Swimmers shoulder is a soft-tissue condition caused by inflammation and is the most common injury in swimmers. If misdiagnosed or mal-treated, it can become chronic and very painful. Someone experiencing swimmer’s shoulder might ask the following questions:
- Why does my shoulder hurt when I swim?
- I train a lot and my shoulders are strong, why does swimming still hurt?
- What can I do to treat my shoulder so that I can return to swimming?
- I heard swimming injures the rotator cuff. Is swimming safe for my shoulders?
This article delves further into shoulder anatomy and the causes and resolutions of swimming-related shoulder injuries. It will answer the most important injury-related questions and provide insights to help avoid recurring injuries in swimmers and for other causes of shoulder pain.
The shoulder is the most mobile joint in the human body however it’s biomechanical structure sacrifices stability for mobility. This design disadvantage can be visualized as a golf ball sitting on a tee. The large humeral head (the top of the arm) sits on a tiny scooped out glenoid cavity (part of the shoulder blade) and together, they form the shoulder joint. Unlike the golf ball which is meant to be launched from the tee, the head of the humerus must remain centered and stable yet allowing for a large range of motion.
An important muscular system called the rotator cuff stabilizes this “ball” and prevents it from sliding off the socket. The rotator cuff has the largest effect on joint stability and is comprised of four muscles; supraspinatus, infraspinatus, subscapularis and teres minor. These muscles and their tendons run around, over and under the joint and are protected from the rough surfaces of the bone by a cushioning fluid filled layer called the “bursa”. In a healthy shoulder, the tendons are protected by the bursa and glide underneath the bony structures without being harmed when the arm is moved. However, when it comes to competitive swimmers where each shoulder averages roughly 4000 strokes in a single workout, the biomechanics start to change.
1. Why does my shoulder hurt when I swim?
Swimmer’s shoulder injuries occur primarily due to excessive repetitive overhead motion. This movement narrows the subacromial space, a tunnel like opening located between the acromion (the front part of the shoulder blade) and the humerus. As this narrows, the space for the tissues becomes restricted. This results in the bone applying direct pressure to both the tendons and bursa, inflaming and irritating the soft tissues. This can lead to conditions such as impingement, bursitis or tendonitis.
2. I train a lot and my shoulders are strong, why does swimming still hurt?
Swimming long distances, excessive training, poor stroke mechanics and lack of rest can all demand more from the shoulder muscles than they have to give. It’s sometimes easy to forget that overworking our muscles and overtraining can interfere with what we are trying to achieve and instead lead to regression, poor performance and detrimental changes. When the rotator cuff is overworked it weakens and fails to stabilize the shoulder; often leading to subluxation of the joint.
3. What can I do to treat my shoulder so that I can return to swimming?
It is important to keep in mind that swimming demands much more than just the isolated function of the shoulder. We use our shoulder blades, back, trunk and legs to stabilize the body and help with the pulling motions. Overall, shoulder injuries can be prevented by adding in dry land exercises that are designed to strengthen these muscles.
At the Orthopedic Therapy Clinic, our physiotherapists determine the source of your shoulder injury by assessing your shoulder strength, range of motion and posture. We look for signs of glenohumeral instability, altered scapulohumeral and poor neuromuscular control.
- Shoulder dislocation : https://www.youtube.com/watch?v=fHRe6LXCJT8
- Scapulo-humeral rhythm https://www.youtube.com/watch?v=H4nfQEeJmFo
- Poor neuromuscular control: https://www.youtube.com/watch?v=7PEJyCO-hgQ
Each of these alterations can lead to training errors and restrictions which can cause and prolong the recovery from a painful swimmer’s shoulder.
Whether your shoulder pain is due to swimming or other causes, once the source of injury has been determined, our physiotherapists guide you through a comprehensive rehabilitation program that includes these five important steps:
Step 1: Injury Protection: The aim in this step is to decrease pain and inflammation and provide active rest from pain-provoking movement. Treatment includes modalities such as ultrasound, TENS, Interferential current, acupuncture, massage, heat/ice, rest and anti-inflammatory tips. In this step, we want to avoid painful movements while making sure the shoulder keeps moving in order to prevent other complications such as frozen shoulder.
Also at this stage we want to keep the body moving and work on restoring the core as well as strengthen the areas that haven’t been affected. It is crucial to keep in shape and keep active without straining the injured shoulder.
Step 2: Regain full shoulder range of motion: In this step, the goal is to help regain healthy, pain-free shoulder mobility. Our physiotherapists focus on stretching, myofascial release, joint mobilization and active/active assistive exercises. This is accomplished by lengthening shortened muscles, manually working on the joint and prescribing light strengthening exercises. Massage therapy can also be helpful in regaining motion and lengthening tissues.
Step 3: Restore scapulo-humeral movement: The shoulder is highly dependent on the scapula (shoulder blade) and its ability to control normal movement. An improper ratio of motion of the shoulder blade to the shoulder joint is a major cause of rotator cuff impingement and chronic shoulder pain. This step aims to correct this altered scapulohumeral rhythm and promote exercises to strengthen the shoulder blade and upper back muscles. This is an essential component for successful rehabilitation.
Step 4: Restore rotator cuff strength: In this step, our physiotherapists prescribe an exercise routine designed to regain the full strength of the rotator cuff muscles. Each exercise is individually tailored, progressing the athlete’s strength and endurance through the rehabilitation.
Step 5: Return to swimming: In this step, physiotherapists may suggest the professional coaching of a kinesiologist or work with your swim coach. This close interface will help to customize a training program designed to progressively increase speed, power, and agility. Athletes should work to perfect their technique as they slowly return to a full load.
4. Is swimming safe for my shoulders?
At the Orthopedic Therapy Clinic, we believe that prevention is the best medicine. We strongly suggest that all athletes undergo a screening evaluation prior to the start of their swimming season. Our physiotherapists focus on prevention and early treatment, identifying and addressing impairments prior to injury and evaluating our swimmers’ training methods and mechanics to ensure they are best suited for their goals. The screening evaluation of an uninjured athlete is as extensive and detailed as the one used for a swimmer with symptoms and in both cases, the goal is to determine if restrictions exist and then a plan is provided to prevent shoulder pain. The best prevention remains through specifically tailored exercises, good stroke mechanics and gradual increases in workload.
In my practice I have had the privilege of working with many water based athletes as well as expanding my knowledge by completing a number of courses related to the shoulder and the rotator cuff muscles. In my experience, the prognosis for recovery is very good as long as the problem is caught in the early stage of injury and if all the steps of healing are successfully completed.
Swimming is an excellent sport that I encourage for many people. I am motivated to help those suffering from injuries so that they can get back in the water as soon as possible. If you are experiencing a swimming shoulder injury, a rotator cuff injury, or any shoulder pain and want to get it resolved, please contact me, Svetlana Marianer Registered Physiotherapist, at the Orthopedic Therapy Clinic in downtown Toronto.
This information is not meant to replace medical/health advice. Contact your health professional to ensure the diagnosis and treatment options are appropriate for your condition.
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