How to Rehab: Swimmer’s Shoulder

Happy September! With the end of summer and dawn of fall comes the beginning of high school sports, and, Dr. Kari’s favorite, high school swimming. As you might know, Dr. Kari at Streamline has been coaching swimming for more than 20 years. As a PT and coach, she is specifically skilled in (and keen on) keeping swimmers dealing with pain or injury in the water. The most common injury for swimmers? Swimmer’s shoulder, of course!

A quick definition of the syndrome: “Swimmer’s shoulder is a term that can represent numerous shoulder pathologies. These include impingement syndrome, rotator cuff tendinitis, labral injuries, ligamentous laxity or muscle imbalance causing instability, muscular dysfunction, and neuropathy from nerve entrapment.”

Rehabbing swimmer’s shoulder differs from other shoulder injuries in a few key ways, mainly because of the repetitive, high-intensity nature of swimming and the specific mechanics involved in the strokes. Here’s our breakdown of how swimmer’s shoulder rehabilitation might be different from rehabbing other shoulder injuries:

1. Focus on Overuse Injuries

• Swimmer’s Shoulder: This injury is often exacerbated by repetitive overhead motions, leading to irritation of the shoulder muscles and tendons, especially the rotator cuff or biceps. Rehabilitation focuses on addressing the muscle imbalances and fatigue caused by these repetitive motions.
• Other Shoulder Injuries: In sports like football, rugby, or hockey, shoulder injuries often occur due to impact or acute trauma rather than repetitive motion. Rehab in these sports might focus more on healing after dislocation, fractures, or ligament tears rather than dealing with overuse. The nature of the shoulder injury in these sports may involve more time spent on joint stability and protection from impact.

2. Swimming-Specific Muscle Training

• Swimmer’s Shoulder: Rehab often includes exercises specifically designed to strengthen the rotator cuff and scapular (shoulder blade) stabilizers, which are crucial for proper swimming mechanics. Since swimming heavily relies on shoulder rotation and scapular movement, as well stability and strength overhead, rehab programs need to ensure these muscles are balanced and conditioned to handle the demands of the sport.
• Other Shoulder Injuries: While technique is important in all sports, the rehab focus for shoulder injuries in sports like tennis, baseball, or volleyball may not be as intensely centered on correcting form during the rehabilitation phase. However, sports like tennis and baseball also require attention to overhead motion (serves and pitches), and form correction is still essential, but the rehab approach might differ based on the sport’s specific demands.

3. Emphasis on Technique Correction

Technique plays a huge role in swimmer’s shoulder rehab. Improper stroke mechanics can put excessive strain on the shoulder, so part of the rehabilitation process involves correcting technique to reduce stress on the joint. Swimmers may need to work closely with a coach or physical therapist to make these adjustments.

4. Gradual Return to Full Activity

Because swimmer’s shoulder can be exacerbated by the repetitive nature of swimming, the rehab process often involves modifications in intensity or volume of swimming, with close attention to technique. Athletes are typically advised to slowly build up their swimming distance and intensity while incorporating strength and recovery periods.

5. Prevention of Future Injuries

Preventive care is a significant part of swimmer’s shoulder rehab. Swimmers are often encouraged to incorporate mid back mobility, and core and shoulder-strengthening exercises into their regular training, even after rehab, to avoid future injuries. There is also a strong focus on warm-ups and cooldowns tailored to the demands of swimming.

Conclusion

Rehabilitating swimmer’s shoulder involves a specialized approach tailored to the unique demands of swimming, with a focus on improving technique and strengthening the muscles needed for repetitive overhead shoulder motions. This differs from other shoulder injuries, where rehab might focus more on healing from trauma, restoring joint stability, or addressing non-repetitive stress issues. Understanding these differences helps ensure that rehab is effective and prevents future injury.