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游泳肩是個(gè)一般用語，用來描述游泳者因肩膀使用過度而造成的肩傷。它是一種肩膀軟組織（腱、肌肉、韌帶）的慢性發(fā)炎。這也被稱為夾擊癥侯群（Impingement Syndrome）。以游25米的自由式為例，若右臂要?jiǎng)?次。那么游4000米右臂將旋轉(zhuǎn)1280次。如果你的右肩有點(diǎn)小問題，在旋轉(zhuǎn)1280次后，可以想見，這問題將會(huì)變得更嚴(yán)重。 
圖片來源：speedyswimming.co.uk 歡迎轉(zhuǎn)載，注明出處。 合作請(qǐng)直接回復(fù)。 — 用心，做精致的康復(fù)微信 —
游泳肩最早由Kennedy JC等于1974年提出，原指游泳運(yùn)動(dòng)員出現(xiàn)由于肩關(guān)節(jié)反復(fù)撞擊導(dǎo)致的肩關(guān)節(jié)疼痛綜合征，以后用于特指游泳運(yùn)動(dòng)員因游泳動(dòng)作所引起的肩峰下撞擊綜合征和肩袖腱炎，以及與此相關(guān)的肩關(guān)節(jié)功能紊亂，是影響游泳運(yùn)動(dòng)員成績(jī)的重要原因之一。 
圖片來源：physioworks.com.au
以往的觀點(diǎn)認(rèn)為游泳肩是一種出口撞擊綜合征，近年來臨床工作者通過大量的研究，認(rèn)為游泳肩并不是真正的出口撞擊綜合征，而更可能是繼發(fā)于游泳運(yùn)動(dòng)員中普遍存在的盂肱關(guān)節(jié)前向松弛和肩胛骨不穩(wěn)定的一種肩袖前向撞擊征。 
圖片來源：physioadvisor.com.au
流行病學(xué) 諸多報(bào)道顯示游泳肩的患病率有很大的差別，Stocker等報(bào)道大學(xué)游泳隊(duì)運(yùn)動(dòng)員的患病率為47%，優(yōu)秀運(yùn)動(dòng)員患病率為48%；McMaster等以問卷調(diào)查1262名專業(yè)游泳運(yùn)動(dòng)員。結(jié)果顯示低年齡組、高年齡組及國(guó)家隊(duì)隊(duì)員的患病率分別為10%、13%、26%。如果包括既往的游泳肩病史。那么這些游泳運(yùn)動(dòng)員的患病率分別為47%、66%、73%。其它的報(bào)道從3%～80%不等。
值得慶幸的是，隨著研究的深入，劃水生物力學(xué)已由S形理論發(fā)展為以軀干力量支撐身體旋轉(zhuǎn)和平衡，早入水早出水的直向劃水理論，使游泳技術(shù)更符合人體生理特性，游泳肩的發(fā)病率逐漸降低。 
圖片來源：precisionphysicaltherapy.net
在各種游泳項(xiàng)目中，以自由泳選手最容易患游泳肩，其次為蝶泳，這與游泳的動(dòng)作特點(diǎn)有關(guān)。專項(xiàng)運(yùn)動(dòng)年限、游泳技術(shù)動(dòng)作、訓(xùn)練量、力量訓(xùn)練方式、劃水掌及打腿板的使用、肩關(guān)節(jié)松弛度、肩袖肌群及所謂的“肩胛骨穩(wěn)定肌群”的肌力和耐力等都是影響游泳肩發(fā)生的重要因素。 
圖片來源：alwaysfysio.nl 發(fā)病機(jī)制 游泳是使用肩關(guān)節(jié)頻率最高的運(yùn)動(dòng)，1名游泳運(yùn)動(dòng)員每年每側(cè)手臂劃水超過100萬次。無疑，游泳運(yùn)動(dòng)員在日常訓(xùn)練中的反復(fù)劃水的動(dòng)作是引起肩關(guān)節(jié)疼痛的重要因素。 
圖片來源：feelforthewater.com
除此以外,肩前關(guān)節(jié)囊松弛也是導(dǎo)致游泳肩的重要原因之一，肩前關(guān)節(jié)囊主要由關(guān)節(jié)囊韌帶復(fù)合體組成，是維持肩關(guān)節(jié)前方張力和盂肱關(guān)節(jié)穩(wěn)定的靜力性結(jié)構(gòu)。游泳運(yùn)動(dòng)員普遍存在一定程度的肩前關(guān)節(jié)囊松弛，這種松弛可以使運(yùn)動(dòng)員上肢和軀干在游泳過程中呈180°，以減少劃水的阻力，同時(shí)還可以增加有效的劃水長(zhǎng)度，提高運(yùn)動(dòng)成績(jī)。但肩前關(guān)節(jié)囊松弛也降低了盂肱關(guān)節(jié)的穩(wěn)定性，使肱骨頭有向上、向前的傾向，增加了維持盂肱關(guān)節(jié)的動(dòng)力性結(jié)構(gòu)——肩袖肌群的負(fù)擔(dān)，促進(jìn)了肩峰下撞擊形成，同時(shí)加劇了維持盂肱關(guān)節(jié)穩(wěn)定的肩袖肌群的負(fù)擔(dān)，使撞擊更易發(fā)生。
