Sports Medicine Handbook
Developed by
Jason C. Bracco, PT, DPT, ATC,
CSCS
February 2000
Updated October 2006
TABLE OF CONTENTS
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Introduction
to the |
3 |
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4 |
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Sports Medicine
Staff Bios |
5,6 |
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Dr. Frank Bonnarens |
5 |
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Jason Bracco, PT, DPT, ATC, CSCS |
6 |
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Sports Injury Screenings |
7 |
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Shoulder Anatomy,
Mechanics, & Injuries |
8 |
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Common
Shoulder & Knee Injuries in Swimming |
8 |
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Strength
Training & Injury Prevention Program |
9-12 |
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Exercises:
Scapular Stabilizers |
9 |
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Exercises: Rotator Cuff Muscles |
9 |
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Exercises:
Trunk Muscles |
9-10 |
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Stretching Exercises |
11 – 12 |
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Frequently Asked
Questions |
13- 14 |
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Shoulder Pain |
13 |
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Shoulder Popping |
13 |
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When should I see the doctor? |
13 |
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Pain during practice |
13 |
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Pain medication |
13 |
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Using ice & heat |
14 |
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Age Group & Senior II Shoulder
Specific Injury Prevention Program |
15-16 |
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Senior I & National Team
Specific Injury Prevention Program |
17-20 |
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Introduction
This
booklet is designed to help introduce you to the Lakeside Swim Team sports
medicine program. Incorporated within
this text is information regarding the medical services available to each
coach, parent, and student athlete. Also
included are tips for injury prevention, care, and treatment. Our team is here to help
The purpose of this
program is two-fold and will focus on injury prevention, as well as performance
enhancement. In September 1999 we
designed a strength program based on the anatomy, physiology, and biomechanics
of swimming. We have updated this
program each year so that our program reflects the most recent evidence based
scientific literature. The focus of our
program is to compliment your sport, not to focus on body building or power
lifting. Remember swimming is your
primary endeavor, we don’t want to overdo it with your weight training and
jeopardize your ability to perform.
I will be visiting the team one time every few weeks
to perform injury screenings. The
purpose of this is to help the swimmers rule out serious involvement while
helping to guide their activities and reduce injury. Athletes with more serious involvement will
be referred to Dr. Bonnarens or their family MD for follow-up care. If surgery or physical therapy is required I
will be happy to get you set up with times that are convenient for you. I will also coordinate closely with Dr.
Bonnarens, and the coaching staff to ensure that you get back to competition as
quickly and safely as possible.
If you have any
specific questions about this program or about a sports related injury feel
free to give me a call at 387-1100.
Sincerely,
Jason C. Bracco, PT,
DPT, ATC, CSCS
The mission of the Lakeside Swim Team Sports Medicine Program
is to provide quality sports medicine care with the safety and interest
of the athlete being the first priority.
Method
1.
Injury prevention.
2.
Effective injury evaluation, management and
referral
3.
Accurate documentation.
4. Proper
communication between the athlete, coach, parent, and physician.
5. The
efficient, safe and timely return of the athlete to active competition.
Lakeside Swim
Team’s Sports Medicine Staff consists of the following team members:
Team
Physician:
Dr. Frank Bonnarens
Orthopaedic
Associates, PSC.
Jewish
Suite, 403
Office: (502) 585-4376
fax: (502) 581-1274
Dr. Bonnarens specializes in orthopedic
sports medicine and athletic-related injuries. He has been involved in the care
of professional, collegiate and high school athletes. He has published numerous research papers,
abstracts, and has made numerous presentations relating to the advancement of
arthroscopic surgery and fracture management.
Dr. Bonnarens specializes in injuries to the Shoulder, Knee, and
Hip. Dr. Bonnarens currently serves as a
Clinical Assistant Professor of Surgery at the
Dr. Bonnarens earned his undergraduate
degree at the
Dr. Bonnarens is an ex-swimmer, recently
trading in his flippers for a kayak. He
now focuses on ways to stay out of the water.
Dr. Bonnarens is married and has four children, two of which are members
of the Quarry Gators Swim Team.
