Swimmer’s Shoulder Injuries: Source versus Cause

Shoulder Bursitis, Rotator Cuff Strains and Shoulder Impingement are the three most common pain complaints seen at Flow Physiotherapy Fremantle in the last quarter of the year.

Many of these relate to an increase in water -based sporting activities. School swimming programs crank up with the warmer weather and surf-lifesaving and distance swimming clubs are in expansion mode. The Fremantle Leisure Centre across the road from FLOW is open daily and serves a catchment from Coogee through South Fremantle, Beaconsfield, White Gum Valley to North Fremantle. It has increased numbers with the warmer weather.

Shoulder Bursitis, Rotator Cuff Strains and Shoulder Impingement are related. All are blamed on causing pain in the shoulders of swimmers. This pain is however likely to have a number of causes including shoulder joint laxity, muscular overuse and fatigue and muscular imbalance.¹

The key to getting rid of the problem with treatment is correct diagnosis. The diagnosis should identify the source of the pain but also the cause of that painful structure.

Evidence-based medicine supports treatment measures used at FLOW for the treatment of shoulder pain. Such recommended treatment includes:

• manual therapy (hands-on) directed at tight joints and muscles^2-6,
• exercise therapy for weakness and muscle imbalance^{5, 7}
• taping techniques for scapular and shoulder stabilising.^{4, 8}

There is some evidence for acupuncture and dry needling techniques to be used in shoulder impingement treatment⁹ and these techniques are also offered at FLOW in selected cases.

Evidence suggests that in most cases of shoulder pain, conservative treatments such as used at FLOW achieve significant reduction of shoulder pain without the need for medical interventions such as surgery.

Treatment of a painful shoulder needs to be preceded by a careful musculoskeletal assessment.^{10, 11} A good Manual Therapist will take time to check the neck (cervical) structures and the thoracic spine as dysfunction in these areas can refer symptoms into the shoulder² or influence the biomechanics of the area.¹²

Cause versus Source

Treatment may include modification of your training schedule after discussion with your coach or mentor. There is no point in treating the source of the symptoms (eg. a painful joint or tendon) without treating the cause (eg. improper technique or overuse). All FLOW physios are happy to talk with coaches and other health professionals to achieve the best results.

References:

1. De Martino I, Rodeo SA. The Swimmer’s Shoulder: Multi-directional Instability. Curr Rev Musculoskelet Med 2018; 11: 167-171.
2. Haider R, Bashir MS, Adeel M, Ijaz MJ, Ayub A. Comparison of conservative exercise therapy with and without Maitland Thoracic Manipulative therapy in patients with subacromial pain: Clinical trial. J Pak Med Assoc 2018; 68: 381-387.
3. Stone MA, Jalali O, Alluri RK, et al. Nonoperative treatment for injuries to the in-season throwing shoulder: a current concepts review with clinical commentary. Int J Sports Phys Ther 2018; 13: 306-320.
4. Steuri R, Sattelmayer M, Elsig S, et al. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. Br J Sports Med 2017; 51: 1340-1347.
5. Youdas Jw Pt MS, Hubble Jw Pt DPT, Johnson Pg Pt DPT, McCarthy Mm Pt DPT, Saenz Mm Pt DPT, Hollman Jh Pt P. Scapular muscle balance and spinal stabilizer recruitment during an inverted row. Physiother Theory Pract 2018: 1-12.
6. Bjornsson Hallgren HC, Adolfsson LE, Johansson K, Oberg B, Peterson A, Holmgren TM. Specific exercises for subacromial pain. Acta Orthop 2017; 88: 600-605.
7. Clausen MB, Bandholm T, Rathleff MS, et al. The Strengthening Exercises in Shoulder Impingement trial (The SExSI-trial) investigating the effectiveness of a simple add-on shoulder strengthening exercise programme in patients with long-lasting subacromial impingement syndrome: Study protocol for a pragmatic, assessor blinded, parallel-group, randomised, controlled trial. Trials 2018; 19: 154.
8. Singh B, Bakti N, Gulihar A. Current Concepts in the Diagnosis and Treatment of Shoulder Impingement. Indian J Orthop 2017; 51: 516-523.
9. Kamali F, Sinaei E, Morovati M. Comparison of Upper Trapezius and Infraspinatus Myofascial Trigger Point Therapy by Dry Needling in Overhead Athletes With Unilateral Shoulder Impingement Syndrome. J Sport Rehabil 2018: 1-24.
10. Land H, Gordon S, Watt K. Clinical assessment of subacromial shoulder impingement – Which factors differ from the asymptomatic population? Musculoskelet Sci Pract 2017; 27: 49-56.
11. Cetinkaya M, Ataoglu MB, Ozer M, Ayanoglu T, Oner AY, Kanatli U. Do subscapularis tears really result in superior humeral migration? Acta Orthop Traumatol Turc 2018; 52: 109-114.
12. Andrews DP, Odland-Wolf KB, May J, Baker R, Nasypany A. The Utilization Of Mulligan Concept Thoracic Sustained Natural Apophyseal Glides On Patients Classified With Secondary Impingement Syndrome: A Multi-Site Case Series. Int J Sports Phys Ther 2018; 13: 121-130.