Although triathlon’s first discipline, the swim leg, is often considered the toughest, it’s also blessed with the lowest injury rate. They can happen, though – so we asked qualified osteopath (and former GB powerlifter) James White to look at the most common shoulder injury swimmers get: subacromial impingement, aka ‘swimmer’s shoulder’.
What is swimmer’s shoulder?
Swimming, while relatively low impact, puts your shoulder joint through a huge range of repetitive motion, which can lead to a cumulation of stress and sometimes results in pain and dysfunction. As a result, it’s very difficult to pin the cause of shoulder pain down to one specific part, and it’s instead important to take a global approach to the shoulder and torso.
Swimmer’s shoulder symptoms
Symptoms of swimmer’s shoulder can include:
- Pain in and around your shoulder
- Noticeable weakness or fatigue in your arm and shoulder
- Impacted range of motion
- Swelling in the shoulder
The anatomy of the shoulder joint
The shoulder is a complex joint with a fantastic range of motion, as lots of structures work closely to each other, overlapping in their roles and responsibilities. However this is at the cost of stability, and is the reason shoulder injuries are fairly common, even though it’s not a weight-bearing joint.
The shoulder joint is a ball and socket joint, which – unlike the hip joint – has a very shallow socket. A good way of imagining what it looks like is by thinking of a golf ball on a tee.
The bone part of your shoulder that you can feel sticking out at the end is called your acromion and this is where your collar bone meets your shoulder blade. When you lift up your arm above your head there is potential for the top of your humorous (upper arm) to knock and cause irritation against the under surface of your acromion.
There are a number of tissues that could be inflamed and causing pain. One is the bursa which is a flat sack that acts as to encourage smooth gliding of two tissues against each other. The bursa is likely to become inflamed if the shoulder is fallen on.
Another common one is the supraspinatus tendon. This is a small muscle that runs along the top of your shoulder blade and the tendon passes under the acromion and attaches onto the top of the humerous.
There is a part of the tendon called the critical zone where the blood supply is poor and this increases the chances of it becoming irritated due to its inability to heal itself quickly.
A healthy shoulder should not have any problems going through a full range of motion without any issues. It’s when poor posture (such as excessive kyphosis in thoracic spine), lack of thoracic mobility, or even poor diet contribute to the mix that things can start to get irritated and under-repaired.
How do I test to see if I have swimmer’s shoulder, aka subacromial impingement?
A simple and fairly accurate way to know if your shoulder pain is due to swimmer’s shoulder (subacromial impingement) is the painful arc test. To perform this test simply stand and raise your arm out to the side all the way above your head.
If it is subacromial impingement the pain tends to kick in around 40-60° of abduction before going away as you pass 120° of abduction and your shoulder rotates so your palm faces in.
How to get rid of swimmer’s shoulder?
To get rid of swimmer’s shoulder, firstly, stop doing the movements that hurt it. When people learn that a movement hurts for some reason they keep doing it throughout the day to remind or confirm to themselves that it still hurts! Every time you do a movement that brings the pain back you are increasing the inflammation and damage to the area.
If you continue lifting your arm in such a way that it hurts then it will not get better. This also applies to doing activities or sports that aggravate the injury. If swimming front crawl causes pain then you need to stop doing it as you’re not allowing the injury to repair itself.
Sometimes, a short recovery period will be enough to let symptoms settle and allow you to slowly build your swim volume back up. Not all pain means something is wrong, it can just be your body’s way of asking for some more downtime and recovery.
Secondly, improve your posture so that the shoulder joint sits in an improved position can improve the function of the shoulder and aid in recovery. For the vast majority of people this means reducing the amount of kyphosis in the thoracic spine and retracting the head. This can be achieved by simply standing taller – pretend there is a piece of string pulling you as tall as you can be.
By doing this, your shoulder blade moves into its intended location which brings your shoulder into the correct position. Exercises are great for improving strength and posture but without consistently practising good posture as mentioned above they’re much less likely to be successful. While at your desk, walking, eating and any other time of the day you need to make sure you’re thinking about your posture.
Lastly you need to Strengthen the rotator cuff muscles in the shoulder joint. The best way to begin doing this is with your arm in the neutral position (which is with your elbow at your side), and trying the following…
Swimmer’s shoulder treatments
1. External rotation
Attach a theraband to something solid and hold the other end. While keeping your elbow at your side and at 90° you externally rotate your arm.
This works the deep external rotation muscles of the shoulder (teres minor and infraspinatus) which improve the functioning and strength of the shoulder joint. In a controlled manner, complete 15 reps.
This movement is intended to strengthen the supraspinatus muscle and also initiate a healing response in the supraspinatus tendon.
To perform the exercise simply stand side on to a wall with the back of your hand against the wall.
Push your hand into the wall for 5 seconds and then relax. Complete 15 reps.
This last exercise is done to strengthen the scapular retraction muscles, which will improve your posture and the overall health of your shoulder complex. Stand with the band looped over something solid and hold the two ends at arms length.
Then, while keeping your shoulders down and relaxed, squeeze your shoulder blades back together. Hold for 5secs and then relax. Complete 15 reps.
By performing these exercises every day, while also following the other advice in this article, you’re giving yourself a great chance of a full recovery with no future problems. But if the pain persists, or returns as you start to build your volume back up to where it was potential initially, seek the help of a qualified osteopath or physio to help find causes in a little more detail.
After assessing you and your shoulder, you can implement a treatment plan with specific exercises that can modify the way your shoulder handles load.
- Avoid large spikes in swim volume
- Include regular strength and conditioning work in your regime
- Allow time for recovery if shoulder pain arises and seek help if you can’t get on top of it
- Address the movements and increase your tolerance over time – don’t focus too much on which structures to blame
- Stay positive and be patient
For more info, head to tauntonhealth.co.uk.