Soft Tissue Massage on Non-Specific Shoulder Pain

van den Dolder PA, Ferreira PH, Refshauge KM. Effectiveness of soft tissue massage and exercise for the treatment of non-specific shoulder pain: a systematic review with meta-analysis. Br J Sports Med. 2012 Jul 26. [Epub ahead of print]

Background
Shoulder pain is prevalent in the general population and the most injured site for swimmers. Many of these injuries are not classified with diagnostic imaging.

Non-specific shoulder pain is typically treated by a physical therapist. Many therapists commonly utilize massage and exercises during the intervention. The purpose of this study was to review the effectiveness of soft tissue massage and of exercise for non-specific shoulder pain when these interventions were compared with placebo, no treatment, another active treatment or when soft tissue massage or exercise were added to supplement to other interventions.

What was done
The researchers used inclusion criteria: randomized controlled trials, adults, handling nearly all shoulder pathologies (tendonitis, impingement, frozen shoulder). A total of 23 studies were reviewed.


Results
The review suggest there is low-quality evidence that soft tissue massage is effective in improving range of motion, function, and pain in patients with non-specific shoulder pain immediately following treatment. Exercise approaches improve non-specific shoulder pain immediately following treatment, but not in the short term.

The most effective location of soft tissue massage was to the lateral border of the shoulder blade. This resulted in a mean 22 degree improvement in flexion and 42 degree improvement in abduction, a decrease in the visual analog scale by 26.5 mm, and functional scores improved by 28.7%. Exercise appears to improve pain by 9.8 mm. Stretches to shortened muscles around the glenohumeral joint and high-intensity exercises show weak correlation with improvement. It is uncertain whether exercises benefit from professional supervision.

Discussion
Soft tissue massage seems beneficial for improving pain, function, and range of motion in patients with non-specific shoulder pain in the short term. Strengthening exercises appear to produce small changes in pain, but not in function or range of motion.

Practical Implication
This is the first review on the effectiveness of soft tissue massage on shoulder pain. The positive results with massage need further research on larger groups and better grouped patients with their stage of injury (acute, sub-acute, chronic). This generalization does a disservice to the specifics of rehabilitative care.

Despite this, it seems soft tissue mobilization is effective in treating non-specific shoulder pain and one could speculate this techniques should be used as a preventative measure prior to injury.

Related Reading
Tennis Ball Tip (The “magic” of tissue work)
Fixing the “Disco” Crossover Swimmer with Scapular Stabilizer Tissue Work + Strengthening Exercises


Swimming Science Research Review 
This is a piece of the July Swimming Science Research Review. Read Swimming Science Research Review September 2012 for a complete list of the articles reviewed.

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Sun Yang 1500 Swimming Stroke Analysis London 2012

Swimming biomechanics highly influence swimming success. Sun Yang 1500 swimming stroke analysis London 2012 hopes to provide a frame by frame analysis of the current top male distance swimmer. As you will see, some of the mechanics Yang uses are far superior to other swimmers, however he still has some deviations. Moreover, he demonstrates a few nuances uncommon, but potentially progressive for the stroke.

If you enjoyed this review and wish to have your stroke analyzed by the Swimming Science team, purchase a Swimming Science Stroke Analysis today! If you purchase one before September 20th you will receive a complimentary 6 month subscription to the Swimming Science Research Review!
Number of Strokes


Frame 1 (Corresponding Pictures below):
Pushes off wall with streamline slightly separated from ears. Head is down facing floor of pool. Little to no flutter kick is occurring during this frame.

Frame 2:

Initiates pull with right arm. Head position remains in same position as frame 1, and kick still appears to be minimal.

Frame 3:
Initiation of pull continues (note the absent of any white bubbles or turbulence with this hand). Both arms begins to abduct (come apart) from the head.  Head remains fixed. Right hip flexion and knee flexion while the left hip appears to extend.

