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Shoulder Mobility, Back Pain, and Elite Divers

The joint-by-joint approach to training remains one of the most influential explanatory models in modern strength and conditioning.  Coined originally by Gray Cook and Mike Boyle, this approach is simple way to understand the interrelationships of different joint systems.  No body part exists in isolation, and the interaction of structure and function among the joints ultimately determines how movement is expressed.  (complete Joint by Joint article HERE)

One recent study (Narita (2013) added some formality to this concept by looking at elite junior divers of both genders.  Specifically, authors explored potential causes of low back pain, as low back pain is undoubtedly the number one malady among competitive divers.    (Baranto 2006: Eighty-nine percent of the divers [in the study] had a history of back pain)  Divers sustain high impact forces hitting the water, which are magnified due to voluminous training needed just to become proficient.   Add in the young age at which this stress occurs along with any prior gymnastics wounds and you have a recipe for high injury risk.

Within the sample of 83 divers in the Narita study, 37.3% reported low back pain.  Authors found that shoulder flexibility and age were associated with back pain in the males, but only age was associated with pain in females.   One thought: Age may be a proxy for “use” or “volume” as the evidence suggests that simply getting older and being in the sport predispose one to injury! 

However, of note for this post is the connection between shoulder flexibility and back problems.  Diving is a sport in which certain positions are fundamental to the sport (technique doesn’t help performance acrobatics…technique IS performance in acrobatics!).    Authors recognized that “[l]imited shoulder flexibility could cause lumbar hyperextension when adjusting for the angle of water entry.”  Any coach with a decent eye can observe that their athletes who can’t achieve the requisite overhead positions often compensate with low back arching.  Endless core strength routines are often prescribed for this issue, but a global approach is needed to recognize the potential contribution of upper body mobility limitations.  This finding is joint-by-joint in action.    

Conclusion

The caveat here is that pain is multifactorial and is not always correlated with biomechanics.  However, when you have an activity such as diving with strict technical standards, it is imperative to understand ways to improve technical dysfunction.  Divers and other acrobatic athletes spend a great deal of time in thoracic flexion, which may also be a contributing factor to the shoulder restrictions but does not appear to have been examined in this study.  Adaptive posture from repeated flexion may be captured within the “AGE” variable that was correlated to low back problems in both genders.    

References

Narita T, Kaneoka K, Takemura M, Sakata Y, Nomura T, Miyakawa S.  Critical factors for the prevention of low back pain in elite junior divers.  Br J Sports Med. 2013 Apr 25. [Epub ahead of print]

Baranto A, Hellström M, Nyman R, Lundin O, Swärd L.  Back pain and degenerative abnormalities in the spine of young elite divers: a 5-year follow-up magnetic resonance imaging study.  Knee Surg Sports Traumatol Arthrosc. 2006 Sep;14(9):907-14. Epub 2006 Jan 17.

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