Swimmers shoulder is a broad term encompassing a variety of conditions that result from overuse of the shoulder in swimming activities. It is also known as impingement syndrome. It's caused by a pinching of the rotator cuff tendon between the humeral head and part of the shoulder blade during arm movements, a common issue in swimmers due to the repetitive nature of the sport.

This complex joint comprises several structures, including the humerus or humeral head (upper arm bone), the scapula (shoulder blade), and the clavicle (collarbone), along with an array of muscles and soft tissues. The shoulder's complexity gives rise to different types of pain experienced with swimmers’ shoulders, from localized discomfort to spreading pain down the arm or even shooting pain ascending up the neck. These symptoms all signify different forms of the swimmer's shoulder.

The common thread across all these forms is that the pain is not attributed to a single, specific incident. Instead, the discomfort arises from overuse or stress caused by repetitive motions inherent to swimming training. To give you an idea, a competitive swimmer might execute up to 16,000 shoulder revolutions in a single week of training.

Among these rotations are the work of external and internal rotators, critical sets of muscles in the shoulder's complex biomechanics. Overuse or imbalance of these muscles can lead to problems such as shoulder impingement, where the rotator cuff tendons are compressed during shoulder movements, leading to pain and limited movement.

Moreover, poor spine mobility can exacerbate the problem by placing extra strain on the shoulder, emphasizing the importance of whole-body fitness in preventing such injuries.

With such demanding activity, it's unsurprising that around 30% of professional swimmers will suffer from some form of swimmer's shoulder during their swimming careers. Hence, understanding these different aspects can help with preventive measures and appropriate treatment protocols.

Anatomy of the Shoulder

The three bony components of the shoulder, the humerus, scapula, and clavicle together form a very shallow ball and socket type joint. This shallow socket is encased within a rim of cartilage that adds additional depth to the shoulder socket and helps to maintain the stability of the shoulder.

Surrounding the joint is your articular capsule, made up of fibrous material with thickened extensions forming the ligaments in your shoulder.

The rotator cuff is the set of muscles that have the most impact on your shoulder stability. Four muscles in total make up the ‘rotator cuff’ and these are the muscles that ensure your shoulder is kept centred within the shallow socket.

What causes Swimmers Shoulder?

The shoulder is an extremely mobile joint and as a result needs to have its movement controlled in a proper manner by the muscles and ligaments surrounding it.

Excessive training, hypermobility, muscular tightness or imbalance, training when the body is fatigued and poor stroke technique are all factors that can lead to overload of the muscles and ligaments. Training with any or a combination of the above can potentially lead to rotator cuff impingement and tendonitis, rotator cuff tears, bursitis, capsule, ligament or cartilage damage.

Do you have Swimmers Shoulder?

To ensure the fastest possible recovery time to get you back in the water as quick as possible, an accurate diagnosis is essential. The Limitless Physio team have significant experience with shoulder injuries. A thorough assessment needs to be performed including a number of tests to determine exactly what structures in the shoulder are the source of pain. Diagnosing the pain is only one part of the work required, finding the “driver” or root cause of the issue is essential to ensure recovery and minimise the chance of a repeat injury.

Swimmer’s Shoulder and its Treatment

A tailored individual program is essential when rehabilitating a client with Swimmer’s Shoulder. The rehabilitation program should be adhered to and until its completion to avoid reoccurrence. Successive damage through re-injury can impede your abilities as an athlete and possibly lead to permanent damage.

The shoulder is both complex in the number of muscles and tendons that make up its parts and simple in that it has only one bony joint articulation that attaches your clavicle to your scapula.As explained in the “Anatomy of a Shoulder”, your rotator cuff is the group of muscles that maintain “centralisation” of your shoulder joint within the shallow socket. Injuries such as bursitis, impingement, subluxations and dislocations are all prevented by proper function of the rotator cuff and scapular stability.

Full shoulder movement also relies on the ability for shoulder joint to glide and slide with relative ease and many subtle movements rely on dynamic control of the rotator cuff. The scapula also has a vital role as the main stable platform or base of power production.

There are 7 primary stages of recovery, healing and rehabilitation. We will cover each specifically in relation to Swimmer’s Shoulder.

Phase 1 - Early Injury Protection: Pain Relief & Anti-inflammatory Tips

RICE treatment (Rest, Ice, Compression and Elevation) is the most common immediate treatment recommended in the case of soft tissue injuries and Swimmer's Shoulder is no different.

In the initial stages of treatment it is quite possible that sleeping will be uncomfortable, lifting your arm and any sudden movements may result in pain. This is your body's natural warning system, the pain is a clear indicator that you should cease the activity that is causing the pain in your shoulder. Avoiding the movement or exercise that caused the problem in the first instance is essential, however the cessation of any activity that results in pain in the shoulder is also incredibly important.

