By James N. Johnson

House Calls

Swimming is an excellent form of aerobic exercise. However, improper technique or trying to ramp up too quickly can result in repetitive overuse injuries of the shoulder. These injuries are commonly called “swimmer’s shoulder.”

Swimmer’s shoulder is a general term that encompasses many types of shoulder injuries but is most commonly fatigue-related rotator-cuff inflammation. It can also be related to the inherent instability of the shoulder joint.

Swimmer’s shoulder can be caused by improper technique due to a strength imbalance or shoulder instability, rapid increase in training volume or rapid increase in training intensity.

A swimmer with shoulder instability or overly “loose” joints is more likely to demonstrate improper technique while swimming freestyle, the stroke preferred by most training athletes. A loose shoulder joint causes what’s commonly called “dropping the elbow.” In fact, while it appears the elbow is dropping, it’s actually just the front part of the shoulder joint moving forward in the plane connecting the body to the arm.

A swimmer can correct this problem by rolling his or her body as a unit - with hips, trunk and shoulders rolling at the same time with each stroke. It helps to think of a barbecue skewer - the goal is to keep the head and spine in line and for the body to rotate on the long axis of the spine.

Following are some additional strategies to reduce the risk of swimmer’s shoulder:

If you have an asymmetric body roll, try bilateral breathing or taking breathing breaks on both sides.

Try training with a buoy. This floats the legs, decreasing the load on the shoulders and emphasizes the importance of rolling from the hips and trunk.

Don’t overdo it. Make sure your training program is progressive in terms of volume and intensity.

Develop strength and endurance in the muscles surrounding the shoulder, specifically around the shoulder blade and rotator cuff. Try strengthening exercises such as seated rowing, push-ups with a “plus” (rounding the back at the top of the movement, similar to a cat stretching) and lateral raises with the thumb pointing toward the ceiling (also called “full-can”). Be sure to do all rotator-cuff exercises with low weights to avoid injury.

To review these and other shoulder-injury-prevention exercises, logon to www.usa-swimming.org and do a word search for “shoulder injury prevention.”

While prevention is foremost, there are treatments for swimmer’s shoulder. An individual who suspects an overuse injury should stop his or her swimming workout routine and see a doctor.

Once the doctor makes a diagnosis of swimmer’s shoulder, the initial treatment includes rest, ice (at least three times a day, 20 minutes each time) and anti-inflammatory medication. The individual may be able to continue a moderate swimming workout schedule, but only if it doesn’t cause pain. If the pain persists, the workouts should be reduced.

If the initial treatment isn’t effective after two weeks, the physician may recommend physical therapy. In some cases, cortisone injections may be beneficial. Surgery is a late-stage treatment in rare cases.

Dr. Jim Johnson is a sports medicine physician at the Palo Alto Medical Foundation and a U.S.A. Swimming national team physician. This monthly column is provided by the Palo Alto Medical Foundation and column editor Arian Dasmalchi.