Recovering From Shoulder Pain: Tips for Swimmers
Alvin R. Loosli, MD; June Quick, RPT, ATCTHE PHYSICIAN AND SPORTSMEDICINE - VOL 24 - NO. 2 - FEBRUARY 96
Swimmers often develop shoulder pain as they push to go faster and farther. The pain usually stems from overusing the rotator cuff muscles and typically comes on gradually. (The rotator cuff muscles attach the upper arm to the shoulder blade. They help hold the head of the humerus, or upper-arm bone, in the shoulder socket and help with shoulder motion.) One or more rotator cuff muscles may be involved, but a well-rounded strengthening program can help return the whole rotator cuff to full strength and endurance.
After a doctor diagnoses your injury as a rotator cuff problem, there are several steps to take to help ease shoulder pain and defend against its return.
Pain relief. To lessen pain and swelling, ice the painful part of your shoulder for 15 minutes after each workout and before you go to bed at night. To avoid frostbite, place a wet paper towel between your skin and the ice. Taking aspirin or another anti-inflammatory drug after each workout will also help reduce pain and swelling.
Sport specifics. Because poor technique may have contributed to your injury, have your coach check your form and suggest needed improvements in your stroke. Even with good technique, you need to slow down at first and choose strokes that don't cause pain. Then, try short, fast sets with extra recovery time. For endurance swimming, using fins can help reduce shoulder strain.
Avoid hand paddles, using a kickboard with your arms stretched out in front, and prolonged "streamlining" (coming off a turn or dive with your hands together over your head). Above all, do not swim through pain!
By altering your workouts in this way, you can slowly work back to your preinjury level, letting pain guide how fast you progress. You only need to stop completely if you have continual pain. If you do, see your doctor.
Strain producers. Activities that stress shoulders can be found outside of sports, too. Be careful carrying heavy books, backpacks, and briefcases. Travel and gardening, in particular, can aggravate a shoulder injury.
Stretching. Do extra stretching early on in your workout-after you've warmed up-and after your swim. Ask your doctor to recommend some good stretches, or read the book Stretching (1). While doing the stretches, make sure you keep your arm below shoulder height.
Strengthening. Begin a rotator cuff strength and endurance program as soon as you can do the exercises without pain. Because swimmers take thousands of strokes per session, repetitions are more important than weights in rehabilitation. Swimmers injure the supraspinatus more than any other rotator cuff muscle, so the thumbs-down supraspinatus exercise (figure 1) is a good gauge of the shoulder's health. A swimmer with a healthy shoulder should be able to do it 50 times without weights.
This and other strengthening exercises can be done at home, at school, in the office, or at poolside. The exercises shown in figures 2 through 4 require elastic exercise bands. Avoid taking anti-inflammatory drugs like aspirin or ibuprofen before doing the strengthening exercises because they can mask the pain.
Back in the swim. As you build strength, you can try gradually returning to more intense swimming. As you increase your effort, let pain be your guide: Ease up if your shoulder starts to hurt again, and stop if the pain persists. But a comprehensive recovery program such as the one described above will help you get back in the swim quickly and with minimal pain.
Remember: This information is not intended as a substitute for medical treatment. Before starting a rehabilitation program, consult a physician.
Dr Loosli is a family physician at the Center for Sports Medicine at Saint Francis Memorial Hospital in San Francisco and in Walnut Creek, California, and an associate clinical instructor of family medicine at the University of California, Davis School of Medicine. He is a member of the editorial board of The Physician and Sportsmedicine and a member of the United States Swimming Sports Medicine Society. Ms Quick is a physical therapist in private practice in Palo Alto, California, and serves as a consultant to the Stanford University swim teams.