Pain Prevalence in Swimming Athletes Of
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LOCOMOTOR APPARATUS IN PAIN PREVALENCE IN SWIMMING ATHLETES EXERCISE AND SPORTS OF SÃO CAETANO DO SUL ORIGINAL ARTICLE Bárbara Oliveira Venâncio1 ABSTRACT Pascale Mutti Tacani1 Paulo César Porto Deliberato1 Introduction: Swimming is a sport that has been on the high in the last years and requires high levels of training and performance, which can cause overuse on muscular skeletal system, causing injuries 1. Municipal College of São Caetano to swimmers. Objective: To verify the pain prevalence and the body areas with pain, correlating with do Sul (USCS) main style and practice time in swimming athletes from SERC Club in São Caetano do Sul. Method: A survey with 19 questions was applied to 71 athletes (30 female and 41 male) in child I (10-12 years Mailing address: old), child II (12-14 years old), juvenile (14-16 years old), junior (16-18 years old) and senior (From 18 Pascale Mutti Tacani Rua Santo Antônio, 50 years old) categories. The variables were analyzed by Two-Proportional Equality Test and Mann-Whitney 09521-160 – São Caetano do Sul, Test. Results: Pain prevalence was of 74.6% (n = 53; p < 0.001),namely: 39.6% (n = 21) in shoulder and SP, Brasil 22.6% (n = 12; p = 0.059) in thighs and the back stroke swim was the only style that had no correlation E-mail: [email protected] with pain (p = 1.000) or time of practice (p = 0.075). Conclusion: In the studied subjects, there was high pain prevalence, with the shoulder and thigh being the most affected areas, not presenting correlation with the back stroke style neither in sports time of practice. Keywords: swimming; athletes; pain; physical therapy. INTRODUCTION scapular waist, are the main etiological factors of the development 3 From the health point of view, swimming is a sport which pre- of the excessive syndrome termed “swimmer’s shoulder” . sents prophylactic and therapeutic value, with low risk of trauma Competitive swimming is one of the most demanding sports and which occurs in an impact-free environment, being the second and which involves the longest time consumption. Elite swimmers most practiced modality in Brazil (only after soccer) and which inclu- train from 20 to 30 hours per week. During one year, an average des many styles: freestyle (crawl), butterfly, backstroke, breaststroke high-level swimmer performs over 500,000 strokes on each arm, and medley1. approximately 1,000.000 strokes/year. The search for maximal per- Brazilian swimming has participated in the Olympics Games sin- formance during the abundant competition volume, as well as the ce 1920, joined by the first Brazilian Olympic delegation. Nowadays, workload increase during training are responsible for progressive the country has high-level athletes in national and international increase of the number of injuries which always present physical competitions who bring an increasing number of good results, and emotional implications in the athlete4. such as South-American and world records, finals and medals in The injuries in swimming were firstly described by Councilman the World Championship and Olympic Games. In the last Olympic in 19685, who studied the prevalence of injuries in competitive Games, for example, Brazil fulfilled its duty bringing two medals swimmers and identified more frequency in the shoulder, with 37% home: the Thiago Pereira’s silver and the César Cielo’s bronze. These out of the total, followed by the knee, with 28%, and the foot and medals add up to 13 Olympic medals in the history of Brazilian ankle, both with 19%. The author reported that musculoskeletal swimming. In world championships, Brazil won three gold, one silver injuries in swimmers may be of trauma or secondary origin, by over- and four bronze medals in the long course pool, and nine gold, five training. Acute trauma injuries are rare and injuries by overtraining silver and seven bronze medals in the short course pool2. predominately occur in competitive athletes. This sport requires very high training levels, which expose In the study conducted in a club from São Paulo, 63 athletes the athletes to constant and intense stress, with the possibility of were assessed where the most frequent injury was tendinitis/bur- injuries or pain, decreasing hence sports performance and leading sitis (75.9%), followed by back pain (9.6%) and low back pain (6%). to early dropout. One of the most frequent complaints in swimmers Concerning injuries classified under ‘other’ (8.4%), we can name: is shoulder pain, known as swimmer’s shoulder. This syndrome and chondromalacia, biceps femoris myalgia, knee sinovitis, injury to other injuries may lead to psychological problems since the athlete medial meniscus, cervicobrachialgia and shoulder sinovitis6. builds his/her life around the sports modality, and may make him/ In São Caetano do Sul, a city which has stood out within the her unable to continue training and