If you ask any swimmer or overhead sport athlete, chances are they will have had some form of shoulder injury. Triathletes are no exception with swimming usually making up a percentage of their training. Recent research has defined “shoulder impingement” as a symptom of an injury rather than a type of injury itself. It is this fact that makes the correct diagnosis key to re-engaging athletes into swimming or other sports as quickly and safely as possible.
In general terms there are two different types of impingement; external and internal. These are then broken down into the structures within or external to the shoulder that are causing the ‘impingement sign’. The most common cause for the triathlete would be either overuse of the shoulder, through following that black line just a little too much, or due to poor scapular or shoulder blade control. Both of these may start with just a niggle but can lead to rotator cuff (the muscles at the back of the shoulder) pathology or narrowing of the sub acromial space within the top of the shoulder. Once an initial injury has occurred an impingement cycle begins. A damaged rotator cuff tendon leads to swelling of the tendon, which narrows the sub-acromial space, causing impingement, which can cause further damage to the rotator cuff. The cycle then starts again.
Signs and Symptoms
The signs and symptoms of shoulder impingement depend on where the issue is originating from. There are a few key symptoms that generally occur, which include, but are not limited to,
- a restriction in movement, especially above shoulder height in most directions
- decrease in strength
- pain associated with overhead activities and anything behind your back (ie putting on your bra)
Depending on the stage of injury, the pain can either be localised to the tip of the shoulder or have a referral pattern down the outside of the arm or back of the shoulder. If caught early, it might only be an issue within the pool or within an athletes chosen sport, but if time is taken to get on top of the issues, it can effect the individual throughout their day.
If you are feeling that little niggle or are experiencing any of the other signs, your best option is to go and get it checked out by your local physiotherapist to figure out why this is happening to you. Catching shoulder impingement early on in its cycle will undoubtedly lead to better outcomes and less recovery time.
Prevention exercises (pictures to be added)
There are a few exercises that can assist in preventing the wear and tear on your rotator cuff muscles. With some simple exercises you can keep your shoulder mechanics in check, decreasing the risk of impingement. These are exercises that can be done pre or post activity and should be done as regular maintenance for your shoulder. Good training habits create stronger athletes.
Remember these exercises are for a shoulder that isn’t experiencing any pain. If your shoulder is already sore please visit your local Physiotherapists for exercises that are right for you.
Wall Push Off Exercise
Standing with hand behind you, palm facing the wall. Keeping your body stable, push away from the wall without your elbow touching the wall.
External Rotation Exercise
Standing with your elbow in by your side, thumb up to the ceiling and body straight. Take your hand away from your body and return to the starting position.
Posterior Capsule Stretch
Lying on your side with arm out to the side. Slowly apply pressure to your forearm to take it closer to the ground.
Trigger Point of Shoulder
Place the trigger point ball on the back of your shoulder, leaning against the wall or floor. Use the ball to get into the muscles in the back of your shoulder. Hold each until the pain settles or for about 40-60 seconds.
Thoracic Rotation Exercises
Lying on your side with your hands out in front, slowly take your top hand across your body to the other side, keeping your hips on top of each other.
The way you train is also important in decreasing the risk of shoulder injuries. A graduated training program that focuses on your level of fitness and ability, and builds gently, is key to any injury prevention.
Treatment Once Diagnosed
The treatment, once diagnosed, will depend on what is causing the impingement in the first place. Initially, it is usually associated with rest from swimming or sport and modification of the overhead or aggravating activities.
Treatment will generally consist of muscular retraining exercises, manual therapy, soft tissue massage, trigger pointing/stretching and dry needling. Treatment should also include a revamp of your training program to de-load the shoulder so that the smallest amount of overall impact is felt in your training.
The treatment time once diagnosed really depends on where the injury is stemming from and your compliance with the program. There will be a recommended amount of healing time from the tissue point of view, but that isn’t usually what keeps people out of the water. Sneaking in that little swim or doing that extra 500m may be the difference between recovery in time for the next race or sitting on the sideline cheering. Get into a habit of doing your exercises prior to a routine session and you’ll be better for it in the long run.
In more severe cases of impingement where there is structural damage to the shoulder or a tear in the rotator cuff, surgery may be required.
Training habits are the key to longevity and optimization of performance. Don’t let that niggle turn into a nightmare. Build your training routine around the suggested pre workout exercises and your body will thank you for it.
Contact one of the best Sports Physiotherapists on Gold Coast, for advice or treatment services.