Swimmer's Shoulder
Article by John Miller
Swimmer’s Shoulder
What is Swimmer’s Shoulder?
Current data suggests that more than 30% of swimmers will miss competition or training due to injury. Of that population, over one-third of these injuries are concerning shoulder pain [1]. Additionally, up to 91% of swimmers aged 13-25 years old experience shoulder pain frequently [2].
“Swimmer’s shoulder” is an umbrella term used to describe numerous injuries related to the swimming population and shoulder injuries. Due to the structural and biomechanical complexity of the shoulder, many factors relating to the swimming stroke can contribute to the presence of pain. Specifically, shoulder pain can either be local to the injured joint or refer to other body areas, namely the thoracic, cervical and upper arm regions. Elite swimmers generally perform approximately 2500 shoulder revolutions per day, and thus, most issues surrounding the shoulder are attributed to an overuse phenomenon [3].
What Causes Swimmer’s Shoulder?
Irrespective of competitive level, the swimming population’s most prevalent injury is shoulder pain. Intrinsic (tendon morphology, vascularity) and extrinsic (acromion formation, stroke biomechanics, muscular imbalances) can influence how and why a swimmer experiences shoulder pain. An example of an external factor is crossing the midline during hand entry – this leads to an increase in internal rotation and resultant mechanical rotator cuff related shoulder pain (RCRSP) [4]. However, the pain produced is known to be multifactorial as opposed to a singular cause. Influential factors include the following issues:
- Stroke biomechanical abnormalities
- Overuse, fatigue or improper control and utilisation of the muscles of the shoulder, scapula and upper back
- Glenohumeral (shoulder) laxity
Shoulder pain is primarily due to the muscular imbalance between the dominant muscles (adductors, internal rotators) and stabilising muscles (rotator cuff). Consequently, this leads to muscle activation and control deficits, causing a superior and anterior translation of the humeral head generally accompanied by tightening of the posterior capsule of the shoulder. This superior joint translation and poor muscle control results in the humeral head colliding into soft tissue. Impingement results in tissue trauma and pain. These structures include your supraspinatus tendon, subacromial bursa, and biceps tendon.
Pain and discomfort can further exacerbate if the swimmer continues to train at the same level of intensity and frequency as pre-injury.
Shoulder Anatomy
The shoulder is a ball and socket joint with a rim of fibrocartilaginous tissue to help deepen and stabilise the humeral head. Surrounding the joint is your joint capsule, a fibrous material, with thicker parts of the capsule forming ligaments.
There are several muscles and associated tendons that surround the shoulder joint. These muscles that have the most effect on the joint’s stability are the rotator cuff. This cuff comprises four muscles that work in unity to help maintain the shoulder positioned in the socket during shoulder and arm movements.
Specifically, the most well researched and controversial muscle is the supraspinatus. This tendon can become thickened and pathological in most swimmers reporting shoulder impingement. Furthermore, this tendon thickening is positively associated with kilometres swum in the pool and correlates strongly with shoulder pain [1]. Other structures have the potential to exhibit strain at the shoulder. These include the biceps tendon, glenohumeral labrum, and acromioclavicular joint.
How Long Does it Take to Recover from Swimmer’s Shoulder?
The longevity of your shoulder pain depends upon early assessment, treatment or coaching technique interventions. Rapid assessment is the quickest way to identify what is causing your swimmer’s shoulder. Then You can implement a treatment and coaching plan to return you to full training optimally. If you ignore early intervention, chronic shoulder problems can often persist for 3 to 12 months.
Please seek early diagnostic advice for an optimal resolution.
Swimmer’s Shoulder Treatment
Swimmer’s shoulder is a common but complex complaint at PhysioWorks. It is an injury that often recurs if you return to swimming too quickly – primarily if you don’t thoroughly rehabilitate.
Can You Swim with Shoulder Bursitis?
Shoulder bursitis is an inflammation of the bursa due to impingement. Mild bursitis sufferers can usually continue to swim with modifications to their swimming program while undergoing treatment. You will do yourself no favours by continuing to swim with a severely inflammed bursa.
Does Swimming Aggravate Your Rotator Cuff?
When your shoulder biomechanics, joint flexibility, muscle control, and soft tissue length are optimal, your rotator cuff will function correctly and is usually strengthened by swimming. However, when your technique, training loads, muscle strength or flexibility is inadequate, your rotator cuff can become injured and result in rotator cuff injuries such as rotator cuff tendinopathy or rotator cuff tears.
How Do You Prevent Swimmer’s Shoulders?
A swimmer screening is an ideal way to assess the current risk status of your developing swimmer’s shoulder. Your testing results will enable your physiotherapist to prescribe customised prevention exercises to reduce your risk of developing a swimmer’s shoulder.
Our PhysioWorks swimmer physiotherapists provide club, school, and individual swimmer screening programs. Please get in touch with us for more details.
