Shoulder 3

Article by John Miller

What is Scapulohumeral Rhythm?

Your shoulder-scapula joint motion has a regular functional motion pattern known as scapulohumeral rhythm - to provide you with pain-free and powerful shoulder function. When elevating your shoulder overhead, roughly one-third of your shoulder motion occurs at your scapulothoracic joint. Two-thirds of movement occurs at the glenohumeral joint, or 'true" shoulder joint. However, the timing and coordination of your shoulder muscles and how they control your scapulohumeral rhythm are essential factors.

scapulohumeral rhythm

View it on Youtube here:

Alteration of this regular scapulohumeral movement pattern results in shoulder injuries, pain and impingement.

When your scapulohumeral rhythm becomes abnormal -due to pain, weakness or muscle incoordination - you are rendered more likely to suffer shoulder clicking, pain or rotator cuff injury.

Shoulder Joint Anatomy

Your shoulder motion occurs via a complex group of joints that involves dynamically controlling the movement of three bones (scapula, humerus and clavicle) upon your ribcage. Your shoulder blade (scapula) is the centralised triangular base for your shoulder and arm movements. Your scapular muscles guide your scapula as it articulates around your rib cage. This motion is known as scapulothoracic motion.

Your clavicle or collarbone is the only skeletal attachment of your arm. It attaches to your upper sternum and the lateral edge of your scapula at the acromioclavicular (AC) joint. Your shoulder ball and socket joint is the glenohumeral joint where your upper arm bone (humerus) articulates on the glenoid fossa of your scapula.

What are the Symptoms or Abnormal Scapulohumeral Rhythm?

Poor shoulder blade stability results in abnormal tipping and rotation of your scapular, which causes your acromion (bone) to pinch down into the subacromial structures (e.g. bursa and tendons), causing impingement leading to swelling or tears. Typically signs of abnormal scapulohumeral rhythm include shoulder pain, instability and clicking. Researchers have identified abnormal scapulohumeral rhythm as a major cause of rotator cuff impingement.

Your shoulder physiotherapist is an expert in the assessment of scapulohumeral rhythm. They will observe your shoulder motion and perform strength and control tests to assist their diagnosis. X-rays, MRI's, ultrasound scans and CT scans are unable to determine scapulohumeral rhythm dysfunction.

Why is Scapulohumeral Rhythm Important?

Poor scapula stability usually results in tipping and downward rotation of your scapula. The downward posture causes your shoulder (tip of acromion) to pinch down on the subacromial structures.  Rotator cuff impingement, shoulder bursitis or rotator cuff tears result from subacromial impingement.

Normal shoulder blade-shoulder movement - (scapulohumeral rhythm) - is required for a pain-free and powerful shoulder function. Luckily, abnormal scapulohumeral rhythm can be retrained by an experienced shoulder physiotherapist.

Scapulohumeral Rhythm Correction

Your skilled physiotherapist can assess and correct your scapulohumeral rhythm. Any deficiencies will be an essential component of your rehabilitation. Among other treatment options teaching you how to control your shoulder blade via scapular stabilisation exercises dynamically is a crucial ingredient for a successful recovery.

Your physiotherapist will be able to guide you in the appropriate exercises for your shoulder.

Restore Normal Neck-Scapulo-Thoracic-Shoulder Function

You may find it challenging to comprehend that your neck and upper back (thoracic spine) are essential in treating shoulder pain and injury. Neck or spine dysfunction can not only refer to pain directly to your shoulder but can affect a nerve's electrical energy supply to your muscles, causing weakness.

Plus, painful spinal structures from poor posture or injury don't provide your shoulder, or scapular muscles, with a solid pain-free base. In most cases, especially chronic shoulders, some treatment directed at your neck or upper back may ease your pain, improve your shoulder movement and stop pain or injury returning.

For more information, please consult your shoulder physiotherapist.

More Info:

Article by Zoe Russell

Swimming is one of Australia’s most successful sports at the Olympic Games!

Out of a total of 190 Medals that Australian Swimmers have won – 59 of them are gold. Quite often, it looks pretty easy for these athletes. However, there is several injuries and hours of training that swimmers put in to ensure their success.

