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by Ross A Hauser MD

August 8, 2010

Swimmers need a delicate balance of shoulder mobility and stability in order to meet the tremendous demands of their sport. While joint hypermobility can be advantageous for the swimmer, to have good reach and range of motion in their stroke, too much laxity in the shoulder can leave it unstable. For the swimmer who has hypermobility, the simple first steps include altering training hours, working on stroke mechanics, and trying specific exercises aimed at tightening the muscular support around the shoulder. But after these are tried, and the athlete is still left with pain or instability, what is the next step? 

Step 1: Get Some Help From A Sports Medicine Specialist

A sports medicine specialist, whether a physiotherapist, chiropractor, physiatrist (this is my specialty: Physical Medicine and Rehabilitation), osteopathic or orthopedic physician, can evaluate the shoulder joint to help determine if hypermobility is the problem, or if it is anything more serious. In my experience, it is preferable for patients to seek specialists who are athletes themselves. You want to know they are as passionate about getting you back to swimming as you are. They will understand that you simply don’t want to just stop swimming. Upon consulting a specialist, it is important to find out the following:

  • What is the diagnosis?
  • Are there contributing factors to the pain that have not been considered yet?
  • Is an MRI necessary?
  • What are the treatment options?

Step 2: Address Contributing Factors To The Pain

When athletes “self-doctor,” they do not objectively consider possible contributing factors to their pain, outside of their primary sport. For swimmers with shoulder pain and instability, there are commonly overlooked shoulder stressors. For instance, athletes can aggravate shoulder pain by sleeping on their sides, or on the bad shoulders. A very commonly overlooked stressor is extended computer usage. Many of us are guilty of this one. But there is a simple fix. If you have right-sided shoulder pain and you are right-handed, you can learn to use the computer mouse with the left hand. Basically, if you have shoulder pain on your dominant side, simply switch the hand you use to control the computer mouse. This can take some getting used to. But it is a good test to see if, after a couple days, the shoulder improves.

Another contributing factor to shoulder pain, or any sports injury, is nutrition. Simple nutritional deficiencies can inhibit sports injuries from healing. The typical American diet is not conducive to good health and healing. For starters, always choose fresh food, over processed food. Do not be fooled by gimmicky fads of “low fat,” “low sodium,” or “sugar free” just to get you to buy processed food products. Eat real, fresh food to encourage strength and recovery. Lastly, sometimes athletes have hormonal imbalances that contribute to non-healing sports injuries. You can test for, and address hormonal deficiencies with your doctor.

Step 3: Is an MRI Necessary?

If it appears that the injury is severe, such as multidirectional instability, the doctor may feel it necessary to order an MRI. An MRI arthrogram (MRI with dye) may be ordered, if the doctor feels there is a chance that the shoulder labrum could be torn. Unfortunately, MRIs do not show weakened or stretched out tissues, such as ligaments. MRIs do show some tears and degenerated tissue. Typically, MRIs are reserved for athletes who have a good chance of needing surgery to resolve their sports injuries. However, even if the MRI shows a tear, it typically only has to be surgically repaired if it is a “complete” tear. Surgery is generally seen as a last resort. This and other options should be discussed with the athlete’s personal sports medicine physician to see if an MRI is needed.

Step 4: Start Treatment

Once an accurate diagnosis is made, a treatment plan can be started. For the swimmer with hypermobility, the treatment plan would be different than for the one whose shoulder pain is due to rotator cuff tendinopathy. Sometimes treatment plans are as simple as modifying an athlete’s exercise or stretching regime. Whereas sometimes contributing factors such as hormone imbalance and poor nutrition are to blame. Physicians who use osteopathic or chiropractic manipulation as a treatment modality, may recommend this type of treatment to improve shoulder function. A sports-minded physiotherapist can also shed light on improper muscle firing and other musculoskeletal imbalances that need to be corrected for optimal shoulder function.

There are a lot of options when confronted with shoulder pain and instability. When a swimmer has tried “simple” techniques to alleviate shoulder pain and hypermobility, but to no avail, ask an expert in the field. Get a diagnosis, a plan, and on the road to improvement.

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