The Problem with the Shoulder: A Swimmer’s Bane
Swimming as a sport has been a field which grew exponentially in its audience and skill of the athletes. Starting its competitive debut in Britain 1830, it only took until 1896 until it was an official game in the Olympics. Not much was known of swimming back then besides a basic understanding of how to stay afloat and propel yourself forward. There was no exact efficient technique, and many of the swimmers at the time couldn’t compare marginally close to the athletes now. Strokes have changed, techniques were formed, and science-based studies were performed to understand the perfect way to get from point A to B while in the water. While our training and teachings have improved greatly, our knowledge of the physical toll it has on the body and how to heal it has only just begun to be studied closely.
Shoulder pain is the most common injury in swimming- period. It is the most complained about among swimmers and almost every swimmer knows of it personally or known of another who struggled through it. From swimmers starting at a young age and into an elite level of their sport, as many as 90% of them will complain of shoulder pain throughout their career. While this number is already high, as many as 60% will be injured where exercise must be decreased to allow healing. While every sport comes with its own form of injuries, it is a staggering amount, and as seen from the percentage, not treated for in a proper manner nor taken seriously as it should. Many swimmers are convinced that a painful shoulder is normal to have because all most all swimmers experience it. So these poorly informed athletes swim through the pain, some for years, causing more damage to their shoulders. This is an issue among the sport that still hasn’t been solved and needs to have a heavier focus in and treated promptly. Not all shoulder injuries are the same, and, as such, not all can be treated the same, which is it must have a better understanding of by swimmers and coaches.
Technique is an important part of swimming and is considered to be the most important in competitive swimming. In swimming, there are many strokes; butterfly, breaststroke, backstroke, and freestyle. All strokes involve the shoulders to a high degree, and, as such, improper execution of a stroke can lead to shoulder injuries.
Freestyle is the most recognized stroke around the world. Floating on one’s stomach, the swimmer moves their arms just above the water before scooping downwards and back to the hip. As one is pulling the water, they’re also rotating their body side to side. This rotation swings the arms causing major inner rotation inside the shoulder joint leading to injury.
In figure A, you can see a swimmer lying flat on the ground showcasing how many people perform freestyle. His elbow is pointed straight upwards and his forearm down causing stress on his rotator cuff. Not only that, but he is leading with his hands instead of his elbows which causes restricted movement of his rotator cuff. When this swimmer pulls water, they’re forcing their arms downwards making their shoulders do all the work. Above all, the most crucial observation of the swimmer is that they are not rotating. A rotating body forces the swimmer to pull with their latissimus dorsi, a muscle that aids in the internal rotation of the shoulder joint. Pulling wit this muscle relieves the shoulder of so much stress. In figure B, a swimmer with perfect form is seen. He is on his side, rotating by using his hips. A key note in this picture is that he is leading his stroke with his elbow. Doing this movement causes the shoulder to be in a neutral position also relieving the shoulder of stress. There are many other factors in freestyle that prevent shoulder injuries, but these are the most common and frequent. Other factors involve; hand placement, not going thumb first in the water; how you pull the water, not letting your elbow point downwards under the water; and posture, making sure your body is align correctly.
How does this all relate to shoulder injury anatomically? Over long periods of time, swimmers develop increased laxity of the glenohumeral joint and ligaments. These joints and ligaments stabilize the muscle while being supported by the rotator cuff. An increase in laxity is then needed to be compensated by a stronger rotator cuff, as the laxity causes the joints to be weaker since they are stretched longer. Swimming with imperfect form stated above causes great stress on the glenohumeral joint furthering its weakness and the rotator cuff overworks becoming damaged.
The shoulder is the most mobile joint in the body with the ability to maneuver 360° from the point in which it’s attached to the body called the sagittal plane. Its movements are important as it allows adduction, abduction, flexion, extension, internal rotation, external rotation, scapular protraction, retraction, elevation, and depression. What is noticed here is its simple movements being governed by intricate and complex mechanics and structures within its anatomy.
