Recreational and professional swimmers and surfers experience shoulder pain from time to time, and this condition is commonly referred to as swimmer’s shoulder, or sometimes surfer’s shoulder. The condition can also affect other athletes who participate in overhead throwing sports such as baseball or cricket. The typical symptoms are very similar to rotator cuff and impingement shoulder injuries.
A shoulder impingement refers to a group of conditions that cause pain when the shoulder muscles and tendons become irritated or inflamed as they rub or ‘impinge’ on the bones in the shoulder joint. It is a shoulder injury caused by overuse.
Shoulder pain during or after exercise
Swimmers and surfers are required to use freestyle and ‘front crawl’ strokes, and these repetitive actions can lead to over-activation of the pectoralis muscles and overdevelopment of the internal rotator cuff muscles (subscapularis) located within each ball and socket joint. The condition can affect the posterior rotator cuff muscles by causing bursitis ( inflammation of the fluid-filled sacs that cushion the shoulder joint).
The pectoralis muscles may become much tighter than normal, and repetitive stress may lead to irritation of the soft tissues found around the shoulder, causing pain. The posterior rotator cuff tendon (infraspinatus and teres minor) works to control the position of the humerus (upper arm bone) as it moves within the shoulder socket.
People with swimmer’s shoulder will have a reduced subacromial space, and the scapula (shoulder blade) will take a protracted abducted position (sticking out to the side). Left untreated, swelling will continue and subacromial space will continue to reduce. This is a debilitating condition, and without treatment individuals place themselves at risk of developing supraspinatus tendinosis, which is a condition where the tendon that stabilises the shoulder joint becomes frayed and worn.
Treatment for swimmer’s shoulder should focus on two key areas:
- Resting from the activity that is causing pain
- Mobilising and stretching the muscles and soft tissues around the shoulder
Diagnosing Swimmers/Surfers Shoulder
This is a straightforward condition which can be diagnosed through a physical examination. The first sign is the presence of anterior shoulder pain, which is most acute either during physical activity or immediately after a swimming or surfing session. The thoracic spine and cervical spine will also likely need to be checked to rule out other potential sources of shoulder pain. Thoracic spine mobility may be tight in people with swimmer’s shoulder, and this can lead to referred pain.
The condition can make it difficult to maintain an even freestyle stroke, with individuals instead displaying a wide, flattened stroke and lowered arm position. This is commonly referred to as the “dropped elbow” and can usually be seen when you first start swimming. In some cases, it may become more pronounced after you have warmed up and the scapula stabilizers start to suffer from fatigue.
During a physical examination, individuals may display bilateral abnormal scapula mispositioning which causes them to take on a round shouldered appearance. Impingement tests will be performed to confirm the diagnosis.
Treatment of Swimmers Shoulder
Treatment of swimmers/surfer’s shoulder at Sydney Shoulder Clinic is tailored to each individual, with the aim of addressing any muscle imbalance and improving shoulder strength and flexibility.
In the early stages, resistance band programs are typically used to assist with external rotation strengthening and helping to stabilize the scapular. This may then be followed by rotator cuff strengthening exercises weight machines that include free weights and stretching as advised by your physiotherapist.
Most individuals respond well to treatment, and within a few weeks you should be able to resume normal activity and gradually return to swimming as your rehabilitation progresses. Occasionally, subacromial corticosteroids used to supplement physical therapy.