competing. Prevention is a key Brazilian swimming scenario, there are no studies on the prevalence element here, since it presents a great importance and relevance of injuries in swimmers, showing the importance of this research to factor in these cases1. verify the physical conditions of its athletes, aiming further research The countless movement repetition during many years of inten- on prevention and rehabilitation which can contribute to the inte- se training joined with the increasing lack of muscular balance of the gration of athletes, trainers and the multidisciplinary health team. 394 Rev Bras Med Esporte – Vol. 18, No 6 – Nov/Dec 2012 Thus, the aim of this study was to verify the prevalence of pain (n = 30) female, aged between 10 and 23 years, mean of 13.9 ± 0.6 years. in swimmers from São Caetano do Sul, to identify which are the Generally speaking, it was observed that out of the 71 inter- body regions with most pain and correlate pain complaint with the viewed athletes, 74.6% (n = 53; p < 0.001) presented complaint of main style and the time of swimming practice. moderate intensity pain through the visual analog scale (VAS) 5.09 ± 1.84; being the shoulder 39.6% (n = 21) and thigh 22.6% (n = 12; METHOD p = 0.059) the most reported, as shown in table 1. A clinical, observational, analytical and transversal study Pain presented correlation with style practiced, except for the performed in a single center, initiated after free and clarified consent backstroke, as seen in table 2. from the athletes in the 11-12; 13-14;15-16; 17-18-year-olds and Concerning time of practice, it was observed that the athletes masters age groups from the swimming team of SERC (Sports with pain presented time of practice (7.06 years) longer than tho- Recreational and Cultural Society) from São Caetano do Sul and se without complaint (7.0 years); however, this difference was not was approved by the Ethics and Research Committee of the City considered significant (p = 0.075; Mann-Whitney). of São Paulo University under the number PP 13507959. The categories were presented in table 3 with the number of The investigation selected athletes with over one consecutive athletes, sex, age, specialty, level, style practiced, time of practice year of training, healthy, aged between 10 and 30 years, of both sexes, and weekly frequency. and excluded those with less than one consecutive year of training, It was observed that pain presented correlation with the most over a month of absence and/or who underwent recent surgeries. advanced categories, with all specialties and with competitive levels A questionnaire composed of personal information and 18 which demand higher performance, as seen in table 4. questions 12 open and six closed (Appendix 1) was designed It was also seen that the majority of the athletes (37.7%), presen- for evaluation of the prevalence of the pain sites, searching for ted pain worsening immediately after training, while no significant information related to the athlete, type of training and possible differences have been observed in the specific, strength or physical injuries. These athletes were gathered on the bleachers of the trainings. What the athletes did to obtain relief was for the majority training premises, followed by the trainer in charge for the age (34.0%) to search for medical/physiotherapeutic help, followed by group, where the researcher read the questionnaire outloud to each application of ice and do “nothing”, as pointed in table 5. age group separately, ranging approximately between 20 and 30 It was observed that the majority (52.8%) did not search for swimmers. The researcher remained available for any clarification, treatment; however, out of the ones who did (47.2%), they chose while the athletes answered the questions, with the use of a conservative and/or physiotherapy treatment (p < 0.001), obtaining clipboard, pencil and blue or black pen. improvement in the majority of the cases (54.7%), but without The information was collected at the training climax, with high significant difference, as evidenced in table 6. mileage in swimming pool and higher physical training intensity, at Among the athletes who underwent treatment, only the low which period the athletes could be more overloaded both physical back region presented significant difference between the impro- and psychologically. Finally, the athletes and trainers were joined vement percentage 88.9% (n = 8; p < 0.001; two-way equality test), and received feedback about the findings. the other regions did not present significant difference (shoulder It is worth mentioning in this research that any symptom related p = 0.123; thigh p = 0.201; knee p = 0.371; rhomboid p = 1.000; to discomfort, weight sensation, decrease of functional capacity, biceps p = 0.109; trapezius p = 0.248; and pectoralis p = 0.527). pain complaint itself and any other manifestation of deficit of the physical wellness normality status was considered “pain”.