Swimmers require an intricate combination of strength, power, endurance and flexibility! Although most injuries occur in the pool as a result of training and competition, it is also essential to recognise that “out of water” injuries, such as rolling an ankle, can also affect a swimmer!! Not surprisingly, injuries to swimmers are pretty standard, with four injuries for every 1000 hours reported in male competitive swimmers, with female swimmers reporting 3.8 for every 1000 hours of training (Wolf et al., 2009).

What Injuries Do Swimmer’s Suffer?

If gold medals were awarded, the shoulders would win GOLD for the more frequently injured part of a swimmer's body! Sein, Walton & Linklater (2010) reported that 91% of swimmers report a shoulder injury!

Swimmer’s shoulder is the colloquial name for Rotator Cuff Injury that can range from shoulder impingement to shoulder tendinopathy to rotator cuff tears that can require surgery. Although we often associate the elite swimmer with the swimmer’s shoulder – it is essential to realise that all swimmers can sustain these injuries! Swimmer’s shoulder is the most common swimming injury and often presents with pain in the shoulder with stroke, and can sometimes have clicking and clunking, with or without pain.

The Winner of the Silver Medal May Shock You!

Did you pick the Knee?

Knee injuries have been reported as high as 86% of swimmers who have had at least one episode of knee pain (Rovere et al., 1985). However, these are almost exclusive to breaststrokers.

More info: Breaststrokers Knee

What about Bronze?

You would hand the bronze medal to spinal injuries, which often occur due to the repetitive nature of swimming. The good news is that most of these consist of muscle strains and joint stiffness. However, early presentation for an accurate diagnosis and management plan is essential! 50% of butterfly swimmers and 47% of breaststroke swimmers have reported back pain at some stage in their career (Drori et al., 1996).

Some of the more common spine injuries can include:

Don’t Forget the Other Competitors in the Swimming Injury Race!

Swimmers can less commonly injure other regions of their bodies. Given the nature of swimming, requiring them to be buoyant in the water, it is often overlooked how serious an injury can be for a Swimmer’s performance!! Other injuries to not forget include:

Foot and Ankle:


Wrist and Hand:

What Causes Swimming Injuries?

Swimming injuries most commonly occur as a result of:

  • Overtraining
  • Poor technique
  • A sudden spike in workload

Several factors can predispose a swimmer to develop an injury. Your highly skilled physiotherapist identifies these factors and correcting them to reduce your risk of developing an injury. At PhysioWorks, our physiotherapists have special interests in treating swimming injuries and can speak directly to your coach to ensure a speedy recovery!

Some of the factors that can contribute to the development of an injury include:

  • Previous Injury
  • Joint stiffness
  • Muscle tightness
  • Shoulder blade - Scapulohumeral rhythm issues
  • Poor rotator cuff strength
  • Inadequate joint range of motion
  • Inadequate recovery periods from training and racing
  • Insufficient warm-up/warm down
  • Poor core stability

Prevention is Key!

Although the number of injuries that a swimmer can have can be scary – the great news is that you can prevent them! Evidence suggests that injury management should focus on prevention and early treatment, addressing the impairments associated with the condition, and analysing training methods and stroke mechanics. (Tovin, 2006).

The first step in preventing injury is to tell someone that you can feel your symptoms. You can discuss this with your coach or physiotherapist.

The next step is to assess your body’s suitability for your chosen pet event! Swimmers require a combination of strength, mobility, power and endurance specific for their event – whether it’s the 100m or 1500m!

Did you know that PhysioWorks has devised a specialised swimmer screening tool, specific for swimmers of all ages and levels of competition, to help identify areas they can improve! It takes an extended consultation time to run fully through a swimmer screening! If that's what you are after, please tell us at the time of booking.

Need a Whole Swimming Squad Screened?

Your PhysioWorks physiotherapists can also come to your squad, screen everyone, and identify areas that can help you prevent injury. Screening can also help improve performance as we liaise directly with your coach to identify your individual and specific needs!

