1. Please introduce yourself to the readers (how you started in the profession, education, credentials, experience, etc.).
I
have been a physical therapist for 26 years. I received my BS in
Physical Therapy at Thomas Jefferson University in Phila, PA and then I
went back to further my education and earned an MS and then a PhD in
Physical Therapy from Temple University, in Phila. PA. My doctoral
dissertation was done on Division I and Division 3 athletes who perform
repeated overhead motions, including throwers, swimmers and those
competing in water polo. I worked with a renowned shoulder researcher,
Phil McClure, who is a professor at Arcadia University, in Glenside,
PA. We developed a classification system for motion of the scapula
(shoulder blade) and developed a test to determine if shoulder pain may
be due to a problem with motion of the shoulder blade due to weakness or
muscle tightness. I use this test, called the Scapula Reposition
Test, with all of my patients referred for shoulder pain due to
swimming. We have also published research on a 5 state multicenter
trial on shoulder impingement which is pain caused by compression of the
tendons in the shoulder ( a condition that commonly affects competitive
swimmers).
I am an Associate faculty member of Arcadia University where I teach in the doctoral physical therapy program. I spend most of my time as the Clinical Director of Willow Grove Physical Therapy in Willow Grove, PA, where I specialize in the treatment of patients with shoulder disorders, especially athletes such as swimmers, tennis players, and throwers. I am a member of the Ocean City Master’s Swim Team and now compete in triathlons. I currently volunteer with my daughter’s swim team where I teach yoga as a means of cross training, as my research found that cross training was associated with a reduced incidence of shoulder pain.
2. You recently published an article on risk factors for shoulder injuries and swimming?
I was awarded a grant from United States Masters Swimming to study shoulder pain in swimmers across the lifespan. I was interested in determining if differences in training or physical characteristics existed between swimmers with and without shoulder pain. If differences exist, this could be used as starting point for designing a shoulder pain prevention program. My research team consisted of myself and 4 graduate physical therapy students. We tested swimmers from 18 different teams. They completed a survey about their training and shoulder symptoms and we did a shoulder examination and measured swimmers strength, flexibility, and endurance poolside. We had some really interesting findings. Swimmers who engaged in another sport such as walking or running for masters swimmers and soccer for youth swimmers were less likely to have shoulder pain. Those who swam a greater number of hours and high school swimmers who participated in competitive swimming for a greater number of years or who played water polo were more likely to have pain. Those who had better core endurance, middle trapezius (mid back) strength and longer pectoral (chest muscles) were also less likely to have shoulder pain. Taken together, it appears that training affects shoulder pain and so modifications of current training techniques could be tested to determine if the incidence of pain can be reduced. Our research found that 31% of our youth swimmers (aged 8-11) had pain during swimming, 56% of our 12-14 year olds, 81% of our high school swimmers and 64% of masters swimmers had shoulder pain, so the majority of swimmers are affected by pain, even through the masters level. TATE, A., TURNER, G. N., KNAB, S. E., JORGENSEN, C., STRITTMATTER, A. & MICHENER, L. A. 2012. Risk Factors Associated With Shoulder Pain and Disability Across the Lifespan of Competitive Swimmers. Journal of Athletic Training, 47, 149-158.
3. Who is doing the most interesting research on shoulder injury in overhead athletes?
The best study I have read was done in Australia and published in the British Journal of Sports Medicine (SEIN, M. L., WALTON, J., LINKLATER, J., APPLEYARD, R., KIRKBRIDE, B., KUAH, D. & MURRELL, G. A. C. 2010. Shoulder pain in elite swimmers: primarily due to swim-volume-induced supraspinatus tendinopathy. British journal of sports medicine, 44, 105-113.). Sein et al studied 80 elite swimmers aged 13-26 and found that 91% had pain. The performed MRI studies on 52 of these swimmers and found that 69% had shoulder tendinopathy (degeneration of a rotator cuff tendon). They also found significant correlations between tendinopathy and the amount of yardage swum per week and number of hours practiced. They report that swimming 15 hours per week or more than 35 miles per week increases the risk of tendinopathy. I found it shocking that 13 year old swimmers incur actual tendon damage due to overuse and that restrictions on yardage are not in effect to protect these young athletes.
