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by Ross A Hauser MD

November 1, 2010

Competitive swimming takes a tremendous amount of discipline. For some swimmers, this can include multiple swim workouts in one day. It is no surprise that some swimmers make thousands of revolutions per week with their shoulders. This predisposes swimmers to microtrauma, the mechanical wear-and-tear of the shoulder joint and the structures that move it. The most common injury is to the rotator cuff tendons. What is the swimmer to do when the MRI shows a torn rotator cuff?

Get Several Opinions

While a torn rotator cuff is a serious injury, it can often be treated conservatively, so getting several opinions is often a good idea.

Most rotator cuff tears in swimmers are chronic, meaning they have occurred slowly over time. The rotator cuff tendon was first degenerated, and then with repeated overuse, led to an eventual tear. The most common reason for this is because the swimmer continues to swim despite a painful shoulder. If changes in training do not alleviate the pain, then it is prudent for the swimmer to have the injury evaluated for treatment. In general, it is easier to treat a sports-related injury when it is early in its course, rather than later when a tear is present.

Try Conservative Care If Tear Is Not Complete

If a swimmer suffers from a complete rotator cuff tear, then surgery is required to repair it. However, almost all rotator cuff tears in swimmers are partial tears, since they typically occur over time in degenerated structures. Partial tears can be treated with conservative care. The swimmer can choose to see a physical therapist or chiropractor with a sports medicine specialty to correct any muscle imbalances. For the swimmer this generally involves strengthening the scapular stabilizer muscles and any weak rotator cuff muscles.

Become A Bilateral Breather

If swimmers breathe more on one side than the other, depending on their individual technique, one shoulder will experience more strain than the other. This is the most critical fact as to why swimmers develop muscular imbalances, which can lead to altered forces on one shoulder, leading to shoulder pain and a potential rotator cuff tear. If the swimmer has a rotator cuff tear on one side, then one solution is to become a bilateral breather. This takes time and should not be forced or the swimmer may experience neck pain from trying to breathe to their weak side.

Sculling Is Your Friend

For the swimmer with a rotator cuff tear, the typical exercise recommendations are to “let pain be your guide.” What this means is the swimmer should not perform any exercise that causes sharp pain. If the shoulder hurts more after exercise, the pain should dissipate within two hours. If pain persists, the person did too much during exercise. One of the best exercises to rehabilitate an injured shoulder for a swimmer is sculling with hands at the sides of the body – of course avoiding sculling drills that put the hands above shoulder level. As long as there is no pain, sculling drills can help a swimmer stay active during the healing process.

Platelet Rich Plasma (PRP) Prolotherapy

If the swimmer’s rotator cuff tear occurred because of joint imbalance associated with looseness in the front of the shoulder, due to weakness in the supporting ligaments, then prolotherapy may be an option. Prolotherapy, in particular platelet rich plasma prolotherapy, is an alternative new treatment that is getting some good results with top athletes.

Ross A. Hauser, MD, 47, has completed numerous endurance swim events, in addition to five Ironman Triathlons. He received his undergraduate degree from University of Illinois. He graduated from the University of Illinois College of Medicine in Chicago and did his residency at Loyola/Hines VA in Physical Medicine and Rehabilitation. Dr. Hauser is the Medical Director of Caring Medical and Rehabilitation Services in Oak Park, Illinois