Swimming may place severe stress on the shoulder and other parts of the body. Swimmer’s Shoulder, also known as the Impingement Syndrome, refers to a wide set of symptoms relating to traumatic injuries stemming from undue exertion over an extended period of time, i.e. overuse, of the various parts of the shoulder while swimming. Pain is an inevitable result of such exertion and may be limited to the shoulder joint and muscles or spread in either direction – to the extremities and neck. The condition involves chronic inflammation of the muscles, ligaments and tendons of the joint.
Swimmer’s Shoulder is a feared phrase amongst swimmers. Because of the high volume of arm rotations required in intense swimming sessions, especially in competitive settings, swimmers are at high risk for shoulder problems — a 1995 study noted that 47% of collegiate swimmers suffered from shoulder pain lasting longer than three weeks. In this article, we’re going to take a detailed look into the common symptoms and causes of Swimmer’s Shoulder, as well as some methods of treatment.
First, let’s get a clear idea of what Swimmer’s Shoulder is, and why it’s not a blanket label for any shoulder pain. Brian J. Tovin, DPT, MMSc, PT, SCS, ATC, FAAOMPT, noted in his 2006 study, “Prevention and Treatment of Swimmer’s Shoulder,” that Swimmer’s Shoulder is “a musculoskeletal condition that results in symptoms in the area of the anterior lateral aspect of the shoulder, sometimes confined to the subacromial region.” A musculoskeletal condition is any condition that affects mobility, such as carpal tunnel syndrome. Swimmer’s Shoulder refers specifically to the musculoskeletal condition that prohibits movement of the shoulder around the joint, that is occasionally felt only in the joint.
Anatomy of the Shoulder
It is easier to comprehend how rotator cuff problems can emerge if you have an understanding of how your shoulder is designed to operate. There are several joints at your shoulder, including the junction of the ball and socket located at the top of your arm bone (glenohumeral joint), along with another joint which resides at the junction of the collar bone and the shoulder blade (acromioclavicular joint).
There are three bones of the shoulder which are called the humerus (long bone in the upper arm), the clavicle (collar bone) and the scapula (shoulder bone) — which connects the humerus with the clavicle. Along with the bones is a group of muscles and tendons that surround the aforementioned glenohumeral joint. This collection of muscles and tendons is responsible for your ability to rotate and lift your arm.
You can encounter problems if your rotator cuff becomes inflamed or irritated, which can occur for various reasons including repetitive usage, age and participation in sports activities. There are also other issues that can also develop in your rotator cuff, including swimmer’s shoulder.
Causes
- Excessive training without proper rest or breaks
- Overuse of the shoulder joint
- Bad swimming technique
- Inadequate ‘body roll’
- Imbalanced development of various muscle groups
- Inherent weakness of muscles, ligaments and tendons of the shoulder
- Subsisting shoulder injuries may be an underlying cause
If you are contending with swimmer’s shoulder, this is a term that actually encompasses a group of injuries that emerge from overuse. This can create multiple issues, some of which are specific to the supraspinatus tendon — which is frequently the tendon that is associated with rotator cuff injuries. If this tendon becomes irritated and swells due to repeated exertion over an extended period of time, this can create discomfort, along with an unwanted condition that can also be referred to as shoulder impingement syndrome, or subacromial impingement.
This can occur when there is sufficient wear and tear on this area of your rotator cuff, due to a repeated overhead motion. This can take place as the result of frequent swimming, throwing a baseball or swinging a tennis racket. Or it could develop due to other activities that involve lifting your arm repeatedly such as painting or gardening. Other potential causes include poor posture, an unfortunate fall or inadequate muscle strength in the muscles of your shoulder blade.
Tovin lists several possible causes for Swimmer’s Shoulder in his study. He starts this list by saying, “Swimmer’s Shoulder usually presents as subacromial impingement involving the rotator cuff tendon, bicipital tendon, or subacromial bursa.” This impingement, or pain, is referred to as the primary impingement. Tovin says that the most typical cause for primary impingement is a tight posterior capsule. The posterior capsule refers to a point where a joint meets two bones — in this case, where the shoulder meets the arm. The posterior capsule is considered tight when these two bones are too close at the joint, or (occasionally) when they touch.
Primary impingement is not often found in competitive swimmers, though. What is more common is that a competitive swimmer suffers from secondary impingement. Secondary impingement is caused by the excessive rate of overhead motion in competitive swimming. This leads to compression of the tendons in the shoulder, which often appears first as muscle fatigue, then as muscular pain. The repetitive overhead motions in swimming can also lead to increased muscle and joint laxity — or looseness — which will in turn cause secondary impingement.
