Member Case Study: Swimmers' Shoulder?

author : AMSSM
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Member Question from Lukester1980
I started swimming in Feb to get ready for the upcoming triathlon season and the 1st tri in April. Three days a week, approx 30 mins a time. Of course, I'm an idiot and don't stretch before I swim, do nothing but free style and never got any instruction/guidance. My right shoulder started to hurt. So, I stopped swimming. Three days later the shoulder feels much better. After reading online, it looks like I have classic symptoms of swimmer's shoulder. The article I read said that swimmer's shoulder can result from improper stroke, overtraining and one sided breathing. Do you have any comments on this and how to prevent? Will stretching or warming up help?

Answer from Marjie Delo, MD

“Swimmers’ shoulder” refers to shoulder pain in a competitive swimmer. The most common causes are rotator cuff tendonitis (or tendonopathy) and external impingement syndrome. The cause is multi-factorial.

1. With swim training, the shoulder will have increased laxity, or instability, overtime. While this is helpful for maximal efficiency of your stroke in the water, it also leads to changes in the biomechanics of the shoulder, and may exacerbate underlying muscle weakness or imbalance.

2. The rotator cuff is a group of muscles that surround and cover the head of the humerus (arm bone) and stabilize it in the shoulder joint. The increased laxity of the shoulder must be compensated for by a stronger rotator cuff. If the rotator cuff is weak or fatigued, the head of the humerus will begin to rise upwards out of the joint while swimming. This can cause the rotator cuff to be “impinged” or pinched between the head of the humerus and the acromion (the bone on top of your shoulder). Over time, the rotator cuff can become inflamed and even torn.

3. The other muscular factor to swimmers’ shoulder is potential weakness of the muscles that stabilize the scapula (shoulder blade): trapezius, levator scapulae, rhomboid, and serratus anterior. If these muscles are working properly, they will elevate the acromion during the swim stroke. However, if they are weak or fatigued, the acromion will not elevate, and again the rotator cuff will be pinched between the acromion and the head of the humerus.

Therefore, the answer to your question is rotator cuff and scapular stabilizer strengthening. The pain you are feeling is coming from the rotator cuff itself. Remember that the rotator cuff and scapular stabilizers are smaller muscle groups, so in order to work these muscles, use smaller weights with high repetitions, see example.

 

Some swimmers will have posterior shoulder tightness, so stretching the back of the shoulder may improve your symptoms, but ironically laxity in the front of the shoulder is part of the problem, so be sure that your pectoralis stretches are specific for those muscle groups, and you’re not overstretching the anterior shoulder joint. Stretching tight traps and the levator scapulae will help with scapula mobility.

 

If you have good form, one-sided breathing should not cause shoulder pain. However, if your body is rotating too much when you breath, or your arm is abducting away from your body, you may be impinging. It is always a good idea to have a coach or experienced swimmer evaluate your stroke form.

Good luck with your season!

Marjie Delo, MD
Mercy Walworth Sports Medicine & Rehabilitation Center

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date: July 15, 2008

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AMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

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