The Relationship of Preseason Upper Extremity Function, Pain and Training on Normalized DIII Collegiate Swimming Performance.

Context: Shoulder injuries comprise the largest proportion of swimming injuries and there is a large percentage of swimmers participating with pain. Therefore, it is assumed that shoulder pain decreases performance, but studies have not compared collegiate swimmers' performance with and without pain.

Objectives: 1) Determine if individual swimmer's shoulder pain and function are associated with a change in normalized swimming performance over a season.2) Determine if differences in normalized swimming performance exist among 3 collegiate teams. 3) Qualitatively describe and compare team's training regimes.

Design: Cross sectional study.

Setting: Swimmers completed pre-(T1) and post-season (T2) surveys including pain ratings and shoulder function using the Kerlan-Jobe Orthopaedic Clinic (KJOC) shoulder and elbow questionnaire. Swimming times were obtained from published meet results. Coaches reported training programs through interviews and tracking logs.

Participants: 52 NCAA Division III swimmers from 3 teams.

Main outcome measures: Stepwise linear regression was used to determine if pain and function related to performance. Team demographics and normalized swimming performance (reduction in time per lap from season's beginning to end) were compared with ANOVAs with post-hoc tests.

Results: Initial KJOC scores, but not pain, related to individual swimming performance. Differences in team performance were found (p=0.006), with Team 3 having greatest reduction in time (1.01 sec/lap), lower percentage of females, a more experienced coach and a periodization schedule with large increases and decreases in yardage. There was a main effect (p=0.043) for baseline demographics with Team 3's swimmers being taller and having longer competitive experience.

Conclusions: The initial KJOC score predicting swimming performance improvement demonstrates the need for athletic trainers to prioritize enhancement of pre-season function. Endurance training induced hypoalgesia and motivation may explain the lack of effect of shoulder pain on performance. Further research is needed to elucidate optimal periodization and dryland training.