When figuring out where to start in discussing the anatomy of the shoulder, the articulations are the most logical place to start. An articulation, or joint, is the area of contact between bones or between bones and muscle. There are three articulations of the shoulder: the Sternoclavicular joint, the Acromioclavicular joint, and the Glenohumeral joint. These three joints are what give the shoulder the tremendous amount of mobility it has.
The Glenohumeral joint is the most distinctive of the three articulations and is considered to be the main joint. This multiaxial ball-and-socket synovial joint, giving it the capability of 360° of motion, is formed by the glenoid cavity and the humerus head. The humerus head is the proximal articular surface of the humerus, meaning the top part of your arm bone connecting to your shoulder. There, the head humerus nests in a shallow articulation of the glenoid cavity, barely touching it. The glenoid cavity is oval shaped and located on the outermost area of the lateral angle of the scapula. Surrounding the glenoid cavity is the labrum, a ring composed of dense fibrous tissue that increases the depth of articulation between the cavity and the head humerus, though its increase in depth doesn’t correlate to an increase in mobility.
The scapula, a triangular-shaped bone, is the main site where muscle attachment occurs. The rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) and the trapezius, serratus anterior, rhomboids, and levator scapulae insert on the scapula. These muscles together create mobility and stability in the scapular bone, as the shoulder is rendered vulnerable with its high range of mobility. The scapula itself has 4 processes, the spine, the acromion, the coracoid, and the glenoid. The spine is the vertebral column, the glenoid has been discussed, the coracoid is a projection of the shoulder connecting to the biceps, and the acromion is a process on the scapula that runs laterally over the shoulder joint.
The Sternoclavicular joint connects between the axial skeleton, the bones of the head and trunk of a vertebrae, and the upper extremity. It’s the second most mobility giving joint to the shoulder, behind the Glenohumeral joint, and aids in anteroposterior movement and movement along the clavicle.
The Acromioclavicular joint is formed by distal clavicle connected with the acromion of the scapula, creating an articulation between the clavicle and scapula. Held together by trapezoid and conoid ligaments, this joint gives little to no motion to the shoulder.
Many of us know the clavicle, an s-shaped bone neighboring our shoulder. The bone itself protects the subclavian artery, subclavian vein, and brachial plexus posteriorly and inferiorly, and creates an articulation between the axial skeleton a
nd the upper extremity. In
terms of how it affects the shoulder it’s an important connection between the Acromioclavicular joint and the Sternoclavicular joint.
Ligaments are a vital part of the shoulder, damage to them can cause complete intrusion with shoulder mobility. Ligaments themselves are bands of tough, fibrous tissue that connects two bones (almost like joints), cartilages, or even holding joints themselves together. 3 ligaments play a large role inside and around the shoulder: the Coracoclavicular, the Glenohumeral, and the Coracohumeral.
Ironically enough, the Glenohumeral ligament is actually comprised of 3 more ligaments; the superior glenohumeral ligament (SGHL), inserted on the humerus near the lesser tubercle protecting against inferior translation of the humeral head in the adducted shoulder; the middle glenohumeral ligament (MGHL), spawns from the labrum and inserts on the humerus medial to the lesser tubercle; and the inferior glenohumeral ligament (IGHL), again, originating from the labrum and the glenoid neck, inserting itself on the neck of the humerus, and protects against humeral head anterior and posterior translation.
Coracohumeral starts from the previously mentioned scapula process, coracoid, and inserts on the greater tubercle. It has two bands which connect itself to the greater tubercle of the humerus. The ligament itself strengthens the shoulder joint, but not much is known about it.
Coracoclavicular are made up of the conoid and trapezoid ligaments, your deltoids (behind shoulders) and traps (right beside the neck on top of the shoulder). It keeps the articulate of the clavicle and the coracoid process of the scalpula.
A torn rotator cuff is infamous in the swimming world and many shoulder injuries are damaged rotator cuffs. The rotator cuff is made up of a group of muscles; supraspinatus, infraspinatus, teres minor, and subscapularis muscles. The muscle form a protective shield that envelopes the humeral head and glenoid cavity. This then aids in giving the shoulder more mobility.
