Dealing with hypermobility in swimmers

Written by Behnam Liaghat, recognized specialist by the International Federation of Sports Physical Therapy, based in Denmark at the University of Southern Denmark.

With hypermobility, it is really a balance for the swimmer between taking advantage of the condition by reducing drag and avoiding excessive motion that may potentially damage the joint. I propose that you may easily acquire the knowledge to test many of your swimmers for generalized joint hypermobility, including shoulder hypermobility, within 1-2 minutes.

In our recent research study on young competitive swimmers, the main findings were that healthy swimmers with hypermobility in the shoulder had a decreased strength and a larger fatigue development. In addition, more experimental data indicated a poorer stability of the shoulder blade. As a swimming coach, you can prescribe exercises to target these deficits and help your swimmers take advantage of their joint hypermobility. Generalized joint hypermobility is evaluated with the 9-point Beighton scale, which requires the performance of five maneuvers, four passive bilateral and one active unilateral performance:

  1. Passive dorsiflexion and hyperextension of the fifth MCP joint beyond 90°
  2. Passive apposition of the thumb to the flexor aspect of the forearm
  3. Hyperextension of the elbow beyond 10°
  4. hyperextension of the knee beyond 10°
  5. Active forward flexion of the trunk with the knees fully extended so that the palms of the hands rest flat on the floor

    Image credit: Clinical Examination in Rhuemetology, Michael Doherty and John Doherty (Mosby, 1992)

Each positive test scores one point, with cut-off values of more than 5/9 being indicative of the presence of generalized joint hypermobility. These cut-off values may vary, and some authors suggest lower cut-off values (e.g. 4/9) for males.

Since the shoulder is not represented in the Beighton scale, you may use a shoulder external rotation (positive score more than 90°) with the upper arm in neutral along the side of the body.

Image credit: Frederick A. Matsen III, M.D., UW Medicine, Orthopaedics and Sports Medicine

In case further investigation is required of the musculoskeletal condition of the swimmer or in case the swimmer experiences pain, please refer to a sports physiotherapist, who can perform additional tests and examination.

For more detail on this topic, please read the freely available research paper by Liaghat et al. (2018): “Competitive swimmers with hypermobility have strength and fatigue deficits in shoulder medial rotation”. https://authors.elsevier.com/a/1WU8g3kurobLDS

Contact the author directly via email: bliaghat@health.sdu.dk 

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