Q&A: Help! Experiencing shoulder pains when swimming

Question:

I’m just came back from my offseason and have started training again. I’m experiencing shoulder pains when I swim that I never had before. What are the possible reasons and what are the things I can do to keep it healthy for my new season?

Dr Roland Chong answers: 

Your pain sounds mechanical as it is exacerbated by swimming. There are several causes of mechanical shoulder pain ranging from those arising from the neck (cervical spine) to problems within the shoulder joint itself. The most common causes of persistent pain arising from the shoulder joint seen in triathletes include rotator cuff problems (impingement), acromioclavicular joint arthrosis(wear and tear), biceps (long head) tendonitis(inflammation)/ tendinosis(microtears) and labral (shoulder joint shock absorber) injury.

The location of the pain and association with other symptoms like loss of range of motion and clicking helps with differentiating the sources of pain. Pain on overhead activity, like those during the front crawl in swimming, suggests that impingement may be the most likely cause of your pain. Pain located at the acromioclavicular joint (protruding part at the end of the collar bone) or the long head of the biceps tendon (at the front of the shoulder joint) suggests problems there. Labral injuries often may result in sensations of instability, deep seated pain and also painful clicking.

I would recommend that if the pain is persistent and is hampering your training, a quick visit to your doctor should be considered. Also, ask yourself if the pain is affecting your daily activities like washing of hair, dressing or sleeping on your side. That suggests that the pain may be affecting your daily life in addition to your sporting lifestyle.

With a thorough history, proper physical examination and perhaps a targeted investigation, the root cause of your pain can be isolated and addressed accordingly. Often, improving the scapular (shoulder blade) stability and modification of your swimming stroke can help a lot in preventing the pain from recurring.

To reduce injuries to the shoulder joint, scapular stabilization exercises are important and can be easily done. I often recommend my patients to start by pulling their shoulder blades backwards, imagining they are trying to crack a nut between the blades. They are to hold that position for 10 seconds, doing it at least 5-6 times a day. Of course, if there is persistent pain that affects your daily life or sporting lifestyle, seeking help early at your doctor’s will help with getting back your second wind quickly.