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 Photo Town Crier File Photo
To avoid swimmers shoulder, common among freestyle and butterfly swimmers, athletes should use proper swim mechanics and develop a conditioning program. Whether you are a young athlete, an active adult or a sports enthusiast, injuries are par for the course. Swimmers are no strangers to pain, especially pain associated with swimmer’s shoulder. It is estimated that more than 70 percent of competitive swimmers develop a shoulder injury at some point in their careers.
Why is swimmer’s shoulder so pervasive? Understanding swimmer’s shoulder requires a basic knowledge of the joint anatomy. The shoulder joint is surrounded by several strong ligaments and a thick, fibrous structure known as the joint capsule. Collectively, these static stabilizers support the joint and help keep it snug primarily at rest but also during active movement. While swimming, support is provided by the rotator cuff muscles and to a lesser extent by the biceps. These muscles lend dynamic stability to the joint. Sitting atop the joint is a bursa sac, which helps decrease friction and provides cushion to the rotator cuff tendons.
Swimmer’s shoulder is an impingement syndrome in which the bicep tendon, the rotator cuff tendon and the bursa are compressed between the bony structures of the joint. It is more common among freestyle and butterfly swimmers. As the soft tissue structures become pinched and inflamed by repetitive overhead motion, the space within the joint decreases, which can start a painful impingement cycle.
The causes of swimmer’s shoulder are varied. Faulty swim mechanics have been linked to this condition. Swimmers who cross midline during catch and pull, use a thumb-first entry and breathe only to one side greatly increase their risk of injury. Insufficient body roll and swimming with an “eyes-forward” position impedes normal shoulder function. Hand paddles are popular among swimmers; however, if overused, then they too can lead to joint strain or impingement.
Posture can contribute to a swimmer’s problem. As a group, swimmers tend to have rounded shoulders, which cause the shoulder blades to tip forward and down, increasing the risk of impingement. Swimmers commonly have tight chest and neck musculature, and research suggests that this tightness inhibits the shoulder blade dynamic stabilizers, resulting in improper shoulder mechanics.
Rotator cuff weakness and fatigue are major causes of swimmer’s shoulder. If the dynamic stabilizers are weak, then the joint mechanics will be altered and function compromised.
In conjunction with muscle weakness, swimmers typically have more shoulder joint laxity due to an overstretched joint capsule. Years of improper stretching and even a previous subluxation or dislocation can cause the joint capsule to be irreversibly stretched. Lax static stabilizers plus weak dynamic stabilizers greatly increase the risk of injury.
Avoiding swimmer’s shoulder is possible. Using proper swim mechanics and developing a proper conditioning program is integral.
A stretching program performed three to five days a week targeting flexibility of the neck and chest is important to offset the typical swimmers’ posture. Performing a 10-15 minute warm-up prior to stretching is ideal. Aggressive joint capsule stretches should always be avoided.
An endurance-strengthening program that focuses on the rotator cuff and shoulder blade stabilizers performed two to three times per week is recommended. Strengthening should be done following a swimming session, never before, to avoid fatigue. The goal is to increase the strength and stability of the shoulder joint and shoulder blade stabilizers, thereby promoting normal joint function.
For more detailed exercises, visit www.taylorpt.org.
Robert Abrams has been practicing sports and orthopedic physical therapy since 2001. He works at Taylor Physical Therapy: Orthopedic and Sports Rehabilitation in Los Altos.
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