Biomechanics and Medicine in Swimming XI

BiomechanicsandmedicineinswimmingXi
Athletic Rehabilitation of a Platform Diver for Return
to Competition after a Shoulder Dislocation
Fujinawa, o. 1,2 , Kondo, Y. 3 , tachikawa, K. 1,3 , Jigami, h. 1,4 , hirose,
K. 2 , Matsunaga, h. 5
1Medical Science Committee of Niigata Swimming Federation, Nagaoka,
Japan
2Saitama Prefectural University, Koshigaya, Japan
3Yuyukenkomura Hospital, Nagaoka, Japan
4Niigata University of Health and Welfare, Niigata, Japan
5Himeji Dokkyo University, Himeji, Japan
A high-school male diver was diagnosed with tendinitis of the left supraspinatus
secondary to shoulder dislocation during the water-entry
stage of a 10-m dive. Land-based athletic rehabilitation consisting of
15 sessions was initiated at a hospital on the 5 th day after the injury. After
treatment with anti-inflammatory medication and immobilization
by using a chest band, the patient performed stabilizing exercise of the
glenohumeral joint and scapula abduction-adduction exercises from the
13 th to the 22 nd day. Aquatic rehabilitation (total, 6 times) was started on
the 17 th day; joint mobilization of the glenohumeral joint and mobilization
with movements and motor control exercises were applied until just
before competition. He started diving practice on the 21 st day; then, he
returned to the National Sports Festival competition and won the 2 nd
prize for the 10-m platform dive on the 26 th day after injury.
Key words: mobilization with movement, joint mobilization, PnF,
impingement, motor learning
IntroductIon
Diving-related injuries among children and adolescents younger than
20 years were comprehensively examined, and the research showed that
the percentage of upper-extremity injuries was 9.5% (Day et al., 2008).
According to their report, the frequency of diving-related extremity injuries
was relatively low. In this study, we describe the treatment and
rehabilitation protocol for a high-school diver with an injury to the
left supraspinatus tendon secondary to shoulder dislocation during the
water-entry stage of a 10-m dive. He started athletic rehabilitation on
day 5 after the injury, and he tried to dive on the 21 st day; then, he returned
to the National Sports Festival in Japan and won the 2 nd prize for
10-m platform diving on the 26 th day after injury. The objective of this
case study is to retrospectively analyze the rehabilitation program and
to suggest effective physical therapy (PT) procedures with regard to the
biomechanical aspect.
Methods
The patient’s medical records, including magnetic resonance imaging
(MRI) scans, were evaluated, and the PT records for hospital and poolside
rehabilitation were retrospectively analyzed with regard to the biomechanical,
anatomical, and kinesiologic aspects. This study program
was approved by the Saitama Prefectural University Ethical Committee.
results
History. The male patient, who was 17 years of age, experienced shoulder
dislocation during diving practice for the Inter-High School Championships
held outside his native city. He dislocated his left shoulder
due to abduction of the arm during entry into the water. When a coach
raised him from a supine to a sitting position to apply a sling at pool
side, the dislocated shoulder was spontaneously reduced. He was admitted
for emergency care to a local hospital because of joint swelling
and severe pain. After the championship, he visited the orthopaedic
department of a hospital in his native city and commenced land-based
362
rehabilitation (Table 1).
Diagnosis and Medication. He was diagnosed with supraspinatus tendinitis,
and MRI indicated swelling of the supraspinatus tendon and
glenohumeral hydrarthrosis (fig. 1). Anti-inflammatory medication and
immobilization by a chest band were prescribed.
Land-based rehabilitation at a hospital commenced on the 5th day
after injury and was completed on the 22nd day (15 visits total). During
the immobilization period (from the 5th to the 12th day), PT programs
consisted of the sound side and general conditioning exercises. From the
13th to the 22nd 24
BMS XI Chapter 6. Medicine, Rehabilitation and Prevention
aspects. This study program was approved by the Saitama Prefectural University Ethical
Committee.
RESULTS
History. The male patient, who was 17 years of age, experienced shoulder dislocation
during diving practice for the Inter-High School Championships held outside his native
city. He dislocated his left shoulder due to abduction of the arm during entry into the
water. When a coach raised him from a supine to a sitting position to apply a sling at
pool side, the dislocated shoulder was spontaneously reduced. He was admitted for
emergency care to day, a local the hospital PT programs because of joint introduced swelling and stabilization severe pain. After exercises the
of championship, the left glenohumeral he visited the orthopaedic joint using department isometric of a hospital rotator in his cuff native exercises city and and
commenced land-based rehabilitation (Table 1).