Last, but not least, the subacromial, back again where the deltoids are located but the lower portion of it. Located on the superior aspect of the supraspinatus tendon, it lessens friction during motion between the overlying bone of the acromion and the soft rotator cuff muscles, and it creates a cushion effect.
Shoulder pain is taxing on the swimming community but not taken as seriously as it should. In a tactic to raise awareness to this, a case study of two-hundred and fifty-seven swimmers who raced in the Brazilian Swimming Championship were questioned on the subject. The conclusion of this studied showed that 20% of the swimmers there stated that they currently had shoulder pain. More surprising was that 60% of the swimmers said they have had shoulder issues throughout their lives from swimming. Shoulder pain is indeed a problem with a prevalence such as that.
To showcase how prevalent these injuries were, in observational study done by a shoulder surgeon, 14 elite swimmers were presented to him and studied for over 6 years. The swimmers themselves had to have no operations done 6 months prior to the referral to the doctor. The swimmers were elites but came from different competing backgrounds; international competitors, club teams, and Paralympic teams. All of them majored in different strokes and varied with gender and age. After being observed and running diagnoses using computed tomography (CT) scans or magnetic resonance imagings (MRI), the surgeon concluded that four swimmers had subacromial impingement syndrome, three with internal impingement, five with labral tears, and some of the had a mix of these. The description of each of these injuries will be described later.
Seeing how shoulder injuries affect swimmers over, the need to develop a program preventing it arose. 236 competitive female swimmers of ages 8 to 77 years who filed out the Penn Shoulder Score and went through tests of core endurance, range of motion, muscle force production, and pectoralis minor muscle length and the Scapular Dyskinesis Test. The Penn Shoulder Score is a test filled out by a subject measuring shoulder pain, satisfaction, and function. The Scapular Dyskinesis Test is done by a physician determining if a patient has a deviation in the normal resting or active position of the scapula. 49 of the studied women, spread among many ages, had shoulder pain and disability. Because of their injuries, the affected women had many symptoms; decreased core endurance, reduced motion in shoulder flexion, weakness in internal shoulder rotation, and shorter latissimus. But the importance of this study was how it affected the swimmers’ lives. Many of retired swimmers weren’t able to participate in other sports or do certain activities throughout their lives. Not only does this affect a person’s activity, but their emotional state if one is accustomed to an active lifestyle. In the end, this article was a great portrayal of the need to create more programs preventing injuries and treating injured swimmers.
Typically when a swimmer experiences muscle pain or a shoulder injury, they label it swimmer’s shoulder unanimously. However, not every shoulder injury is the same and swimmer’s shoulder is only one of the many kinds of injuries a swimmer can sustain. This lack of understanding is usually followed by false treatments for the real issue. A swimmer can have perfect technique but still have a shoulder injury, so it’s important to learn the most common ones.
While fatigue isn’t an injury on the shoulder itself, it leads to complications. Swimmers are always fatigued throughout a whole practice. They are never not moving and when they stop it is only for a maximum for 5-10 seconds depending on the training. In a study done on 17 national level swimmers, studiers tried to find a correlation between fatigue and range of motion and joint control. Do induce a state of fatigue, they had the subjects swim 100m at their fastest pace 10 times. Once they measured their blood glucose and oxygen levels to agree that they were tired, they studied their joints and movements. What they found was they swam with shorter stroke lengths, a reduction in external rotation of the shoulder joint, and a change in the joint’s positon. Reduction in stroke lengths rotation leads to improper form, and then into injuries. With a 6-7 day training regiment, the probability that a swimmer’s shoulder will become injured is greatly increased due to the fatigue, as technique is everything.
