Swimming After a Shoulder Injury
“Now that my shoulder is feeling better can I try swimming?”
This is a question that we hear frequently as physical therapists. Being a New Yorker in the summer months we want to escape the hot and humid city and go to the beach or take a dip in the pool. When these questions come up each case is reviewed on an individual basis and we look at a patient’s current symptoms and progress throughout their course of treatment. Once you have reached this stage where you are ready to try swimming there are considerations and tips to follow.
The Shoulder Joint
The shoulder is a ball and socket joint which allows freedom to move the arm in all directions. The flip side is that this also makes the shoulder joint inherently unstable, imagine a golf ball sitting on a tee. Due to this structure, the shoulder ligaments and muscles surrounding the joint must provide strength and stability. The rotator cuff muscles act to hold and control the upper extremity in place when the arm is moved to the out to the side or overhead. In addition, other scapular stabilizing muscles must act to achieve a full and controlled range of motion of the upper extremity. All of these muscles need to be strong and work in a coordinated pattern to prevent injury. Posture is also important! Tight muscles in the chest and neck can cause improper resting alignment of the shoulder and inefficient shoulder mechanics.
How should I swim?
When deciding what is the best way to swim we must look at what is the most biomechanically sound position and motion for the upper extremity given our anatomy. The four swimming styles are freestyle, backstroke, butterfly, and breaststroke. No matter which stroke is performed they all requires repetitive motions of the arms. Additionally, in freestyle and backstroke, the top of the arm bone is more likely to come into contact with archway in which the tendons aggravated by an impingement injury pass prolonging the injury. Breaststroke is typically seen as best because the arms stay under the water and there is no overhead motion while still a repetitive activity. Furthermore, freestyle, backstroke, and butterfly require the upper extremity to lift out of the water requiring greater muscle forces and putting the arm into a higher risk position as it extends behind the body. Swimming is a full body activity! The more you use your core and legs the less work will fall on the shoulder joint- this is an easy way to tailor the swim to your current needs. Do be cautious however if you have a knee injury and want to try breaststroke.
Do I still need to do my PT Exercises?
Yes, even though you have gone for a swim you must still complete your home exercise program! These exercises are designed to address the root of the problem to allow you to complete all of your daily activities pain-free and prevent your symptoms from returning. After swimming is the best time to complete exercises because doing them before can lead to fatigue and faulty mechanics of the muscles that you will need to use when swimming. It is important to also have an exercise routine to strengthen not just the rotator cuff but the muscles of the trunk and legs because swimming is a full body activity.
Listen To Your Body
The most important thing that you can do while swimming as with return to any sport or activity is to listen to your body. Remember that it is not just about what stroke you are doing but it is also your ability to maintain good form. If you are having pain while swimming then it is not the right activity for you at this time but it doesn’t mean that you won’t be able to swim again. If you do not experience pain then keep building up slowly, you are on the road to recovery!