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Swimmers Shoulder Overuse Syndrome

By Dr. Richard Izzo

Newbies get so excited about how their fitness has increased, that they want this to continue. Instead of taking a break when the season is over they continue training at a high intensity. When the next season starts they even increase their mileage because they feel that more is better. This is also because they are listening to others who train more and think that it's time to step it up for increased performance. This is when a little knowledge is dangerous.

Even veterans fall into the trap of increasing mileage or intensity because it has worked for someone else. Prior to an overuse injury there is usually a cumulative fatigue associated with the specific range of motion. This can be over the course of one or several seasons.

Specifically with respect to swimmers shoulder, or rotator cuff tendonitis, there is an imbalance of the rotator cuff muscles that precedes overuse.

The swimming motion results from the internal and external shoulder rotators contracting. The pectoralis major, triceps and biceps muscles aid this. The subscapularis, another rotator cuff muscle is also needed to stabilize the humeral head in the glenoid cartilage.

Imbalances, such as shortening of the internal rotators, pecs, and biceps can cause internal rotation of the shoulder, and a less stabile shoulder position. This changes the angle that the rotator cuff muscles must travel through the shoulder as it works to produce force to pull you through the water. Another imbalance is weakening of the subscapularis. This can cause the humeral head to rise, which decreases the space the cuff has to travel through. Constant rubbing of the cuff against this area causes subsequent irritation and can cause thickness micro-tears over time.

When the cuff has been irritated for a time, the inflammation becomes chronic, with scar tissue adhesions forming in the muscle belly or in between independent muscles in the area. These adhesions over time cause further shortening of the muscles with more resultant weakness. This cumulative stress with less stability can cause a thickness tear or frank rupture.

Another very important influence on the shoulder is the position of the neck in relation to the shoulder. The posture of your neck comes into play directly because most of the muscles that originate in the neck insert into structures of the shoulder.

Indirectly, neck joint mobility and postural distortion i.e. forward neck, causes the angle that the rotator cuff has to travel through the shoulder to change and increase the stress upon it.

Treatment for the acute onset of shoulder tendonitis focuses on decreasing the inflammation. This is accomplished by decreasing activities by 30%, ice massage, ultrasound and electric stimulation. The next phase of care focuses on increasing the resting length of the shortened weakened muscles by breaking adhesions utilizing soft tissue work and doing PNF stretching. Concurrently, spinal joint manipulation, and shoulder mobilization are done to re-establish normal motion of the neck and shoulder.

Lastly rehabilitation of the shoulder/neck muscles is done. The primary aim of this is to strengthen the external rotators, while stretching the shortened internal rotators. With sports specific stretch cord exercises you can then re-train the normal neuromuscular motor patterns.

Some of the best athletes I have had the privilege of training with have taught me that the most effective way to improve is to remain injury free. This way your base in all three sports continues to grow from year to year without any setbacks.

Remember that sometimes less is more; that recovery is when your body is repairing itself; that it is better to be a participant then be the most fit spectator; that training is cumulative over one season and over many seasons. Listen to your own body. Train smart. Don't do things that someone who has been in the sport for 10+years does. Their body is acclimated to handle the greater demands of increased loads. At the end of the day it's all about being there RACE DAY. And one last word of advice never train using someone else's training plan.

Dr. Richard A. Izzo is a Board Certified chiropractic sports doctor with a practice in Rye Brook NY. 96 Ironman Canada, 99 Ironman USA , 01 Ironman Austria, 02 Ironman Wisconsin, New York City Marathon 88-92, 01 Phil Marathon, 02 LI Marathon

Contact Rich with questions at:
Rye Ridge Sports and Family Chiropractic
Rye Ridge Plaza Ste 210
R.Izzo@worldnet.att.net