Swimmer’s Shoulder

Swimmer's Shoulder

What is Swimmer’s Shoulder?

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 in relation to shoulder pain [1]. Additionally, up to 91% of swimmers aged 13-25 years old experience shoulder pain on a frequent basis [2].

“Swimmer’s shoulder” is an umbrella term used to describe numerous injuries that relate both 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, pain can either be local to the injured shoulder or can refer to other areas of the body, namely the thoracic, cervical and upper arm regions. Elite swimmers are generally performing 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 most prevalent of injuries surrounding the swimming population is shoulder pain. Both 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 extrinsic 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 and can be influenced by 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 thought to be 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 translation and inadequate control results in the humeral head colliding with soft tissue structures (supraspinatus, subacromial bursa, biceps tendon) subsequently manifesting as RCSHP.

Pain and discomfort can be further exacerbated 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 a number of muscles and associated tendons that run surround the shoulder joint. These muscles that have the most effect on the joint’s stability are collectively termed 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 supraspinatus. This tendon has been shown to be thickened and pathological in most swimmers reporting shoulder impingement. Furthermore, this tendon thickening is positively associated with kilometers swum in the pool and correlates strongly with shoulder pain [1]. Other structures that have the most potential to exhibit pain at the shoulder 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.  Early assessment is the quickest way to identify what is causing your swimmer’s shoulder, and then a treatment and coaching plan can be implemented to optimally return you to full training.  Chronic shoulder problems can often persist for 3 to 12 months if they are not attended to early enough.

Swimmer’s Shoulder Treatment

Swimmer’s shoulder is a common but complex complaint that we see at PhysioWorks and it is, unfortunately, an injury that often recurs if you return to swimming too quickly – especially if a thorough rehabilitation program is not completed.

Can You Swim with Shoulder Bursitis?

Shoulder bursitis is an inflammation of the bursa due to impingement. You will do yourself no favours by continuing to swim with a severely inflammed bursa. Mild bursitis sufferers can usually continue to swim with modifications to their swimming program while undergoing treatment.

Does Swimming Aggravate Your Rotator Cuff?

When your shoulder biomechanics, joint flexibility, muscle control, and soft tissue length are working optimally your rotator cuff will be functioning normally and 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 you developing swimmer’s shoulder. Importantly, the results of your screening will enable your physiotherapist to prescribe customised prevention exercises to reduce your risk of developing swimmer’s shoulder.

Our PhysioWorks swimmer physiotherapists provide club, school, and individual swimmer screening programs. Please contact us for more details.

Summary

There is no specific time frame for the rehabilitation of swimmer’s shoulder. Your time frame is individual to your training loads, swimming technique and your bodies ability to perform a normal swimming stroke. Your injury rehabilitation status will be determined by many factors during your physiotherapist’s clinical assessment. You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves.

It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration. Ideally, your swim coach and physiotherapist should be communicating regularly throughout your rehabilitation phases.

Common Shoulder Pain & Injury Conditions

Rotator Cuff

Adhesive Capsulitis

Shoulder Bursitis

Shoulder Instability

Acromioclavicular Joint

Bone Injuries

Post-Operative Physiotherapy

Muscle Conditions

Systemic Conditions

Referred Pain

Shoulder Treatment

Researchers have discovered that managing your shoulder injury with physiotherapy is usually successful. Typically, you have two options: non-operative or a surgical approach. Your condition will dictate which option is best for you at this time. Non-operative care is conservative rehabilitation.

If shoulder surgery is required, then your physiotherapist may undertake:

  • Pre-operative rehabilitation  - to either try a non-operative treatment approach or to condition and prepare your body for a surgical procedure.
  • Post-operative physiotherapy - to safely and methodically regain your normal range of movement, strength, speed and function.

PhysioWorks physiotherapists have a special interest and an excellent working relationship with leading shoulder surgeons. Our physiotherapy team provide you with both conservative and post-operative shoulder rehabilitation options. We aim for you attaining the best possible outcome for your shoulder injury.

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