肩關(guān)節(jié)周圍肌群力量失衡是引起游泳肩的另一重要因素，在游泳運(yùn)動(dòng)員中，推進(jìn)力主要由胸大肌、背闊肌和菱形肌提供，推進(jìn)力增強(qiáng)意味著成績(jī)的提高，同時(shí)也意味著胸大肌、背闊肌和菱形肌肌力的增強(qiáng)，導(dǎo)致了內(nèi)收肌、內(nèi)旋肌和菱形肌肌力相對(duì)強(qiáng)于前鋸肌、外旋肌和外展肌的力量，使肩關(guān)節(jié)周圍維持穩(wěn)定的肌群出現(xiàn)力量失衡，使盂肱關(guān)節(jié)動(dòng)力性穩(wěn)定機(jī)制受到破壞，導(dǎo)致肩關(guān)節(jié)處于半脫位的傾向，促進(jìn)了撞擊的發(fā)生。 
圖片來源：physioworks.com.au
游泳肩有什么癥狀？
癥狀會(huì)隨起因的不同而不同。不過，也有通則可循。一般仰泳的癥狀是最痛的，而蛙泳則是最不痛的（除非，二頭肌腱是主要罪魁）。自由式則依發(fā)生的階段，階段不同診斷將不同(即，如果在恢復(fù)階段痛感加劇，可能是旋轉(zhuǎn)袖?。╮otator cuff）有問題，而如果是在最初拉水時(shí)加劇，則可能是二頭肌腱（biceps tendon）問題。睡在傷肩上也會(huì)使痛感加劇。當(dāng)問題惡化后，不游泳也會(huì)痛，并且肩膀變得一碰就痛。 游泳肩不是精確的診斷。為了準(zhǔn)確診斷（傷了哪些肌肉和肌腱），你應(yīng)該從運(yùn)動(dòng)醫(yī)學(xué)與康復(fù)專家尋找專業(yè)幫助。受檢者應(yīng)該帶詳細(xì)的游泳歷史并且應(yīng)該理解游泳的力學(xué)(如下)。這檢查至少包括：在有和沒有阻力（resistance）之下，對(duì)您肩部所有動(dòng)作做一份（痛感和弱點(diǎn)）評(píng)估。通常不需要到X-光。
圖片來源：swimsmooth.com
診斷 游泳肩主要表現(xiàn)為肩關(guān)節(jié)的疼痛，必須詳細(xì)詢問病史，了解潛在病因，如近期游泳技術(shù)的改變、訓(xùn)練量的增加、訓(xùn)練成績(jī)的變化、生長(zhǎng)發(fā)育情況等。最初的疼痛可由增加的訓(xùn)練強(qiáng)度或距離誘發(fā)，以肩前上方或彌漫性的疼痛感為多見。在自由泳中，疼痛往往發(fā)生于劃水期的前半部分或恢復(fù)期的前半部分。
圖片來源：swimsmooth.com
體檢可以發(fā)現(xiàn)肩關(guān)節(jié)前側(cè)或前外側(cè)的壓痛和疼痛弧的存在，肩關(guān)節(jié)抗阻外展試驗(yàn)陽性，肩關(guān)節(jié)撞擊試驗(yàn)陽性。Neer's試驗(yàn)與Hawkins'試驗(yàn)是常用的撞擊試驗(yàn)。 Neer's試驗(yàn) 受試者取坐位，檢查者立于受試肩關(guān)節(jié)同側(cè)，一手向下壓受試側(cè)肩胛骨，另一手將受試側(cè)肩關(guān)節(jié)在輕度外展位屈曲，誘發(fā)疼痛者為陽性；
Hawkins'試驗(yàn) 受試者取坐位，檢查者立于受試肩關(guān)節(jié)同側(cè)，將受試側(cè)肩關(guān)節(jié)于屈肘位前屈90°，被動(dòng)內(nèi)旋肩關(guān)節(jié)，誘發(fā)疼痛者為陽性。
有研究顯示，Hawkins'試驗(yàn)可以更敏感地誘發(fā)疼痛。盡管在體檢中能發(fā)現(xiàn)游泳運(yùn)動(dòng)員的肩關(guān)節(jié)比較松弛，但正如前面所述,這種松弛是游泳運(yùn)動(dòng)本身所需要的，除了仰泳運(yùn)動(dòng)員之外，其他游泳運(yùn)動(dòng)員一般沒有肩關(guān)節(jié)不穩(wěn)的主訴，恐懼試驗(yàn)可以用于鑒別有無明顯的前關(guān)節(jié)囊松弛。