Swimmer’s shoulder has many names; shoulder impingement, tennis shoulder, shoulder bone spur. In a group of 137 elite swimmers, 58 of them had symptoms of swimmer’s shoulder. Keep in mind that these elite athletes have exceptionally strong bodies, so the percentage of regular swimmers having this injury increases. Frequent in freestylers at most, this injury causes inflammation of the muscles and ligaments inside of the shoulder. The muscles affected are the subscapularis muscles, the supraspinatus muscle, and the deltoid muscle. Beside these muscles are the tendons affected; the subscapularis, supraspinatus, teres minor, and infraspinatus tendons. Many swimmers will feel an ache, the more severe cases can’t even lift their shoulders. As stated earlier, the shoulder is a ball and socket joint, glenohumeral joint, fit into a deepened crevice, the glenoid cavity, surrounded by the labrum. Overworking the muscles surrounding the glenohumeral joint causes inflammation in them and the labrum, pushing on the joint itself. It is also caused by the acromion grinding against the supraspinatus causing bones spurs, a protruding bone. This sometimes produces a crunching sound as there is no space between the humerus and the glenoid cavity. Basically, the tendons surrounding the rotator cuff become inflamed and irritation occurs when these tendons pass between the spaces under the acromion. If not treated, this injury wil
l most likely be a rotator
cuff tear.
There are 3 stages of shoulder impingement syndrome. The first stage is simply the hemorrhaging or bruising of the tendons, like the supraspinatus. The second stage is when reoccurring and frequent inflammations of the tendons surrounding the glenoidhumeral joint occurs. This inflammation causes the rotator cuff tendon to become thick from all the scarring it’s receiving. This increase in its volume then creates a deficit in the full range of motion of the swimmer. Bone spurs, protruding bone, develop around the acromion and narrow the spaces between the rotator cuff. More so, at stage II, the damage is irreversible through activities like stretching or creating more strength in the shoulder. The final stage, stage III, the rotator cuff tears completely and the bicep tendon rips. This stage requires surgery that is discussed later. Many patients who are diagnosed with stage III shoulder impingement syndrome develop arthritis in their joints, specifically in their shoulder affected by the tear.
Stated earlier, the rotator cuff is composed of 4 tendons and bones. These tendons are subscapularis, supraspinatus, infraspinatus, and the teres minor. The bones are the humerus and the shoulder itself, creating that “ball and socket joint”. There are three ways a rotator cuff can occur. An alarming 75% of rotator cuff tears are caused by swimmer’s shoulder. This portrays how easily it is to lead into such a shoulder-damaging situation since many swimmers have shoulder impingement syndrome. This is caused by the acromion pressing up against the tendons, wearing them down. If the situations worsens, the bicep tendon along the humerus head can become severed. The next two causes are; shoulder instability, very common in active patients; and trauma, a blow to the shoulder causing a fracture of some sort.
What’s interesting about rotator cuff tears is that many people have different shaped acromions. Depending on one’s type, I can increase or decrease your risk of rotator cuff tears. There are three types; flat acromion, curved acromion, and hooked acromion. These types are confirmed with an X-Ray or MRI. Hooked acromions account for 70% of rotator cuff tear, while a flat acromion accounts for only 3%. Because of its shape, the hooked acromion is in a more vulnerable position while grinding against the tendons.
The more serious side of swimmer’s shoulder is a labrum tear, AKA labral tear or internal impingement, like what occurred with the five swimmers studied by the shoulder surgeon. The constant stress laid upon the labrum from swimmer’s shoulder eventually develops into this. In order to diagnose a labrum tear, a CT or MRI will be done on the area in question. There are different kinds of labrum tears as the ripping can happen on the superior or inferior of the glenoid cavity where it resides. The different labral tears depending on location are labeled as SLAP or HAGL. If left untreated, labral tears can develop into bursitis.
Bursitis is another common injury in swimmers. Around the shoulder joints are the bursae, cushioning pads that reduce friction within the shoulder. There are 3 bursae within the shoulder: subcromial bursa, subdeltoid bursa, and the subcarocoid bursa, seen in figure C. Bursitis is the inflammation of these pads from irritation of excessive movements, and in swimming, the shoulder is in a constant repetitive motion enabling this. Not only does it cause pain, but the inflammation of these pads lessens the room for the rotator cuff to move freely, inhibiting a swimmer’s performance. As stated earlier, many swimmers will swim through this pain, furthering complications.
