Sharp pain - upper T-spine when swimming

Hi,

I currently have a patient who is complaining of sharp pain in the upper T-spine area during the downward pull phase of frontcrawl when swimming. When the patient swims breastroke, there is no reproduction of this pain.

Any thoughts as to what could be causing this sharp pain in his spine? Could it be the facet joints? Referred pain?

Any thoughts would be greatly appreciated!

Thanks in advance!

I'd be looking of the dynamic scapula stability and strength of the rhomboids, lat dorsi and checking the levator scap for tightness. Assess the shoulder especially looking for limitation of internal rotation in the "catch" position ie above 90deg shoulder abduction.

If shoulder is unstable or weak or tight ( or a combination of these) then the swimmer will compensate with thoracic spine.

I would put the patient in prone and the arm over the edge of the bed to assess functional movements to see whether it is the positions or the active movement that hurts.

A trial treatment to the thoracic spine and ribs would be a reasonable start as these would allow a quick improvement if the problem is thoracic mobility.

I suppose my answer is based on practicalities rather than answering an exam question!

Let us know what you find!

Is it during the breathing action of cervical rotation or during the exhalation stroke with the cervical spine in relative 'neutral' ? I would deffinatley raise an eyebrow in the general direction of the Cervicothoracic junction. If breatstroke (with minimal cervical rotation) is pain free then the that is a good clue. Try checking cervical rotation in thoracic neutral (watch for cheats) and at variou ranges of thoracic rotation (better still, as suggested, in the patients painfull position) and look for differences.

I would deffinately also be looking at scapula stability and control through range and in functional position. Use repeated movements and sustained positions or wieghts (even 1 kilo will do) during range to fully explore this - one quick rep might not do it!

Over activity in scapulothoracic muscles could be rotating the thx or CTJ under loading and upsetting biomechanics.

Swimmers regularly throw up the most complex and confusing cases especially as its hard to assess then fully functionally on dry land!!

I hope this gives you some ideas of things to check. I would say practice checking these things on 'normals' so any descrepancies will be easier to identify.

Chocks Away!!!

Stop swimming. if you have any pain in your body then first of all you stop any type of exercise or physical work. because it increase the pain more.

sorry to hear of your pain.In 1997 I had the first time pain usually when pain started I lay down on the hard surface for the some moment and it feel me free with pain.I am using my medicines regularly.