圖片來源：southvanphysio.com
此外，應(yīng)對(duì)肩關(guān)節(jié)活動(dòng)度、穩(wěn)定性和周圍肌群的肌力進(jìn)行常規(guī)的仔細(xì)檢查。拍攝肩關(guān)節(jié)前后位和出口位X線片，CT檢查的意義不大，MRI可以發(fā)現(xiàn)肩袖的信號(hào)改變，但遺憾的是，在許多無癥狀的運(yùn)動(dòng)員中，MRI也能發(fā)現(xiàn)肩袖的信號(hào)改變,這降低了MRI應(yīng)用的價(jià)值。
圖片來源：alwaysfysio.nl
鑒別診斷需要排除頸椎疾病、臂叢損傷、腫瘤、感染、胸長(zhǎng)神經(jīng)或肩胛上神經(jīng)卡壓、肩鎖關(guān)節(jié)損傷、肩關(guān)節(jié)骨關(guān)節(jié)炎、肱骨頭無菌性壞死、肩關(guān)節(jié)盂損傷等疾病。
徒手評(píng)定 Shoulder impingment test 1
圖片來源：alwaysfysio.nl
Shoulder impingment test 2
圖片來源：alwaysfysio.nl
Shoulder impingment test 3
圖片來源：alwaysfysio.nl
防治措施 游泳肩發(fā)現(xiàn)越早，治療越早，療效越好。指望忍住疼痛，堅(jiān)持訓(xùn)練的想法只能使疾病加重，并可能出現(xiàn)肩袖撕裂的嚴(yán)重后果。不要試圖通過長(zhǎng)期的非甾體類抗炎藥和冰袋的使用來維持訓(xùn)練。因?yàn)檫@些措施只能控制炎癥，并不能從根本解決問題。教練應(yīng)該知道，落肘、游泳時(shí)不能保持中心線路、水下劃水路線縮短、過度或不足的身體旋轉(zhuǎn)等都可能是游泳肩的早期代償表現(xiàn)。
圖片來源：swimsmooth.com
治療手段 停止所有誘發(fā)疼痛的活動(dòng)或訓(xùn)練； 2周的大劑量非甾體類抗炎藥(NSAID)治療和冰敷； 使用肩峰下局封應(yīng)該非常謹(jǐn)慎,只有在2周口服藥治療和冰敷無效的情況下,運(yùn)動(dòng)員面臨喪失運(yùn)動(dòng)狀態(tài)的危險(xiǎn)時(shí)才可以使用； 停止或減少對(duì)肩前關(guān)節(jié)囊的牽拉,開始或增加對(duì)肩后關(guān)節(jié)囊的牽拉； 針對(duì)以外旋肌群、岡上肌為主的肩袖肌群練習(xí)； 增加肩胛骨穩(wěn)定肌群的練習(xí)；
圖片來源：ptclinic.co.uk
對(duì)于保守治療無效的運(yùn)動(dòng)員可以考慮肩關(guān)節(jié)鏡手術(shù)治療，對(duì)存在肩關(guān)節(jié)囊松弛并有不穩(wěn)定癥狀的運(yùn)動(dòng)員，可以用關(guān)節(jié)囊緊縮術(shù)；在存在持續(xù)關(guān)節(jié)疼痛，在活動(dòng)中有彈響者，可采用肩峰下探查術(shù)，清理增生的炎性組織和疤痕組織，術(shù)后有望恢復(fù)到患病之前的運(yùn)動(dòng)水平。
圖片來源：drrogerchams.com
在肌肉的練習(xí)中，必須注意以耐力訓(xùn)練為主，訓(xùn)練量和強(qiáng)度從低到高，以無痛為準(zhǔn)，在訓(xùn)練耐力的同時(shí)，可以在岸上開始游泳動(dòng)作訓(xùn)練，隨著力量的增強(qiáng)，可逐步進(jìn)行浮板輔助游泳，最終恢復(fù)正常訓(xùn)練。 預(yù)防措施包括： 注意保持正確的游泳技術(shù)； 避免做引起疼痛的動(dòng)作，疼痛出現(xiàn)時(shí)應(yīng)立即告知教練，并及時(shí)采取治療措施； 注意牽拉肩前后關(guān)節(jié)囊; 堅(jiān)持肩袖肌群和肩胛骨穩(wěn)定肌群的練習(xí); 增加腹肌的訓(xùn)練以保持骨盆和脊柱的穩(wěn)定。
圖片來源：ptclinic.co.uk
預(yù)防游泳肩的38個(gè)最佳訓(xùn)練動(dòng)作
Chest Stretch
