I once had a client named Nicole, completely new to physical therapy, schedule an evaluation with me after complaining of inflammation, pain, weakness, and reduced range of motion in her shoulder. Nicole had been dealing with shoulder pain for months and was finally willing to give physical therapy a try. After a thorough examination, I told her she was suffering from swimmer’s shoulder. “Doc,” she replied, “that’s not possible. I don’t even know how to swim!”
While her response was amusing, the pain associated with swimmer’s shoulder is no laughing matter. Medically known as shoulder impingement, swimmer’s shoulder is a condition that causes persistent discomfort from even the most basic activities. I’ve seen clients unable to perform everyday simple activities like scratch their back, shower, reach into a cabinet for a plate or glass, or even put on their jacket thanks to this impinging swimmer’s shoulder.
But why does shoulder impingement happen in the first place? What are the exact symptoms? And is physical therapy the answer? (Spoiler – it is!). Let’s read on a bit more to learn together, shall we?
What Exactly IS Shoulder Impingement Syndrome (a.k.a. Swimmer’s Shoulder)?
Your shoulder is made of a complex group of joints, muscles, tendons, and bones. It allows your shoulder to move in a variety of ways. But beware…. because of these many parts, and all the ways they can move, your shoulder is susceptible to a variety of injuries.
And one of the most common injuries is shoulder impingement syndrome, which is thought to be the cause of 44% to 65% of all shoulder pain complaints in some shape or form. How does this happen? Well, in the shoulder, which is a ball and socket joint, there is a small space for things such as tendons and bursae that run in between the “ball” and the “socket” portions. If the space is decreased due to inflammation, inappropriate mechanics, or posture, and/or overuse, a “pinching” sensation appears, leading to pain and difficulty with normal arm use.
How Do I Know If The Pain I’m Suffering from Is Shoulder Impingement?
There are several telltale signs that indicate if someone is suffering from shoulder impingement. The major things to lookout for are:
Pain when using your arms overhead, like when trying tob something off a shelf
Pain when reaching behind your back, like reaching into a back pocket or trying to scratch an itch on your back
Pain that moves from the front of the shoulder to the side of the arm
Pain or achiness at night, which affects your ability to sleep, regardless of sleep position.
If you’re experiencing any of the discomfort mentioned above, chances are you may have Swimmer’s Shoulder.
Common Misconceptions About Shoulder Impingement….
Over the 10 years of being a Doctor of Physical Therapy, and even more years of working with athletes with shoulder issues as an Athletic Trainer, I’ve had hundreds of clients come to me suffering from shoulder impingement. And believe it or not, Nicole, who I mentioned above at the beginning of the blog, was not the first to hold a mistaken belief about shoulder impingement syndrome. Here is a list of a few of the misconceptions I’d like to dispel about swimmer’s shoulder.
Misconception #1: You need to be an athlete to develop it…..
WRONG: While shoulder impingement syndrome does commonly affect people who engage in athletic activities, such as swimming (hence the name), weightlifting, baseball, tennis, and other overhead athletics, anyone can develop the syndrome if he/she does repetitive overhead arm movements or heavy lifting. For example, if you’re in an occupation that’s more susceptible to raising your arms frequently, such as those in construction, then you’re at risk of developing the condition. Seriously, even office workers who sustain postures for extended periods of time at their desk can develop shoulder impingement as well.
Other risk factors for shoulder impingement include advanced age and people with previous shoulder injuries, such as a dislocation. So it’s not only swimmers, and not only athletes, who can develop it.
Misconception #2: Anti-inflammatory pills are all that’s needed for the pain…..
WRONG: If I said it before, I’ll say it again - you SHOULD be treating the condition itself as opposed to the symptoms exclusively. Aspirin, naproxen, ibuprofen, and other oral anti-inflammatory pills are some of the most common ways that people treat shoulder impingement. And while they do help, you’ll have to take these types of medications for around eight weeks if you want it to be effective. And even still, you won’t get the results you want unless you’re consistent with your usage (not to mention the irritation these medications will cause to your stomach).
While taking these pills for a few days might relieve your pain, it won’t deal with the underlying problem which can be a variety of things as mentioned below (keep reading) — meaning the symptoms will eventually come back.
Other people may think that they simply rely on a cortisone shot to deal with the pain. As I spoke about in my blog earlier this year, there are MANY unwelcomed side effects associated with cortisone shots. From mood swings to potential nerve and joint damage, cortisone shots are a risky band-aid to bank on. And just like anti-inflammatory pills, you’re not fixing the problem.
Misconception #3: The pain isn’t THAT bad, I’ll just deal with the inconvenience….
WRONG: As with most injuries, diagnosing shoulder impingement early on is important, as treatment can help prevent symptoms from getting worse. And trust me - shoulder impingement symptoms CAN become quite severe, limiting an individual's ability to participate in most daily activities. Without trying to seem too dramatic, research shows that without proper treatment, shoulder impingement syndrome can lead to an actual and gradual tear or rupture of the rotator cuff if left for long enough.
Bear in mind - some tears are not repairable due to the size and/or age of the tear, and may necessitate reverse shoulder replacement, tendon transfer, or a debridement of scar tissue without repair or the rotator cuff or bicep tendon involved. Rather than back yourself into a corner, of having no choice but undergo surgery, the resounding answer given by medical professionals on handling swimmer’s shoulder is…you guess it….Physical Therapy!
Is Physical Therapy Really the Answer to Swimmer’s Shoulder?
In a simple word, yes! Shoulder impingement usually responds well to physical therapy, which uses guided and specific exercises under the appropriate load to rebuild strength, range of motion, and stability to your shoulder and shoulder girdle. Research has demonstrated that 10 weeks or more of physical therapy both improved function and reduced pain in people with shoulder impingement. The duration of healing will vary, however, depending on the individual case (i.e., just like most injuries, a person’s age and overall fitness will play into how quickly they can recover).
Your physical therapy sessions will likely focus on the muscles in your shoulder, arm, upper back, and chest, which can help to improve the function of your rotator cuff. If you’re an athlete or work in a field that requires frequent use of your shoulder, your physical therapist can teach you proper techniques to reduce your chance of recurrence. They may also give you some exercises that you can do at home, which may help you recover faster. Just make sure you don’t overdo it.
Through guided and specific strengthening exercises, effective stretches and manual therapy, physical therapists can help athletes not only recover from shoulder impingement, but also prevent future injury. Doctors of Physical Therapy will also provide the necessary education, such as tips for better form, to facilitate future success in your sport. Physical therapy can also improve range of motion and flexibility, two factors that impact your performance.
Also, keep in mind that no amount of stretching and strengthening will help you if you overcome the pain associated with shoulder impingement if you don’t know how to apply the gains you make to your daily activities and habits. As a Doctor of Physical Therapy, I will be able to identify little nuances in your daily movements and posture that you don’t realize are aggravating your shoulder. Plus, certain lifestyle choices such as poor diet, little exercise, stress, and poor sleep can also be discussed and addressed as needed. Making sure your recovery is functional and related to your actual daily life will make it easier to stay on track, heal well, and hopefully prevent future issues.
So there you have it folks. If you have questions about any shoulder pain you are dealing with, please let us know! We would love to assist in any way to make sure you stay active and healthy. To learn more or speak with a Doctor of Physical Therapy, please give us a call at 516-387-4669. You can always email me as well at rberghorn@ascentphysicaltherapyny.com. And if you would like to follow us along as we present more information about different topics related to endurance athletics, please give us a follow on Instagram.