By Dr. Ayyappan V Nair
Swimming is a sport, which requires repetitive shoulder movements involving various types of strokes predisposing the joint to injuries. These injuries varies from rotator cuff tear, impingement syndrome, labral injuries, instability arising from muscle imbalance or laxity, rotator cuff tendinitis, nerve entrapment neuropathy and muscular dysfunction. Thus the term swimmers shoulder can represent a wide variety of conditions.
Does this condition affect swimmers only?
An important thing to note is that swimmer’s shoulder is not restricted to swimmers but also in sports like baseball, volleyball and even in occupation demanding repeated over head activity like construction workers and electricians.
What is the basic cause of developing such a condition?
Swimming demands a heavy work load from shoulder where 90% of body’s propulsive force is generated by shoulder. The chief muscles helping in producing such massive force are latissimus dorsi and the pectoralis major. The subscapularis and serratus anterior also play a major role in freestyle strokes. To provide such a massive propulsive force repeatedly a properly balanced muscle is required.
A sudden increase in training or poor techniques can lead to a wide variety of injury to the shoulder. Repeated over head activities such as swimming strokes and spiking in volleyball can lead to this condition. The repeated activity induce strains in muscle and tendons around shoulder leading to inflammation, micro tears which can end up in scars tissue formation, thereby leading to abnormal mechanics and muscle imbalance damaging further tissues.
When to suspect swimmer’s shoulder?
You might be suffering from swimmer’s shoulder if you have deep shoulder pain radiating along the back of your shoulder, which gets worse after swimming or any repetitive overhead activity. It can also present as reduced movement in one shoulder compared to other, loss of strength, pain during overhead activity, difficulty in reaching behind you back or if your stroke pattern has changed (lazy elbow).
I think I am suffering from swimmers shoulder. What next? What should I expect?
It is recommended to consult a medical professional especially a sports physician or surgeon if you are suffering from the condition even after giving rest to the joint for at least a period of 1 to 3 weeks following an episode of pain or discomfort. Your medical professional will take detailed history of your complaints from the onset or the time you noticed the symptoms first and will conduct a series of physical examination to come to a provisional diagnosis and might recommend to undergo investigation as deemed necessary following the detailed examination. Tests can vary from basic blood tests, x-rays, ultrasound or even MRI.
Does this condition require surgery?
Majority of conditions encompassing the swimmers shoulder are treated conservatively with rest, anti-inflammatories and physiotherapy. In fact, physiotherapy is the main stay in prevention as well as cure for this condition where u will be undergoing various stretches and strengthening of different muscle groups depending on the site and pathology diagnosed. Other recommendations include ergonomic adjustments and steroid shot.
Who needs surgery?
Surgery is usually recommended in patients not responding to 3 to 6 months of physical therapy or to those who are diagnosed with conditions which are not expected to heal by itself like high grade rotator cuff tear, those with multidirectional instability, or even sub acromial decompression in cases where bursitis is not responding to long term ant inflammatory medication, rest and physical therapy
How to prevent such a condition?
Proper training in sports, reducing repeated overhead activities, stretching and warm ups before any sports, maintain generalised fitness. Occupational demands can be met by proper ergonomic consultation, resting when the shoulder feel tired and strength and condition training depending on the professional demand.
Swimming demands a heavy work load from shoulder where 90% of body’s propulsive force is generated by shoulder.
