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Swimmer's Shoulder

Condition can be crippling later in life

SATURDAY, July 20, 2002 (HealthDayNews) -- Michael Ritter started having minor shoulder problems in his 20s. This wasn't surprising, given that he was a competitive swimmer and routinely logged 20,000 yards a week.

At first, ice and ibuprofen took care of the problem, but eventually the pain started interfering with his swimming.

About a year ago, Ritter, who is also a lifeguard, got tossed in the surf, landed on his elbow and compressed his shoulder.

"It took this kind of degenerative injury, and compounded it to a point where it was beyond dealing with it. It put me to the point where an operation was imminent," says Ritter, now 39 and a master's swim coach at Asphalt Green in New York City.

Ritter may not have put a name to it, but for the past 10 or 15 years he had been suffering from various manifestations of swimmer's shoulder, a chronic irritation of the shoulder's joints and soft tissues that is thought to affect 35 percent of swimmers.

Swimmer's shoulder is really a whole set of related conditions.

"I would characterize it as pain in the shoulder of someone who swims. I don't think there's any discrete pathological entity like tennis elbow," says Dr. Peter D. McCann, Ritter's surgeon and the director of the Insall Scott Kelly Institute for Orthopaedics and Sports Medicine at Beth Israel Medical Center in New York City.

Competitive swimmers tend to suffer from ligament problems resulting from the repetitive motion and overhead use.

"[The shoulder] can get too flexible and too loose, and that can cause pain," McCann says. A swimmer's shoulder rotates 1,200 to 1,500 times per mile, while major league baseball pitchers "only" rotate 1,000 times a week.

Recreational swimmers can run into tendon problems and rotator cuff problems if they overdo it their first time in the pool after a long, cold winter sitting in front of the TV.

Fortunately, swimmer's shoulder can be prevented.

Ease into the activity. "Stay active, but increase activities at a pace that doesn't cause pain," McCann advises. If you feel pain, that's a clear signal to stop. Often pain doesn't manifest until that night or the next day, which means you need to monitor what you do even if you're not feeling pain.

Start at 20 percent of whatever distance you want to get to, then three days later, step up your workout to 30 percent. It'll take several weeks to achieve your goal, but you'll do it without injury.

Swimming requires flexibility, so stretch before you swim. Try stretching with your hands up against a wall, or try grabbing a towel in both hands and moving it as if you were drying off your back. Yoga is also an effective way to stay flexible.

Also you should try some simple rotator-cuff exercises:

  • Put both arms straight up overhead, lean to the left side as far as possible, then to the right. Hold for 10 to 20 seconds in each position.
  • Put both arms behind your back, fingers interlaced, and slowly, steadily raise your arms upward behind you as far as possible. Hold for 10 to 20 seconds.
  • Put one arm across your body so that the shoulder is under your chin and hand, and your forearm and upper arm are parallel to the ground. Without turning your body, use your other hand to pull the arm close as close to your chest as possible. Hold for 10 to 20 seconds.

Pay attention to how you swim. A balanced body puts less load on the arms, and is that much easier on the shoulder.

While swimming, breathe to both sides. It spreads the work more equitably between the shoulders.

If you have pain that persists for 10 to 14 days, stop what you're doing and see a doctor.

Frequently, physical therapy and exercises will take care of the problem, though occasionally something more serious is needed.

Michael Ritter's surgery was successful, but he still needs to follow a strict stretching and exercise regimen. Before he had surgery, he swam the 100-yard freestyle in 50 seconds. Now he clocks in at 52 seconds. Not bad for someone whose shoulder pain used to take him right out of the water.

What To Do

For more information on shoulder problems and swimming, check out the National Institutes of Health or this article on swimmer's shoulder.

SOURCES: Peter D. McCann, M.D., director, Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, Beth Israel Medical Center, New York City; Michael Ritter, master's swim coach, Asphalt Green, New York City
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