Team Physical
Therapist/Athletic Trainer
Jason C. Bracco, PT, DPT, ATC, CSCS
Frazier Rehab Institute - Owsley Brown
Frazier Sports Medicine
Phone: 502-637-9313
Fax: 502-635-9317
Cell: (502) 387-1100
Jason is a Doctor of Physical Therapy, a state
and nationally certified athletic trainer as well as an exercise
physiologist/strength and conditioning specialist. Jason earned his undergraduate degree from
the
Sports Injury Screenings
If you have an
injury and are not sure what to do, make sure you see Jason on the days he
visits Mary T. Jason will evaluate your
injury, and either give you some recommendations for treatment and care or if
it is serious enough he will refer you to Dr. Bonnarens or the MD of your
choice. If you are injured and need to
be seen quickly you can call me and I will be happy to set up a time to see
you.
Shoulder Injuries & Swimming
Shoulder problems
account for about 15% of all injuries incurred in sports participation. The
majority of these
injuries occur in sports like Baseball, Swimming, and Volleyball. 85% of swimming injuries involve the shoulder
complex. Part of the reason this occurs
is because swimming requires repetitive overhead use of the arms, which often
leads to overuse and subsequent irritation.
Injuries are an inherent part of all sports and each sport has it’s own
specific type of injuries. The key to
preventing these injuries is to understand what type of injuries occur commonly
in your sport, what factors cause these injuries, and how to eliminate or limit
these factors from occurring.
ANATOMY
& PATHOMECHANICS
The shoulder
complex is comprised of several different joints that combine to provide a lot
of
mobility. Of these the most commonly injured joint is
the Glenohumeral joint. The Glenohumeral
joint is a modified
ball & socket joint. The glenoid
fossa (socket) is a projection of the scapula (shoulder blade) and is very
small like a golf tee, the humerus (upper arm) has a head (ball) that is very
large like a golf ball and sits unevenly on the glenoid fossa. The "unequal size" of these two
structures relates to increased of mobility at the sacrifice of joint
stability.
Passive Stabilizing Structures
Several
"passive" structures help to provide stability to this joint. We refer to these structures as passive
because they cannot react to support the joint.
The glenoid labrum is a round piece of fibrocartilage that helps to
widen the surface area of the shoulder socket, while also providing stability
by "sucking" the ball of the humerus into the socket. The Glenohumeral ligaments and Joint Capsule
further provide passive stability for the shoulder joint.
Dynamic Shoulder Stabilizers
Several muscles
work together to provide motion and joint stability at the shoulder
complex. The anterior (front) of the
shoulder has several strong "power" muscles. The most notable of these are the Pectoralis
(Chest) muscles and the Anterior Deltoid.
These muscles are very strong for several reasons. First, they are in a position on the body that
insures that they are used a lot.
Secondly they are muscles that are easily trained with popular exercises
like the bench press, shoulder press, and flyes. The Posterior Deltoid, The Latissimus Dorsi,
The Rhomboids, and the Trapezius muscles are often neglected during strength
training. This often leads to muscle
imbalances, which can relate to poor posture and resultant shoulder overuse
problems. Also neglected are the deep
muscles of the Rotator Cuff. These
muscles have three main jobs. First they
cause internal and external rotation of the arm to occur. Secondly they provide "dynamic
stabilization" of the Glenohumeral joint by actively holding the ball of
the humerus into the socket. And third,
they act as control & steering muscles during high velocity movements like
throwing a ball, swimming, or swinging a racket. The rotator cuff is comprised of the
Subscapularis anteriorly and the Supraspinatus, Infraspinatus, and Teres Minor
posteriorly. Weaknesses of these muscles
can lead to poor stabilization of the Glenohumeral joint, adverse swimming
mechanics, and ensuing overuse syndromes like shoulder impingement (tendonitis,
bursitis), and in extreme cases a tear of the shoulder cartilage.
Injuries That Are Common In
Swimmers
The most commonly injured joint in the swimmer is
the Shoulder Joint. Two common injuries
that occur in the swimmer and may be prevented by a good strength and
conditioning program are:
(1)
Muscle
Strains: These usually occur to the posterior muscles of the upper back and
rotator cuff. It occurs because these
muscles constantly have to stabilize the shoulder during dynamic activity. If they are weak and neglected they will
become irritated during swimming. The
scapular (upper back) and rotator cuff strengthening exercises we are doing are
designed to help limit this from occurring.