Ice Packs, Ice Bandages and to a limited extent deep freeze sprays can all be simple and effective means to control the pain, reduce swelling and generally aid in recovery during the initial stages of injury. At a minimum every 2 to 3 hours you should be applying an ice pack for 15 minutes during the first couple of days recovery.

To avoid aggravation it might be necessary to wear a sling, use rigid taping or kinesio tape to limit the movement of the shoulder and to encourage correct scapular positioning.

Phase 2: Regain Full Range of Motion

You must ensure that you protect your injured rotator cuff structures in the appropriate manner to ensure the injured tissues will heal properly. Issues such as tendonitis and bursitis are simply inflamed structures, and with the proper protection from additional damage will settle and resume to normal.

It is true that the correct treatment can help speed up recovery time, however time will always be a factor in the treatment of Swimmers Shoulder. For some it may take several weeks before you are back to full strength. During this time avoiding aggravation by correctly positioning your shoulder will minimise the chance of recurrence and limit the possibility of further damage .

During this period we are looking for recovery of tendon fibres and be aiming to optimally re-mould your scar tissue. The lengthening and orientation of the scar tissue during the healing process is extremely important. Massage, muscle stretches, both active and assisted range of motion and finally strenghtening exercises, all form part of proper rehabilitation.

Your shoulder being able to perform a full range of motion (initially assisted and then under your own muscle power) is a clear sign you have regained full soft tissue extensibility

Phase 3: Restore Scapular Control

The foundation of all your shoulder and arm movements is in fact the scapula.

Scapulohumeral rhythm is the correct term for normal movement of the shoulder and shoulder blade, this is a requirement for pain-free and powerful shoulder functions. Any change or alteration of this pattern of movement may result in impingement, injury and joint capsule damage.

Expert assessment of scapulohumeral rhythm and treatment for the correction of irregular movement is something your physiotherapist can provide. Poor scapulohumeral rhythm is a leading cause of rotator cuff impingement and in turn a critical component of your rehabilitation is addressing such deficiencies.

Scapular stabilisation exercises have been identified as a core element of successful rehabilitation, however this is often a difficult element to master for patients. At Limitless we use live video feedback so that you can actually see your scapular and learn to control it effectively during movement and exercise.

Phase 4: Restore Normal Neck-Scapulo-Thoracic-Shoulder Function

Whilst it may not be immediately obvious both your neck and thoracic spine are essential elements in the proper rehabilitation of shoulder pain and injury. Not only does neck and spine dysfunction refer pain directly to your shoulder, it can also affect a nerve’s ability to conduct electrical impulses to your muscles. This miscommunication with muscles can cause weakness and alter the natural patterns of movement.

Additionally painful or stiff spinal segments can result in poor posture, which inhibits good scapular function and provides a poor base for your shoulder and scapula muscles to act upon. It is therefore very likely that exercises designed to treat your neck and/or upper back will also be prescribed with a view to improve the healing process and minimise the chance of recurrence.

Phase 5: Restore Rotator Cuff Strength

Whilst you might think that restoring the strength of your rotator cuff should occur at an earlier stage in your rehabilitation it is in fact essential that primary healing occurs in the first instance. With primary healing having occurred you can then look to load your shoulder with resistance and anti-gravity exercises.

Obviously strengthening the rotator cuff is an indispensable part of any rehabilitation program, however it is essential the progression of these exercises be closely monitored by your physiotherapist to ensure the loading is appropriate to the stage of tendon recovery.

Phase 6: Restore Technique, Speed, Power & Agility

Your program should address the entire musculoskeletal system to ensure your return to the pool or ocean is not short lived and the chance of future recurrence is minimised. Swimming specific exercises will do more than reduce the chance of re-injury but likely improve your sporting performance. Your swimming specific training will look to correct the technique that led to injury in the first instance. It ill also incorporate progression through speed, agility and power drills.

Phase 7: Return to Swimming

Critical to an injury-free return to swimming are tailored exercises and a well thought out progressive training regime. Working with your physiotherapist can ensure that your individual goals, training schedules and timeframes for recovery are accounted for . The ideal conclusion to a recovery program is one that sees you return to pre-injury performance, function and power. Knowledge of how to avoid reoccurrence and maintain the control of your scapula muscles and rotator cuff is also desirable.

Conclusion

As you can see, the issue of Swimmers Shoulder is often a complex one. As a result an exact timeframe for each stage of recovery is difficult to predict as it is unique to the athlete and injury in question. It is essential the progression between the various stages of rehab be guided by your physiotherapist and not rushed. Attempts to progress through the stages too rapidly or without the correct guidance may increase the risk of experiencing the frustration of re-injury.

The use of video feedback at Limitless is a valuable tool in expediting scapula control and awareness. It has been working great in the clinic since its inception and in short is getting swimmers back in the ocean ahead of schedule.

For more specific advice about your shoulder injury, please contact us on 83139217.

Swimmers Shoulder: What is it?