Take Home Points on Post-Operative Prognosis for Swimmers
Shoulder injuries are unfortunate realities of competitive swimming. Most commonly, injuries can be treated with some combination of rest, treatment, and exercise. Evidence favors conservative care before trying surgery and also encourages rehabilitation post-op for optimal function. Unfortunately though, many injuries progress to needing invasive care (ie surgery).
Many factors go into surgery: surgical skill, injury mechanism, severity, patient status (Age, health, etc), patient motivation, among others variables. But what are realistic expectations for surgical outcomes among swimmers? At the extremes, some believe you can never return to prior performance, while others believe surgery cures all. The truth likely exists somewhere in the middle.
Asking the right questions is imperative: what are the chances of returning to prior level of performance (or even higher)? Surgeons may sometimes evaluate success based on a) the quality of their craftsmanship (it didn’t break!!!!) and b) whether the patient can resume normal activities of daily living. The problem for swimmers is that the swimming shoulder has far greater demands than 99 pct of the general population.
To my knowledge, there has been no formal study on post-op outcomes on return to level of performance in swimming. Designing these studies can be difficult too, with the temptation of surgeons to cherry pick cases with a likelihood of a favorable outcome. Though swimming has unique demands, research from other sports can offer some clues.
One recent study (Fedoriw 2014) examined professional baseball players who suffered superior labrum anterior posterior (SLAP) tears. Of the pitchers, 22% who attempted conservative (non-surgical care) returned to a prior level of performance or higher, with level marked by the level of league in which they competed (A, AA, AAA, Majors). Only 7% who underwent surgery returned to prior performance levels though 48% returned to play at all. However, among non-pitchers, 54% returned to prior performance levels.
A similar study by Van Kluenen (2012) focusing only on pitchers revealed another low rate of return to prior performance. All players studied underwent surgery (no conservative care in this study) but only 6 of the 17 players in the sample returned to their same or higher level of play following their procedure. Notably, all the patients in this study presented with Glenohumeral Internal Rotation Deficit (GIRD).
Another review (Sayde 2012) expanded the inquiry beyond baseball players and foundbetter results among non-overhead athletes. Overall, 83% had "good-to-excellent" patient satisfaction and 73% returned to their previous level of play whereas only 63% of overhead athletes returned to their previous level of play.” Though the results seem more favorable when expanded beyond pitchers, it’s still unclear where swimming falls on the continuum between non-overhead athletes to pitchers.
Shoulder surgery is a very personal choice. While favorable outcomes are very possible in high level athletes, the prognosis gets bleaker with greater overhead demands on the shoulder. If we equate swimming shoulder demands to baseball pitchers, at best we can say that return to prior performance levels is unlikely. That said, there can be many confounding variables at work. Better surgical skill and deeper athlete motivation can make or break and outcome. Ultimately, know that swimmers who return to higher levels of performance after shoulder surgery have done so against long odds.
- Fedoriw WW1, Ramkumar P, McCulloch PC, Lintner DM. Return to play after treatment of superior labral tears in professional baseball players.Am J Sports Med. 2014 May;42(5):1155-60. doi: 10.1177/0363546514528096. Epub 2014 Mar 27.
- Van Kleunen JP1, Tucker SA, Field LD, Savoie FH 3rd. Return to high-level throwing after combination infraspinatus repair, SLAP repair, and release of glenohumeral internal rotation deficit. Am J Sports Med. 2012 Nov;40(11):2536-41. doi: 10.1177/0363546512459481. Epub 2012 Oct 10.
- Sayde WM1, Cohen SB, Ciccotti MG, Dodson CC. Return to play after Type II superior labral anterior-posterior lesion repairs in athletes: a systematic review. Clin Orthop Relat Res. 2012 Jun;470(6):1595-600. doi: 10.1007/s11999-012-2295-6.
Written by Allan Phillips is a certified strength and conditioning specialist (CSCS) and owner of Pike Athletics. He is also an ASCA Level II coach and USA Triathlon coach. Allan is a co-author of the Troubleshooting System and was selected by Dr. Mullen as an assistant editor of the Swimming Science Research Review. He is currently pursuing a Doctorate in Physical Therapy at US Army-Baylor University.