‘Swimmers shoulder’ is a broad term utilised to describe the musculoskeletal injuries that develop due to overuse of the shoulder. The progression of pain and can be described in stages as follows;
- Mild discomfort after training
- Pain during and after training
- Finally, the pain affects the ability of the swimmer to train
The term ‘swimmers shoulder’ encompasses a broad rage of specific injuries as there are several structures within and surrounding shoulder which can be affected. This results in varied symptoms which can anything from pain in the front of the shoulder joint to pain travelling to the arm and neck. Most commonly the injuries result in significant inflammation in the shoulder therefore resulting in pain.
It is estimated that swimmers complete 15-20, 000 arm rotations each week therefore overloading the shoulder and surrounding muscles leading to the development of pain. Swimmers shoulder occurs in around 1/3 of competitive swimmers with the intensity and frequency of training one of the key influencing factors.
What are the symptoms?
Swimmers shoulder can present as a variety of symptoms that vary in severity including:
- pain in the front of the shoulder during swimming
- pain down the outside of the arm during swimming
- Pain in the shoulder or arm after swimming ceases
- Difficulty lifting objects
- Feeling of dead arm
- Ache in the arm or shoulder at night
- Inability to lie on the affected shoulder
- Difficulty and pain reaching behind your back
- Neck pain
It is important if you experience any of these symptoms that you see your physiotherapist to determine the correct diagnosis. As Swimmers shoulder is an overuse injury that has multiple contributing factors it is important that an extensive rehabilitation treatment plan is developed. This allows underlying muscular, anatomical, biomechanical and strength issues to be identified and corrected to not only prevent injury reoccurrence but also improve overall performance
The Shoulder Complex:
The Shoulder is a complicated joint comprising of:
- 3 major bones and joints, the humerus and shoulder blade (scapula) make the ball and socket joint that most people recognise as their shoulder, however the shoulder blade and the collar bone (clavicle) also have an important role in shoulder movement and pain.
- Four major muscles (rotator cuff) that control the movement of the joint by keeping the Ball section of the humerus centred in the shoulder socket
- Surrounding the joint is a capsule that also forms supporting ligaments
- A fluid filled sack called the bursa that sits below the acromion (end of the collar bone) and above the shoulder
What goes wrong?
The shoulder joint is a very unstable joint as it has ‘ball’ that is too big to sit snuggly in the ‘socket’. Therefore the surrounding muscles have to work extremely hard to stabilise the joint particularly during overhead movements. Over-training, fatigue, hypermobility, poor stroke technique, muscle weakness, tightness and poor posture all contribute to overload of the shoulder structures and the development of pain.
Most common causes of pain include:
- Bursitis: prolonged overload and poor Shoulder blade position results in prolonged compression of the bursa between the shoulder blade and shoulder joint this becomes inflamed and swollen
- Rotator cuff impingement (Primary impingement): where the tendons gets compressed due to micro-instabiity from overload and weakness, when this compression occurs repetitively over a period of time chronic changes occur which result in tendinosis and chronic shoulder pain
- Secondary shoulder impingement due to a series of technique flaws and strength deficits that result in an increased external rotation of the shoulder. This is due to increased stretch (laxity) of the shoulder ligaments at the front. This further limits the shoulders Internal rotation range and causes inflammation of the Biceps tendon and Rotator Cuff
- Overuse of the shoulder doesn’t allow for adequate recovery, most commonly due to an increase in overall training distance and intensity without adequate muscle strength.
- ‘Misuse’ of the shoulder due to poor stroke mechanics, technique and use of training aids such as paddles. These can cause increased load on the shoulder and result in the development of pain. The most common technique issues are:
- hand across the midline
- dropping elbow
- straight arm recovery
- thumb first catch
- head position too high (hips down)
- incomplete pull phase
- inadequate body rotation
Can we prevent ‘Swimmer’s Shoulder’?
Regular screening by a physiotherapist can identify any issues that may increase an athlete’s risk of developing Swimmers Shoulder. This may also identify early signs of pain or dysfunction. Your Physiotherapist can then prescribe a range of strength and mobility exercises coupled with targeted stretching to address identified issues and prevent the development of injury. As training loads constantly vary and as swimmers are constantly growing regular screening is crucial to prevent shoulder injuries.
Make sure to contact your PhysioHealth physiotherapist if you have experienced any of the symptoms listed above in order to have a full assessment and commence a rehabilitation, dryland and strengthening program.