Most swimmers get shoulder pain at some point in their career. Training distances can be large and many of the upper limb revolutions in a swimming stroke are done in sequence, without sufficient rest for the muscles to recover. This can lead to injury from repetitive micro trauma. Julie, who swims with East Leeds Swimming Club, came to Yorkshire Shoulder Physiotherapy when shoulder pain began affecting her training for the World Masters Swimming Championships in Budapest. She was struggling to complete the training distances required for this competition. Typically, Julie trains 3-4 times a week; sessions are either a one hour sprint training session, up to 2000m, or a two hour long distance session which can be up to 6000m.
Upper extremity endurance is unique to swimming. Research suggests that the serratus anterior fatigues in swimmers with painful shoulders, producing an unstable scapula. An unstable scapula will lead to incorrect positioning of the shoulder joint during swimming and can lead to more shoulder pain. The subscapularis, part of the rotator cuff, is also susceptible to fatigue because of its continual activity in swimming.
Other muscle groups often upregulate to compensate for fatigue, which can lead to muscle imbalance around the shoulder girdle. Traditionally it has been assumed that swimmers shoulder pain is due to subacromial impingement, but recent evidence suggests that swimmers also experience internal impingement, which is where the rotator cuff becomes pinched against the glenoid labrum. Realistically multiple factors contribute to shoulder pain in the swimming population, including subacromial and internal impingement, tendonitis, laxity and muscle imbalance. This creates unique and complex shoulder problems.
Julie and I worked together on a resistance programme focusing on scapulothoracic stability as well as rotator cuff strength and endurance. We also looked at core and hip stability, alongside manual therapy targeting the soft tissues around the shoulder girdle and thoracic mobility. And along the way we had some help from a reassuring ultrasound scan and a subacromial injection. Although not pain free, Julie managed to successfully participate in the Masters Championships and bring home 5 medals! In her individual events she achieved silver medals in the 100m and 200m backstroke, and bronze in 50m backstroke. She also had success in the freestyle and medley relays, with 2 more silver medals.
For the future we have put together a strength and conditioning programme looking to maintain the benefits Julie has gained from her rehabilitation programme, and continue to increase the strength and endurance around her shoulder girdle. As she says herself, she is now ‘ training smart’. The determination, training and level of fitness required to compete at this level is phenomenal and I feel honoured to have played a small part in Julie’s success. Good luck for the next challenge!