Recently a swimmer, Kevin (fake name), came to see me with complaints of swimmers shoulder. In this case, Kevin was having discomfort in the front of the shoulder and had not been able to swim because of the pain. His shoulder was painful enough that even sleeping on his shoulder was painful. It was also painful to raising his arms overhead, without any weight. Kevin tried seeing another physical therapist closer to his home. But he was not making any progress. While Kevin knew recovering from swimmers shoulder was not easy. He started to feel like he might not be able to swim the way he used to again. Needless to say, Kevin was pretty frustrated by the time he came to see me. This blog will go overs Kevin’s case of swimmers shoulder and how we got him back to swimming.
After talking with Kevin. The most important question to ask him was what did he try at the last PT before. According to Kevin, he did a lot of external rotation exercises and rows. After watching Kevin move, it became clear why these exercises didn’t work and why he was still having pain.
Why Didn’t Kevin Get Better?
For any swimmer, you want to clear any soft tissue tension in the neck and ensure they have proper shoulder motor control before progressing their exercise program. Without doing this, it will be tough to fully recover from swimmers shoulder.
In Kevins case, he had underlying soft tissue tension in the neck, particularly the levator scapulae muscle. Without clearing that soft tissue tension, it will be hard to get scapula moving well. Without your scapula moving well, it will be hard to restore optimal shoulder mechanics. As a result of this, Kevin had had poor scapular control, which can make it look like your rotator cuff is weaker than it actually is.
How to Eliminate Soft Tissue Tension in the Neck
While in person I will tend to use a couple of manual therapy techniques for this, with virtual clients I have a couple of exercises that I have found to be super very effective for eliminating neck tightness.
Chin Tuck + Extension.
Chin Tuck + Rotation.
Chin Tuck on Foam Roller
How to Strengthen the Muscles Around The Scapula
There are many different exercises that can be useful in strengthening the serratus anterior, but typically ones where you hands are fixed to the ground (closed chain) tend to be more effective at first. Some of my favorites are…
Quadruped Protraction
Plank Protraction
Push Up plus
What did Kevin Do Next?
After getting Kevins pain down, decreasing tightness in his neck, and improving the strength of his muscles around the scapula, it was time to start getting Kevin back in the pool and begin progressing his exercises.
If a swimmer has been out of the water for over three weeks, starting out between 800-1000 yards/meters or ~20% of their previous volume is a good starting point. Kevin started out with 900 yards. He was instructed to alternate 100 fist drill-100 freestyle swim. He was given the following parameters…
- Pain must stay less than 4/10
- If pain increases while swimming and lasts for more than 24 hours after, decrease yardage next swim
- No backstroke or butterfly, but you can do breastroke.
- If pain is less than a 4/10 and does not increase for 24 hours, increase 100 yards a day.
- At least one complete rest day a week
- At 2000 yards, you can start backstroke
- At 4000 yards, you can start butterfly.
If you want to read more about swimming modifications you can make to decrease your pain in the pool, click out a blog that takes more a deep dive into that topic here.
Kevins Exercise Progression
In order for Kevin to keep progressing, he needed to progress his exercises. To ensure his muscles would be strong enough to handle the demands of swimming. There were two many categories of movements Kevin worked on.
- Scapula upward rotation
- Scapular retraction
In addition to these categories, Kevin worked on maintaining general upper body strength as well.
Scapula Upward Rotation
For scapula upward rotation, here are some example exercises that Kevin completed. It is important to note that Kevin spent a couple weeks of nailing the basics before progressing to these. Starting out with these exercises would not help you recover from swimmers shoulder.
Upright Row
Wall Slides with Band
Military Press
Scapular Retraction
One thing to look for, especially in swimmers, is anterior translation of the shoulder during movements that require scapular retraction, see the video below for a more in depth explanation of what this means. In short, many swimmers get into the pattern of lifting their arms WITHOUT retracting their shoulders. This pattern will lead to anterior shoulder pain, that will often go away after correcting this pattern.
Here are the exercises Kevin completed for scapular retraction…
Three way banded pull apart
TRX Row and Twist
Face Pull
After working on all of these, Kevin started to add speed and power into his exercise routine. While all of the exercises above are great exercises, they are done at slower speed compared to swimming. Training movements at a faster speed helps get all of the muscles around the shoulder to activate and stabilize quickly. And also helps trains those muscles in a way similar to swmming.
Some of the plyometric and power exercises Kevin added to his routine were…
Med Ball Slams
Med Ball Chest Pass
All of these are done a lighter weight, but done at a much higher speed compared to the previous exercises.
The Wrap Up:
While this may seem simple, this was a long process that took about ~12 weeks. Notice that tone of these exercises involved external rotation or specifically targeted the rotator cuff. For many swimmers, the rotator cuff can become overworked, because of weak scapular muscles. NOT because the rotator cuff is weak. Knowing this, we were able to get to the root of Kevins shoulder pain and on the path towards full recovery.
If you are are struggling with swimmers shoulder, have tried PT elsewhere, can’t swim the way you want, schedule a free consult to see what we can do to get you back to swimming with full confidence.
Happy Swimming,
Alex Ewart PT, DPT, CSCS