Swim-Training Volume and Shoulder Pain Across the Life Span of the Competitive Swimmer: A Systematic Review

Background: Competitive swimmers are exposed to enormous volumes of swim training that may overload the soft tissue structures and contribute to shoulder pain. An understanding of training factors associated with the injury is needed before practice guidelines can be developed. Objectives: To investigate the relationship between swim-training volume and shoulder pain and to determine swim-training volume and shoulder pain prevalence across the life span of the competitive swimmer. Data Sources: Relevant studies within PubMed, Web of Science, and MEDLINE. Study Selection: Studies that assessed the relationship between a defined amount of swim training and shoulder pain in competitive swimmers. Data Extraction: Twelve studies (N = 1460 participants) met the criteria. Swimmers were grouped by age for analysis: young (<15 years), adolescent (15-17 years), adult (18-22 years), and masters (23-77 years). Data Synthesis: Adolescent swimmers showed the highest rates of shoulder pain (91.3%) compared with other age groups (range = 19.4%-70.3%). The greatest swim-training volumes were reported in adolescent (17.27 +/- 5.25 h/wk) and adult (26.8 +/- 4.8 h/wk) swimmers. Differences in exposure were present between swimmers with and those without shoulder pain in both the adolescent (P = .01) and masters (P = .02) groups. In adolescent swimmers, the weekly swim-training volume (P < .005, P = .01) and years active in competitive swimming (P < .01) correlated significantly with supraspinatus tendon thickness, and all swimmers with tendon thickening experienced shoulder pain. Conclusions: Evidence suggests that swim-training volume was associated with shoulder pain in adolescent competitive swimmers (level II conclusion). Year-round monitoring of the athlete's swim training is encouraged to maintain a well-balanced program. Developing athletes should be aware of and avoid a sudden and large increase in swimming volume. However, additional high-quality studies are needed to determine cutoff values in order to make data-based decisions regarding the influence of swim training.