Summer is rapidly approaching, and with global climate changes, the summers are getting hotter and what better way to cool down than to hit the beach or pool for a swim!

Unfortunately though, as with many sports there are always associated injuries and in swimming it is often the shoulder. One of the most common conditions that can occur is shoulder impingement.

Lets have a quick chat about the muscles and their function in the shoulder. There are 4 major muscles which make up your rotator cuff. Theses 4 muscles work to stabilise the shoulder as it moves through range.

If one of these 4 muscles are weak or there is tightness in the muscles controlling the shoulder blade then the top of the arm bone (humerus) can jam up under the roof of the shoulder blade (acromion). This can cause the tendons or the bursa (pocket of fluid) to become inflamed and painful.

Shoulder impingement usually occurs when your arm is up close to your ear in backstroke, freestyle, butterfly. It can also be when you are in a streamline position where your arm is slightly rotated inwards (internally rotated).

So think of the shoulder like a canoe and paddle – the swimmers hand is like a paddle and the rotator cuff muscles work like a fulcrum to stabilize the shoulder as the arm comes in and out of the water.

So how does shoulder impingement happen?

Shoulder impingement usually occurs when your arm is up close to your ear in backstroke, freestyle, butterfly. It can also be when you are in a streamline position where your arm is slightly rotated inwards (internally rotated).

This position causes friction of the head (ball) of the arm against the ligaments and the tendons.

This occurs due to:
• Poor swimming technique
• A large amount of training which can cause the muscles to fatigue and therefore work inefficiently or be overworked and fail
• Your hand crossing your bodys midline when it enters the water in freestyle or butterfly
• Your thumb pointing down and the palm facing outwards as your hand enters the water
• Unilateral breathing (ie only breathing on 1 side), as it can cause the opposite shoulder to become overworked
• The use of a kick board and streamline positions with the palm facing out can place the shoulder in a position of impingement
• The use of hand paddles or paddles without holes can increase the pull-through load, again placing increased strain on the shoulder muscles

Here are a few common swimming stroke problems to take note of to help avoid having a painful shoulder this summer!

Things NOT to do!

Butterfly:
• entering the water with your arms too far outside the shoulders or too close together (too close to midline)

Backstroke:
• pulling through with elbows extended (fully straight) which results in a straight arm pull through instead of an S shaped pull through.
• inadequate body roll

Freestyle:
• pulling through beyond the midline
• reaching out too far or aiming for too much length ahead
• inadequate body roll

Breaststroke:
• Excessive elbow straightening in the streamline position.

So have a think about your technique, have a think about the few technical problems mentioned above, and have a safe and painfree swimming season!

Shoulder pain can be one of the most debilitating injuries for people to live with. If you are experiencing a sharp catch of pain when taking you arm above your head you may be suffering from a shoulder injury known as rotator cuff tendinopathy.

The rotator cuff muscles are a group of muscles that sit around the shoulder. Their primary function is to stabilize the shoulder in its socket. If a person is participating in regular overhead activities such as swimming or tennis and these muscles are not properly conditioned the shoulder loses it overall stability and the tendons of these muscles can become pinched against the bony surfaces. Over time this leads to the tendons becoming inflamed, thickened and weakened. If shoulder pain is left untreated the symptoms can increase in both severity and frequency.

The first line of treatment for settling this condition is to reduce the inflammation in the tendons. This is best achieved through a combination of electrotherapy devices administered by a physiotherapist and regular icing and anti-inflammatory medications.

Once the inflammation has settled correcting the causative factors is critical to ensuring long term recovery of the shoulder. Two of the most common factors affecting correct shoulder function are muscle tightness and rotator cuff weakness.

The most common area where muscle tightness predisposes a person to rotator cuff tendinopathy is at the back of their shoulder. Excessive tightness in this area changes the resting position of the shoulder so that the shoulder sits slightly elevated and slightly forward. This change in the resting position of the shoulder means that the tendons of the shoulder are more likely to become pinched by the bony surfaces when attempting any arm movement.

If weakness is apparent in the rotator cuff muscle groups the shoulder is less stable and movement will not be as well controlled. Repeated overhead work or repetition of a specific task that requires the rotator cuff muscles to work predisposes a person to rotator cuff tendinopathy. Individuals are unable to control their shoulder movement leading to pinching of the tendons against the bony surfaces. Over time the repetition of shoulder movement and the pinching of the tendons will lead to thickening and weakening and increasing overall recovery time.

Early diagnosis and management of shoulder pain is essential to ensure recovery time is minimized. Physiotherapy can assist in also correcting any predisposing factors contributing to the condition to ensure long term recovery of your shoulder.