Swimmer's Shoulder

Swimmer's shoulder is the term used to describe the problem of shoulder pain in the competitive swimmer. Swimming is an unusual sport in that the shoulders and upper extremities are used for locomotion, while at the same time requiring above average shoulder flexibility and range of motion (ROM) for maximal efficiency. This is often associated with an undesirable increase in joint laxity. This increase in movement often leads to rotator cuff tendonitis and impingement.

As the shoulder is pushed to its limits in terms of strength and endurance, the rotator cuff muscles generally fatigue before the power muscles, allowing micromotion and subluxation of the humeral head. This, in turn, decreases stroke efficiency, while leading to injuries of the rotator cuff, biceps tendon, and glenoid labrum.

Superior subluxation of the humeral head is particularly problematic as it can impinge the rotator cuff tendons against the acromion above, leading to tendinitis and/or tears. The overlying subacromial bursa (also referred to as the subdeltoid bursa) often becomes inflamed, leading to painful bursitis.

Examination

Your Sports Physician or Physiotherapist will look for changes in the Range of Motion (ROM), strength to resistance, increase in instability and joint laxity. Occasionally a painful click in the shoulder could indicate a Labral tear.

Rehabilitation

• Rest
  
• Ice
  
• Anti-inflammatories
  
• Inner range cuff strengthening exercises
  
• Scapular thoracic exercise for stability
  
• Cortisone injections for impingement
  
• Shoulder stabilisation surgery for severe instability not settling with treatment

A structured rotator cuff strengthening program during the off-season and a gradual increase in training at the beginning of the season can help prevent the occurrence of swimmer's shoulder. Avoiding rotator cuff fatigue through proper mechanics and conditioning is the key to preventing injury. Knowing the signs and symptoms of rotator cuff fatigue and tendinitis can help the physician, trainer, and coach determine when a swimmer should rest his or her shoulder.