Frame 4:
High elbow on right arm continues to be more pronounced with an increased in shoulder internal rotation. Right arm appears to begin flexing to help achieve an early vertical forearm. Left arm abducts slight more. Head begins to lift through an apparent cervical extension. Right leg kicks through to finish kick and left leg remains in slight extension.

Frame 5:
Right shoulder internally rotates more as the wrist returns to neutral, early vertical forearm is achieved. Left arms abducts even more. Head appears to extend more. Legs appear unchanged, while the right ankle appears to slightly dorsiflex to return to streamline.

Frame 6:
Right shoulder extension begins for the catch, while the arm remains fixed in internal rotation. Left arms abducts even more and is now in full shoulder and elbow extension. Head extends and rotates right. Left hip extends more in preparation for a downkick.

Frame 7:
Right shoulder comes under the body with the shoulder fixed in internal rotation with the wrist in extension. The left arms appears unchanged. The head rotates and extends more.  The body initiates right rotation. The left leg rises, from what appears knee flexion.

Frame 8:
Right shoulder continues catch as the arm adducts, now approximately 45 degree abduction. Left arms remains fixed. Head appears to only rotate more. The body continues to increase right rotation. Right leg appears to undergo slight hip extension. Left leg has large amount of knee flexion, to what appears bring the foot through the surface of the water.

Frame 9:
Right arm adducts more as the hand passes the hip. The left arms is still fixed (potentially elongating via spinal rotation). The head extends and rotates, noticeable turbulence is present on right shoulder in this frame due to this swimmer's breathing biomechanics. The body rotates more right. Right leg continues to extend through the hip, while the leg knee undergoes hip flexion and knee extension (downkick).

Frame 10:
Right arm is out of view, but appears to have initiated recovery. The left arm remains still. The head is at it's most rotated and extended position, resulting in the largest amount of visible turbulence on the upper right side of the body. The body is in maximal right rotation (maximizing left arm elongation). The right continues to perform an upkick (knee flexion initiating), while the left is performing a strong downkick predominantly through knee extension.

Frame 11:
Right arm likely continues recovery, while the left arm is still fixed. The head begins to rotate left and flex to return to the water. Note the large turbulence during this phase. The body lowers in the water as it rotates left. The right leg continues it's upkick through increased knee flexion. The left leg finishes it's downkick with pronounced knee extension (note the athlete's dorsiflexed ankle, far from the 'typical' swimmer's body).

Frame 12:
Right arm likely continuing recovery, as the left arms remains fixed while the left wrist flexes to initiate the pull. Head continues to rotate left, to return to streamline. No apparent body rotation. Right leg likely is initiating downkick,  through hip flexion and knee extension. Left leg begins upkick through hip extension.

Frame 13:
Right arm likely continuing recovery, left arm begins to press down (likely through glenohumeral (shoulder) internal rotation) as the wrist appears to flex slightly more. Head likely continues left cervical rotation, no cervical flexion appears present in this frame. The right leg continuing the downkick through knee extesion. The left knee continues to upkick with large knee flexion.

Frame 14:
Right arm likely recovering, left arm continues internal rotation as the wrist returns to neutral. Head likely continuing left cervical rotation. Right leg  is finishing the downkick with knee extension as the left leg finishes the upkick with knee flexion.

Frame 15:
Right arm enters the water above head visible turbulence during this re-entry. Left arm undergoes more internal rotation to achieve early vertical forearm. Head continues to rotate left (currently near neutral position), cervical extension persists. Body rotates left and slightly drops. Right leg likely initiating upkick. Left leg is performing downkick with knee extension.

Frame 16:
Right arm extends forward with minimal turbulence, left arm performs adduction to catch water. Head and body rotate left. Right leg undergoes knee flexion for upkick and left leg finishes downkick through knee extension.

Frame 17:
Right arm extends (likely from left body rotation). Left arm continues to catch water with a high elbow as arm during adduction. Head rotates left and extends. Body rotates left. Right leg begins downkick through knee extension while the left hip extends for the initiation of the upkick.

