Nearly all small talk I’ve had inevitably lead to, “so when did you decide you wanted to be a physical therapist?” I have gotten this question probably a hundred times both in and outside of work, yet I have the same answer for everyone: “I knew when I was a freshman in high school!”
I consider myself lucky that I found my passion rather early in life. I come from a family of athletes–swimmers specifically–and was regularly shuttled between sports practices about 5 to 6 nights a week. My practice schedule began with swim to soccer to basketball, then right back to swim. I w
ould eat dinner or do homework in the car just so I could continue participating in everything. I played almost every sport growing up, but the constant in my life was always swimming. And it was because of this sport I was introduced to Physical Therapy (PT) at just 14 years old.
As a whole, swimmers are not known to have the best posture in the world. The typical forward head, rounded shoulders look you see when you watch any major swim meet you will now be sure to notice more than you will notice “good posture.” You will notice this same posture in the general population as well (but that is not the topic at hand, even though many of the traits and stretches/exercises below can carry over to the general public). It is because of this posture that I found myself in PT. I was a freshman in high school and at the time and was committed to two swim practices a day plus lacrosse practice. Eventually, I began to notice pain along the side of my shoulder that would radiate mid-way down my arm. The pain was only made worse when I raised
my arms overhead.
The diagnosis: Swimmer’s Shoulder
I had the typical swimmers’ posture with overdeveloped chest musculature and underdeveloped/weaker middle of the back musculature leading to a pinching of one of the rotator cuff tendons creating the pain in my shoulder and down the arm.
The Technical Term: Upper Crossed Syndrome
This is categorized by the following tight/overdeveloped musculature and weak/inhibited musculature with the addition of the Latissimus Dorsi as “tight”” in the swimming population.
The Breakdown
In swimming, the majority of the strokes activate the anterior chest and internal rotators of the shoulder. The big ticket muscles involved are the pectoralis major and the latissimus dorsi. For all the anatomy experts out there, the “pec major” as a whole adducts and internally rotates the humerus. The “lats” are responsible for extension, adduction and internal rotation of the shoulder joint. So for all the non-anatomy nerds, what this means is that the two main muscles active during the major strokes of swimming actually perpetuate the rounded shoulder posture.
When the shoulder girdle is in an adducted and internally rotated state, the tendon of the supraspinatus gets “pinched” (impinged) between the acromion and the head of the humerus. If you look above, you can see the supraspinatus is in an already vulnerable position as it traverses underneath the acromion to insert onto the humerus. When you adduct and internally rotate the shoulder girdle, the space under the acromion (the subacromial space) for the muscle and tendon to run through gets smaller and then gets even smaller when the arm is lifted overhead. With the subacromial space decreasing, the supraspinatus muscle and tendon are more likely to get impinged leading to the pain referral pattern that you can see diagrammed below.
