A Detailed Look: Swimmer’s Shoulder

September 18th, 2017 Orthopedic Associates

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, swimmer’s 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.

Common Symptoms

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 affects. The repetitive overhead arm movement required to swim can aggravate the pain. Bon Secours notes that 50-75% 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.

Causes

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.”

Treatment

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 focus 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.

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