Stand up straight and put a forearm that is against the wall or the doorframe. You lean it gently forwards and turn away to stretch your chest muscles. Hold the position for 20 seconds and repeat the exercise. You must feel some stretches in front of your shoulder, but it does not cause pain. If you feel pain, stop it.
2. Supraspinatus StretchPut a hand on your lower back and use another hand to pull your elbows forwards. You keep the hand on the lower back and feel slight stretch at the back of the shoulder. Hold the position for 20-30 seconds and repeat 5 times. You stop doing exercise if you feel pain.
3. Anterior Shoulder StretchYou pick up something and grasp it above the doorframe. Move the body forwards and put your arm behind to stretch the chest muscles and the shoulder. Hold it for 20 seconds and repeat it. You will feel some stretches in front of your shoulder, but not the pain.
4. Posterior Shoulder StretchAcross an arm in front of the chest and tighten with the another arm. You will feel some gentle stretches at your back of your shoulder. Hold this position for 20 minutes and repeat. If you feel pain in your back of the shoulder, stop exercising.
5. External Rotationyou lie down on the side with your arm put on the top. You rest your upper arm on the side and bend the elbow so your hand points toward the ground. Now you rotate your shoulder and move the hand up, toward the ceiling as far as you can. Return to the beginning position slowly. You can hold a weight for 2kg. Repeat 10 reps
6. Internal RotationLay down on the side and put your arm on the bottom. Keep your forearm parallel to the ground. You rotate your shoulder and move your arm forwards your stomach (hold a proper weight on your hand). Point the hand upwards. Reduce the weight back on the beginning position. Repeat 10-20 reps and you could perform the exercise each day.
