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# Background There are 2.8 million youth competitive swimmers in the United States (US), and shoulder pain is the most common complaint among swimmers. # Purpose To determine prevalence of shoulder pain, disability, and dissatisfaction in youth competitive swimmers. A secondary purpose was to determine influence of age, competitive swimming experience, and previous history of shoulder pain or injury on shoulder pain, disability, and dissatisfaction, and finally to determine if sex, geographic area, and participation in a second sport relate to shoulder pain, disability, and dissatisfaction. # Study Design Multi-site cross-sectional design # Methods Six-hundred and seventy-one swimmers aged 9–17 years from six states in the US completed surveys which included demographics, the Penn Shoulder Score (PSS), and the Disability of Arm Shoulder Hand (DASH) Sports. Independent t-tests were used to compare pain, disability, dissatisfaction, the influence of age, sex, participation in second sport, geographic region, and history of shoulder pain. Linear regression analyses were performed to determine the interaction of these variables with reported pain and disability. # Results Forty-nine percent of swimmers had shoulder symptoms. Greater shoulder pain and disability were reported in 15 to 17-year-olds compared to 9 to 10-year-olds (pain and disability: p

Inflammation is the body’s non-specific response to injury or infection. It is a natural defense mechanism that helps to maintain homeostasis and promotes tissue repair. However, excessive inflammation can lead to cellular, tissue, or organ dysfunction, as well as contribute to the development of acute vascular events and diseases like Crohn’s disease, psoriasis, obesity, diabetes, and cancer. The initial response to injury involves the activation of platelets and coagulation mechanisms to stop bleeding. This is followed by the recruitment of immune cells and the release of cytokines to promote tissue repair. Over time, the injured tissue undergoes remodeling and returns to its pre-injury state. Inflammation is characterized by the activation of inflammatory signaling pathways involving cytokines, chemokines, and growth factors. Mast cells play a role in initiating inflammatory responses. Pattern recognition receptors (PRRs) such as Toll-like receptors (TLRs) and nucleotide-binding domain (NOD)-like receptors (NLRs) are involved in the activation of these inflammatory pathways. Inflammasomes, which are cytoplasmic complexes, also contribute to inflammation by activating cytokines. Inflammation can also be triggered by factors like dietary components and the composition of the gut microbiota. Dysregulation of the gut microbiome can lead to excessive inflammation and contribute to diseases like atherosclerosis and irritable bowel syndrome (IBS). The immune system and gut-associated lymphoid tissue (GALT) play crucial roles in the inflammatory response and the development of conditions like colorectal cancer. Anti-inflammatory therapy can play a significant role in reducing or inducing the remission of inflammatory diseases such as Crohn’s disease and ulcerative colitis. The fetal origin of adult diseases theory suggests that conditions during fetal development, such as low birth weight and maternal obesity, can influence the risk of cardiometabolic diseases later in life. All of the known risk factors associated with cardiometabolic diseases such as hypertension, excess weight, obesity, type-2 diabetes, and vascular diseases are accompanied by chronic low-grade inflammation. Inflammation seems to have a role in precipitating even acute vascular events such as heart attacks and stroke. Common markers of inflammation associated with cardiometabolic disease include interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF-α), C-reactive protein (CRP), and soluble TNF receptors such as sTNFR1 and sTNFR2. These markers serve as indicators of systemic inflammation. However, these markers are not disease-specific but provide an insight into the overall chronic inflammatory status. In fact, inflammation has been identified as a potential target for future treatments to reduce or reverse the risk of atherosclerosis-related complications. The regulation of inflammation is complex, and further research is needed to better understand its mechanisms and develop strategies for managing inflammatory disorders. In summary, inflammation is a natural response to injury or infection, but excessive or prolonged inflammation can lead to the progression of various diseases. Understanding the underlying mechanisms of inflammation is important for developing treatments and preventive measures for inflammatory disorders.

According to the World Health Organization (WHO), cardiovascular diseases (CVD) are the number one cause of death globally, taking an estimated 18 million lives each year. Framingham Heart Study Group in Boston developed, the very first 10-year CVD risk prediction model. The WHO recently derived a 10-year risk prediction model, for fatal and non-fatal CVD events using individual participant data, from the Emerging Risk Factor Collaboration. This CVD risk model, derivation involved participation of 376,177 individuals from 85 cohorts, and 19,333 incident CVD events. Cardiometabolic diseases in general, - and metabolic diseases like hypertension, excess weight, obesity, type-2 diabetes, and vascular diseases collectively, contribute to the overall morbidity and mortality related to CVDs. Of the 18 million CVD-related deaths in 2017, more than three quarters were in low-income and middle-income countries. Risk stratification, management, and prevention models can be very important components of disease prevention and control efforts. In view of this very important role the risk assessment plays, we have reviewed and discussed three specific areas of integration of emerging diagnostic technologies,-population level, individual level, and novel ways of collecting, collating, derivation, and validation of individual risks, risk scores for cluster of risks, and for the use of such data for treatment management. For collection of massive data from general population, we have discussed the National Institutes of Health’s flagship program, -All of Us. For empowering individuals in risk assessment and management of identified risks, we have discussed ambulatory diagnostic devices, blood pressure monitors, and continuous glucose monitors. As an example of futuristic approach for the integration of diagnostic tools, we have discussed the products developed by LD-Technologies, Miami, Florida by Dr. Albert Maarek and associates. There are thousands of mHealth apps available for download, and not all are of great use in developing, a seamless diagnostic platform, that we at AayuSmart are trying to put together for cardiometabolic risk stratification, risk prediction, and risk management. We have provided, just a brief glimpse of available tracking, computing, collating, and the software analytical capabilities that exists, and discussed how innovators are trying to use them to build novel diagnostic tools. Despite the important role of telemedicine and internet of things (IOT) in disease management, and healthcare delivery, we have not discussed those applications. In this overview, we have discussed the use of emerging diagnostic tools, for obtaining data at the population level, personal level, as well as for clinical settings. Having said that, we must inform the readers, that there is a great difference between the consumer devices (wrist-worn activity trackers), medical devices (FDA cleared or CE Marked), and a variety of technologies that are in use, but not yet considered clinical testing devices.

In-pool return to swim protocols have been described for swimmers returning from being deactivated from swimming due to a shoulder injury who have full shoulder strength. Many swimmers actively participate in swim practice and competition with shoulder pain and experience deficits in performance. There are multiple reported risk factors associated with shoulder pain among swimmers, including training errors and physical impairments. These include pool and dry-land training errors, weakness in the scapular stabilizers and rotator cuff, and muscle tightness. A need exists for dry-land rehabilitation programs for impairments common to swimmers that can be performed in a traditional outpatient physical therapy setting. The purpose of this clinical commentary is to present a protocol using neuromuscular electrical stimulation (NMES), taping, strengthening, and stretching to address impairments that are common among swimmers while allowing continued active participation in practice and competition. # Level of Evidence Level 5