# data[].attributes.body
AIM Here:
- increased strength and less pain (close to pre injury?)
- back no pain, can train again, make it on team
- end goal is make it to nationals
- close to good biomechanics

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- progress RC muscles to isotonic (priority is cables, dont have gravity influencing)
- retraction (90deg) and progress to row

# data[].attributes.body
- re-test functional tests, observe pain/ROM/swelling; EX: pain test in movements specific to swimmer
- NSAIDS, reduce later on
- repeat exercises, if swelling/pain symptoms reduce, then progress scapular stabilisers
- strengthen RC muscles (isolation/isometric)

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Education
- Work lower limb, rest/reduce upper limb (scapular stabilisation; retraction, scapular depression, avoid RC/GH muscles or joint, muscular endurance + strength
- yellow flags (confidence, motivation, crying, wants to work ahrd)
- NSAIDS
- talk with GP, sports doc, physio, coach to offload

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Primary
- Overuse causing tendinopathy

Secondary (Cycle)
-  Muscle fatigue
- Muscle inhibition
- Biomechanics
- Compensation
- Instability (Weak rotator cuffs)

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- control for pain (anti-inflammatories)
- offload shoulder during inflammation with dry land training or kicking drills
- improve biomechanics (stroke technique, scapula use)
- strengthen rotator cuff muscles and scapula stabilizing muscles

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Muscle bulk R>L
R Painful arc 90-120
R lateral subacromial tenderness
R ER/IR pain/stiffness
Hands behind back painful
Protraction weaker
Winging on push-up

Apprehension test: pain but no apprehension
Hawkins’ test: positive R
Neer’s test: positive R

-Can rule out anterior instability
-Do more SAIS special tests
-Do crank test
-No red flags

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2x physical therapy sessions for a duration of 6weeks

Reduce yards of swimming.

They must have full ROM pain free

same ST of RTC in comparison to opp side strength (5/5)

Modification of swimming distance so that it is in the pain free range less than 3/10 VAS

NO more than 10% increase in yardage each week to ensure soft tissues and joint is not irritated / recurrence of  impingement episode

Considerations

Stop swimming if in pain above 3/10 VAS or fatigue (elbow drop)

longer duration warm up at the swimmers pace

increase rest intervals

​​use fins to help propel from the legs and offload the shoulder

avoid use of kickboards, hand paddles

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- Disturbed Sleep
- Anxiety from sitting out of sport
- Placement on Aus team

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- place in Vic championships
- Increased training (4 hours per day)
- Works in PR

Goal:
- wants to return to sport

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Increased work load - extra training sessions

Mechanics - stop sign, a lot of reaching and IR/ER

-  glenohumeral laxity, biceps or rotator cuff lesions, and impingement syndrome.
- It might be due to weakness or reduced endurance of the shoulder muscles, a lack of scapular stability, poor posture, reduced flexibility, or bony alterations”

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Possible non-conservative interventions for shoulder pain; best approach is likely conservative

# data[].attributes.subject
Possible non-conservative interventions for shoulder pain; best approach is likely conservative

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Includes pharmacological and surgical interventions
Pharmacology = pain relief medications, corticosteroid injection

Surgical = depends on injury type; bony/joint may require surgery (arthoscopy, laser for pain, electrotherapy). Conservative treatment does work, may consider surgery

conservative likely best approach as tests indicate pain and weakness in rotator cuffs and possibly scapula stabiliser (serratus ant?) that may influence some effecto r damage within local structure of GH joint (thus want to avoid surgery)

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Hopeful

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swimmer (ELITE)
- since primary school

Age: 19