The Keys to Dealing with Swimmer’s Shoulder

22 Oct The Keys to Dealing with Swimmer’s Shoulder

by Dr Matt Fontaine, DC With the rigorous training volume of competitive swimming, the body often suffers from accumulation of load that can result in a repetitive strain injury.  The repetitive motion is the cause of chronic irritation to soft tissue.   This irritation creates a friction and pressure, which eventually leads to small tears within the soft tissue.  The friction created by the tightness in the soft tissue in turn cause inflammation, decreased circulation, and edema.  This leads to decreased oxygen in the tissues which is a catalyst for biochemical changes that lead to scar tissue formation and adhesions.  These adhesions cause muscles to get stuck together like two pieces of Velcro and result in restricting normal movement, muscle imbalances, inflammation and swelling.  This cycle repeats itself, and escalates in pain, inflammation, and new injuries caused by the restrictive scar tissue.   Pattern overload describes injury to soft tissues resulting from repetitive motion in one pattern of movement, or restricted movement in one or more planes of motion.  Pattern overload results primarily from faulty movement patterns and repetitive stress.  Our body is composed of a series of structural kinetic chains, whereas dysfunction or imbalance in one area can quickly lead to dysfunctions in other parts of the body.  This can arise due to the body’s inability to properly load share across the joints.  Swimmer’s Shoulder   The term swimmer’s shoulder was first coined in 1978¹ to describe anterior shoulder pain occurring during and after workouts.  Pain in the shoulder is common in swimmers.   Since the shoulder is an inherently unstable, but highly mobile joint, shoulder function is highly dependent on the coordinated function of many muscle groups. These include the rotator cuff muscles, those that control the scapula or shoulder blade, pectorals and latissimus dorsi, muscles in the upper and lower back, as well as abdominal and pelvic muscles.  The repetitive overhead activity of the swimming stroke can result in fatigue of these muscles. This in turn can lead to distinct changes in the function of the shoulder, resulting in the pain that is commonly known as “swimmer’s shoulder”.   As of 2007, there were 250,000 competitive swimmers in the US, according to USA Swimming, the governing body.  Competitive swimmers can average between 6000-10,000 m ( 6,500-1,100 yds) per day and upwards of 60,000-80,000m per week^3,4,5.  With an average stroke count at 8 to 10 per 25 m, swimmers perform 30 000 rotations of each shoulder per week, placing tremendous stress on the shoulder girdle and glenohumeral joint.⁶   With swimming, it is important to assess the mobility of the hips and thoracic, as well as stability of the lumbar spine, cervical spine and shoulder girdle.  Commonly the hip flexors are tight and restrict hip extension needed during kicking.  This can shear stress the lower back and lead to lower back pain.  The levator scapulae, a muscle that runs from the top of the shoulder blade and attaches to the back of the vertebrae of the upper neck, often is overworked due to head rotation during breathing.  This is especially true for one sided breathers.  This tightness can pull the shoulder forward and lead to impingement of the rotator cuff. Swimmers typically develop poor posture because of tight latissimus dorsi, pectorals, all internal shoulder rotators.  They also had tight quadriceps and hip flexors which can restrict hip mobility.  These muscles are overused during swimming.  Protracted shoulders disrupt the normal axis of rotation of the shoulder joint.  The subscapularis (the rotator cuff muscle located in front of the shoulder blade) often becomes overworked, tightens and glues down with the serratus anterior and then becomes weak.  This muscle is needed to create a force couple that stabilizes the ball and socket joint during swimming and overhead movements.  Losing this force couple results in shoulder impingement, known in swimmers as “swimmers shoulder”. Another common cause for anterior shoulder pain in swimmers is glued down “adhesions between the anterior and middle deltoid, infraspinatus and the long head of the biceps.  When these tissues get glued down, there is a reduction of sliding of these structures during flexion, horizontal ABDuction, external rotation movements during the swimming stroke.  As these tissues rub, they become inflamed and irritated.  This very issue is often the cause of so called “bicipital tendonitis”. Common mechanical faults in swimming that can lead to shoulder injury are:

1. Hand entry that cross midline.
2. Thumb down entry.
3.  Asymmetric body roll.
4. Unilateral breathing.
5. Crossing midline during catch and pull.

The swim coach is essential to the success of optimal performance in the pool.  An educated swim coach with significant video analysis experience can be extremely helpful by educating swimmers on how to reduce stress in the water and increase efficiency. For proper function and optimal stroke mechanics, we need to have the right amount of mobility and stability.  Mobility is all about getting the right stuff moving.  In some cases that means flexibility training for longer muscles, and in some cases it means mobilization for better joint motion.  Specifically, swimmers and all athletes need to have good mobility of their hips and thoracic spine.  A well developed core will stabilize the lower back and help the swimmer to be more streamlined in the water.  Swimmers, as well as all athletes should focus on plank, side plan and gluteal bridging exercises to strengthen their core.  The main job of the core is to create midline stability, and check flexion and extension movements and prevent rotation of the lumber spine.  A strong well activated core allows for a stiff lumbar spine that is protected from undue stress as the body transfers kinetic energy from the lower extremity through the thoracolumbar fascia and into the thoracic spine, scapulothoracic joints and upper extremity.  A deconditioned core causes the athlete to lose power transfer from the lower to the upper body, and often results in lower back injuries. It is well-established that a comprehensive exercise program should focus on restoring mobility to the hip and thoracic spine, flexibility to tight and overworked muscles, and  improve core and shoulder girdle stability.  Once the body is moving properly, we then can move to improve strength, endurance, balance, and focus on “sport specific drills” to enhance performance.   Releasing all the adhesions in the muscles of the shoulder prior to engaging in strengthening exercises is essential to ensure that they work properly. The Big Picture A common thread to most sports related injuries is overuse of muscles, accumulation of load from high volume training and repetitive strain injury.  Active Release Techniques® provides a means to effectively and rapidly diagnose and treat these stressful repetitive strain injuries without surgical intervention, and allows the patient to quickly return to sport. Remember that once symptoms of injury have cleared, future prevention should begin by including regular foam roller self massage, mobility exercises as well as properly prescribed rehab exercise tracks to offer a progression from muscle activation to strengthening exercises. Find out more about ART & Sports Chiropractic at Potomacsportschiro.com References: References: 1.  Kennedy JC, Hawkins R, Krissoff WB. Orthopeaedic manifestations of swimming. Am J Sports Med. 1978;6:309-322 [PubMed] 2.   Membership demographics for the 2007 membership year. USA Swimming. http://www.usaswimming.org Accessed March 2, 2008 3.  Beach ML, Whitney SL, Dickoff-Hoffman SA. Relationship of shoulder flexibility, strength, and endurance to shoulder pain in competitive swimmers. J Orthop Sports Phys Ther. 1992;16(6):262-268 [PubMed] 4.  Greipp JF. Swimmer’s shoulder: the influence of flexibility and weight training. Phys Sportsmed. 1985;13(8):92-105 5. Richardson AB, Jobe FW, Collins HR. The shoulder in competitive swimming. Am J Sports Med. 1980;8(3):159-163 [PubMed] 6.  Heinlein S, Cosgarea A.  Biomechanical considerations in the competitive swimmer’s shoulder.  Sports Health. Nov 2010; 2(6): 519–525.       Buy , Over The Counter Doxycycline Hyclate 100mg, Dosage Monohydrate amount per day does mono 100mg treat chlamydia how long is  buying online hydroxyzine | buy medication without buy advair diskus 100/50 generic advair diskus inhaler