Physio 4 Swimming

For the most part swimming is an activity that helps prevent injury and assist with improving one’s sense of mobility vitality. It can however become a problematic activity for some people. Many swimmers present for Physiotherapy with a complaint of shoulder or neck symptoms. Perhaps the most common presentation is a sense of pinching in the shoulder during freestyle (that’s front crawl for all the poms reading on) swimming.

Shoulder problems usually emerge from a recent alteration to either the intensity, frequency or duration of training load. Stated more plainly, swimmers often get a sore shoulder when they increase how hard, often or far they swim. When a swimmer ramps up their distance or speed, the extra stress on the shoulder joint can be enough to irritate some structures within the shoulder, which can set up a localised region of sensitive tissue that is less tolerant of loads than it would usually be. Once the shoulder is in a sensitive or if you like “angry” state, it simply won’t be able to perform as well as it usually does.

In it’s angry state, a swimmer will feel pain and a sense of weakness as he or she tries to pull his or her arm through the water with each stroke. There may also be a catching pain as the arm moves overhead with each stroke. If the swimmer decides to keep swimming and attempt to swim “through the pain”, things are likely to become more irritated, and symptoms may then creep into other daily activities such putting on a jacket, opening doors or overhead activities. A sore and sensitive shoulder will eventually also become tight as motor output changes kick in to “protect the shoulder”. Once these muscular changes occur, there tends to be a sort feedback loop where the tension limits movements, which creates more sensitivity, which creates more muscular guarding.

The best way to manage a sore shoulder from swimming is to give it break from the loads that are keeping it sensitive and irritated. Following a couple of weeks of rest you may find that a gradual return to swimming is pain free. Most often though, I find that a sore shoulder needs a bit of help to get going again. There are a few mobilisation maneuvers we can do in the treatment setting to help resolve the muscular guarding in and around the shoulder. This is useful because it helps to break the cycle of sensitivity and localised tension that the shoulder is stuck in.

In cases where the symptoms have been present for a longer period of time (let’s say months rather than weeks), it will probably take longer for things to settle down. For some shoulders, Physio and activity modification alone may not be sufficient to bring about a resolution of symptoms. If we don’t see significant improvements in your shoulder symptoms within 4-5 sessions of physio, we need to start thinking about other options. I find about 1 in 20 shoulders to be stubborn enough to warrant me sending the patient for an ultrasound to investigate for the presence of a structural injury within the shoulder. Usually the ultrasound will reveal a subdeltoid bursitis that requires treatment with a cortisone injection. Or it may reveal structural damage to a rotator cuff tendon. When these findings are present, it is usually an indicator that the overall trajectory of recovery will be a little slower and drawn out (perhaps a matter of 6-8 weeks as opposed to 2-3 weeks).

The keys to effective treatment of a swimmer’s shoulder are;

  • identify and reduce / eliminate aggravating daily activities.
  • identify presence of underlying structural injury (including assessment of neck and upper back).
  • determine the contribution of underlying structural injury to symptoms (e.g. there my be a rotator cuff tear that has little to no contribution to symptoms).
  • carry out treatment aimed at resolving sensitivity and tension in and around the shoulder and neck. The treatment does not need to be painful.
  • once symptoms have settled, commence a graded strengthening program and a gradual return to swimming.