The “Swimmer’s Shoulder” is a debilitating painful condition of the shoulder, in athletes that swim either in an amateur level or in a competitive level.
At this article we address 4 key points of the rehabilitation program, regardless of the painful cause (e.g. subacromial impingement, instability etc.), which are important for restoring restoring proper shoulder function and returning to sports performance.
These key points are:
The selective activation of the rotator cuff muscles. Regardless of the diagnosis (impingement or instability), the athlete should perform exercises to activate the rotators of the shoulder, which are very important for the stability of the entire shoulder girdle. We must emphasise that these muscles are endurance muscles and therefore to activate them, we use low resistance and many repetitions.
The resistance must be increased very gradually to avoid the activation of adjacent muscles. When the neighboring muscles activate as well, the exercises do not provide the expected results.
2. Restoration of the full range of motion of the internal rotation of the shoulder. The internal rotation of the shoulder is often restricted in swimmers, and restoring the normal range is essential, especially at the “recovery phase” of the freestyle. When the full range of motion is not available, the movement is compensated by the neighboring scapula, causing further dysfunction and pain in the shoulder region.
3. Proper activation of the scapular muscles. The shoulder blade functions as the base of support for the upper limb, and when the muscles that stabilize and move it are not properly activated, conditions of instability and/or impingement on the shoulder are created.
4. Restoration of the extension and rotation range of motion of the thoracic spine. During swimming in free style, athletes turn their shoulders and hips in order to speed up and breath. Shoulder rotation is greater than that of the hips and therefore the good rotational mobility of the Thoracic Spine is very important. When thoracic mobility is limited, it is compensated by the shoulder girdle, creating strain, and painful symptoms due to impingement and instability.
The above-mentioned key points should be assessed in every athlete, and if deficiencies or dysfunctions are found, appropriate exercises should be provided to restore the normal shoulder function and prepare the athlete for the demanding swimming conditions.
Alex Karagiannidis, MSc., Dip.MDT., BSc(Hons) Physiotherapy