Swimmer’s Shoulder

I’ve recently seen a huge number of budding triathletes in the Clinic, and – almost to a man/woman – everyone is most nervous about the first leg – the swim! The shoulder is a vulnerable joint for any swimmer, with shoulder pain the most common musculoskeletal complaint amongts swimmers.
It is estimated that shoulder pain occurs in between 27% to 87% of competitive swimmers (1). This is partly down to its repetitive nature – in a single session a swimmer may go through thousands of shoulder revolutions – and partly down to poor biomenchanics….or put another way, form.

Here, I will provide an overview of the symptoms for what is referred to as swimmer’s shoulder, and strategies for injury prevention and treatment. There are, as with all umbrella terms, a multiple of likely causes. I am going to focus on a group of muscles collectively termed the rotator cuff, as these, regardless of which type of swimmers shoulder you may have, will inevitably be key.

Anatomy
The shoulder girdle is designed to achieve the greatest range of motion of any joint in the body. The humerus (arm) sits in a socket created by the clavicle (collar bone) and scapula (shoulder blade). The rotator cuff is a group of muscles that, alongside a number of other muscles, attach the scapula to the humerus allowing the shoulder to move and, importantly, keeping it stable. If an imbalance occurs then the shoulder girdle can become unstable, creating soft tissue micro-trauma, inflammation, impingement or, if not treated, a tear. All which result in…..

Rotator Cuff

Symptoms
Pain is – as always – the thing sufferers notice first, either during, and/or after swimming.The pain can be felt in the back, top, or front of the shoulder. It is often hard to point to, or it feels “deep” in the joint. You may notice reduced performance, alongside the pain, and any activity that involves putting the arm above the head may also illicite pain.
The earlier that the pain in the shoulder is reported, the more specific the assessment can be. If the swimmer waits to report pain, then inflammation will have set in, and the pain is more general, which may mask the root cause.

Self Help
As there are so many variables in swimming, it is only possible to give general advice here. To give yourself the best chance of avoiding shoulder pain, scapular stability and neuromuscular re-education and strengthening of the scapular stabilizers is an essential element of shoulder rehabilitation and prevention. There are a few simple things you could – and should – add to your swimming training schedule, to reduce stress/strain on the offending areas. In the below image are 2 stretches which will help.

Chest Stretch2

A – Chest stretch, B – Tricep stretch

On top of this, strengthening of the internal and external arm rotator muscles will ensure a good level of base strength.

Treatment
As discussed, there are numerous causes of shoulder pain in swimmers. Of primary concern is determining what exactly is causing YOUR shoulder pain. One we have achieved this, we can set about a course of treatment designed for you and your specific needs. This may include a postural assessment and adaptation, joint mobilisations, soft tissue release, and/or a strengthening programme. This is carried out in a safe, logical structure which starts with getting control of the pain.

For all questions, feel free to email me at Dan@DC-InjuryClinic.co.uk

(1) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953356/

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldnt be seen as such. They are merely guides to a better understanding of how our bodies work.
 

For more information please visit www.dc-injuryclinic.co.uk

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