Many swimmers will experience this condition despite proper training. Swimmer’s shoulder is a condition that results in symptoms in the front and side area of the shoulder.
Often, the onset of symptoms may be associated with poor posture, shoulder stiffness (or too much movement), lack of strength control or overtraining. In some cases, patients with swimmer’s shoulder may have irritation or tearing of the rotator cuff, long head of the biceps, or labrum.
The Therapists at Sheddon Physiotherapy and Sports Clinic are familiar with these conditions and have designed a preventative strategy (along with treatment) for these conditions.
The structure of the shoulder is designed to be both very stable by virtue of the rotator cuff tendons, the ligaments of the joint and the surrounding joints as well as mobile due to it being a ball and socket joint attached to a shoulder blade. This creates an environment that allows it to accomplish complex movement patterns.
While most overhead sports such as throwing, racket sports, and volleyball require two or three overhead movement patterns, swimming requires several overhead movement patterns, involving continuous shoulder rotation in both clockwise and counterclockwise directions.
Most shoulder conditions can be divided into macrotrauma and microtrauma based on how it happened.
Macrotrauma is a single incidence that you remember happening and results from outside forces acting on the shoulder.
Swimmer’s shoulder, on the other hand, is a condition that comes on slowly due to repetitive activity and can be classified as microtrauma.
Things Within Us That Affect It
Swimmer’s shoulder usually presents as pinching of the rotator cuff tendon, bicipital tendon, or bursa. Most impingement involves compression of these structures under the top of the shoulder.
The cause is usually a tight back of the joint pushing the ball forward in the socket and tight front muscles (slouch position).
(before and after photos using “The Posture Perfector”)
The mechanism can also occur through a series of problems (this is more common) in swimmers with loose shoulders.
The loose joint, in these swimmers, start to move excessively during the over 4000 strokes done during workouts. They compensate and cause problems at the collarbone, the upper back, the neck…etc.
Failure of the rotator cuff and the shoulder blade muscles to maintain the shoulder properly in its joint, leads to tissue damage and breakdown.
Research has shown that swimmers with painful shoulders alter their stroke subconsciously to avoid painful positions.
For example, during early pull-through, the hand usually enters the water close to the midline with the elbow above the surface of the water. The upper extremity then continues to “reach” forward below the surface of the water towards the midline of the body. In swimmers with painful shoulders, the hand enters further away from the midline with the elbow dropped closer to the surface of the water. This change is usually made to avoid the pinch position. Another adjustment occurs at the end of the pull-through phase, when the hand should be close to the thigh with rotation inward of the shoulder. In swimmers with painful shoulders, the shoulder was rotated outward and the pull-through phase was shortened to avoid impingement.
In addition to identifying the internal problems contributing to swimmer’s shoulder, we must determine if the problem is due to overuse, misuse, or disuse.
Overuse is doing a task with a frequency that does not allow the tissues to recover. OVERTRAINING – This is where good coaches make the difference.
Misuse is using improper form or equipment, which may put abnormal stress on the tissue structures. (this can be poor dryland training or technique). This is where Sheddon Physiotherapy and Sports Clinic coordinates with the coaches and trainers to better inform the swimmers.
Disuse occurs when a swimmer has taken a period of time off without training resulting in atrophy or altered normal movement patterns.
So How Do You Prevent It??
A Pre Season Screening (or very early in the season) of the athletes is the best time to find and correct problems.
Sheddon Physiotherapy and Sports Clinic does a pre-season screen on the senior teams for our local swim club (Oakville Aquatics) to determine whether the shoulder is moving well enough and has enough strength to protect it during the season. We look at many factors in the upper back, hips and shoulder to determine if your swimmer is at risk. With the identification, we offer advice on how to make the shoulder and upper back stronger and/or more mobile during the season.
In swimmers who have already developed symptoms, the physiotherapists at Sheddon will focus on the causes that are associated with the onset of symptoms (such as posture, weak joints, poor movement).
Postural impairments are managed through soft tissue and joint stretching (either therapist or home program) as well as strengthening.
One method that allows the anterior chest to be stretched without overstressing the shoulder is to apply a low load for a longer period of time, such as with a Posture Perfector. This position allows the shoulder blades to retract so the stretch is concentrated on the anterior chest musculature.
Posture Perfector Sold at Sheddon Physiotherapy and Sports Clinic.
Weak or Tight Joints
In swimmer’s shoulder, joint tightness may accompany too much movement at the front and should be addressed by the therapist.
Along with this, a self stretch to the joint may be given by lying on the involved side with the shoulder flexed to 90 degrees. The swimmer applies a self stretch by applying a downward force to the distal forearm towards the bed.
Shoulder Blade Stabilization
Shoulder blade control is an essential element of shoulder rehabilitation and prevention.
An unstable shoulder blade can change the demands on the rotator cuff muscles, potentially leading to injuries.
Good general shoulder blade control maintains good alignment and ensures no compensation is occurring.
What follows are some good exercises used for scapular stabilization.
The rowing motion is accomplished with shoulder extension and elbow flexion.
For prone abduction, the swimmer moves the arm away from the body while on their stomach with the elbow extended.
“Supermans” are performed on your stomach with the arms by your side. Palms should be downfacing.
Pull the Shoulderblades together and lift the hands and arms off the table.
“TYI Exercises.” I: Both Shoulders in full elevation with elbow extension (also done with arms in Y and T position)
Weak Rotator Cuff
The easiest exercise to do is rotator cuff strengthening with a theraband. If done regularly, these exercises can protect the shoulder from further injury by stabilizing it. These can be done as warm ups on deck.
Once these have been done regularly, one can add more difficult and specific exercises to you workout with the help of your therapist.
Swimmers shoulder is a condition that may be prevented with adequate preseason screening that can identify impairments and training errors that may lead to symptoms.
If a swimmer does become symptomatic during the season, the therapist can identify the most likely impairments and work with the coach to help progress the athlete back into safe training.
A comprehensive rehabilitation program usually includes strengthening of the rotator cuff and scapular stabilizers, stretching anterior chest musculature that may be shortened, and implementing activity modification so the athlete can still participate in the sport.
If you have any questions, contact us at 905-849-4576 or Book An Appointment today here.