Clinical joint laxity and instability, internal/external rotation, previous history of pain and injury and competitive level were determined to have a moderate level of certainty. All other risk factors were evaluated as having a low level of certainty. Although several risk factors were identified from the reviewed studies, prospective cohort studies, larger sample sizes, consistent and robust measures of risk should be employed in future research."  Click on the citation below to read the full-text version of this article.

In addition, the United States Olympic Committee spent four years evaluating the elite swimming athlete and their conclusion as of 2017 was as follows: "there is no single variable or multivariate model that identifies a swimmer at risk for shoulder injury."

With the absence of a single variable or multivariate model our conclusion was to  develop a Classification System for treating the painful shoulder in this population.  When treating these athletes, patterns will emerge during your first consultation and it will be clear your swimmer falls in to one of our sub-classifications.  This will streamline the treatment plan and get your swimmer back in the pool, pain free.  For best results, use the classification based treatment paradigm below.  It is well described in an on-line swim course with George Edelman,  Marilyn Pink, and Olympic Coach, Bruce Gemmell via educata.com.  The course is titled The Mechanics of Swimming - Click here to access this course.


Lee Hill, Malcolm Collins & Michael Posthumus (2015) Risk factors for shoulder
pain and injury in swimmers: A critical systematic review, The Physician and Sportsmedicine, 43:4,



The Pathway to Injury Classification System can also be downloaded in PDF - Click Here

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Edelman Spine and Orthopaedic Physical Therapy
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Dover, DE 19901
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