7. External Rotation In AbductionStand tall and abduct your arm to 90-degree. Put your arms parallel to the ground. You can rest the elbow on a bench or a chair. Bend your elbow for 90 degrees. Now you rotate your shoulder and point your hand to the ceiling. Return to the beginning position slowly. You can hold a preferred dumbbell or a resistance band. Do it 10-20 reps. Do it every day.
8. Retraction ExerciseYou pull your shoulder back, straighten the arm, and maintain the head still. Move the shoulder and build it up gradually. You can hold a proper weight and repeat it 10 times.
9. Squeeze Shoulder BladeStand or sit tall, keep the back straight. Squeeze the blades of the shoulder as far as you can. Hold the position for 5 seconds and repeat 10 times.
10. Pendulum ExercisesGet started with the forearm on the bench or a table. Straighten your back, relax the shoulder. Swing the arm forward and backward as far as you can. Swing the arm side to side. Repeat the exercise for 10 times.
11. Pendular CirclesNow you begin the exercise with the good forearm on the bench or the table. Straighten the back and relax the shoulder. You swing the arm in a circle clockwise as far as you can. Repeat by swinging the arm counter clockwise. Repeat for 10 times.
12. Band External RotationYou start the exercise with the band attached on the hand. You grasp an end of the band and put the arm in the plane of the scapular. Now you abduct the arm at 45 degrees and flex the elbow 90 degrees. You move the forearm through the arc from 30 degrees of the internal rotation to 30 degrees of the external rotation. Keep your elbow stable. Hold the position and return it slowly.
13. Scapular Retraction With BandYou grasp a band between the hands and keep it slightly. Bend the elbows 90 degrees. Pinch the blades of the shoulder together. Hold it as long as possible. Return slowly and repeat the exercise.
14. Shoulder Flexion With BandYou secure the end of the band. You grasp another end of the band slightly. Bend the elbow at 90 degrees. Now you lift the arm about 60 degrees of the flexion. Then you extend the elbow and flex the shoulder. Hold the position as long as you can. Return to the beginning position slowly.
15. Shoulder Abduction With BandYou secure an end of the band. Another end of the band grasped slightly. Now you put the arm in the scapular, in front of the body. You flex the elbow at 90 degrees. Lift the shoulder about 60 degrees abduction. Hold it. And return to the beginning position.
16. Internal Rotation With BandYou secure an end of the band. Then grasp another band with slight tension. Put the elbow by the side for 45 degrees of the external rotation. You pull that band inward. Bend the elbow about 90 degrees. Hold it and return the beginning position slowly. Repeat it.
17. External Rotation With BandAttach an end of the bend and grasp another end of the band with the slight tension. Put your elbow by the side about 45 degrees of the internal rotation. Then you pull the band outward. Bend the elbow about 90 degrees. Hold the position and return to the starting position. Repeat the exercise.
18. Shoulder Extension With BandYou attach an end of the bend and grasp another end of the bend slightly. Put your arm forward at 45 degrees. Now you extend the arm backward and straighten the elbow. Hold the position and return it slowly to the beginning position.
19. Chin TuckYou make a pressure on the chin with the fingers. Pull the head back and hold it for 5 seconds. Keep your head horizontally and do not tilt the head back or forward to the ceiling. Hold it and repeat the exercise.
20. Pendulum SwingsYou prepare a table and lean over it, your uninvolved arm will support the body. The involved arm will straighten down and relax. Now you swing the arm gently in the circle clockwise and the counter-clockwise. Then you swing the arm as the pendulum motion, forward, backward, side to side. Repeat the exercise for 30 times.
21. Adduction StretchYou grasp the involved arm with the opposite hand. Then pull the arm across the front of the chest below your chin. Hold the position for 5 seconds. Relax and repeat the exercise.
