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Q&A with Australian Health Practitioners
Any suggestions to assist my 14 year old swimmer struggling with shoulder discomfort/pains?
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My son has been swimming since age 3. He has been struggling with his shoulders for the past 3 or so years. Ultrasound and x-rays came back all clear. Took a year off swimming but still having issues. Physio did not help. Now at the point of quiting. Not keen on cortizone injections and was advised by a friend to perhaps consider occupational therapy. Any suggestions? -
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John Stevens
Exercise Physiologist
John is an exercise physiologist and owner of Kinetic Medicine, an Exercise Physiology practice with 5 clinics on the NSW Mid North Coast. John is … View Profile
Sorry to hear about your difficulties with the nightmare all swimmers struggle with at some point that is shoulder pain. As a former elite level swimmer myself, I can empathise with the disabling pain that nothing seems able to rectify. First we need to consider the overall problem with pain. Pain is the human body's threat warning mechanism and is designed to cause the body to avoid activities it determines are creating some threatening stimulus. This is important to understand because it can explain why all diagnostic imaging comes back clear. Thus we have an elusive functional problem rather than any specific diagnosis that is easy to observe, possibly an aberrant pattern of muscle activity that is causing overload to some soft tissues of the shoulder. The only downside to this is that the biomechanics of specific shoulder function are very individual and hard to correct with generic advice. As such I would encourage you to seek out a consult with your local exercise physiologist which you can find on www.essa.org.au. Exercise physiologists are experts in human movement and biomechanics and have a preference for practical functionality, that is how can we get that shoulder working optimally as part of the whole body in the specific circumstances required of it i.e. during swimming tasks. If I can be of any more assistance to you please feel free to contact me directly.
All the best!
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Dr Andrew Lim
Chiropractor
Andrew has a Masters in Chiropractic and his interest in Sports Chiropractic has led him to treat many athletes from junior to elite levels in … View Profile
Swimming involves very repetitive movements of the shoulder, your son may have developed an overuse injury of the shoulder. Generally XRAY and Ultrasound are not the best imaging for these type of injuries. MRI is considered the gold standard for soft tissue conditions.
Why has your son developed this injury? This is not easy to answer without a proper assessment and examination. Most musculoskeletal conditions can be related to a dysfunctional movement pattern, generally caused by an imbalance of strength, flexibility and/or stability. It does not alway have to be an isolated shoulder problem too, for example, if you have a stiff neck this can lead to shoulder problems due to the change in mechanics causing extra load on the shoulder. So although the shoulder may have been tested and examined, I would stongly suggest having the neigbouring joints assessed too.
If your son has been swimming for a long time, and has not participated in other sports, this may also be a risk to further injury too. Some studies performed on tennis players showed that the earlier the player specialized in the sport (before the age of 14) there was an increased risk of injury, Other findings interestingly were also an increased risk of depression, drug use, failure/drop out of the sport and did not improve chances of successful transition into professional ranks compared to players who specialised in the sport after the age of 14.
Other things to consider with your son's shoulder problem are
1) Sitting posture (particularly at school)- how much time spent sitting?
2) increased use of mobile devices (laptops, ipads, smartphones etc)
3) School bags- weight, backpack vs over the shoulder bags.
Hope all this information helps, and i hope your son gets back to competitive swimming. If you would like any more information, please feel free to contact me. andrew@sportsandchiro.com.au
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Dr Marcus Chia
Orthopaedic Surgeon
Dr Marcus Chia is an Orthopaedic Surgeon in Sydney, Australia. As a Fellowship trained Shoulder and Elbow surgeon, he employs the most current arthroscopic and … View Profile
If your son is suffering from continued shoulder pain despite adequate physiotherapy, I would suggest review by an Orthopaedic surgeon. Intra-articular shoulder pathology is not shown on an ultrasound scan and xrays do not show soft tissue pathology.
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