If you would like to have a Swimming Injury Screening – contact the friendly team at PhysioWorks, and we can arrange a suitable time.

Swimming Injury Treatment

While each swimmer will require extra care, treatment usually involves manual therapy. Your treatment depends on your physiotherapist's thorough understanding of your stroke and discussing your rehabilitation plan with your coach! More importantly, finding the root cause of the injury and then, if required modifying your stroke technique to prevent the issue from reoccurring is the key to success.

Common treatments include:

If you have any further questions about the above injuries or prevention, please do not hesitate to consult your PhysioWorks Swimming physiotherapist.

More info:

Swimming Injuries

Swimmers Shoulder

Breaststrokers Knee

Butterfly Back

How is Kinesiology Tape Different from Conventional Strapping Tape?

kinesiology tape

Rigid strapping firmly wraps around your injured structures. Most standard strapping tapes are non-elastic. They aim to provide rigid support and restrict movement. These rigid strapping tapes can only be worn for short periods, after which you must remove them to restore your circulation and mobility.

Alternatively, kinesiology tape has unique elastic properties that allow it to provide active support, protect muscles or joints, and allow a safe and functional range of motion.

Rather than being entirely wrapped around injured joints or muscle groups, kinesiology tape is applied directly over or around the periphery of troublesome areas. This non-restrictive characteristic of kinesiology taping allows most applications to continue for several days. This period reinforces therapeutic benefits to accumulate 24-hours a day for the entire time they’re worn.

You can wear kinesiology tape during intense exercise, showering or swimming. It quickly dries after a quick pat with a towel.

More info: Strapping & Supportive Taping

Kinesiology Tape

Kinesiology tape has a comprehensive array of therapeutic benefits. Because kinesiology taping can usually be left on for several days or up to a week, these therapeutic benefits are available to the injured area 24 hours a day, significantly accelerating the healing process from trauma, injuries and inflammatory conditions.

Benefits of Kinesiology Taping

Pain Relief via Structural Support for Weak or Injured Body Parts

Kinesiology tape is a flexible elastic tape that moves with your body. The supple elasticity provides supports to your body parts without the tape slipping.

By supporting your body part, kinesiology tape can provide you with pain relief and muscular support to help control body parts affected by muscle inhibition.

Muscle Support

Kinesiology tape potentially assists your muscle strength via physical assistance. It also provides tactile feedback through the skin, e.g. proprioception boost. This phenomenon may help both the non-disabled athlete to enhance their performance and hypotonic, e.g. children with low muscle tone.

Swelling Reduction

Kinesiology provides a passive lift to your skin via its elastic properties. This vacuum effect allows your lymphatic and venous drainage systems to drain and swollen or bruised tissue quicker than without the kinesiology tape.

It is also thought that this same principle can assist the removal of exercise byproducts like lactic acid that may contribute to post-exercise soreness, e.g. delayed onset muscle soreness (DOMS).

More info: Strapping & Supportive Taping

What is Dry Needling?

Dry needling is an effective and efficient technique for the treatment of muscular pain and myofascial dysfunction. Dry needling or intramuscular stimulation (IMS) is a technique that Dr Chan Gunn developed. Dry needling is a beneficial method to relax overactive muscles.

In simple terms, the treatment involves the needling of a muscle's trigger points without injecting any substance. Western anatomical and neurophysiological principles are the basis of dry needling. It should not be confused with the Traditional Chinese Medicine (TCM) technique of acupuncture. However, since both dry needling and acupuncture utilise the same filament needles, the confusion is understandable.

In his IMS approach, Dr Chan Gunn and Dr Fischer, in his segmental approach to Dry Needling, strongly advocate the importance of clearing trigger points in both peripheral and spinal areas.

Dry needling trained health practitioners use dry needling daily for the treatment of muscular pain and dysfunction.

dry needling

What Conditions Could Acupuncture or Dry Needling Help?

Acupuncture or dry needling may be considered by your healthcare professional after their thorough assessment in the following conditions:

Private Health Fund Rebates

Most private health funds offer rebates on acupuncture or dry needling treatments as a component of your physiotherapy or acupuncture consultation.

More Info