Ow! Shoulders & Swimming
May 11, 2005 12:30 PM   Subscribe

What's wrong with my shoulder? Or: How can I tell the difference between normal muscle soreness and incipient injury?

I started swimming with a Masters swim team in January. I do 6000 to 8000 yards a week. In March, I hit the water funny doing a start and the next time I swam I had some pain in the "front of the armpit" muscle. I stopped swimming, did some heat and ibuprofin, went back a few days later, and that same muscle never hurt again.

However, my shoulder still gets sore, mostly the muscle that connects my neck to the top of my shoulder and along the inside of my shoulder blade. This tends to happen after I finish working out, but sometimes I'll get sore towards the end of a workout. How can I tell if I'm hurting myself through bad technique or not giving myself enough time to heal, or if it's just normal soreness due to getting those muscles in shape?

Some other facts:
* It's my nondominant side.
* It's the arm I use for open turns, which means it gets used more.
* If I skip heat for a day or two, it begins to feel tight.
* It is definitely less flexible than my other shoulder--when I stretch I feel it more.
* It's sorer today than it has ever been. Last night, by the end of the workout, both my shoulder and elbow hurt it a bit. Coincidentally, we swam pretty hard and fast, which meant lots of very snappy open turns. I hope that means it's just normal soreness & that I should work on flip turns and thereby solve the exacerbation situation.

If I had healthcare, I would ask a doctor. But I don't. And I want to keep swimming! Any insights?
posted by dame to Health & Fitness (15 answers total) 1 user marked this as a favorite
Does it hurt when you raise your hand over your head?
posted by konolia at 12:43 PM on May 11, 2005

Response by poster: No.
posted by dame at 12:46 PM on May 11, 2005

Curiously enough, there are professionals out there that can diagnose this very thing. They are called "doctors".
posted by xmutex at 12:47 PM on May 11, 2005

xmutex, note the very last line.
posted by stavrogin at 12:54 PM on May 11, 2005

I think you have an injury on low simmer. (I think your hitting-the-water injury is probably unrelated, although it may have prompted what's going on.)

If you were equally sore (or mostly equally, since you use that arm more), I'd say it was normal muscle building owies. But the fact that your shoulder is tight, stiffer than the other, requires heat on a regular basis, and your elbow started bothering you (yikes!), means that you've got something unusual going on. I don't know if it's tendonitis or a small connective tissue tear or what, but it does not sound good.

I recommend taking a four week break from swimming (I know that's a long time, but those connective tissues/tendons take a long time to heal) and allow your body to heal. After that, I'd start again slowly, and work on your form intensively. If the same problem comes back, consult a sports massage therapist.

If you keep going on the way you are, you may run the risk of damaging your shoulder beyond a heal-itself point.

Incidentally, have you had any tingling or numbness anywhere (neck, shoulder, arm, fingers) on either side?
posted by Specklet at 12:59 PM on May 11, 2005

Best answer: Pain is a gift; If you doubt this, look into leprosy. It is telling you to back off. If you don't you will turn a minor injury into a long-term chronic ailment. If the soreness continues even after you have warmed up, you definitely aren't doing yourself any favors by continuing.

Be careful with heat, I very rarely use it to treat injury, and then only well after the fact. In general you are better off icing it immediately after causing the injury. Also be careful with ibuprofen. While it can reduce the severity of an injury by controlling inflammation, it also inhibits the healing response. If you are not trying to control swelling, you are better off going easy on the NSAIDs and listening to your body. Cox-2 Inhibitors (Vioxx, Celebdex) are better than Cox-1 (Ibuprofen, Naproxen) but increase the incidence of heart problems.

Once you give it some time to heal, there are several things you can do to prevent reinjury. Flexibility is always good. Resistance training of the shoulder (weights) esp. rotator cuff exercises are essential for any sport that makes heavy use of the shoulder. The Theracane is an excellent self-massage device that can help with shoulder and back trouble spots.
posted by Manjusri at 1:00 PM on May 11, 2005

Response by poster: Incidentally, have you had any tingling or numbness anywhere (neck, shoulder, arm, fingers) on either side?


If the soreness continues even after you have warmed up, you definitely aren't doing yourself any favors by continuing.

That's the thing: it only hurts after except yesterday, when it hurt a bit at the very end. And it doesn't hurt equally bad every time.
posted by dame at 1:07 PM on May 11, 2005

Good point about the heat, Manjusri.

dame, after strenuous exercise, what you want is ice. Heat should not be used unless 24 (some say 48) hours have passed. After that, heat should be applied only for 20 minutes or less, no more than once an hour. More than that, and more blood is drawn to the muscle than it can disperse effectively, and you'll actually end up with more soreness.