Summary
There is no specific time frame for the rehabilitation of the swimmer’s shoulder. Many factors will determine your injury rehabilitation status during your physiotherapist’s clinical assessment. Individual training loads, swimming technique and your body’s ability to perform a normal swimming stroke influence your outcome. In most cases, you’ll find that your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improve.
Ideally, your swim coach and physiotherapist should be communicating regularly throughout your rehabilitation phases. It is also crucial to carefully monitor each progression. Attempting to progress too soon to the next level can lead to re-injury and frustration. Please contact your shoulder physiotherapist for specific advice regarding your swimmer’s shoulder.
Shoulder Pain Causes
Common Injuries & Conditions
Understanding the common shoulder pain causes is crucial, as this discomfort can stem from various issues like rotator cuff injuries, arthritis, and frozen shoulder. Our guide offers a comprehensive exploration of these causes, providing insights into both acute and chronic conditions. It aims to equip you with knowledge and strategies for effective treatment and recovery, catering to those grappling with recent injuries or long-term pain. This resource is your go-to for navigating the complexities of shoulder pain and its management.
Rotator Cuff
- Rotator Cuff Injury: A common condition causing shoulder pain, often due to repetitive overhead activities.
- Rotator Cuff Tendinopathy: Inflammation or damage to the rotator cuff tendons, leading to pain and reduced mobility.
- Rotator Cuff Calcific Tendinopathy: Characterised by calcium deposits in the rotator cuff tendons, causing intense pain.
- Rotator Cuff Tear: Involves a tear in the rotator cuff muscles, often resulting from injury or wear over time.
- Bicep Tendinopathy: Affects the bicep tendon, leading to pain in the front of the shoulder.
Shoulder Impingement Syndrome
- Shoulder Impingement: A condition where shoulder tendons are pinched during arm movements, causing pain and limited mobility.
- Shoulder Bursitis: Inflammation of the bursa, a small fluid-filled sac in the shoulder, causing pain and discomfort.
- Swimmer’s Shoulder: An overuse injury common in swimmers, causing shoulder pain and impingement symptoms.
Shoulder Stiffness
- Adhesive Capsulitis / Frozen Shoulder: A condition where the shoulder becomes stiff and painful, often developing gradually without a specific cause.
Shoulder Instability
- Shoulder Dislocation: Occurs when the shoulder joint is forced out of position, causing pain and instability.
- Functional Shoulder Instability: Chronic instability in the shoulder, often leading to recurrent subluxations, dislocations and pain.
Acromioclavicular Joint
- AC Joint Injury: Involves damage to the acromioclavicular joint, common in athletes and after falls.
Bone Conditions
- Shoulder Arthritis: Degenerative joint disease affecting the shoulder, causing pain and stiffness.
- Broken Shoulder / Fractured Humerus: A break in the shoulder bone, often resulting from trauma or falls.
- Stress Fracture: A small crack in the bone, typically caused by overuse and repetitive activities.
Post-Operative Physiotherapy
Post-Operative Shoulder Rehabilitation: Essential for recovery, involving tailored exercises and therapies to regain strength and mobility after shoulder surgery.
- Subacromial Decompression: A surgical procedure to alleviate shoulder impingement symptoms.
- Shoulder Arthroscopy: Minimally invasive surgery for various shoulder conditions.
- Acromioplasty: Surgery to reshape the acromion and relieve impingement.
- Rotator Cuff Repair: Surgical repair of a torn rotator cuff.
- SLAP Repair: Surgery to fix a specific type of labrum tear in the shoulder.
- Biceps Tenodesis: Surgical procedure to reattach the biceps tendon.
- Biceps Tenotomy: Involves cutting the biceps tendon to relieve pain.
- Total Shoulder Replacement: Replacement of the shoulder joint with artificial components.
Muscle Conditions
- Muscle Strain: A tear or stretch in a muscle, often causing pain and limited movement.
- DOMS – Delayed Onset Muscle Soreness: Muscle pain and stiffness that occurs hours after unfamiliar or strenuous exercise.
Neck Arm Syndromes
Referred Pain: Pain in the shoulder that originates from another area of the body, such as the neck or spine.
- Neck Arm Pain: Pain that originates in the neck and travels down to the arm and shoulder.
- Cervical Radiculopathy: Occurs when a nerve in the neck is compressed or irritated, leading to shoulder pain.
- Thoracic Outlet Syndrome: A condition where nerves or blood vessels between the collarbone and first rib are compressed, causing pain in the shoulder area.
Systemic Conditions
- Fibromyalgia: A chronic condition characterised by widespread musculoskeletal pain, including in the shoulder.
- Rheumatoid Arthritis: An autoimmune disorder that can cause joint pain and damage throughout the body, including the shoulders.
Shoulder Products & FAQs
Explore our range of shoulder products and find answers to frequently asked questions about shoulder pain and treatment options.
