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Shoulder Impingement in Swimmers

Swimmer’s shoulder is a common orthopedic injury in people who swim. It is caused by abnormal rubbing and pinching of the structures in your shoulder. This injury is experienced by about 40% to 90% of swimmers at one time or another.

It is also known as rotator cuff impingement syndrome, and it may cause pain and irritation of your shoulder’s rotator cuff tendons and the bursa (fluid-filled sac) that resides in your shoulder.

Anatomy of the Shoulder

Your shoulder is a complex joint that is extremely mobile. It is comprised of three bones: the scapula (shoulder blade), the clavicle (collar bone), and the humerus (upper arm bone). These three bones come together at various places to make up your shoulder joint.

Several muscles attach to and move your shoulder joint.2 One important group of muscles in your shoulder is called the rotator cuff.

This group of four muscles lies deep in your shoulder and surrounds the joint. When you lift your arm, these muscles contract to hold the ball in the socket of your shoulder joint, allowing you to raise your arm with a fluid and smooth motion.

Several ligaments hold your shoulder joint together as well. They connect the various bones of your shoulder, giving the joint stability as you move.

Swimmer’s Shoulder Symptoms

Common symptoms of swimmer’s shoulder include:

  • Shoulder pain
  • Swelling in the front or top of the shoulder
  • Difficulty reaching up overhead
  • Shoulder pain when bearing weight through your arm

Symptoms of swimmer’s shoulder tend to be worse during or immediately after swimming. This is due to the position of your arms and upper extremities while swimming.

Reaching overhead and turning your hand inward, similar to the motion that occurs during the crawl or freestyle stroke, can cause your rotator cuff tendons or shoulder bursa to become pinched underneath the acromion process of your shoulder blade.

When this pinching occurs, the tendons or bursa can become inflamed, leading to pain and difficulty with normal arm use.

Swimmer’s shoulder may also occur due to the laxity of the ligaments in your shoulder. It is theorized that over time, ligaments in a swimmer’s shoulders become stretched and lax, leading to shoulder joint instability. This may cause your shoulder joint to be loose and may lead to pinching of the structures in your shoulder.

If you are experiencing any of these symptoms and are a recreational or competitive swimmer, you may have swimmer’s shoulder. It is recommended you visit your physician to get an accurate diagnosis of your condition and to begin the correct treatment for your shoulder.

Diagnosing Swimmer’s Shoulder

Many cases of swimmer’s shoulder can be diagnosed by a routine clinical examination.1 Components of this exam may include:

One shoulder test that is often used to diagnose swimmer’s shoulder is called Neer’s test. During this procedure, your physician elevates your arm overhead to the maximum degree. If this results in pain, your rotator cuff tendons may be getting pinched, and the test is considered positive. Swimmer’s shoulder may then be suspected.

You may begin treatment for swimmer’s shoulder after your examination with your physician, but your doctor may also refer you to have diagnostic testing.

An X-ray may be taken to visualize the bones of your shoulder. Magnetic resonance imaging (MRI) may be done to examine the soft tissue structures in your shoulder, like the rotator cuff tendons and the bursa.

Once you have an accurate diagnosis of impingement from swimmer’s shoulder, you can begin treatment.

Treatment

Appropriate treatment of swimmer’s shoulder involves managing pain and inflammation in your shoulder and improving the way your shoulder moves so you avoid pinching structures inside the joint.1 There are various avenues that you can choose for treatment. These may include:

Medication

Medication may include over-the-counter anti-inflammatory medicine to help decrease pain and inflammation. If your swimmer’s shoulder is severe, your physician may prescribe stronger medication to manage inflammation.

While taking medication, it’s a good idea to rest, so spending a week or two avoiding swimming (or other aggravating shoulder movements) may be necessary.

Physical Therapy

Working with a physical therapist (PT) may be a good idea to treat your swimmer’s shoulder. Your PT can assess your condition and prescribe treatments and exercises to improve your shoulder mobility and strength.

They may also use various treatment modalities to decrease pain and improve circulation to your shoulder muscles in order to facilitate healing.

Physical therapy treatments for swimmer’s shoulder may include:

Injections

Some people benefit from a cortisone injection into their shoulder.1 Cortisone is a powerful anti-inflammatory medicine. When injected into your shoulder, it can help decrease pain and reduce swelling in the rotator cuff and bursa. This may lead to improved shoulder mobility with less pain.

HELPING SURGEONS TREAT THEIR PATIENTS BETTER

Surgery

If your symptoms are persistent and fail to be alleviated with conservative treatments, your doctor may recommend surgery for your shoulder impingement. An arthroscopic procedure called subacromial decompression may be done.4 This type of surgery is done with small incisions, inserting a camera, and tiny tools.

During this procedure, inflamed tissue and bone spurs are removed from the underside of the acromion process of your shoulder blade, giving more space to your shoulder joint. After surgery, you can gradually return to swimming (and all other activity) in about eight weeks.

Exercises for Swimmer’s Shoulder

Exercises for swimmer’s shoulder can help improve the pain-free mobility of your arm and increase strength of your rotator cuff muscles. This can help keep your shoulder from pinching when you are swimming and reaching overhead. Check-in with your physician or PT before starting any exercise program for swimmer’s shoulder to ensure that it is safe for you to do.

Internal Rotation Towel Stretch

This exercise stretches the shoulder joint capsule. To perform it:

  1. Hold a towel over your shoulder.
  2. Reach behind your back with your other arm and grab the towel.
  3. While holding the towel behind your back, slowly pull the towel up until a gentle stretch is felt in your shoulder with the hand behind your back.
  4. Hold the stretch for 15 seconds, and then slowly release.
  5. Repeat five times.

Prone Scapula Squeeze

Sometimes scapular movement problems can be one cause of swimmer’s shoulder, so getting muscular control of the scapula may be a good idea. To do this:

  1. Lie on your stomach on a bed with your painful arm hanging down to the floor.
  2. Slowly lift your arm to the side while keeping your elbow straight.
  3. Once your straight arm is parallel to the floor, hold the position for 3 seconds, and then slowly lower your arm down.
  4. Repeat the exercise 15 times.

Rotator Cuff Strengthening

If weakness in your rotator cuff muscles is causing your swimmer’s shoulder, then strengthening this muscle group may be warranted. To strengthen your rotator cuff muscles:

  1. Lie on your side with your painful shoulder on top.
  2. Bend your elbow 90 degrees while keeping it against your rib cage.
  3. Slowly lift the back of your hand up towards the ceiling. Be sure to keep your elbow bent and pressed against your ribs as you lift.
  4. Hold for 3 seconds, and then slowly lower.
  5. Repeat the exercise 15 times.

How Long to Get Better?

Most episodes of swimmer’s shoulder last for about eight to 10 weeks.3Some severe cases last up to three months. Most often, the symptoms slowly abate with rest and gentle stretching.

As your symptoms improve, you can slowly return to normal activity and swimming, but performing a few shoulder exercises two to three times a week may be necessary to keep your shoulder strong and mobile. This may help prevent future episodes of impingement from swimmer’s shoulder.

Summary

If you have a pinching and sharp pain in your shoulder or shoulders while swimming, you may be suffering from swimmer’s shoulder. This condition may limit your ability to swim and use your arm normally for functional tasks.

Treatment involves rest, anti-inflammatory medication, and exercise to restore normal shoulder mobility. Most cases resolve completely within a few months, but exercises may be required to help keep the pain away so you can enjoy a lifetime of pain-free swimming.

By Brett Sears, PT for verywellhealth

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