(2)
Shoulder
Impingement (Tendonitis): This injury can be caused by multiple factors.
Loose
shoulder joints, individual shoulder structural alignments, rounded
shoulders/back, anterior dominant muscles, and the positions that the shoulder
are put in during the pull
phase
of swimming. Impingement is classified
by the repetitive “pinching” of a tendon or
bursa
between the humerus (upper arm) and the coracoacromial arch (roof of the
shoulder joint). This causes
inflammation, weakness, and further injury to occur. The scapular (upper back)
and rotator cuff strengthening exercises we are doing are designed to help
limit this from occurring.
The knee is often
injured in swimmers who specialize in the breast stroke. This pain often occurs on the inside of the
knee and can be attributed to the mechanics of the flutter kick. This pain usually involves the connective
tissue structures of the inner knee, and sometimes the medial collateral ligament. We normally recommend ice massages over the
area to help decrease inflammation, and exercises to help strengthen the Vastus
Medialis muscle. This muscle is the
inner most of your quadriceps muscles and helps to stabilize the knee. Seated Quad Sets, Standing Step Ups (6 - 8
inch step), Partial Lunges, and Ľ Squats all help to strengthen this
muscle. If you are having problems with
your knee see Jason and he will give you a personalized program.
THE
Shoulder injury
prevention begins with the proper education of the athlete. Athletes need to understand the mechanics of
their sport and the proper techniques involved in that sport. Nothing short of surgery can change the
stabilizing factors of the passive structures of the shoulder. It is for this reason that prevention should
focus on strengthening the dynamic structures of the shoulder complex. Remember muscles that are stronger and have
good endurance take longer to fatigue and can better withstand repetitive
overuse stresses.
The Lakeside Swim
Team Strength Training Program has two goals.
The first of these is injury prevention with the second being
performance enhancement. These two goals
go together hand in hand. If you stay
injury free during a competitive season you will obviously perform better. Our program is based on swimming stroke
mechanics and the injury mechanisms that commonly effect swimmers. Most traditional strength programs focus on
the large muscles that enhance an athlete’s strength and power (combination of
strength and speed). We will focus on
these types of exercises when we train in the Cresent Hill weight room. The exercise program listed in this guide
focuses on the small stabilizing muscles of the upper back and rotator cuff. You can perform these exercises in the
Cresent Hill weight room or at home three
to five nights per week. THESE
EXERCISES WILL HELP YOU ONLY IF YOU PERFORM THEM CORRECTLY AND CONSISTENTLY!!
Because these
muscles are small stabilizing muscles, they respond better when they are
trained using light weights and higher
repetitions. You should perform three to five sets of 10 - 20 reps with
a comfortable but challenging resistance.
Once this becomes too easy, progress to 3 fatigue sets (until you are
too tired to continue). Make sure you
exercise at a slow, controlled pace.
This usually relates to holding
each contraction about 3 to 5 seconds.
Give yourself about 15 to 30 seconds of rest between sets. Make sure that you perform each exercise
slowly and correctly. Focus on the
proper technique and make sure you don’t rush through your exercises. You should feel a burning sensation towards
the end of each set you perform. If you
don’t feel this burning it means that you are performing the exercise incorrectly
or you need to increase the intensity of the exercise. You can increase the intensity of exercise
by: 1. Increasing the weight, 2. Increasing the number of repetitions, or by 3.
Decreasing the amount of rest time between sets. It is better to perform these exercises after
you swim. Performing these exercises
prior to swim practice will fatigue the stabilizing muscles and may cause
shoulder pain.
Scapular Stabilizers
The muscles of the
scapula and thorax help to hold the scapula on the rib cage. This insures that the arm has a “stable base”
so that normal mechanics occur at the shoulder complex. As discussed above, these muscles are often
neglected during strength training programs.
If these muscles are weak and fatigue easily they may become injured, or
may cause injury to occur to the rotator cuff and shoulder joint. Use light weight (1 – 10#) for the dumbell
exercises, and moderate to heavy weight for the machine exercises. If you use an exercise band, make sure that
it provides enough resistance to challenge you.
