What Causes Swimmer’s Shoulder?
Swimmer’s shoulder is also known as shoulder impingement, subacromial impingement, or painful arc, which is a type of shoulder tendinitis. Tendinitis is the inflammation of the strong, fibrous tissues that connect muscle to bone.
In this form of tendinitis, the tendons of the rotator cuff muscles become inflamed, causing pain, tenderness and difficulty moving the shoulder.
The rotator cuff tendons surround the shoulder joint to stabilize and protect it. These muscles are the supraspinatus, infraspinatus, teres minor and subscapularis (SITS) muscles. These muscles and tendons allow you to move your shoulder in various ways, such as overhead movements.
The SITS tendons, together with other soft tissue structures such as the bursa and ligaments, are situated in the subacromial space. The subacromial space is between the top of the bone in your upper arm (called the humerus) and the bony knob at the top of the shoulder blade (called the acromion process).
The subacromial space becomes smaller during overhead movements, which can impinge on the structures that it houses and cause inflammation.
Swimmer’s shoulder occurs when the soft tissues in the subacromial space are squeezed and become inflamed. It can also occur during repetitive shoulder movements that create microtears in the tendons, causing inflammation.
Individuals with a narrow subacromial space or a curved or hooked acromion process are predisposed to swimmer’s shoulder, as the tendons can rub against the bones and cause irritation and swelling.
Bone spurs in the shoulder, previous shoulder injuries, and straining any of the SITS muscles are some factors that increase the risk of developing swimmer’s shoulder.
What Happens if Swimmer’s Shoulder Is Left Untreated?
If you fail to see a doctor and do not receive appropriate treatment, pain and tenderness may increase in the injured shoulder. You might not be able to fully move the shoulder joint because of the pain, resulting in tightness and weakness of the shoulder muscles.
Prolonged lack of movement in the shoulder can result in a condition called adhesive capsulitis (frozen shoulder). The capsule that surrounds the shoulder joint becomes inflamed, further limiting shoulder movements.
Moreover, if a strain in the SITS muscles causes the swimmer’s shoulder and is left untreated, it can progress into a full rotator cuff tear. An untreated swimmer’s shoulder can also cause a tear in the shoulder cartilage, also known as a labral tear.
Can I Still Swim Even if I Have a Swimmer’s Shoulder?
Swimming involves repetitive overhead movements of the arm. Therefore, swimming can irritate the structures involved in a swimmer’s shoulder resulting in further inflammation and worsening of the condition.
It is better to rest the affected arm first to give time for the inflammation to settle, lessen the pain and allow faster healing of the tissues.
You can go back to swimming once overhead movements are pain-free, and the range of motion of the shoulder joint and the strength of the muscles are the same as before the injury or similar to the uninjured shoulder.
However, you should return to swimming gradually and under the supervision of a sports therapist or a trained coach to prevent reinjuring the affected shoulder.
How Do I Stop My Shoulder From Hurting When Swimming?
If your shoulder hurts during swimming, it is best to stop the activity and rest. Refrain from doing overhead activities and tasks that entail repetitive shoulder movements. You may still perform other shoulder movements as long as they are not painful.
For the first 24 to 48 hours, you may apply a cold compress or take over-the-counter pain medication like Ibuprofen to decrease the pain. If there is swelling in the shoulder joint and the pain persists or worsens, you need to seek a doctor immediately.
After 48 hours, you may apply a hot compress to the area to help relax and loosen the joint and make shoulder movements easier. You may perform light exercises for the shoulder joint as long as it is pain-free.
If moving the shoulder overhead is painful and difficult, seek a doctor or a physical therapist for proper evaluation and treatment intervention.
Is Ice or Heat Better for Shoulder Impingement?
A cold compress or ice therapy is good for reducing swelling and pain, while a hot compress or heat therapy decreases the stiffness of the joints and relaxes the muscles. Both are useful depending on the affected individual’s stage of healing.
Immediately after the injury, when the pain and inflammation are severe, it is best to use a cold compress. A cold compress constricts the blood vessels, decreasing the blood flow and preventing excessive fluid from accumulating in the injured area.
