Shallyn's Physical Therapy Blog: Swimmers Shoulder

Rocky Mountain Rehabilitation recently hosted CO APTA SE District's monthly educational meeting for community PTs and PTAs. This months topic was "Swimmers Shoulder" by Ed Belding PT OCS COMT FAAOMPT. Some key points addressed in his talk included:

Swimmers Shoulder is the pain in and around the shoulder temporarily related to the act of swimming
Prevalence of Swimmers Shoulder

Age swimmers (4300 yds) 47% at some point in their swimming career
Senior Swimmers (6800 yds) 66% at some point in their swimming career
National Swimmers (10,000 yds) 73% at some point in their swimming career

Likely Causes

Overuse/fatigue causes shoulder adduction to be replaced with increased IR during the early pull through phase making the swimmer more vulnerable to impingement
Pathology/Instability (most swimmers demonstrate too much motion in their shoulder joints especially forward...stretching is not typically advised except for potentially the posterior capsule)
Altered Biomechanics
Pain

Symptoms can lead to problems not only in the shoulder but in the neck, thoracic spine and ribs.
Normal Shoulder Muscular Mechanics

Teres minor couples with pec major (propulsion phase)
Serratus anterior has a constant level of function
Rhomboids and upper trap, with serratus, help position the hand for entry/exit
Pec major and lat are strong in propulsion

Painful Shoulder Muscular Mechanics

Serratus is weak/inhibited while the rhomboids overcompensate causing a downward scapula rotation (dropped elbow in recovery phase)
Upper trap over fires during pull through to compensate for the abnormal serratus/rhomboid firing pattern (creating early hand entry/exit)
Infraspinatus over fires to avoid pain/active trigger points and/or stabilize the shoulder joint
Subscap under fires during late pull through and mid recovery for pain avoidance (creating asymmetric pull)

So, how can we help your Swimmers Shoulder? We can provide an evaluation that is specific to your sport, adapt our tests to mimic stroke positions and thus identify your pain generating tissues and stroke abnormalities (consultation with your swim coach and/or video of you swimming is helpful if we can not physically watch you swim). Secondary to the high prevalence of Swimmers Shoulder within the swimming population, prevention and education is key. Optimizing tissue length through various manual techniques and improving scapular stability is our priority to get you back to comfortable swimming.

Here are a couple of my favorite scapular stabilizing exercises.