Conservative management of shoulder pain in swimming

Swimming fast is a complex skill that requires physical attributes to maximize propulsive force whilst minimizing drag forces. The models that have historically been used to explain the incidence of shoulder pain in swimmers have been very mechanical in nature. The interplay between the requirement of the sport, the shoulder's mechanical restraints, the biomechanical effect of the kinetic chain, and the powerful influence of the neuromuscular system must be appreciated in pathological and rehabilitation models. The interaction between flexibility, strength, fatigue, muscle inhibition, proprioception, muscle patterning and pain is complicated and poorly understood. It is, however, in these complex intertwining relationships that the origin of shoulder pain in swimming must lay and therefore where the conservative management of that pain must have its effect. (C) 2004 Elsevier Ltd. All rights reserved.