Diagnosing these ailments are tricky as swimmers avoid help. Of course, if pain is experienced and hasn’t healed over time, help should be sought for immediately. Minor injuries, like swimmer’s shoulder, can be remedied by taking a break from swimming or a lot of anti-inflammatory medication. Major shoulder issues can lead a swimmer into surgery.
A collegiate Division I female athlete, 19, with shoulder pain that had been occurring for over 3 years, consulted with her primary care doctor during her junior year of high school. The doctor stated it was just “swimmer’s shoulder” and prescribed her anti-inflammatory pills and nonsteroidal injections for 6 weeks. With her pain only improving minimally, she had to discontinue her competitive swimming. She later was given subacromial corticosteroid injections and stayed out of the water for 2 months. Returning to swimming, her pain completely returned, hindering her performance again. She ultimately decided to have X-Rays done and found she had an os acromiale in her shoulder. Os acromiale is the failure of growth plates, ossifications centers, to fuse around the acromion and scapula. This could possibly be a direct effect of swimming, one could argue that the persistent stress placed on the joints, muscles, and bones, could have hindered that developmental stage of her shoulder. In the end, it wasn’t swimmer’s shoulder, but it showcases the point that coaches and doctors are ill-informed about shoulder issues in swimmers.
When the shoulder injury is at a very serious stage (inability to move arm, extreme pain or discomfort), surgery is sought out. Many injuries gained from swimming can end in such a way, but labral tears are more likely to lead to surgery. A labral tear is an abrasion or cut of the labral. The labral is between the humeral head and glenoid. The tear itself can be caused by repetitive movements like in swimming. There are two kinds of labral tears: SLAP and HAGL (or Bankart tears).
SLAP injuries, or Superior Labrum from Anterior to Posterior (meaning from front to back), are the most common in swimming. Bankart tears are usually caused when shoulder dislocation occurs, which rarely happens in swimming. Swimmers who have a SLAP injury feel extreme pain and discomfort where their bicep tendon connects to the shoulder. Sometimes patients report their shoulders feeling like they’re “locking up” and can’t move them. If minor, icing of the painful region, accompanied with anti-inflammatory medications and less exercise, usually does the trick. But, if the tear is severe, then surgery will have to be done.
The first step of fixing an ailment medically is to diagnose what is occurring. The confirmation of a SLAP is by receiving a physical exam coupled with an MRI or X-Ray. From here, they can see the severity of the situation and classify the tear into 4 types; type I, II, III, and IV. From these different degrees of tears, arthroscopic surgery is conducted.
Arthroscopic surgery is a specific procedure on the shoulder that allows for a complete, direct visual of the shoulder joint. What makes it special is how small the incisions are (2-3 cuts), making it a minimal invasive surgery allowing faster healing times. Arthroscopic surgery is actually the main surgery conducted on shoulder injuries related to swimming. Rotator cuff tears, swimmer’s shoulder, and others are all done this way. During surgery, after the first few incisions are made while the patient is under anesthesia, a fiber optic camera is inserted. This creates that direct view of the glenohumeral joint talked about earlier. What is done during the procedure depends on which of the 4 types of SLAP tears currently experienced by the patient.
Type I is the most common of all SLAP tears and accounts for almost half of all instances. It is the damage of the superior labrum. Sometimes with SLAP tears, the bicep tendon connecting to the shoulder becomes detached as well, but that is leading into the more severe types. Common with rotator cuff tears, this one is the most minor in damage to the labrum. Because of its minimal status of danger, it is usually solved with physical therapy and anti-inflammatory drugs. When all else fails, the surgery conducted is composed of removing the damaged tissue.
Type II i
nvolves the bicep tendon.