You may place a cold compress on the injured shoulder for 15 to 20 mins. Place a towel in between the skin and the cold compress to prevent ice burns or frostbite. It is best applied 24 to 48 hours after the injury.
When the pain and swelling decrease, you may use a hot compress. This typically occurs after 48 hours. A hot compress dilates the blood vessels, improves blood circulation, and allows nutrients essential for healing to go to the affected joint. It also relaxes the muscles and reduces joint stiffness and muscle spasms.
Therefore, it is best to apply a hot compress before performing shoulder exercises. Like a cold compress, you need to put a towel between the skin and the hot compress. To avoid burns, never leave the compress on for more than 20 minutes.
How Long Does It Take for a Swimmer’s Shoulder to Heal?
A swimmer’s shoulder requires three to six months to heal completely. However, you can perform other shoulder movements while the joint is still healing, provided that the movements do not produce pain.
You may be able to perform daily activities with your shoulder within two to four weeks, even if the healing is not yet complete.
Just make sure that your doctor or physical therapist is aware of your activities, and be sure to consistently attend your scheduled visit to ensure that the healing progresses.
How Do You Stretch Your Shoulders After Swimming?
Swimming subjects the back, shoulder, and leg muscles to heavy work, so stretching is essential. Stretching after swimming can prevent the build-up of waste products such as lactic acid and reduces the chances of muscle cramps and stiffness. Each stretching exercise can be done for 10 to 15 seconds and repeated two to three times.
To stretch the triceps and mid-back muscles, place one arm across the chest at shoulder level. Using the opposite arm placed in front of the arm across the chest, gently stretch. Make sure that your head and body remain straight, and your back does not rotate.
To stretch the muscles in front of the shoulders and the chest muscles, place both arms behind your back. You may intertwine your fingers or place your palm against a wall with fingers pointing upwards. Maintain a straight back.
In addition to your shoulder muscles, make sure that you also stretch your legs. To stretch your hamstrings or the muscles at the back of your leg, sit on the floor with your legs straight and slowly reach for your toes while keeping your arms straight.
Alternatively, you may stand in the pool, lift one leg, straighten your knee, and gently reach for your toes until you feel the stretch at the back of your knee.
To stretch the muscles in the front of your leg, stand on one leg and bend the opposite leg so that the heel of your foot is in contact with your buttocks. Hold your foot with one hand to increase the stretch and keep your back and head straight. You may hold onto a surface for support to keep your balance and ensure a straight posture.
These are just some of the stretching exercises that a swimmer can do after swimming. You can do several other stretching and flexibility exercises to improve your performance further. You can also modify them depending on your condition.
How Do You Sleep With a Swimmer’s Shoulder?
The best sleeping position when you have shoulder impingement is lying on your back.
This position does not put pressure on your shoulders and back and promotes a neutral spine position. If lying on your back is uncomfortable, you may sleep on the unaffected side and use a pillow in between your knees to better align the spine.
How Is Swimmer’s Shoulder Diagnosed?
Thorough patient history and physical examination by a trained physician are necessary to diagnose swimmer’s shoulder. The doctor will ask about the location and type of pain and the presence of numbness or tingling sensations in the affected arm.
The physician will also want to know the task or type of activity you were doing when the injury took place. You will also have to list the movements that increase the pain, as well as your lifestyle and usual daily activities.
- A physician or physical therapist may conduct several manual orthopedic tests which involve movements and maneuvers that will elicit pain or tenderness in the affected shoulder.
- A physician will also assess the functional strength of the shoulder muscles, especially the SITS muscles, and the range of motion of the shoulder joint.
In some cases, the doctor may request an X-ray to check for fractures, bone spurs, or arthritis which can all contribute to the impingement.
A physician may also order a magnetic resonance imaging (MRI) scan to determine damage to the soft tissues, such as a tear in one of the SITS muscles or an inflamed bursa or ligament.
Dr Aarti is an MBBS (Bachelor of Medicine and Surgery) from Baroda Medical College (The Maharaja Sayajirao University, Baroda). Dr. Aarti has also completed her Masters of Medical Science and Technology from the prestigious Indian Institute of Technology, Kharagpur.