22. Triceps StretchYou bend the involved elbow, then you raise, grasp and pull the involved arm down behind your head. Put the uninvolved hand behind the head. Hold the position for 5 seconds. Relax and repeat the exercise.
23. Corner StretchStand tall and face the corner. Then you abduct the shoulders and flex your elbows about 90 degrees. You lean into the corner slowly, stretch eh chest in front of the shoulders. Hold the position for 5 seconds. Relax and repeat 10 times.
24. Standing Adduction StretchStand straight. Put the involved hand behind your body. Grasp the elbow gently across back he uninvolved hand. Pull it slowly, hold it for 5 seconds. Relax and repeat 10 times.
25. Chicken PositionPut the hands behind your head. You push the elbows slowly straight back. Hold the position for 5 seconds. Relax and repeat for 5-10 times.
26. Leaning The DoorYou stand straight and grasp the door frame at the level of the shoulder. Lean slowly away from the door. Stretch the chest and the shoulder muscles. Hold this position for 5 seconds and relax. Repeat for 10 times.
27. Active FlexionStand tall and straighten the elbow, face the thumb forward. Now you raise the involved arm upward in front of the body as high as possible. Hold the position as long as you can. Lower the arm slowly and repeat it.
28. Active AbductionStand up, keep the elbow straight, and point the thumb out. You raise the involved arm outward to the body side as high as possible. Hold it for some seconds and reduce the arm slowly. Repeat it.
29. Prone ExtensionLie the stomach down and hang the involved arm forward the floor. You rotate the thumb and arm outward as far as possible. Raise the arm toward the hip. Avoid raising higher than the parallel level to the ground. Hold the position for 5 seconds and return to the beginning position. Repeat it.
30. Prone Horizontal AbductionLying prone on a table. Then you rotate the thumb and arm outward as far as you can. Next, you raise the arm out to your side. Avoid raising higher than the parallel level to the ground. Hold the position for 5 seconds. Return to the beginning position and repeat.
31. Supine RotationLying supine on the floor or a table. Abduct the shoulder about 90 degrees with the support of the arm and flex the elbow. Raise the hand slowly and forward as far as you can. Hold the position for some seconds. Return to the beginning position. You should try to put the back of the hand on the table in up position and the palm on the down position. Repeat the exercise as instructed.
32. Supine Triceps ExtensionLying flat on the floor and bend the elbow near your head. Now you rest the involved hand on the uninvolved shoulder You extend the elbow slowly as straight as possible. Avoid moving the upper arm. Return the beginning position and repeat the exercise.
33. Seated DipsFirstly, you sit on the edge of the chair or a table and grip the table sides with your hands. You keep the arms straight and lift the buttocks gradually. Hold the position for 3-5 seconds. Then lower the arm. Repeat the exercise.
34. Towel SqueezingYou fold the towel into eight and put it between your involved elbow and the chest. You squeeze the arm that is against the towel and the chest. Cross the forearm in front of the body at 45 degrees. Hold the position for 5 seconds. Relax and repeat the exercise as instructed.
35. ShrugsYou stand tall and put the arms at your sides. Next, you lift the shoulders toward the ears, hold it. Pull your shoulder back, pinch the shoulder blades. Hold it for some seconds. Relax and repeat it.
36. Bicep CurlsYou straighten the arm and face the palm forward. Flex the elbow slowly and bring the hand up to the shoulder as far as you can. Hold the position for 5 seconds. Return to the starting position. Repeat as instructed.
37. Bent-Over RowsBent over and put the back parallel to the ground. Hang the arms to the ground, pull your arms up slowly. Bring the hands to your chest level. Then you reduce the arms slowly to the beginning position. Then repeat the exercise.
38. SupraspinatusThe last but not least, you will get the effectiveness like doing other exercises for shoulder impingement. Here is the instruction how to do it: Stand tall, keep the elbow straight. Rotate your arm inward and point down the thumb. Now you raise the hand to the eye level about 30 degrees angle to the body. Avoid lifting the hand over the eye level. Hold the position and lower slowly to the beginning position. Repeat as the direction
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