You should perform 3 to 5 sets of 10 – 20 reps of these exercises. Remember to focus on squeezing your shoulder
blades during each of the following exercises.
Rotator Cuff Muscles
The rotator cuff
muscles are small endurance muscles and should be trained using a light weight
(1 to 10 lbs.) while adding repetitions to increase the intensity. Make sure you squeeze a towel roll between
your elbow and side during these exercises.
This is necessary for two reasons.
1. This helps to inhibit the
larger more powerful muscles and effectively isolates the smaller rotator cuff
muscles we are trying to strengthen, 2. This brings the arm out about 20
degrees from your body and helps decrease the amount of tension and provide
adequate blood flow to the rotator cuff muscles.
Trunk Muscles
The muscles of the
hip, abdomen, and lower back are the key power muscles involved in
swimming. We often refer to these
muscles collectively as the “Core”. If
these muscles are weak the shoulders will have to do more work and may become
predisposed to injury. A good analogy to
use when explaining this is that of building a house. You can’t have a nice well built house
without a stable foundation. If your “foundation” is weak and crumbling you
will have lots of problems. Athletes should begin with three sets of 10 - 50
repetitions and progress by adding 5 - 10 reps as tolerated. Remember to focus on keeping your low back
flat on the floor while you perform each exercise.
Pelvic Tilts
Muscles
Worked: Transverse Abdominus/Rectus Abd.
Lying
on your back, tighten up you abdominal muscles and
flatten
your lower back against the table.
Concentrate on
holding
your back flat in this position for 5 seconds.
Abdominal Crunches
Muscles
Worked: Rectus Abdominus
Lying on your back. You can
either place your hands behind your head or across your chest. If you place your hands behind your head
remember to use hem only as a guide, do not use them to pull up on your head. During the exercise remember to keep your
eyes focused on the ceiling above. To
begin the actual exercise, perform a pelvic tilt as above, next curl your body
up until your shoulders raise up off the floor.
Hold the contraction 5 seconds, then relax and repeat the exercise.
Oblique Abdominal Crunches
Muscles
Worked: Internal/External Obliques/Rectus Abd
Begin as above, however this
time rotate your body so that you twist towards one side. Hold the contraction 5 seconds, then relax
and repeat this time going to the opposite side.
Lower
Leg Raises
Muscles Worked: Rectus Abdominus
(lower fibers)
Lying on your back. Place your hands behind
your head. Next begin the exercise by
performing a pelvic tilt.
Slowly raise you legs up off the table and
then lower them back to the table.
Remember to keep you back flat on the mat. In the beginning stages you
can bend your knees this will make it easier to hold your back flat on the
table, as you get stronger you can advance by straightening your legs out.
Stretching
Prior to stretching
your should warm up well. A good warm up
helps to prepare the body for activity by increasing neuromuscular reaction
time, and blood flow to the muscles. A good
warm up should last between 5-10 minutes (until you perspire) and can consist
of rythmic aerobic activities such as jump rope, light jogging, and riding an
exercise bike. Stretching all of the
major muscles of the upper and lower extremities further prepares muscles to
endure the forces that occur during athletic activities. Stretching should be performed before
exercise, after exercise and one other time per day for optimal results. Each
stretch can be done 3-4 times and held for 30 seconds. The
bottom line: Muscles that are warmed up & stretched are better able to
handle the stresses that are imposed upon them.
Lower Extremity muscles: With swimming it is not necessary to always
stretch the lower extremity muscles unless you are unusually tight. Young athletes who are still growing often do
have very tight thigh muscles.
Specifically the hamstrings, quadriceps, and the calf muscles. If these muscles are tight they can effect
your swimming mechanics and may cause a decrease in your performance. If you need these exercises see Jason and he
will show them to you.
Upper Extremity muscles: The major muscles that need to be stretched
are the pectoral (chest) muscles. These
muscles are usually tight and may contribute to that rounded shoulder
appearance that most swimmers have. You
should also stretch the muscles of the upper back, shoulder and neck.
Remember you should
never have shoulder pain while stretching.
