Welcome to the series Swimmers Shoulder, What is the Cause? Where each post I will break down common findings I see in swimmers that come to my clinic with shoulder pain, common causes of swimmers shoulder, and how I go about getting them back to performance level. This blog will cover some of the common impairments I see, and dryland exercises given to address them. If you haven’t read part 1 or part 2, give them a read!
Now that we have talked about what swimmers’ shoulder is, common spots in the freestyle stroke where the shoulder hurts, and what potentially leads to swimmers’ shoulder. It is a perfect time to talk about a “typical” exercise progression I would use with a swimmer who is experiencing shoulder pain. I use quotes around typical because every swimmer is different. If two swimmers walked into my clinic with the same shoulder problem, there is a high chance that they would get a different program. Swimmers’ shoulder is complex and tailoring your program to each swimmer is important.
Begin with the End in mind
For most swimmers, the end of goal of the rehab process is to be able to swim without pain. They want to be able to train and race at 100% in order to reach their goals. As a physical therapist, it is my job to break this down further.
For example, if a swimmer has pain with during the recovery phase of freestyle, it is my job to determine what movements they need to be able to do this movement without pain. In this scenario, a swimmer needs to be able rotation their trunk, retract their scapula, and use the rotator cuff muscles to center the humeral head in the glenoid fossa.
In the examination, I need to be able assess the swimmer’s ability to do all of these movement individually. Then assess their ability to do all of them together, like in freestyle. If there is a deficit in their ability to do any of these movements, then figuring out why they cannot do the movement. It could be due to a movement dysfunction, an irritated muscle, limitation in range of motion, amongst other things. Once figure out what the limiters are, then we know exactly what we need to work on in the clinic.
Common Deficits to “Correct”
Some of the common impairments I see with swimmers, leading to their dysfunction are
- Weakness or inhibition of the scapular upward rotators
- Decreased neck mobility
- Irritation of the subscapularis and long head biceps tendon
- Instability of the shoulder
Exercise Examples
For each of the deficits listed above, here is an example dryland exercise I would start with to help work on those impairments.
Weakness or Inhibition of the Scapular Upward Rotators
Quadruped protraction
Decreased neck mobility
Diaphragmatic breathing
Irritation of the subscapularis and long head biceps tendon
Subscap isometric
Instability of the shoulder
Press up
Exercise Progressions:
After mastering the initial dryland exercises, progressing to a harder version of exercise will help challenge the tissue with the issue. Without challenging the swimmer at the appropriate level, they will not be able to return to performance level. Therefore, increasing the difficulty of the dryland exercises is necessary. After all, rehab is training in the presence of injury.
Here is an example progression of the exercises shown above:
Quadruped Protraction Progression: Push Up Plank Protraction
Diaphragmatic breathing Progression: Talk Test During Functional Movements
Subscap isometric Progression: 90/90 Internal Rotation
Press Ups Progression: Push Up Plus
What is the Swimmer Doing in the Pool During all of This?
This is where the rehab process really becomes unique for each swimmer. Ideally, I will have a swimmer stay in the pool during the entire rehab process. Usually, there will be specific modifications in order to swim with tolerable level of discomfort. Gradually increasing the total yardage, amount of yardage done doing other strokes, and intensity as the swimmer gets stronger is key. During the latter part of the rehab process, swimming becomes the main form of exercise. There is no better way to strengthen all the muscles in a swimming specific way than swimming itself.
Are you currently dealing with shoulder pain and unsure what to do? Contact me and let’s work together to get you back to performance level.