Persistent Shoulder Pain
by Paul Hutinger

Question: What can I do to keep training when I have persistent pain in my shoulder?

Answer: You can verify rotator cuff injury by testing as follows: stand, arm against your side; bend forearm at 90; resist a force on your hand, inward and outward. A weakness in movement will indi- cate rotator cuff injury.

The most important muscles for the swimmer and the most overused involve the rotator cuff. These are a group of muscles and tendons that help hold the head of the humerus (upper arm bone) in the shallow socket in the scapula (shoulder blade). There are no strong ligaments to do the job.

The tendons of the rotator cuff pass under the bony arch of the acromion (outer tip of the shoulder). The muscles and tendons can get pinched under the acromion arch, especially with poor stroke mechanics. Other swimming injuries can occur from overwork and old injuries to the shoulder and arm.

The rotator cuff is primarily four muscles (subscapularis, infraspinatus, supraspinatus, and teres minor) and their tendons. It stabilizes the upper arm in the shoulder socket and allows a great range of motion.

Rotator cuff pain is caused by an "impingement syndrome." This is because exertion or overuse causes a compression of tendons by the shoulder bone, resulting in tears and/or inflammation. Bursa are fluid-filled sacs that protect muscles and tendons from irritation by the bone. A shoulder problem of tendinitis or bursitis may be a result.

1. Use ice before and after practice. Invest in a commercial fabric bag, cold compress, that is reusable, to keep in the freezer. Check your local drug store.

2. Change the strokes you use in training or competition. At LCM Nationals one year, I had to change from my usual fly and IM events to the three breast stroke events.

3. Use fins or zoomers for all your swim training and do more kicking. A national record holder used this approach over ten years ago. Unable to do any training because of neck and shoulder problems, she implemented fin training for the entire season. She made the switch to regular swimming several weeks before Nationals and swam some of her best times. Use more kicking­ do sets of repeats and time them. Heart rates of 150-160 (depends upon your age) or at the anaerobic threshold and VO2 race speed, for your age, should be part of your kick training.

4. Use stretching and flexibility ex- ercises to keep your range of motion.

5. Strengthen the rotator cuff with special exercises for the muscles involved. Since the rotator cuff muscles are small, you only need to use 2# to 5# weights. The emphasis should be on a high number of repeats, such as 3 sets of 25 repeats.

6. Use aspirin, ibuprofen, or naproxen as an anti-inflammatory.

7. IF THE PAIN PERSISTS, SEE YOUR PHYSICIAN. HE MAY REFER YOU TO AN RPT.. EXTREME PROBLEMS MAY REQUIRE SURGERY, AS A LAST RESORT.

Anyone wanting more info, please send a large SASE to: Dr. Paul Hutinger; 1755 Georgia Ave. NE; St. Petersburg, FL 33703 or e-mail: phut@usms.org.