Although triathlon’s first discipline, the swim leg, is often deemed the toughest, it’s also blessed with the lowest injury rate. They can happen though – so we asked qualified osteopath (and former GB powerlifter) James White to look at the most common shoulder injury swimmers get: subacromial impingement, aka 'swimmer's shoulder'.
Nine tips for dodging injury and illness as a triathlete
Rotator cuff: What it is, how it works and what happens if it becomes damaged
Swimming puts your shoulder joint through a huge range of motion. Although relatively low impact, this huge range of motion has the potential to cause irritation or damage in the shoulder joint if the joint isn’t already working optimally.
Compared to many other joints in the body, the shoulder joint has a fantastic range of motion. However this is at the cost of stability, and is the reason shoulder injuries are fairly common even though its not a weight-bearing joint.
Image courtesy of By OpenStax College
It is a ball and socket joint which – unlike the hip joint – has a very shallow socket. A good way of imagining what it looks like is by thinking of a golf ball on a tee.
The bony part of your shoulder that you can feel sticking out at the end is called your acromion and this is where your collar bone meets your shoulder blade. When you lift up your arm above your head there is potential for the top of your humorous (upper arm) to knock and cause irritation against the under surface of your acromion.
There are a number of tissues that could be inflamed and causing pain. One is the bursa which is a flat sack that acts as to encourage smooth gliding of two tissues against each other. The bursa is likely to become inflamed if the shoulder is fallen on.
Another common one is the supraspinatus tendon. This is a small muscle that runs along the top of your shoulder blade and the tendon passes under the acromion and attaches onto the top of the humerous.
There is a part of the tendon called the critical zone where the blood supply is poor and this increases the chances of it becoming irritated due to its inability to heal itself quickly.
A healthy shoulder should not have any problems going through a full range of motion without any issues. It’s when poor posture (such as excessive kyphosis in thoracic spine), lack of thoracic mobility, or even poor diet contribute to the mix that things can start to get irritated and under-repaired.
How do I know if I have subacromial impingement?
A simple and fairly accurate way to know if your shoulder pain is due to subacromial impingement is the painful arc test. To perform this test simply stand and raise your arm out to the side all the way above your head.
A positive for subacromial impingement is pain to begin at around 40-60 degrees of abduction and then for the pain to go away as you pass 120 degrees of abduction and your shoulder rotates so your palm faces in.
In this first picture the pain will be starting around this area. In the second picture the arm begins to externally rotate and the pain will begin to reduce.
How do I get rid of/treat swimmer's shoulder?
Firstly, stop doing the movements that hurt it. When people learn that a movement hurts for some reason they keep doing it throughout the day to remind or confirm to themselves that it still hurts! Every time you do a movement that brings the pain back you are increasing the inflammation and damage to the area.
If you continue lifting your arm in such a way that it hurts then it will not get better. This also applies to doing activities or sports that aggravate the injury. If swimming front crawl causes pain then you need to stop doing it as you are not allowing the injury to repair itself.
Secondly, improve your posture so that the shoulder joint sits in an improved position can improve the function of the shoulder and aid in recovery. For the vast majority of people this means reducing the amount of kyphosis in the thoracic spine and retracting the head. This can be achieved by simply standing taller – pretend there is a piece of string pulling you as tall as you can be.
By doing this, your shoulder blade moves into its intended location which brings your shoulder into the correct position. Exercises are great for improving strength and posture but without consistently practicing good posture as mentioned above they are much less likely to be successful. Whilst at your desk, walking, eating and any other time of the day you need to make sure you are thinking about your posture.
Lastly you need to strengthen the rotator cuff muscles in the shoulder joint. The best way to begin doing this is with your arm in the neutral position (which is with your elbow at your side), and trying the following...
Three exercises to try to treat swimmer's shoulder
1. External Rotation
Attach a theraband to something solid and hold the other end. Whilst keeping your elbow at your side and at 90 degrees you externally rotate your arm.
This works the deep external rotation muscles of the shoulder (teres minor and infraspinatus) which improve the functioning and strength of the shoulder joint. In a controlled manner complete 15 repetitions.
This movement is intended to strengthen the supraspinatus muscle and also initiate a healing response in the supraspinatus tendon.
To perform the exercise simply stand side on to a wall with the back of your hand against the wall.
Push your hand into the wall for 5 seconds and then relax. Complete 15 times.
This last exercise is done to strengthen the scapular retraction muscles which will improve your posture and the overall health of your shoulder complex. Stand with the band looped over something solid and hold the two ends at arms length.
Then whilst keeping your shoulders down and relaxed you squeeze your shoulder blades back together. Hold for 5secs and then relax. Complete 15 repetitions.
Seeking some form of physical therapy such as osteopathy, physiotherapy or chiropractic can speed up the recovery from an injury like this.
However by performing these exercises every day whilst also following the other advice in this article you are giving yourself a great chance of a full recovery with no future problems.
For more info, head to http://thewclinic.com.
For lots more injury recovery advice head to our Training section