Swimmers shoulder is a generic term used for what is an overuse issue for the shoulder, particularly concerning the muscles and tendons of the rotator cuff. Despite the name, this painful shoulder issue isn’t specific to swimmers but is seen in a variety of people, from those who are highly active to people who are couch potatoes.
People with swimmers shoulder generally experience a dull pain in the morning which ‘warms up’ throughout the day but may not necessarily disappear completely. You may also feel a sharp pinching pain in the shoulder with overhead activities. As with most musculoskeletal injuries, swimmers shoulder can have a number of contributing factors including load management, muscle strength and endurance deficits, stiffness or tightness, and inadequate neuro-muscular control of the shoulder.
Swimmers shoulder will often come on due to an increase in the use of the shoulder. For example a swimmer may have had a sudden increase in the amount of time they’ve been training per week, the intensity, or have been training a new stroke. In those who are less active, it may be due to things like giving the house a new coat of paint or doing some spring cleaning. The reason these rather innocuous activities may cause shoulder pain is not so much related to the activity itself but to the ability of the shoulder to tolerate what you’re asking it to do (i.e. having the strength and control of the shoulder and shoulder blade to perform the activity).
In order for the upper limb to move freely and allow us to complete tasks like reaching up to the top shelf to grab something or to reach behind us to do up the zip on a skirt, the joint itself relies less on bony stability (like the deep ball and socket joint of the hip) and relies more heavily on active stability (muscles). When these muscles don’t have the strength and/or endurance to control the shoulder joint, we can get excess movement and aggravation of the structures surrounding the joint. Often there can be an underlying weakness, but you won’t know it until you ask the muscles to do something quite difficult or something you’re not used to, such as spring cleaning, painting or a sudden increase in training load.
Although a sudden increase in activity is usually the catalyst, there are other factors that can leave you more susceptible to this issue and these should be targeted in terms of treatment. Tightness at the front of the chest, weakness of your upper back muscles, thoracic cage mobility and shoulder blade control all may have some contribution to a swimmers shoulder issue. As with many musculoskeletal issues, swimmers shoulder is a complex pathology which requires thorough assessment in order to identify the contributing factors. Once these have been identified, a thorough rehabilitation plan targeting the contributing factors is paramount in achieving the best outcomes for you and your shoulder moving forward. If you think you have a case of the swimmers shoulder, come in and see one of our physiotherapists for a comprehensive assessment and treatment plan that targets your specific goals!
One of the most common complaints we see as physio’s is shoulder pain, and it doesn’t just affect athletes. While acute shoulder injuries often happen in collision sports or because of a sporting accident, people performing overhead activities such as lifting in the gym, throwing, racquet sports or swimming are also prone to shoulder pain.
Shoulder Impingement Syndrome is the most common cause of shoulder pain in the general population & with many types of sports activities. It can be very debilitating for people such as swimmers, racquet sports players and gym-goers. Throwing, bowling or pitching sports like cricket, baseball and softball are also common places to find shoulder impingement injuries.
Some occupations that involve lifting, carrying, and other repetitive tasks, especially if they are performed with the arm away from the side of the body, are also common causes of shoulder impingement. Even some common DIY tasks like painting walls or ceilings, repetitive drilling at shoulder height or above, and digging in the garden can bring on the pain.
As the arm is raised, the rotator cuff muscles keep the ball of the humerus tightly in the centre of the socket of the scapula. If this position is not maintained well, the tendons of the rotator cuff may be pinched between the top of the arm bone & the bony “roof” of the scapula. This can cause irritation of the tendon which can lead to inflammation, weakness and pain. Eventually it can lead to more significant problems like tearing of the tendon.
The classic presentation is a painful arc, which is when you feel pain as you lift your arm away from your side and up to your ear. This corresponds with the narrowing of the sub-acromial space, which is where the tendon gets pinched.
Many people also feel pain with twisting movements such as putting on a jacket or when reaching behind your back. When the inflammation is active you may feel pain at night and be unable to sleep comfortably on that side, and your shoulder can ache even when your arm is resting. Sometimes people describe a ‘locking’ sensation in the arm on certain movements.
Initially, avoiding painful activities to help settle your symptoms is important. If you have recently started or significantly increased your exercise regime you may just need to progress more slowly once your pain has resolved. However because most shoulder impingement is caused by an imbalance in muscle length &/or strength around the shoulder, you need to fix the underlying cause of your pain otherwise it is likely to return again in the future. This is especially true if you have had more than one episode of pain because recurrent pain strongly indicates an underlying imbalance within your shoulder, often within the rotator cuff muscles or the muscles that control your shoulder blade.
Keeping correct shoulder alignment relies a lot on keeping the right balance of length and strength within your shoulder muscles. Having a balanced gym program of pulling and pushing exercises is a great way to help achieve this. If you don’t normally go to the gym then you may need to do some extra strengthening for the muscles at the back of your shoulder, especially if you are an office worker and tend to hunch over your desk a lot. Shoulder and pec/chest stretching can also help.
If you have had a significant episode of pain, or several mild-to-moderate episodes recently, then you should get it checked out by a physio because you are very likely to have an underlying imbalance that will keep giving you problems in the future. Treating the pain when it is only recent and relatively mild is usually fairly simple. However, recurrent episodes can lead to more tendon damage requiring prolonged treatment, costly investigations such as an MRI, potentially more invasive management like cortisone, and much more time away from doing the things that you love.