Swimmer’s Shoulder- A close examination of the most common injury suffered by swimmers

Swimming is a full-body fitness workout. It helps people in staying active and build cardiovascular fitness, strength, and endurance of their bodies. A common injury that plagues both amateur and professional swimmers is Swimmer’s Shoulder. It is a common orthopedic ailment. 

It occurs by abnormal rubbing and pinching of the Swimmer’s Shoulder. This injury affects between 40% to 90% of swimmers at some point.

It is also known as impingement syndrome or shoulder impingement. Volleyball, softball, and baseball players also suffer from it. Swimming causes irritation, inflammation, rips, and scarring to the Shoulder joint. This results in pain, weakness, and impairment of function.

Structure of Shoulder affected by Swimmer’s Shoulder

The Shoulder is the most mobile joint in the body, with the highest range of motion. Unfortunately, because of its mobility, the Shoulder is also intrinsically unstable. It consists of three bones:

• The scapula (shoulder blade)
• The clavicle (collarbone)
• The humerus (upper arm bone) (upper arm bone)

These three bones connect at various points to form your shoulder joint.

Several muscles attach to your shoulder joint and move it. The rotator cuff is a vital collection of muscles in your Shoulder.

It’s between the acromion (top of the Shoulder) and humerus (arm bone). Repetitive movements (such as swimming strokes, tossing a softball, throwing a volleyball, and other physical activities.) can trigger rotator cuff irritation. Swimmer injuries occur when one or more of these structures is overworked, strained, or wounded.

Causes-

A common cause of the injury is the swimmer’s Shoulder stretching. Muscle fatigue without rest in between sessions is another cause. It doesn’t allow the tissues to heal. It is particularly prevalent among swimmers who have a high stroke count. Increases in training time or distance also increase the chance of developing a swimmer’s Shoulder.

Swimmers have overactive adductor muscles and internal rotators. Weak external rotators and scapular stabilizers are also common to swimmers. It contributes to Shoulder instability by slightly misaligning the shoulder joint, increasing the risk of the swimmer’s Shoulder. Poor technique is also a cause. Dropping the elbow or improper body roll positions the shoulder incorrectly, increasing the swimmer’s shoulder risk.

Fatigue due to excessive movement to the scapular region or rotator cuff is another cause. An abnormal acromion shape or stiff joint capsule also causes the swimmer’s Shoulder. Thoracic spine stiffness can also impede shoulder movement.

Symptoms-

Weakness of the shoulder joints is a common symptom. 

It results in a loss of speed and pace. Shoulder pain with deep aching is another symptom suffered due to Swimmer’s Shoulder. 

Shoulder stiffness and joint laxity also lead to swimmer’s injuries. Patients tend to experience a clicking or grinding sensation in the Shoulder. It happens when you elevate your Shoulder above your head due to instability.

Characteristics that distinguish the injury include reduced strength of one Shoulder to another. A reduction in the range of motion in one Shoulder compared to the other is also a sign of a swimmer’s Shoulder. The patient is also prone to experience increased joint laxity in one Shoulder relative to the other.

Swimmer’s shoulder symptoms generally worsen during or immediately after swimming. It occurs due to the positioning of your arms and Shoulder muscles while swimming. Reaching overhead and rotating your hand inside, like in the crawl or freestyle stroke, can cause your rotator cuff tendons or shoulder bursa to become squeezed behind your shoulder blade’s acromion process. The tendons or bursa become inflamed when pinched, causing pain and trouble with regular arm movement.

Diagnosis-

Doctors conduct a routine clinical examination to diagnose the swimmer’s Shoulder. There are multiple tests to diagnose the injury. Joint Laxity Tests to analyze widespread hypermobility, Shoulder Instability Tests like Sulcus sign, and apprehension/relocation tests are the most used tests by doctors.

Shoulder Impingement Tests, such as the Hawkins-Kennedy test, are also commonly used. Doctors recommend X-Rays scans to examine bone problems and CT scans/MRIs to assess the inherent issues in soft tissues. Neer’s test or tests measuring the strength of your Shoulder are also some measures to examine the presence of a swimmer’s Shoulder.

Treatment of Swimmer’s Shoulder

Appropriate treatment for a swimmer’s Shoulder includes regulating discomfort and inflammation in your Shoulder. Optimizing your Shoulder’s movement to avoid squeezing tissues inside the joint is also crucial to the treatment. Swimmer’s shoulder treatment should begin as soon as possible to minimize damage and accelerate healing. In most cases, conservative (non-operative) treatment is sufficient.

Complete rest for 24-48 hours after the injury is advisory to the patient. Non-Operative treatment includes the application of ice to the Shoulder after training for 20 minutes. A temporary reduction in training sessions is crucial to prevent strain on the injury. Anti-inflammatory medicines and pain relief medications also provide relief. Certain injections (corticosteroids) are used by doctors, though they come with side effects.  

Swimmer’s Shoulder stretching exercises that treat swimmer’s injuries include rotator cuff exercises. It engages the muscles without moving the Shoulder. This workout strengthens the rotator cuffs of shoulder muscles. Posterior capsule stretches, training to stabilize core muscles, and exercises to stabilize the scapular region provide relief from such injury. 

Physical therapy comprises ultrasound scans, cross-friction massage (also known as deep transverse friction massage), and joint movement to extend the posterior joint capsule is also quite beneficial to the patient.

Usually, with effective treatment, the symptoms vanish within six to twelve weeks. It would be best if you underwent surgery if it’s still not healed.

Prevention from Swimmer’s Shoulder

It’s well known said prevention is better than cure. A swimmer should always get a check on their stroke techniques from experts. It ensures the prevention of such injuries. Avoiding excessive training sessions without breaks is highly recommended by doctors. Regular stretching and other forms of exercise are also mandatory for a fit swimmer’s routine.

Anyone engaged in any form of sports is prone to risks. Therefore, for even a swimmer maintaining their fitness is highly crucial. injury like this  is very much prevalent among swimmers. Thus it is vital to know and treat it well.