Finally, Tovin notes that a swimmer experiencing shoulder pain should see a clinician or orthopedic doctor to determine if the pain was caused by overuse, misuse, abuse or disuse. He goes on to quantify these terms:
“Overuse in sports is performing a task with a frequency that does not allow the tissues to recover and symptoms may be due to lack of muscle strength or endurance. An example of overuse would be a swimmer increasing her yardage in a swim workout from 5000 yards to 10,000 yards per day. Misuse is using improper form or equipment, which may put abnormal stress on the tissue structures. An example of misuse is a swimmer using faulty stroke mechanics… Abuse is having excessive force going through normal tissues. An example of abuse is a swimmer who trains excessively with hand paddles, increasing strain on the shoulder. Disuse occurs when a swimmer has taken a period of time off without training resulting in atrophy or altered neuromuscular control of the stabilizing shoulder girdle musculature. In all of these cases, the tissues cannot accommodate the repetitiveness, force, or stress that is encountered with a specific activity.”
Symptoms
- Localized pain is felt in the affected part of the shoulder
- Pain may extend to the neck and/or down the arm in some cases
- Pain worsens while resting on the affected shoulder
- Tenderness of the affected area
- Decreased range of movement
- Decrease in shoulder strength
- Increased joint laxity
Now that we have an understanding of what Swimmer’s Shoulder is, it’s pretty easy to determine its symptoms. The most common symptom of Swimmer’s Shoulder is pain in the back of the shoulder, though some feel the pain in the front of the shoulder, instead.
The condition gets its name not only from how susceptible swimmers are to it, but also because of how much worse swimmers feel the effects. The repetitive overhead arm movement required to swim can aggravate the pain. Bon Secours notes that 50% to 75% of all swimmers have reported having shoulder pain so severe that they missed at least one workout, and many say that shoulder pain caused them to quit swimming.
Less common symptoms include a decreased range of shoulder motion, as well as a loss of strength in the affected shoulder. These symptoms are also more subtle, but frequent swimmers should be on the lookout for them. As we will discuss later, the easiest way to treat Swimmer’s Shoulder is to prevent it, so catching it early is imperative.
Anyone who is contending with this issue can experience pain when lifting their arm, or when attempting movement that involves twisting. This condition can also make it painful to reach your arm upward, or make the movements that are necessary for tasks like driving or brushing or combing your hair. The pain can also be accompanied by stiffness or weakness, and the injury can also force you to contend with discomfort while you attempt to sleep at night.
Diagnosis
- Physical examination is the first step in the process of diagnosis
- X-rays and other imaging techniques may be needed to assess the changes in structure of the joint
- The doctor may check for any change in the pattern of swimming stroke
- The presence of ‘lazy elbow’ where the elbow on the affected side cannot be lifted to the normal height out of the water.
What a Doctor Will Do
If you are dealing with any of the symptoms that were discussed, then it is important that you visit a physician. He or she will conduct a thorough examination in order to ascertain what is causing your discomfort.
Your doctor might also order X-rays or an MRI so that the diagnosis can be confirmed. Rest, anti-inflammatories or physical therapy might be recommended initially, while a cortisone injection or arthroscopic surgery could be the next steps in your treatment if the situation does not improve.
Treatment
- Rest is important to allow the joint to heal
- Application of ice packs may be recommended to reduce pain and inflammation
- Sling or shoulder tape may give adequate support
- Physiotherapy sessions may be recommended to improve strength and flexibility
- Anti-inflammatory medication may be prescribed
- Surgical repair of tendons and ligaments may be done in case conservative methods do not work
- Improvement or modification of swimming technique may be required
- Warming up slowly before swimming may be suggested
- The doctor may ask patients to avoid movements that cause pain
Brian J. Tovin breaks down methods of treatment into five categories: address impairments, posture, joint mobility, scapular stabilization, rotator cuff strength and address training errors. Before any of this, however, he reminds us in the abstract that, “Physical therapists involved in the treatment of competitive swimmers should focus on prevention and early treatment, addressing the impairments associated with this condition, and analyzing training methods and stroke mechanics.”
Posture, joint mobility, scapular stabilization and rotator cuff strength are the most physically engaging treatments. These methods all involve the use of different exercises and stretches to work on specific areas of the shoulder. Posture stretches focus on maintaining the correct position of the joint, while scapular stabilization focuses on soft tissue release in the shoulder to relieve pressure. Joint mobility involves putting pressure on the shoulder joint to improve laxity, but must be performed by a physical therapist or orthopedic doctor. Finally, rotator cuff strength involves typical workouts that help build muscle in the shoulder.
Addressing impairments and training errors are a bit more abstract. While they can’t be solved by exercises, these steps are arguably more important. Without developing an understanding of the pain being felt and the movement causing the pain, the sufferer can never hope to alleviate the pain permanently while continuing to swim.
Again, having a physical therapist or orthopedic doctor to help is absolutely necessary to the treatment of Swimmer’s Shoulder. While it is possible to take steps by yourself to prevent the condition, once symptoms begin to develop you should seek help from a medical professional as soon as possible.
For complete diagnosis and treatment of Swimmer’s Shoulder, call at (972) 492-1334.