In this form of injury, the top part of the bicep connecting to the supraglenoid tubercle is torn. The tendons surrounding the area, the long head of the bicep, supraspinatus, and subscapularis, connecting to the humerus, become unstable. The surgeon will perform arthroscopic surgery, cutting small incisions around the labrum, and make an assessment of how to fix the situation. They will either remove damaged tissue, or stitches will be placed to reattach the torn areas.
Type III is when the top of the labrum tears and pulls over like a “bucket handle”. In this tear, many patients will complain of a popping or pulling sensation within their shoulder. Surgery with this issue is the same as the past few, but stitches are more commonly used. In some cases of SLAP tears this severe, the bicep tendon connecting towards the labrum needs to be severed to then stitch and create tension between the two.
Type IV is the most severe of the SLAP tears. It is a vertical tear of the labrum that, again, creates a bucket-handle-like formation due to the cut. This vertical tear extends to the biceps and causes the bicep tendons to not be anchored. Anchoring points of tendons are where they connect with bones and other muscles. This lack of anchor creates an inability for stability of the tendon. During surgery, the labrum is reattached with stitches and bicep tendonesis is performed. Bicep tenodesis is the reattachment of the bicep tendon’s anchoring points.
After surgery comes the stages of recovery. 2-3 weeks after surgery, the patient’s effected arm is placed in a sling relinquishing any movement of the shoulder. This allows the labrum to repair efficiently. Afterwards, physical therapy is coordinated by the surgeon. These involve exercises and stretches that strengthen the inner part of the shoulder around the glenohumeral joint. The exercises are composed of the same ones discussed earlier. In total, within 3-4 months the patient, in this case an athlete, can return to their sport. One can see why a highly competitive individual might not seek help in fear of the time taken away from their sport.
As stated earlier, no matter all the precautions a swimmer takes, they can still develop complications with their shoulders. However, this does not mean precautions shouldn’t be taken. There are exercises and thoughts to keep in mind during swimming that will aid in the prevention of swimming injuries. These exercises and tips will indeed help in prevention and healing of the shoulders. Shoulder-isolated exercises are the best of the mix and any overhead athlete should be involved in such.
Dryland references to exercises beneficial to swimming but outside of the water. Many elite swim teams do include dryland outside of their regular training regiment, but these are mostly ab exercises and weight training involving the back muscles. In an attempt to portray a relationship between muscle strength and muscle soreness, a case study was done involving a group of 21 swimmers. Two groups, one control and one experimental, were created with these individuals. In the control, the swimmers went on through their regular training, while the experimental group were involved in shoulder-based exercises in addition to their swimming regiment. These exercises would increase shoulder strength and further scapular stabilization and joint mobility.
There are many exercises that increase the strength of one’s shoulders, but swimmers do specific training which improves swimming, of course. For instance, a swimmer would not be doing heavy weighted exercises like the shoulder-press, mainly to prevent injury, but also because that movement is nowhere near replicated during swimming. Instead, swimmers will do exercises with minimal weight resistance, usually using only their body weight, and ones that also stretch the muscles as well as build them. With this in mind, bands, made of rubber, are used to create resistance while doing specific movements that work the shoulders internally. The bands were mostly used in the case study with the 21 swimmers as seen in figure A. Also heavily used along the bands are mobilization exercises which exercise the joints and scapular directly.
The use of resistance bands are the most common out-of-water exercises swimmers do to date. Their ability to stretch the tendons around the glenohumeral joint and relieve shoulder aches quickly increased their popularity to the point that every pool deck has them. There are many exercises able to be done with bands. For shoulder aids, the internal and external rotation exercises are the most important, but outwards pulls are also very useful.
From figure B, one can see the resistance band exercise for external rotation. Linking a band to a pole, the participant stands parallel to the pole but facing perpendicular to it. Using the arm farthest from the pole and holding the other end of the band, they will have their humerus point directly to the floor and their forearm positioned forward. When done correctly, the arm will create a 90 degree angle. Holding the band, the participant will turn their elbow outwards, like in the figure, exercising the shoulder. Doing this exercise trains the tendons surrounding one’s rotator cuff. This is a stabilization exercise and will help to prevent irritation of the tendons.