I also really like an article by Lynch et al, who found that an exercise program was effective in altering swimmers posture, which is thought to contribute to shoulder symptoms. LYNCH, S. S., THIGPEN, C. A., MIHALIK, J. P., PRENTICE, W. E. & PADUA, D. 2010. The effects of an exercise intervention on forward head and rounded shoulder postures in elite swimmers. British journal of sports medicine, 44, 376-381.
4. What makes your research different from others?
I believe we are the first to study swimmers across the lifespan from age 8 through masters swimmers in their 70s. Our study design used different stations poolside, so swimmers could interrupt their practice and rotate through the stations then return to their workout. This allowed us to test a greater number of swimmers than most other published studies.
5. Which teachers have most influenced your research?
Phil McClure, PT, PhD who is a professor at Arcadia University, was instrumental in mentoring me as a PhD student and assisting me with a pilot study where we worked out the procedure for data collection for my study on risk factors for shoulder pain in swimmers. Lori Michener PT, PhD, a professor at Virginia Commonwealth University, has collaborated with me on my swimming research, particularly on the statistical analysis. Both have been very influential on my research career and I am grateful to have the opportunity to work with them.
6. What are your favorite books on the shoulder and swimming?
I read primarily scientific research articles.
7. What are the most common mistakes you see in those training shoulder prevention?
Stroke technique is very important. Crossing over during the pull phase should be avoided and adequate trunk rotation should be emphasized. In addition, swimmers often have laxity or too much flexibility in their shoulders yet are performing stretches which may further damage the shoulder tissues. Stretching should be specific to the typical mobility restrictions found in swimmers, such as the pectoral tightness. Strengthening of the scapular muscles is also essential to balance the strong shoulder internal rotators. (Refer to the previously cited Lynch et al study).
8. What mistakes still exist in professional athletes and rehabilitation clinics?
Despite the high incidence of shoulder pain, there is a lack of data to support specific safety recommendations for swimmers. Pitch count guidelines are utilized for youth league pitchers to reduce shoulder injuries but I am not aware of yardage or time guidelines available to assist swimming coaches in their efforts to provide safe and effective training. Obviously there is more research funding available for some sports, like baseball, so we have more data available for effective prevention and rehabilitation. Unfortunately, funding for swimmers is lacking, despite an estimated 400,000 competitive swimmers in the US.
9. What research or projects are you currently working on or should we look from you in the future?
We have just completed a survey of dry land and in water training practices of youth, high school and college teams as well as masters swimmers across the United States. Our goal was to identify common training practices and determine if training methods are being employed to reduce shoulder injury. I hope to find a way to disseminate my research findings so the that the information will be widely available for coaches and swimmers.
I am an Associate faculty member of Arcadia University where I teach in the doctoral physical therapy program. I spend most of my time as the Clinical Director of Willow Grove Physical Therapy in Willow Grove, PA, where I specialize in the treatment of patients with shoulder disorders, especially athletes such as swimmers, tennis players, and throwers. I am a member of the Ocean City Master’s Swim Team and now compete in triathlons. I currently volunteer with my daughter’s swim team where I teach yoga as a means of cross training, as my research found that cross training was associated with a reduced incidence of shoulder pain.
2. You recently published an article on risk factors for shoulder injuries and swimming?
I was awarded a grant from United States Masters Swimming to study shoulder pain in swimmers across the lifespan. I was interested in determining if differences in training or physical characteristics existed between swimmers with and without shoulder pain. If differences exist, this could be used as starting point for designing a shoulder pain prevention program. My research team consisted of myself and 4 graduate physical therapy students. We tested swimmers from 18 different teams. They completed a survey about their training and shoulder symptoms and we did a shoulder examination and measured swimmers strength, flexibility, and endurance poolside. We had some really interesting findings. Swimmers who engaged in another sport such as walking or running for masters swimmers and soccer for youth swimmers were less likely to have shoulder pain. Those who swam a greater number of hours and high school swimmers who participated in competitive swimming for a greater number of years or who played water polo were more likely to have pain. Those who had better core endurance, middle trapezius (mid back) strength and longer pectoral (chest muscles) were also less likely to have shoulder pain. Taken together, it appears that training affects shoulder pain and so modifications of current training techniques could be tested to determine if the incidence of pain can be reduced. Our research found that 31% of our youth swimmers (aged 8-11) had pain during swimming, 56% of our 12-14 year olds, 81% of our high school swimmers and 64% of masters swimmers had shoulder pain, so the majority of swimmers are affected by pain, even through the masters level. TATE, A., TURNER, G. N., KNAB, S. E., JORGENSEN, C., STRITTMATTER, A. & MICHENER, L. A. 2012. Risk Factors Associated With Shoulder Pain and Disability Across the Lifespan of Competitive Swimmers. Journal of Athletic Training, 47, 149-158.
