Chronic shoulder pain

Chronic shoulder pain (CSP) is an inflammatory condition caused by the mechanical impingement of soft tissue between the acromion and the coracoid process of the scapula. The most common cause of CPS is friction between the proximal head of the humerus as it rubs across the soft tissues surrounding the shoulder joint: the supraspinatus tendon, the biceps tendon, and the coracoacromial ligament.

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Shoulder tendinitis in swimming can occur by the attempt to push back too early in the downsweep or outsweep. This malady is so widespread among competitive swimmers that is commonly known as swimmer's shoulder. Chronic tendinitis will reduce performance and at worst, it can cause swimmers to end their swimming careers prematurely. Many swimmers can prevent tendinitis or reduce its severity if they do not try to raise the elbows while pushing the arms back. They must wait until the elbows ride above the hands before they start to push back.

Other causes of swimmer's shoulder are: 

• Overtraining can lead to shoulder inflammation and pain. If the swimmer continues to swim with fatigued muscles, the condition may worsen. As the muscles fatigue they work less efficiently, which has two undesirable consequences. First, the muscles will have to work harder in a weakened condition. Second, the swimmer will have to perform more strokes to cover the same distance, which again overuses already fatigued muscles, perpetuating the cycle. Combined, these two factors can result in swimmer's shoulder.
• Unilateral breathing may also cause swimmer's shoulder. Swimmers that consistently turn their heads to one side are risking shoulder pain in the opposite shoulder. This shoulder has to work harder to support forward movement with the head turned to the side. Bilateral breathing transfers this load to both arms.
• Overuse of training equipment may cause shoulder pain. Using hand paddles that are too large places great strain on the shoulder muscles during the pull-through phase of freestyle. Using a kickboard with arms fully extended in front of the swimmer can place the shoulder in a position of impingement. The more often or longer the swimmer uses these devices, or uses them incorrectly, the greater the risk of shoulder impingement. 

 While it is important to attain a high elbow catch in all strokes, where preventing tendinitis is concerned, there is a right way and a wrong way to do it. The most intense friction takes place when swimmers try to push the elbows upward, above the hands, while at the same time pressing the arm backward. By contrast, friction will be less severe if swimmers wait until the elbows are above the hands before they attempt to push the hands backward.

You can feel this for yourself. Hold your arm in front of you at shoulder height with your elbow flexed. Then, try to put your arm in the high elbow position for the front crawl stroke by pushing your shoulder forward and your elbow upward, while at the same time pressing your hand down and back. You should feel a twisting strain in your shoulder joint as the head of the humerus moves forward and rotates downward across the various ligaments. Now starting with your arm outstretched in the same position, move your shoulder forward and your elbow upward as your hands travels down, but do not press your hand back. The sensations of twisting and strain should be considerably reduced.

To prevent CPS you need to strengthen the shoulder and upper back muscles and stretch the shoulder, chest and neck muscles. The muscle imbalance and inflexibility that typically occurs in swimmers contributes greatly to impingement. The following exercises will help you strengthen these areas specifically:

• External rotation
• Front shoulder raise on a swiss ball
• Front latelar raise (with pinkie side up)
• Rear lateral raise