Health & Exercise Forum

Guest Columnist: Dr. Gary Mattingly

2nd of 2 columns on Swimmer’s Shoulder

Last week, Dr. Gary Mattingly, local physical therapist and anatomy professor at the University of Scranton, Department of Physical Therapy introduced shoulder problems in swimmers. He defined “swimmer’s shoulder” as follows: “Part of the rotator cuff, a group of muscles that stabilize the shoulder passes between the arm bone (humerus) and a bone in the back (scapula).  Due to a swimmer’s stroke or the overuse of the rotator cuff with constant lap swimming, the rotator cuff gets repetitively pinched between the two bones.  This produces a painful inflammatory condition known as swimmer's shoulder.”

Impingement in the swimmer’s shoulder can occur during the pull-through phase of freestyle. The problem is more likely to occur in this phase if poor technique allows the hand to cross mid-line of the body. Impingement can also occur during the recovery phase of the freestyle and is more common when the rotator cuff muscles are fatigued and inefficient. Lastly, impingement can occur from overuse or overtraining. A competitive swimmer may perform 20,000 strokes per week which may result in inflammation and swelling. The increased swelling of the tendons make them more vulnerable to impingement in the small space between the shoulder bones.

These three types of impingement can be related. Overtraining can lead to shoulder pain if the swimmer continues to swim with fatigued muscles. As the muscles fatigue they will work less efficiently which has two poor consequences. First, the muscles will have to work harder in a weakened condition. Second, the swimmer will have to perform more strokes to cover the same distance, which is overusing already fatigued muscles. Together these factors can result in swimmer's shoulder.

Swimmer's shoulder can be prevented by using proper freestyle stroke. The hand should enter the water with the small finger first and the palm facing inward. When the hand enters the water it should not cross the middle of the body to avoid impingement. For further stroke instruction, seek the advice of a swimming coach.

Swimmers should avoid rapid increases in training distances or frequency of training as this is likely to wear out the shoulder muscles leaving them at risk for impingement and shoulder pain.

Swimmers have a tendency to develop “swimmer’s posture.” Swimmers have tight neck, chest and anterior shoulder muscles that cause them to assume a hunched over posture.  This poor posture decreases the distance between the humerus and scapula making the shoulder more prone to impingement.  Good posture with head and shoulders back increases the distance between the humerus and scapula.  Therefore good posture is a good treatment for swimmer’s shoulder because it decreases the impingement.  To address posture concerns, stretching shoulder, chest and neck muscles will help to prevent a swimming posture.

The Nicholas Institute of Sports Medicine and Athletic Trauma suggest the following stretches:

• Triceps stretch: Begin by raising your arm directly over your head with your palm facing front. Bend your elbow and try to reach the shoulder blade on the same side of you body. Use your opposite arm to push your elbow back.
• Doorway stretch to the pectoralis major: Begin by placing your elbow against the frame of a door. Keep the angle between your trunk and your arm at 90 deg. Rest your forearms against the door frame. Step forward with one foot to feel the stretch.
• Infraspinatus stretch: Extend your arm out directly in front of you and bend your elbow across your body. With your other hand gently pull your elbow across your body.
• Levator scapulae stretch: Begin by placing one arm as in the first part of the triceps stretch. Look towards your opposite hip and use you free hand to gently pull your head towards your hip.
• Upper trapezius stretch: Lean your head to the side trying to bring your ear towards your shoulder without lifting your shoulder.
• Latissimus dorsi stretch: Raise both arms overhead and place palms together interlocking fingers. At shoulders lift arms upwards with fingers remaining intertwined.
• Axial extension: Pull your chin down and backwards as if trying to make a double chin.

Keep in mind that avoiding bad posture in your day to day activities can help swimmer’s shoulder and remember “Sit up straight!”

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of  Scranton, PT Dept.