Opposite the external rotation, is the internal rotation exercise, and can be seen in figure C. The formation of this exercise is very similar to the first, what differs is the motion. Linking a band to a pole, stand parallel and face perpendicular. Instead of the arm farther from the pole, use the arm closest. Position the arm like in part A of the figure, and then bend the elbow, pulling the band inwards toward the shoulder. This works the internal rotation of the shoulder, preventing repetitive movements from creating issues.
Back to the 21 swimmers, the experimental group participating in the extra shoulder strength exercises concluded with promising results. Using an ANOVA, analysis of variance, comparing the two groups, the experimental group’s external rotation of the shoulders increased greatly in relation to the control group. However, the soreness of their shoulders after working out did not decrease, but soreness isn’t a debilitating trait and it’s a normal, healthy symptom to have as muscles are building in strength and size.
While the exercises used on the swimmers in the last study was useful, they are not the only beneficial workouts athletes can do to prevent shoulder issues. Focused movements using weights, without the resistance bands, increase scapular stabilization, and joint mobility. Also, the exercises don’t have to be on the shoulder in order to increase injury prevention of the shoulder. Training that enhances posture will behoove a swimmer in the water preventing injuries. While take precautions is necessary, what is most important is the swimmer finding care before an injury worsens.
While take precautions is necessary, what is most important is the swimmer finding care before an injury worsens. Eric Mitchell, a former Division I swimmer, did what many swimmers do and hid his injuries. Swimming competitively for 8 years, the now swim coach was diagnosed with a labrum tear in his left shoulder. It was state that, due to his high volume training, overuse of the shoulder caused the tear. Going into surgery, the doctors stated that he had a 50/50 chance of making a full recovery from surgery (arthroscopic surgery wasn’t has high-tech as it is now). His full recovery meant that he would still be able to perform at 100% of the same caliber as before surgery. However, if it didn’t go as planned, his shoulder’s strength and range of motion would have been hindered greatly. Because of his competitions and need to qualify for universities looking for specific standards, Mitchell decided not to go through with the surgery, and hid it from his physical trainers throughout his high
school years.
His regiment for healing is what is usually given by coaches. He still had to make 2-3 hours of swimming a day, but instead had to lay off of arm usages during swimming. His main exercises were just kicking sets in the water. He was then informed to take up to 6 ibuprofen, an anti-inflammatory medication, a day. He started developing scar tissue and the inflammation of his tendons surrounding the glenoidhumeral joint needed to be relieved. The many blunt forces of pressure was applied to create a more full range of motion to be obtained. While this is an effective technique, it only really helps if it was a smaller scale problem like shoulder impingement syndrome. His full labrum tear needed complete surgery done on it.
After high school, Eric Mitchell was accepted into Old Dominion University. He performed at the same intensity as before, maybe even harder, and continued having shoulder issues. The pain of the shoulder became so debilitating at times that swimming was impossible for a short period. Eventually, after graduating and being 10 years into his injury, arthroscopic surgery was at a new level. Surgery was performed and full range of motion and strength was conserved in his shoulder.
While shoulder injuries are frequent and almost unavoidable, there are clearly way to mitigate and treat the problem before and after in a quick and easy manner. Swimmers and, especially, coaches should be more mindful of their bodies, not just for competitive reasons, but for an obligation to one’s own well-being. They must be informed, taught, and be recommended that they pass on such knowledge for new generations. The quality of surges has increased so much in just the past decade that it outweighs the negatively highly, with the possibility of having no negative affects post-surgery being completely in the patient’s favor. This is simply seen from Eric Mitchell’s case in which 10 years prior he had a 50/50 chance of his shoulder having complications after surgery. Swimmers are known for their longevity of their careers, take Micheal Phelps for example, and want to continue to pay no mind to a small pain in their shoulder, seeking no help. Many swimmers are deterred from such help as it might pull them away from races, but in the long run of their careers and future health, it is their best possible option to take.