Shoulder Impingement Since I Began Swimming! - Member Case Study

author : AMSSM

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Often I also see an imbalance in the front muscles of the shoulder, such as the pectoralis, and the back muscles, such as the rotator cuff and shoulder blade stabilizers. I would recommend:

Question from COgirl:

I've had shoulder impingement on the left off an on for many months, since I began swimming! Looking for suggestions for treatment. I have access to a sports med doc and a physical therapist. I'm not really wanting to stop swimming, but it obviously aggravates my shoulder - every time I swim!

Diagnosis:

In your brief description of your symptoms, you mention a recurring impingement issue with swimming. Mechanics of the shoulder blade motion, the mobility of your rib cage and the acromioclavicular (AC) joint and the sternoclavicular (SC) joint can all be parts of the recurring impingement. Apology if you already know the anatomy, but the AC joint is felt at the end of your collar bone and over the part of your shoulder commonly referred to as the shoulder joint. The SC joint is the other end of the collar bone where it attaches to your chest bone. If either is tender to touch, you may have irritation at these joints that could be contributing to recurring issues in impingement.

In most of my swimmers, I consider all aspects of the shoulder joint, especially without a history of trauma, as treatment should address any imbalances in flexibility or strength. Each swimming stroke has its own biomechanics. I am assuming you are referring to freestyle stroke only. On that assumption, I would want to know about your body roll in the stroke mechanics through the water. A coach or other health professional with knowledge of swim mechanics could help you.

Often I also see an imbalance in the front muscles of the shoulder, such as the pectoralis, and the back muscles, such as the rotator cuff and shoulder blade stabilizers. I would recommend evaluation with a sports medicine physician to consider which components are most at fault and address with home program, or, they may involve physical therapy. Lastly, I cannot recall taking my swimmers completely out of swimming: assuming you are continuing to have full range of motion and have not had trauma. I adjust to more kickboard and kicking emphasis, avoid any resistance equipment they may be using on their hands during stroke (these are used to add effort as pull through), and work with them on ‘land exercises’ to address any core/trunk issues that may effect body roll, or complete shoulder motion.

I hope this gives you a starting place to search for your relief.

Katherine Dec, MD
Member AMSSM

Treatment Options:

Shoulder impingement is relatively easy to diagnose, but the greater challenge is to identify the cause. To simplify, in all shoulder activities there is a requirement to prevent the upper arm, the humerus, from striking the undersurface of the upper part of the shoulder blade, acromion, and pinching the associated muscles and soft tissues in this space. This stability is accomplished through the shoulder ligaments connecting the humerus to the shoulder blade and the coordination of the muscles of the rotator cuff and shoulder stabilizers.

The initiation of swimming appears to be the start of your problems. There also may be preexisting factors such as previous history, being left-handed or injury. Look at your training. Have you done too much too fast, do you use hand paddles or are there other activities that may have contributed to overuse? Have a coach or swimming professional also look at your technique. Some minor changes in your stroke may be helpful.

I recommend an initial treatment of relative rest and ice for 15 minutes at least 3 times per day. Since your symptoms have been present for several months, non-steroidal anti-inflammatory medication might not be as helpful, but a 7-10 day course would be worth a try.

Our treatment focus should be directed at improving the tone and strength of your shoulder muscles, including the rotator cuff, biceps, and shoulder blade stabilizers. You can start with this exercise: place your arm tightly to your side with your elbow bent to 90 degrees, like you are holding a ski pole. Now rotate your arm in and out remembering to keep your elbow firmly against your side. Light resistance training with small weights or resistance bands through this range of motion 15 repetitions for 3 sets daily will help. If you still have problems your Sports Medicine physician may direct you to an athletic trainer or physical therapist for more specialized reconditioning training, consider an injection or other evaluation based upon the specific cause of your impingement.


Scott W. Pyne, M.D.
Head Team Physician
United States Naval Academy
Annapolis, MD

 

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date: April 17, 2005