September 28, 2016

A common problem that doesn’t always have a simple fix

Shoulder discomfort is a common complaint amongst Masters swimmers. For some, the pain keeps them awake at night and escalates to chronic. Articles and blog posts promise a pain-free shoulder with a few chest stretches and simple rotator cuff exercises. Although these solutions may provide relief for some, others whose pain has more complex origins will continue to suffer.

“It’s dangerous to put out blanket treatments,” says Arlette Godges, a board-certified physical therapist in orthopedics and geriatrics. A lifelong athlete, with plans to continue doing the sports she enjoys for a long time, Godges operates a private practice specializing in optimal and pain-free movement for competitive and recreational athletes.

Although she advises against one-size-fits-all treatment, Godges says shoulder pain usually results from one of three causes: “lack of mobility, lack of strength, or lack of coordination at the joint.” And these problems aren’t mutually exclusive: A swimmer’s pain may be linked to one or more of these deficiencies. “Many swimmers lack power in their catch, which is the most powerful part of the freestyle stroke. Others lack the mobility to get their hand in position for the catch and use other muscles such as the neck or lower back to compensate. “Everyone's biomechanics are different,” she says, and that’s why it’s important to see a doctor if you’re having shoulder issues.

A physical therapist with experience working with aging athletes can evaluate the cause of the impairment. Some swimmers might lack mobility in the shoulder joint or thoracic spine or have poor postural alignment. They might also lack the necessary strength to handle parts of the stroke where the hand is far from the body such as the catch, Godges says.

“In the case of impaired coordination,” Godges says, “often the shoulder girdle elevation or ribcage rotation coordination with arm movements are out of sync. People sometimes lack strength in the larger muscles in the mid-back or rotator cuff muscles, which often results in the muscles of the upper back and neck working overtime.” But this common yet abnormal, compensatory movement pattern results in the shoulder blade moving down and forward instead of upwardly rotating to set up a strong catch at the top of the stroke. Restoring normal ribcage and shoulder blade movement is often a critical element in alleviating swimmer shoulder pain, Godges says. When swimmers swim improperly day after day, pain ensues.

And simply taking a break, as Godges says many swimmers insist will fix the problem, doesn’t always work. “They rest for two weeks, the muscles get tight, scar tissue builds up, and then they go back to the pool with the same mechanics and the same stroke rate.” A month later, they're experiencing the same pain.

Take it to the Weight Room

Instead of just hoping the problem with go away, Godges says working your shoulder muscles at all ranges in the weight room, instead of just in the mid-range, may help. This is more analogous to the swimming stroke, which also engages all ranges of muscle movement. The catch takes place quite far from the center of the body, whereas a bicep curl or even a chest press are close to the body and more anchored.

What’s more, simply stretching more might help combat the stiffness and pain that’s associated not only with swimming, but ageing, too. “The integrity of our tissues change throughout life,” Godges says. “A lot of the pain people have is related to a lack of spine and ribcage mobility.” To improve ribcage mobility, Godges recommends turning to yoga for help: The cat and cow stretch and foam rolling the mid- and upper-back may offer relief.

In the pool, Godges suggests “going back to basics,” and performing drills to help build up sufficient strength in supporting muscles working during each stroke. Avoiding poor posture in and out of the pool is also imperative, since optimal posture sets the stage for proper movement.

“I believe that diagnosing a specific impairment and proper exercise application is important to being able to perform in your sport. You need proper spinal mobility and proper muscle balance in the extensors and flexors,” Godges says. A physical therapist or skilled personal trainer can assess whether you have appropriate muscle balance and sufficient range of motion in the joint. “Otherwise, you’re asking your muscles to work at 100 percent at an awkward angle,” she says.

Godges believes that shoulder surgery and adaptive strokes should only be considered after other alternatives to halt the pain have failed. Surgery often doesn’t resolve the underlying reason for the pain, and often, changing your alignment and reducing the impairment is enough to alleviate the pain.

“Adapting a stroke to an impairment isn’t good. If you don’t have a major injury, if you have a normal, able body that is aging, fix the impairments so you can do [the stroke] the right way. My whole practice is built on this,” Godges says.

Whatever you do, Godges recommends not giving up on swimming completely. Rather, work with a professional to find a solution that fits your body and your biomechanics. Godges says the previous model has been to tell people to adapt or avoid activity, but she believes lifetime activity and high performance can be achieved through improved quality of movement.


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