Frame 18:
Right arm continues to extend as the left arm undergoes shoulder extends to finish the catch. The head and body rotate left. The right knee kicks down through knee extension. The left knee begins knee flexion.

Frame 19:
Right arms remains fixed. Left arm undergoes recovery. Head maintains cervical left rotation and extension (note large frontal turbulence at the head). Body begins rotation right. Left leg performs knee extension for downkick and right knee flexes to finish upkick.

Frame 20:
Right arms presses down (likely from body dropping due to recovery arm) and wrist slightly flexes. Left arm continues to recover. Head remains fixed as turbulence remains high. Body continues to rotate right. The right leg finishes downkick with ankle dorsiflexion while the left leg initiates down kick with slight hip flexion.

Frame 21:
Right arm continues to press down, now likely due to recovery arm and initiation of shoulder internal rotation. Left arm continues recovery. Head begins rotation right with continued frontal turbulence. Body has slight rotation right. Right hip extends. Left knee extends.

Frame 22:
Right continues to lower beginning catch. Right arm still recovering. Head performs more rotation right. Body rotation appears constant. Right upkick continues and left downkick finishes.

Frame 23:
Right arm internally rotates for the catch phase, left arm re-enters water with minimal turbulence at left hand. Head rotates right and flexes. Body rotates right. Right hip flexes for downkick and left hip extends.

Frame 24:
Right arm maintains internal rotation and begins to adduct. Right arm continues to re-enter water with turbulence visible at elbow and upper arm. Head rotates right and slightly extends. Body rotates right. Right knee extends and the left hip extends.

Frame 25:
Right arm continues to adduct and wrist appears to have slight extended, potentially finishing the catch phase too early. Left arm continues to extend forward, while the head rotates right and extends. Body continues to rotate right. Right leg begins upkick with hip extension as the left leg undergoes knee flexion.

Frame 26:
Right arms returns to a straight forearm to finish the catch. Left arm continues to extend (via right body rotation). Head and body continue right rotation. The right leg continues to perform slight hip extension. The right hip flexes to initiate the downkick.

Frame 27:
The right arm finishes the catch through adduction and extension. The left arms continues to achieve relative extension via right body rotation. The head rotates right and extends. The body rotates right. The right leg performs knee flexion while the left knee undergoes knee extension.

Notable features: 
Streamlined body throughout the stroke. Minimal turbulence upon hand re-entry. turbulence around head and shoulder during poor breathing mechanics. One of the best EVF, especially on the left side. Streamlined body balance through matched contralateral down kick and hand re-entry. Streamlined head position when the athlete is not breathing.

He clearly uses a high elbow anchor position on his left arm. This allows him an elongated distance per stroke and endurance capability. His right arm uses a little lower elbow anchor position, potentially helping him utilizes his hips more. Unfortunately, this angle prevents the reviewer from seeing the distance the arm is from the bodyline.

Areas to improve:
·         Breathing mechanics, remove cervical extension during breath
·         Ankle dorsiflexion during upkick, as this likely increases turbulence in the water [not sure if this feature facilities the rest of the downkick]

Areas to copy:
·         Streamline of body (except during breathing)
·         Early vertical catch, especially on left
·         Body balance between hand re-entry and downkick

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If you enjoyed this piece, considering reviewing Dr. Rushall's "How Champions Do It!"

By G. John Mullen founder of the Center of Optimal Restoration, head strength coach at Santa Clara Swim Club, creator of the Swimmer's Shoulder System, and chief editor of the Swimming Science Research Review.

Swimming Science Stroke Analysis

Stroke technique plays a significant role in swimming success. Unfortunately, many swimmers do not have the resources for optimal feedback, to adjust their stroke and make improvements. The Swimming Science Stroke Analysis provides a whole stroke analysis broken down per frame, providing feedback, finding where each swimmer is having signs of increased drag or poor force production.

Service requires swimmer to submit swimming video (prefer underwater). This is submitted to info@swimmingscience.net or
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Number of Strokes