While George R.R. Martin says, “Some old wounds never truly heal, and bleed again at the slightest word," in his epic series Game of Thrones, this doesn’t have to be the case for those soldiering on in water polo matches. In part II of this series, Alicia Filley advises on how to manage upper extremity injuries and maintain shoulder health.
Water polo athletes are doubly at risk for a shoulder injury, being both swimmers and overhead throwers. In fact, up to 80% of water polo players complain of a painful shoulder, and the incidence increases with the level of play1. The overhand throw used in water polo is similar to a baseball pitch but without the assistance of a base of support. Therefore, the trunk moves as one unit, unlike the segmented rotation in a baseball pitch, contributing only 30% - 35% of the speed producing force acted upon the ball; and leaving the shoulder to provide the remainder1,2.
The muscles of the rotator cuff, the supraspinatus, the infraspinatus, the teres minor, and the subscapularis (SITS), are responsible for stabilizing the humerus within the shallow glenoid fossa, depressing the humerus during shoulder movement, and performing both internal and external shoulder rotation (see figure 1). These muscles fatigue more rapidly in water polo due to increased activation in the head-up swimming posture when compared to freestyle swimming1.
When muscles are strained due to overuse, improper technique, or muscle imbalances, they can suffer from hypoxia, which results in cell death or apoptosis. Early cell death within the tendon, termed tendinopathy but more commonly referred to as tendonitis, is treated effectively with heavy, slow resistance training and strengthening, and correct technique. (Search our extensive library for more on how to treat shoulders, rotator cuff injuries, and tendinopathy) Too much stress and the tendon degenerates beyond repair and may eventually rupture. Therefore, it’s important to monitor any complaints of shoulder pain closely so that tissue stress can be treated while the injury is still minor.
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