Diagnosis: Swimmer’s Shoulder
As swimming is a repetitive sport that involves a lot of force generated through the upper limbs, the shoulder is vulnerable to injury. Similar to the throwing shoulder, the swimmer’s shoulder is at increased risk when the muscles of the proximal segments of the kinetic chain fatigue. Swimmer’s shoulder does not have an actual clinical diagnosis, but rather is a syndrome that may be due to a number of issues with the shoulder. The underlying source of the pain may be benign, such as common post workout muscle soreness and fatigue, or more serious, including subacromial impingement, rotator cuff or biceps brachii tendinopathy, shoulder instability, labral tear or acromioclavicular injury.
How swimmer’s shoulder presents
This condition typically results in the patient having symptoms in the area of the anterior lateral aspect of the shoulder, sometimes confined to the subacromial region. Swimmer’s shoulder usually presents as subacromial impingement, involving pain with overhead activities.
How swimmer’s shoulder is diagnosed
The diagnosis is based off important information given in the subjective assessment as well as objective findings. Subjective information will help the physiotherapist identify the potential sources of the symptoms and the irritability of the patient.
The objective assessment should include observation of posture for such things as increased thoracic kyphosis, protracted scapulae and changes in shoulder position. Range of motion will likely show in swimmers with impingement, a painful arc from 60-120 degrees. Altered scapulohumeral rhythm may be observed. Passive ROM will usually show excessive external rotation and horizontal abduction due to hypermobility of the anterior glenohumeral joint capsule. These swimmers will usually have positive signs in the sulcus test, the load and shift, the relocation test, and may have a positive apprehension sign. Weakness of the rotator cuff and scapular stabilizers will be noted if the swimmer has instability. If these structures are inflamed, impingement tests will be positive and resisted tests may be painful.
Causes of swimmer’s shoulder
With the huge swimming load that some competitive swimmers perform, the shoulder can perform around 30,000 rotations each week. This repetitive behaviour can place huge stresses on the shoulder girdle muscles and glenohumeral joint, and it is why shoulder pain is the most frequent musculoskeletal complaint among competitive swimmers. The onset of symptoms may be associated with impaired posture, glenohumeral joint mobility, neuromuscular control, or muscle performance. Additionally, training errors such as overuse, misuse, or abuse may also contribute to this condition.
training errors such as overuse, misuse, or abuse may also contribute to swimmers shoulder. #performbetter @pogophysio Click To TweetSwimmers shoulder can be related to intrinsic and/or extrinsic factors. Intrinsically, there may be an increase in glenohumeral laxity and shoulder range of motion. This increased movement places greater demand on the rotator cuff and the long head of the biceps. Failure of the rotator cuff and the scapular stabilizers to maintain the correct position of the humerus in the shoulder joint can also put increased stress on the tendons. Fatigue can contribute to this ineffectiveness of the muscles.
Treatment of swimmer’s shoulder
Treatment for this condition is generally conservative, with the aims of reducing pain levels, controlling any inflammation, strengthening and stretching muscles and improving the stability of the glenohumeral joint. Also correcting any abnormal postures is important, and treatment will result in returning the athlete to the sport at the pre-injury level. It is important to focus also on prevention and early treatment in competitive swimmers.
Main areas of focus for treatment are:
- Addressing impairments: this may include pain and inflammation.
- Posture: correcting postures to allow for optimal joint movement and function. This may include mobilisation, flexibility, and strengthening exercises of the scapular and neck muscles.
- Joint mobility: stretching out tight portions of the shoulder capsule
- Scapular stabilisation: many exercises can be performed to optimise the function and control of these muscles. It should involve neuromuscular reeducation and strengthening of the scapular stabilisers.
- Rotator cuff strengthening: this can involve exercises including isometric, concentric, eccentric, and plyometric activities. As healing allows, isometric exercises can be initiated.
- Addressing training loads: implementing activity modification so the swimmer can still participate in the sport.
Sandi Davis
Student Physiotherapist
References
Heinlein, S. A., & Cosgarea, A. J. (2010). Biomechanical considerations in the competitive swimmer’s shoulder. Sports Health, 2(6), 519-525. doi:10.1177/1941738110377611
Leão Almeida, G. P., De Souza, V. L., Barbosa, G., Santos, M. B., Saccol, M. F., & Cohen, M. (2011). Swimmer’s shoulder in young athlete: Rehabilitation with emphasis on manual therapy and stabilization of shoulder complex. Manual Therapy, 16(5), 510. doi:10.1016/j.math.2010.12.012
Tovin, B. J. (2006). Prevention and treatment of swimmer’s shoulder. North American Journal of Sports Physical Therapy : NAJSPT, 1(4), 166.
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