3. Who is doing the most interesting research on shoulder injury in overhead athletes?
The best study I have read was done in Australia and published in the British Journal of Sports Medicine (SEIN, M. L., WALTON, J., LINKLATER, J., APPLEYARD, R., KIRKBRIDE, B., KUAH, D. & MURRELL, G. A. C. 2010. Shoulder pain in elite swimmers: primarily due to swim-volume-induced supraspinatus tendinopathy. British journal of sports medicine, 44, 105-113.). Sein et al studied 80 elite swimmers aged 13-26 and found that 91% had pain. The performed MRI studies on 52 of these swimmers and found that 69% had shoulder tendinopathy (degeneration of a rotator cuff tendon). They also found significant correlations between tendinopathy and the amount of yardage swum per week and number of hours practiced. They report that swimming 15 hours per week or more than 35 miles per week increases the risk of tendinopathy. I found it shocking that 13 year old swimmers incur actual tendon damage due to overuse and that restrictions on yardage are not in effect to protect these young athletes.
I also really like an article by Lynch et al, who found that an exercise program was effective in altering swimmers posture, which is thought to contribute to shoulder symptoms. LYNCH, S. S., THIGPEN, C. A., MIHALIK, J. P., PRENTICE, W. E. & PADUA, D. 2010. The effects of an exercise intervention on forward head and rounded shoulder postures in elite swimmers. British journal of sports medicine, 44, 376-381.
4. What makes your research different from others?
I believe we are the first to study swimmers across the lifespan from age 8 through masters swimmers in their 70s. Our study design used different stations poolside, so swimmers could interrupt their practice and rotate through the stations then return to their workout. This allowed us to test a greater number of swimmers than most other published studies.
5. Which teachers have most influenced your research?
Phil McClure, PT, PhD who is a professor at Arcadia University, was instrumental in mentoring me as a PhD student and assisting me with a pilot study where we worked out the procedure for data collection for my study on risk factors for shoulder pain in swimmers. Lori Michener PT, PhD, a professor at Virginia Commonwealth University, has collaborated with me on my swimming research, particularly on the statistical analysis. Both have been very influential on my research career and I am grateful to have the opportunity to work with them.
6. What are your favorite books on the shoulder and swimming?
I read primarily scientific research articles.
7. What are the most common mistakes you see in those training shoulder prevention?
Stroke technique is very important. Crossing over during the pull phase should be avoided and adequate trunk rotation should be emphasized. In addition, swimmers often have laxity or too much flexibility in their shoulders yet are performing stretches which may further damage the shoulder tissues. Stretching should be specific to the typical mobility restrictions found in swimmers, such as the pectoral tightness. Strengthening of the scapular muscles is also essential to balance the strong shoulder internal rotators. (Refer to the previously cited Lynch et al study).
8. What mistakes still exist in professional athletes and rehabilitation clinics?
Despite the high incidence of shoulder pain, there is a lack of data to support specific safety recommendations for swimmers. Pitch count guidelines are utilized for youth league pitchers to reduce shoulder injuries but I am not aware of yardage or time guidelines available to assist swimming coaches in their efforts to provide safe and effective training. Obviously there is more research funding available for some sports, like baseball, so we have more data available for effective prevention and rehabilitation. Unfortunately, funding for swimmers is lacking, despite an estimated 400,000 competitive swimmers in the US.
9. What research or projects are you currently working on or should we look from you in the future?
We have just completed a survey of dry land and in water training practices of youth, high school and college teams as well as masters swimmers across the United States. Our goal was to identify common training practices and determine if training methods are being employed to reduce shoulder injury. I hope to find a way to disseminate my research findings so the that the information will be widely available for coaches and swimmers.
Great Interview. The sport needs more bright minded, passionate researchers and clinicians like Dr Tate!
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