Surf Life Physio explains "Swimmers Shoulder'

Swimmers Shoulder

Swimmers shoulder is merely an umbrella term for any range of aches and pains that can occur around the shoulder joint. Many pathologies can constitute ‘swimmers shoulder’ such as sub acromial impingement, tendinopathy, rotator cuff tears and bursitis.

Each of these presentations requires a unique approach with a physiotherapy management plan in place, especially if an athlete is currently training for an event.

As previously mentioned, depending on what is actually causing the ‘swimmers shoulder’, treatment will vary specific to the needs of that pathology. However, the general path a Surf Life Physio would take would be as follows:

Pain management –

Pain is obviously undesirable – even more so because we know that pain can drive or create a number of other issues which can be demonstrated in the pain cycle below.

We will work with athletes to change their pain in consultation with a GP or pharmacist for pain relieving medication and also use specialist physiotherapy techniques to reduce pain and inflammation. As physio’s we tend to only recommend cortisone injections in the most severe or unrelenting cases – as the research on cortisone and its effectiveness is not strong enough for us to suggest that everyone should just get a jab! There is emerging research on cortisone to suggest that it may have a detrimental effect on tendon strength which may predispose to further injury in the future. We know that if we can get rid of pain quickly, we can slow the process of the pain cycle and even hopefully break it early. This may also involve a discussion with the athlete about load modification – to keep swimming but reduce the load through painful structures in a number of ways such as using fins, changing the stroke, and changing the intensity, time or type of training.

Shoulder joint specific –

We then often look at the shoulder joint – a golf ball sitting in a golf tee. Because the tee is quite shallow, any level of muscle imbalance can cause this position to change leading to undesirable movement and pain at the shoulder. Whilst this is not always the case, most times physio specific manual therapy techniques can improve the position of this joint, improving mobility about the shoulder and reducing the risk of perpetuating the above pain cycle.

Rotator Cuff control –

I use the word control over strength in this situation – too often the focus is on strengthening the rotator cuff muscles. The rotator cuff is four small muscles whose main role is to suck the golf ball of the shoulder into the golf tee and hold it there all day long. The mind boggles when I walk into the gym and see large humans performing rotator cuff strengthening with weights up to 40kg! There needs to be a focus on endurance of these muscles and more importantly the control – or what physio’s call ‘proprioception’. We use our very own invention – the ‘slosh’ pipe, to train the rotator cuff muscles of our clients for control and stability.

Integration into functional activities –

Once we’ve improved the pain, improved the position of the shoulder joint and gained control in the rotator cuff muscles, we then focus on challenging all of the above aspects by integrating the athlete back into positions that may have original caused issues. By progressing the athlete in this way, we ensure that they are able to adapt to the originally painful position with much better control so that it is now pain free. It is also in this stage that we focus on the bigger picture of biomechanics of the swimming stroke. This is a rabbit hole of confusing terms and physics which is best explained face to face to get the best understanding of!

To leave you with somewhat of an example to think about. Take the notion of swimming with a pool boy between your knees. You can’t kick and so your legs become more of an anchor that sinks your butt down low in the water. With a swimming stroke, we are always trying to create a forwards drive through the water obviously, but also the best swimmers create an upwards lift which makes them sit high in the water to increase the efficiency of their stroke. Keeping this in mind, your shoulders have to work much harder to create this upward lift when you have an anchor weighing the rest of your body down, don’t they?

Assistant Professor Nick Marshall

BPhty APAM