RETURN TO SWIMMING PROTOCOL FOR COMPETITIVE SWIMMERS: A POST‐OPERATIVE CASE STUDY AND FUNDAMENTALS

A large percentage of swimmers report shoulder pain during their swimming career. Shoulder pain in swimmers has been attributed to duration of swim practice, total yardage, and break down in stroke technique. Rehabilitation programs are generally land‐based and cannot adequately address the intricacies of the swimming strokes. Return to swimming protocols (RTSP) that address progression of yardage are scarce, yet needed. The purpose of this clinical commentary is to familiarize the clinician with the culture and vernacular of swimming, and to provide a suggested yardage based RTSP for high school and collegiate level swimmers.

Level of Evidence:

5     

PRE‐OPERATIVE LOW BACK PAIN NEGATIVELY AFFECTS SELF‐REPORTED FUNCTION IN INDIVIDUALS UNDERGOING HIP ARTHROSCOPY

Background/Purpose

Low back pain (LBP) is a common source of disability in adults and highly prevalent in patients with painful hip pathology. Persistent LBP after hip arthroplasty is associated with lower self‐reported function, however, the effect of pre‐operative LBP in patients undergoing hip arthroscopy for FAI has not been evaluated. The purpose of this study was to determine whether improvements in self‐reported hip function following arthroscopic surgery for femoroacetabular impingement (FAI) differed between those with and without reports of pre‐operative low back pain.

Study Design

Cohort

Methods

Three hundred eighteen subjects undergoing primary hip arthroscopy for clinically and radiographically‐confirmed FAI were recruited and consented. One hundred fifty‐six of these subjects completed the International Hip Outcomes Tool (iHOT‐33) and the Hip Outcome Score Activities of Daily Living Subscale (HOS‐ADL) before, and six and 12 months after surgery. Subjects were grouped based on the self‐reported presence or absence of LBP prior to arthroscopy. A repeated measures analysis of variance was used to determine the effects of time and low back pain on iHOT‐33 and HOS‐ADL scores.

Results

Seventy‐five of 156 subjects (48.1%) reported LBP prior to surgery. A main effect of time was found for both outcome measures (p<0.001), demonstrating improvement in self‐reported outcomes over the testing period. There was a main effect of group for the iHOT‐33 (LBP: 52.0 [47.9,56.0]; no LBP 57.9 [53.9,61.8]; p = 0.043) but not for the HOS‐ADL (LBP: 75.2 [72.2,78.2]; no LBP 78.8 [75.9,81.7]; p = 0.088) indicating that subjects with pre‐operative LBP had poorer self‐reported function per the iHOT‐33 compared to those without LBP.

Conclusion

Self‐reported hip function scores improved regardless of the presence of pre‐operative LBP; however subjects with LBP reported poorer self‐reported function per the iHOT‐33 as compared to those without LBP up to 12 months post‐operatively.

Level of Evidence

3c     

THE RELIABILITY,MINIMAL DETECTABLE CHANGE AND CONSTRUCT VALIDITY OF A CLINICAL MEASUREMENT FOR QUANTIFYING POSTERIOR SHOULDER TIGHTNESS IN THE POST‐OPERATIVE POPULATION

Background:

Posterior shoulder tightness (PST) has been implicated in the etiology of numerous shoulder disorders. Although reliable and valid measures have been described for the non‐operative population one does not exist for the post‐operative population.

Study Design:

Blinded repeated measures design.

Purpose:

Investigate the intrarater reliability, minimal detectable change at the 90% confidence interval (MDC₉₀) and construct validity of an inclinometric measurement designed to quantify PST in the post‐operative population.

Methods:

One investigator performed PST measurements on the operative shoulder of 23 participants. Passive internal and external rotation measurements were performed for the validity component of the investigation.

Results:

Intrarater reliability using an intraclass correlation coefficient (ICC) model 3,k was good (ICC = 0.79). The MDC₉₀ indicated that a change of greater than or equal to 8 degrees would be required to be 90% certain that a change in the measurement would not be the result of inter‐trial variability or measurement error. Construct validity was supported by a statistically significant relationship between PST and internal rotation r = 0.54 and by a relationship between PST and external rotation r = 0.30 which was not statistically significant.

Conclusion:

The sidelying procedure described in this investigation appears to be a reliable and valid means for quantifying PST in the post‐operative population. Moreover, the use of inclinometry provides an absolute angle of tightness that may be used for intersubject comparison, documenting change, and to determine reference values.

Level of Evidence:

Therapy, level 2b