We generally classify pain around the shoulder as Shoulder Impingement but it can cover a multitued of issues such as a Bursitis/Impingment/ Tendonitis/ Rotator Cuff/ AC joint injury – most of which display the same/similar characteristics of an IMPINGEMENT and pain a round the shoulder which are:
- pain lifting the arm up – usually out to the side at shoulder level it hurts
- pain when lying on the shoulder
- pain on movement
It it hard to differentiate which is which but management of a shoulder issue is specific to each type and it’s important to know which one you have so you can manage it properly – your attending medical doctor or physio can assess you properly and advise the likely cause:
- bursitis is inflammation of the bursa between the two bones – the shoulder blade and the upper arm bone nand is seen as pain when lifting the arm up either infront or to the side at 90 degrees as the bursa ( swollen bag of fluid) gets squashed between the bones of the shoulder and shoulder blade
- tendonitis is inflammation of a tendon (ususally one of the four rotator cuff muscles) and you will get pain when lifting the arm up to shoulder level as the tendon impinges and gets caught between the shoulder and the shoulder blade bones or pain on resisted action of the movement.
- the AC joint is the joint of the shoulder blade to the collar bone – damage is seen as a ‘lump” on the shoulder and pain will be felt on lifting the arm up , placing the across the body or on putting weight thruogh the arm.
In swimming – a tendonitis or bursitis will result in an impingment of the soft tisses of the shoulder and therefore pain. an AC joint proble will also give pain on the same movements. Pain will be felt when lifting the arm – and in swimming particularly raisng the arm up and out of the water such as in freestyle or butterfly.
Accurate assessment and correct managment is important to aide speedy recovery and return to full activity – a tendonitis or bursitis can lead to prolonged pain and time out of the water if not managed properly.
Pre-disposing factors that can lead to shoulder injury include:
- poor posture!
- correct alignment of the shoulders/ rib cage / thorax ( mid back area) to ensure the swimmer has good movement – those who have limited thoracic extension and are of a ‘slumped” or flexed posture will be more prone to shoulder issues
- good pec muscle length – again – poor posture and in adequate stretching can lead to tight pec muscles which again are a pre disposing factor in shoulder injury
- poor shoulder stability – a lot of swimmers have poor shoulder stability – they over use pecs and trap muscles to compensate for poor shoulder blade stability – this instability means they cannot control and place their shoulder blade well – this imbalance can lead to rotator cuff issues and or bursitis.
- growth spurts in kids – the bones grow first – then soft tissues catch up
- over training – can lead to fatigue or repetitive strain issues
- depends on the severitity and length of the problem
- seeking adequate and good advise quickly will result in a faster recovery
- taping helps as it can support and take pressure off damaged structures
- correct strength training and stretching
- modified stroke training – for example a flatter water entry in more external rotation may allow the swimmer to continue training and therefore maintain fitness.
- ensure you have good body rotation so that you reduce shoulder problems
- good technique – incorrect technique on entry increases internal rotation of the shoulder so increases risk of shoulder injury
- good catch and pull through so you can utilise the right muscles and reduce stress on shoulders
- specific range of motion exercises to increase restricted range if applicable and associated strengthening exercises especially for rotator cuff.
The important thing is to get it seen to QUICKLY! if left untreated and you have poor posture as well – the problem can then turn into a long lasting chronic shoulder leading onto rotator cuff issues and more. Correct management and early intervention will set you in the right direction and bring about the best outcomes.