When you say it's hurting afterward, do you mean the next day or two, or hour or two?
posted by Specklet at 1:12 PM on May 11, 2005

Response by poster: I swim at night, so it'll be a little sore at night and sore & tighter in the morning but not sore by the end of the next day. And it's definitely sore, not totally in pain, if that makes sense.

The heat thing was recommended to me by another swimmer, when I strained my arm on the dive. I'll use ice. Really, I'd do anything not to have to give up, even for four weeks. I want to increase my yardage in July, so I'll happily decrease it some now, but staying totally out of the pool for four weeks--it makes me want to cry just thinking about it.

Thanks, Specklet.
posted by dame at 1:20 PM on May 11, 2005

Best answer: Consider going to a physiotherapist for a diagnosis. You don't need to go to the doctor first if you don't have health coverage, and it will (I'm guessing) be cheaper than a doctor's visit (my physio sessions run me about $40 in Canada, slightly more for the first diagnosis).

You can tell the physio that you can't afford to come for a long therapy, but you need to get a diagnosis and some stretching/exercise options. This way, for a small investment, you can avoid worsening the injury and get some professional advice on how to fix it. They will be able to give you specific advice on how much ice/heat etc.

Physios are very exercise-positive, so it is unlikely they will suggest that you give up your sport, especially considering that you are not having problems during the actual exercise.
posted by carmen at 1:39 PM on May 11, 2005

If all of the pain is gone by the end of the next day, then it really doesn't sound like something to worry about. Just let pain be your guide.
posted by Manjusri at 1:47 PM on May 11, 2005

From experience I would suggest:
-stretching before you swim.
-try kicking (with a board) in the slow lane for a few practices, you may be pulling your entire weight with you arms and they may be wearing out as you increase speed and distance. A good kick can help alot.
-Take it easy - if you only started in January you are using a lot of muscles you have never used before, give them a chance to rest.
-if it hurts when you are swimming, stop, rest, stretch it. Pushing yourself too hard can be the difference between improvement and injury

I would also strongly suggest, as others have, you see a doctor and maybe suck up a few weeks a physical therapy. Tendonitis can be serious and can knock you out of the pool for a long time if you keep pushing through it.
posted by jeffe at 2:13 PM on May 11, 2005

Best answer: As much as you don't want to stop swimming, it's probably not a bad idea, at least for a short time (a week, even). Let the muscles and tendons recover and repair themselves. Don't worry about the planned July increase in yardage now: it will be more productive to slow down a bit until you're sure everything is OK.

A lot of swimming shoulder pain is caused by incorrect technique. Breathing technique is the worst culprit - torquing the head to the side to get a breath, bringing it out of alignment with the rest of the body. Your entire body should be rotating from the hips/core, enough that you are able to lay your head in the water and breathe.

This article is about managing neck pain, but the corrective technique tips definitely apply here. From the same site, here's a series of exercises to build up shoulder strength and flexibility.

Are you breathing bilaterally (both sides)? That might help you get a more balanced, even stroke.

Have you talked to the coach? Does your coach offer swimming stroke advice (not all do, unfortunately)? He or she may be able to modify your workout a bit, choosing alternatives that are less stressful on your shoulder. After a little bit of rest, try a few short workouts of almost entirely drills and very little yardage. Learn how to do flip turns and practice (or learn) backstroke, breaststroke and butterfly.

Don't think of it as a setback, think of it as an opportunity!
posted by letitrain at 2:41 PM on May 11, 2005

Response by poster: letitrain: I do breathe bilaterally, but my coach is useless. Nice, but useless. In July I'm switching programs, so that will help in the long run. I can flip turn, just not well--I'd been doing open turns on sprints to make the interval. I can do the other three strokes (well, my fly is pathetic . . .); back seems to bother it slightly, though less than free.

The physiotherapist seems like an interesting alternative to the doctor. (On that note, can people stop suggesting a doctor unless they plan to pony up the dough? This happened at a very poor time on the money front.)

So thanks everyone.
posted by dame at 3:06 PM on May 11, 2005

Well, the problem is that if it is something like impingement it won't get any better and could lead to surgery. That's why they keep harping on docs.

Get it checked by someone, if only to differentiate between soreness and a real problem.
posted by konolia at 3:47 PM on May 11, 2005

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