Health & Exercise Forum

It’s summer time! 4^th of July weekend is a great time to enjoy the water. Whether your swimming laps for exercise or competition, be careful not to overdo it and injure your shoulder. While there are many different types of shoulder problems, one is specific to the sport of swimming called “swimmer’s shoulder”.

The Shoulder

The shoulder is the most complex joint in the body and one that is commonly injured. Shoulder injuries can span all ages and sports. A little league player can experience shoulder pain after a game while their grandmother can experience a similar shoulder pain after working in the garden. However, it is important to keep in mind that not all shoulder pain is the same. Since the shoulder is such a complex joint, many different things can go wrong resulting in pain. A partial list of some of the most common shoulder problems follows:

• Arthritis – inflammation of the lining of the joint either caused by trauma such as falling on the shoulder or due to a disease such as osteoarthritis or rheumatoid arthritis.
• Frozen Shoulder – occurs when the connective tissue that holds the shoulder together becomes too tight. This limits the shoulder‘s freedom of movement. If you have shoulder pain from trauma, tendonitis, or bursitis and the arm is protected at your side for an extended period of time, you may lose the ability to raise your hand over your head. This is very common in middle-aged females, and diabetics.
• Shoulder Dislocation – when the bones “pop out of joint” either caused by trauma or a genetic predisposition.
• Torn Rotator Cuff – the rotator cuff is made up of muscles which hold the joint together. A rotator cuff can become torn due to trauma such as falling on the shoulder or following wear and tear from years of overhead activities. Rotator cuff tears are common both in athletes and in the older population.
• Impingement – when one or more of the rotator cuff muscles gets pinched between two bones. This is very common and very painful especially when you attempt to raise your hand over your head.
• Tendonitis – inflammation of the rotator cuff tendons of the shoulder from impingement and/or overuse.
• Bursitis – inflammation of a fluid filled sack that tries to protect the shoulder from impingement.

It is well-known that swimmers are vulnerable to shoulder pain for many reasons. The last three shoulder problems from the above list, (impingement, tendonitis, bursitis) are the most common for a swimmer.

Swimmer’s Shoulder – occurs when 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.

“Sit up straight!” While growing up we must have heard this statement thousands of times from parents and teachers and if you have kids, especially teenagers, you have probably said it a few times yourself. Interestingly, your parents may have been on to something very good if you became a competitive swimmer. New research is demonstrating that good posture may help or even prevent swimmers shoulder.

One type of pinching or impingement occurs during the pull-through phase of freestyle. The pull-through phase begins when the hand enters the water and terminates when the arm has completed pulling through the water and begins to exit the surface. At the beginning of pull-through, termed hand-entry, if a swimmer's hand enters the water across the mid-line of her body this will place the shoulder in a position which pinches part of the rotator cuff.

A second type of impingement may occur during the recovery phase of freestyle. The recovery phase is the time of the stroke cycle when the arm is exiting the water and lasts until that hand enters the water again. As a swimmer fatigues it will become more difficult for her to lift her arm out of the water, and the muscles of the rotator cuff become less efficient which can also result in impingement.

A third type of impingement may result from simple overuse or overtraining. A competitive swimmer may perform over 20,000 strokes per week. This overuse may cause the muscles and tendons of the rotator cuff to become inflamed and swell. The swelling of the muscles and tendons will make the shoulder more prone to impingement.

GUEST COLUMNIST: Gary Mattingly, PT, PhD. Dr. Mattingly is a professor of anatomy at the University of Scranton, Department of Physical Therapy.

Read Dr. Mackarey’s "Health & Exercise Forum" in the Scranton Times-Tribune every Monday. Next week: “Swimmer’s Shoulder- Part 2”

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 associate professor in clinical medicine at The Commonwealth Medical College.