Shoulder Pain FAQs
Your Comprehensive Guide to Understanding and Managing Shoulder Injuries
Welcome to the "Shoulder Pain FAQs" page, your go-to resource for understanding various aspects of shoulder pain, injuries, and how to manage them effectively. The shoulder is a complex joint that allows for a wide range of movements, but it is also susceptible to various injuries and conditions that can cause discomfort and limitations in daily activities.
In this comprehensive guide, we will explore the most common shoulder injuries, their causes, and how to identify and treat them. We'll also address frequently asked questions about specific shoulder conditions, providing you with valuable insights into your shoulder health.
When Should You Worry About Shoulder Pain?
Shoulder pain can be caused by numerous factors, ranging from minor strains to more severe injuries. Knowing when to seek medical attention is crucial to prevent further damage and facilitate timely recovery.
Common Shoulder Injuries
We'll swing into the most prevalent shoulder injuries, shedding light on their causes, symptoms, and appropriate treatment options.
More info: Common Shoulder Injuries
What Causes Shoulder Pain?
Understanding the root causes of shoulder pain is fundamental to addressing the issue effectively. We'll explore the various factors that can lead to shoulder discomfort and how to mitigate them.
More info: What Causes Shoulder Pain?
What is Your Scapulohumeral Rhythm?
The scapulohumeral rhythm plays a vital role in shoulder function and movement. We'll explain what it is and its significance in maintaining a healthy shoulder.
More info: What is Your Scapulohumeral Rhythm?
Rotator Cuff: An In-Depth Analysis
The rotator cuff is a critical group of muscles and tendons in the shoulder. We'll dive into its anatomy, functions, and common problems associated with it.
More info: Rotator Cuff: An In-Depth Analysis
How Can You Tell If You Have Torn Your Rotator Cuff?
Identifying a torn rotator cuff can be challenging, but we'll provide you with essential signs to look out for and when to seek professional evaluation.
More info: How Can You Tell If You Have Torn Your Rotator Cuff?
Can You Diagnose A Torn Rotator Cuff Without An MRI?
Find out about diagnostic methods for a torn rotator cuff, including whether an MRI is always necessary for accurate diagnosis.
More info: Can You Diagnose A Torn Rotator Cuff Without An MRI?
Can You Lift Your Arm With A Rotator Cuff Tear?
Discover the limitations and challenges you may face if you have a torn rotator cuff and how to manage arm movement during the healing process.
More info: Can You Lift Your Arm With A Rotator Cuff Tear?
Will Your Shoulder Blade Hurt With A Torn Rotator Cuff?
Learn about the possible relationship between a torn rotator cuff and shoulder blade pain, and what it indicates about your shoulder health.
More info: Will Your Shoulder Blade Hurt With A Torn Rotator Cuff?
Will A Cortisone Injection Help A Torn Rotator Cuff?
Cortisone injections are sometimes used for shoulder pain, but their effectiveness in treating a torn rotator cuff is a point of interest we'll explore.
More info: Will A Cortisone Injection Help A Torn Rotator Cuff?
How Can You Make Your Rotator Cuff Heal Faster?
We'll provide practical tips and strategies to aid in the healing process of a torn rotator cuff and restore shoulder function more rapidly.
More info: How Can You Make Your Rotator Cuff Heal Faster?
Shoulder Bursitis: Understanding the Condition
What is shoulder bursitis, and how does it differ from other shoulder injuries? Get insights into this inflammatory condition and how to manage it.
More info: Shoulder Bursitis: Understanding the Condition
Shoulder Impingement: Causes and Solutions
Understand the concept of the shoulder impingement zone and the factors contributing to rotator cuff impingement and bursitis.
More info: Shoulder Impingement: Causes and Solutions
Frozen Shoulder: Overcoming the Stiffness
Discover how to unfreeze a frozen shoulder and regain a full range of motion through effective therapeutic approaches.
More info: Frozen Shoulder: Overcoming the Stiffness
Shoulder Dislocation/Instability: Seeking Stability
Explore the causes of shoulder dislocation and instability, and the fastest ways to promote healing and prevent future occurrences.
More info: Shoulder Dislocation/Instability: Seeking Stability
Can You Fix Shoulder Instability?
Find out about treatment options to address shoulder instability and regain stability in the joint.
More info: Can You Fix Shoulder Instability?
AC Joint: Identifying and Managing Injuries
Learn how to recognise an injured AC joint and what steps to take for proper care and recovery.
More info: AC Joint: Identifying and Managing Injuries
Swimmers Shoulder: Causes and Remedies
If you're a swimmer or engage in repetitive overhead activities, understanding the causes of swimmer's shoulder and how to prevent it is essential.
More info: Swimmers Shoulder: Causes and Remedies
We hope this comprehensive guide will prove invaluable in your journey to understand and manage shoulder pain and injuries. However, it's essential to consult a healthcare professional for personalised advice and treatment based on your specific condition. Let's dive into the world of shoulder health together!
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