Shoulder Treatment and Management
The previous article reviewed common shoulder injuries that typically affect the masters swimmer. In particular, it focused on injuries to the group of muscles known as the rotator cuff. If you missed this article or would like to review it, you can do so here.
In this article, we look at steps to managing your shoulder injury. You are most likely to notice initial shoulder pain or discomfort whilst partaking in the aggravating activity. Swimming injuries are often caused by overuse rather than trauma. The repetitive nature of swimming can lead to muscle fatigue, heightening the likelihood of impingement type injuries. Poor technique and biomechanics are also a significant contributor to injury. For example, when the hand crosses the midline of the body upon entry during freestyle, excessive flexion and internal rotation occur. This increases the risk of shoulder impingement over time, more so when the swimmer becomes fatigued.
Injury often occurs when there is an increase in intensity, distance or frequency in your training. Initial signs may include:
Pain in the front of the shoulder or biceps
Pain felt on the pull phase of your stroke
Loss of speed and/or endurance
Loss of strength on internal rotation
What to do if you are experiencing shoulder pain in the pool.
The most important thing is not to ignore the pain; it's there for a reason. Pain is your brain’s way of protecting you and getting you to assess the situation. It’s important to remember pain does not always equate to damage, use it as a warning signal.
If you are getting shoulder pain while you are swimming you need to address it. This pain is unlikely to be DOMS (delayed onset muscle soreness) which we all experience at times after a hard session, or when we haven’t used certain muscle groups for a period of time (such as when we first start a strength program). This muscle soreness tends to last 1-2 days before disappearing. Pain or discomfort from swimmers shoulder tends to return when you are back in the pool, it may also begin to disrupt your day to day activities, including, brushing or washing your hair, reaching for things overhead or in your back pocket.
Initial recommendations for shoulder pain
Assess your training – has the intensity, distance or frequency increased? If so, look at adjusting this while your shoulder is painful.
Have your coach assess your swimming stroke throughout the session – it may look great the first half of the session, but it’s important to check it at the back end, when you are fatigued and more likely to have poor technique.
Take note which strokes are causing the pain or discomfort and at which stage of your stroke. Discuss this with your coach and/or therapist.
Long and slow warm-up – Make sure you have an extended warm-up; this may include active mobility exercises before you jump into the pool.
Pool toys – fins are worthwhile using during shoulder injuries as they take some of the pressure off the shoulders. Avoid paddles; they will increase the force generated through the shoulders. If you are doing a kick-set and using a kick board, keep your elbows bent or avoid the board altogether.
Ice following training – ice is great for reducing pain, and is worthwhile using following training.
Still painful, what now?
If you are still experiencing pain after implementing the above, it’s time to see someone about it. Head to your therapist, they will be the most experienced in dealing with soft-tissue injuries. Once your condition has been assessed you will be provided with a treatment plan, which will most likely include assessing your training load, along with providing you with some specific strength exercises for your shoulder and possibly other areas of the body. These exercises are fundamental to full recovery, along with decreasing the likelihood of reoccurrence.
What about swimming?
Initially, you may need to take some time out from the stroke/s aggravating your shoulder. It does not mean you need to avoid the pool altogether; in fact, total rest may be detrimental in the long run as the muscles in the area will become deconditioned. Discuss this with your therapist and coach, there will be some things you should be able to continue doing through the acute stages of the injury. Movement is medicine, even during injury. Knowing which movement to do during injury may require some assistance.