scapula Diagnosis abduction-adduction and Medication. He was exercises. diagnosed Concentric with supraspinatus and eccentric tendinitis, and rotator
MRI cuff indicated exercises swelling of the of the glenohumeral supraspinatus tendon joint and using glenohumeral a rubber hydrarthrosis band were
(fig. 1). Anti-inflammatory medication and immobilization by a chest band were
also prescribed. used. The objectives of the scapula abduction-adduction exercises
were Land-based to gain rehabilitation optimal scapular at a hospital mobility commenced and on stability the 5 for normal scapulohumeral
rhythm and to prevent glenohumeral joint dysfunctions, such
as abnormal stresses to the anterior capsular structures, increased possibility
of rotator cuff compression, and decreased performance. Isometric,
concentric, and eccentric rotator cuff exercises were applied to keep the
optimal position of the glenohumeral joint and to improve adequate
balance of internal and external rotator muscle strength (Niederbracht
et al., 2008).
th day after injury and was
completed on the 22 nd day (15 visits total). During the immobilization period (from the
5 th to the 12 th day), PT programs consisted of the sound side and general conditioning
exercises. From the 13 th to the 22 nd day, the PT programs introduced stabilization
exercises of the left glenohumeral joint using isometric rotator cuff exercises and
scapula abduction-adduction exercises. Concentric and eccentric rotator cuff exercises
of the glenohumeral joint using a rubber band were also used. The objectives of the
scapula abduction-adduction exercises were to gain optimal scapular mobility and
stability for normal scapulohumeral rhythm and to prevent glenohumeral joint
dysfunctions, such as abnormal stresses to the anterior capsular structures, increased
possibility of rotator cuff compression, and decreased performance. Isometric,
concentric, and eccentric rotator cuff exercises were applied to keep the optimal
position of the glenohumeral joint and to improve adequate balance of internal and
external rotator muscle strength (Niederbracht et al., 2008).
Table 1. Process of Athletic Rehabilitation.
Table 1. Process of Athletic Rehabilitation.
Day* Situations Conditions Findings and Programs**
5 th Land-based Immobilizatio -General conditioning exercises such as stretching
rehabilitation at n
and strength training of the neck, trunk, and
a hospital
extremities except the affected left arm
13 th Detachment of -Left shoulder passive ROM: Flex 120, Abd 90, ER
the
20, IR 35
immobilizing -Pain in the supraspinatus and middle deltoid area
brace and -Program: 1) Stabilization of the glenohumeral joint
exercises of
the affected
arm
with isometric exercise; 2) Scapula Abd-Add exercise
15 th Swimming Walking in the -Passive ROM: Flex 145, ER 30, IR 30
team training pool -Program: 3) Concentric and eccentric rotator cuff
camp
exercises by using a rubber band
17 th Aquatic Breast
Findings and programs after camp training 25
BMS XI rehabilitation at Chapter swimming 6. Medicine, -Resting Rehabilitation pain in and the Prevention anterior aspect of the shoulder
pool side
-Active movements: pain with Abd 90, ER 30, IE 80,
Horiz Add 60
-Passive movements: Abd 90 with pain and restricted
at 120 by pain and muscle guarding
-Joint mobility test: could not be performed because
of pain
and muscle guarding
-Palpation: muscle spasms and tenderness in all
rotator cuff muscles
-MWMS with posteroinferior glide: full Flex-Abd-
ER without pain
-Program: 4) MWMS; 5) Taping at the rotator cuff
18 th 2 nd Aquatic
rehabilitation
-Program: 6) Self MWMS
21 st 3 rd Aquatic Diving -Pain condition: no pain experienced during front
rehabilitation
dive; pain experienced during back dive
-Program: 4) MWMS with a 300-g weight; 6) Self
MWMS with a 300-g weight; 7) PNF (slow reversal,
repeated contraction)
22 nd Completed landbased
rehabilitation
-Passive ROM: Flex 170, ER 60, IR 70
23 rd 4 th Aquatic
-Rapid Abd-ER causes pain
rehabilitation
-Program: 4) MWMS with a 500-g weight; 6) Self
MWMS with a 500-g weight; 7) PNF; 8) TFM and
functional massage
25 th 5 th Aquatic 1 day before -The same programs were continued
rehabilitation the
competition
26 th 6 th Aquatic Before the -No shoulder pain
rehabilitation competition -Same programs were continued
*, Day after onset of the injury; ** Abbreviations: ROM, range of motion (numbers represent
degrees); Flex, flexion; Abd, abduction; Add, adduction; ER, external rotation; IR, internal
*, rotation; Day after Horiz onset Add, horizontal of the injury; adduction; ** MWMS, Abbreviations: mobilization with ROM, movements; range PNF, of motion
proprioceptive neuromuscular facilitation; TFM, transverse friction massage
(numbers represent degrees); Flex, flexion; Abd, abduction; Add, adduc-
tion; ER, external rotation; IR, internal rotation; Horiz Add, horizontal
adduction; MWMS, mobilization with movements; PNF, proprioceptive
neuromuscular facilitation; TFM, transverse friction massage
Figure 1. MRI findings of the left Shoulder