Swimmer’s Shoulder

by | Jun 20, 2018 | Physiotherapy

Shoulder pain is one of the most common injuries amongst swimmers. It is notorious for ending promising careers and causing months away from training. As a former swimmer and physiotherapist I have personally experienced and treated many ‘swimmers’ shoulders’ I have dealt with the highs and lows of treatment and rehabilitation and have tried almost all avenues of treatment to sort out an irritating ‘niggly’ shoulder. Having tried and tested physiotherapy, chiropractics, homeopathy (in the form of traumeel and dextrose injections), cortisone, biokinetics, anti-inflammatories, pain patches, shock wave therapy, dry needling and the usual RICE (rest, ice, compression, elevation) regime, nothing is more effective than PREVENTION. I spent most of 2013 recovering from a recurring shoulder problem that came about due to overtraining on an unstable shoulder. I learnt the hard way, like most people do (even though as a physiotherapist I know better), how important it is to rehab, rehab, rehab. Shoulder rehab is one of the most challenging to do as it is mentally unstimulating and just hard work.

The shoulder is a complex joint and it is often difficult to isolate the cause of the problem. Swimming is a tough sport. Although it is known to be gentle on the body, swimmers spend hours a day in the pool rotating their arms through water (resistance). This is a highly repetitive motion and if done incorrectly, will inevitably result in a chronic shoulder problem which can be very difficult to treat and ‘undo’. The most important part of swimming is the catch. If done consistently correctly, one can prevent shoulder problems. In order to ‘catch’ the water correctly, the swimmer is required to have some form of scapular stability.

As I previously mentioned, the shoulder is made up of many muscles and structures and it can become complicated to assess and treat. There are two primary muscle groups responsible for stabilising the shoulder- the rotator cuff muscles and the scapular stabilisers. The rotator cuff consists of four muscles around the ball and socket joint. They are responsible for keeping the ball of the shoulder stable as one lifts or rotates the arm. The scapular stabilisers are responsible for preventing ‘winging’ of the scapula (lifting the shoulder blade away from the rib cage and causing unnecessary loading of the primary shoulder movers). More often than not, these muscles are not firing or functioning correctly and therefore result in an overload on the primary shoulder movers, resulting in fatigue and eventually muscle spasm and pain.

Most swimmers are hyper-mobile (the ability to move your joints beyond their normal range) which is a huge advantage in the sport as it allows for greater flexibility and reach in the water. This flexibility is necessary to allow for freedom of movement in the water as the body rotates and pulls through the water. The disadvantage and danger of being hyper-mobile is that there is less stability in all the joints and thus a higher risk of injury. This risk is much higher in weight bearing sports which is why swimmers get injured from sports such a running and gym (another topic for another day).

Once you have had a shoulder injury, rehab is for life.

So how can we prevent the seemingly inevitable shoulder impingement? PREHABILIATION. Speak to your physiotherapist or biokineticist for a prehabilitation program for the shoulder. The exercises are simple but effective and can be done at the pool before the swimmer gets in the water. Once you have had a shoulder injury, rehab is for life. It is essential to maintain that shoulder stability and strength throughout your career as a swimmer to prevent recurrence. Regular shoulder exercises as shown below will help to prevent recurrence. They should be done a minimum of twice a week.

Photo by Lena Bell on Unsplash

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