Last week, guest columnist, Dr. Gary Mattingly, anatomy professor at the University of Scranton, described the problem of “swimmer’s shoulder” … “inflammation of 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.” Poor swim stroke mechanics and technique contributes to the problem.
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 to prevent swimmer’s shoulder:
Triceps stretch: Raise your arm directly over your head. 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. Feel the stretch behind your elbow. (See PHOTO 1)
Pectoralis Stretch: Place both elbows against the frame of a door or in a corner of a room. Keep the angle between your trunk and your arm at 90 degrees. Rest your forearms against the door frame or corner wall. Lean forward to feel the stretch across your chest. Doorway Stretch (See PHOTO 2) and Corner Stretch (See PHOTO 3)
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. Feel the stretch behind your shoulder and shoulder blade. (See PHOTO 4)
Levator scapulae stretch: To stretch the right side: Look towards your opposite (left) hip and place the right hand behind your back. Use the left hand on to gently stretch your head/nose towards your left hip. (See PHOTO 5)
Upper trapezius stretch: To stretch the right side: Tilt your head to the left side and try to bring your ear towards the left shoulder without lifting the right shoulder. Use the left hand to gently stretch the head toward the left shoulder. (See PHOTO 6)
Latissimus dorsi stretch: Raise both arms overhead and place palms together interlocking fingers. At shoulders lift arms upwards with fingers remaining intertwined. (See PHOTO 7)
Axial extension: Pull your chin down and backwards as if trying to make a double chin. (See PHOTO 8)
Keep in mind that avoiding bad posture in your day to day activities can help swimmer’s shoulder and remember “Sit up straight!”
GUEST COLUMNIST: Gary Mattingly, PT, PhD. Dr. Mattingly is a professor of anatomy at the University of Scranton, Department of Physical Therapy.
MODEL: Katherine Weaver, Assist. Men’s and Women’s Swim Coach at Marywood University and Physical Therapy Aid at Mackarey Physical Therapy.
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum” in the Scranton Times-Tribune.
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: firstname.lastname@example.org.
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 associate professor in clinical medicine at The Commonwealth Medical College.