Chris Robshaw to miss Six Nations: Rugby and the shoulder injury

Chris Robshaw rugby shoulder injuriesEngland’s defence of their Six Nations title has got off to a shaky start against France and Wales; as head coach Eddie Jones described it, England have now used up all of their “get-out-of-jail-free cards”. The loss of Chris Robshaw due to a significant shoulder injury requiring surgery meant the England team entered the tournament with over half of the starting pack missing from action.

However, it’s more of a blow for Robshaw who has fought hard to make it into the starting team. He suffered the injury on New Year’s Day in the Aviva Premiership Harlequins’ 24-17 match.

This will be the first Six Nations he has missed for five years. Other players in the team have also been plagued with injury. Joe Marler is recovering from a calf injury, while James Haskell recently returned after a six-month absence caused by a toe injury, only to get knocked out within 35 seconds of being back.

Rugby is renowned for its high-injury risk and shoulder issues account for 20% of all injuries in the sport.

Understanding rugby-related shoulder injuries

Out of all sports, ruby is known to have the highest risk of injury both per player and per hour. Shoulder injuries make up 20% of all rugby-related injuries coming second to knee injuries.

Approximately 35% of rugby shoulder injuries are recurrent, meaning if a player does injure their shoulder they are more than likely to suffer another. These injuries most commonly occur during the tackle manoeuvre.

The risk of developing shoulder injuries in rugby can never be fully eliminated due to the high-contact and rough nature of the sport. However, players can reduce the risk by ensuring the surrounding musculature is well-built up.

The most common rugby-related shoulder injuries include:

  • Labral tears
  • Rotator cuff tears
  • AC joint sprain

Out of the above, labral tears are significantly more common than any other type of shoulder injury in the sport. Surprisingly, the number of full shoulder dislocations are rare in rugby. This is thought to be because of the additional support provided by the built-up muscles around the joint.

Treatment and prevention of rugby shoulder injuries

The majority of rugby shoulder injuries tend to occur at the beginning of each rugby season. This suggests that adequate pre-season training could help to reduce the risk. A proper training program should work on building up the shoulder gradually, intensifying in duration and strength as the season draws nearer.

It’s also important for players to ensure they are using proper technique, particularly when it comes to tackles and defensive skills. However, even with adequate preparation, it may not be possible to prevent injury completely.

Most players who develop what is commonly referred to as rugby shoulder, end up requiring surgery. They are also unable to return to their performance prior to the injury. This shows just how significant a shoulder injury can be to a player’s career.

The key is to seek treatment as soon as a shoulder injury is identified. Pain is typically the main symptom to watch out for. Early detection and treatment can make all of the difference to a player’s career.

Mr Andrew Wallace of Fortius Clinic operates on Atletico Madrid’s Jan Oblak

At the end of 2016, Mr Andrew Wallace of the London Shoulder Specialists successfully operated on Atletico Madrid goalkeeper Jan Oblak after he suffered a dislocation of the left shoulder while making a save during a game against Villarreal in December. Surgery to repair the labrum was successful but Oblak, who also plays for his national team of Slovenia, will now spend up to four months recovering.

Oblak suffered a Bankart tear to the shoulder

Twenty-three-year-old Oblak suffered a Bankart tear which is more common in younger patients. It is an injury to the labrum which occurs after a shoulder dislocation; to provide stability to the shoulder, particularly with its wide range of movement, the shoulder is supported by a cuff of cartilage called the labrum.

When the shoulder is dislocated, the shoulder pops out of its joint and the inferior glenohumeral ligament that composes part of the labrum can become torn. Oblak would have felt sensations of instability, catching and aching in the shoulder and would have likely experienced repeated dislocations in the future.

The club made the following statement after the surgery: “Jan Oblak has undergone a successful operation of the injury he suffered last Monday in the game against Villarreal. The player underwent arthroscopic surgery to the left shoulder to repair the labrum — with a positive result and stabilisation of the shoulder joint.”

Treatment was provided by Mr Andrew Wallace of the Fortius Clinic, a leading sports orthopaedic centre in London.

Balloon arthroplasty for rotator cuff repair

Recent studies have shown that balloon arthroplasty for rotator cuff repair could provide significant improvement in shoulder function.

Rotator cuff repairs can be notoriously painful and in more serious cases are considered irreparable. This leaves patients suffering with long-term functionality issues and often intense pain. In recent years, balloon arthroplasty has emerged as a possible solution for those diagnosed with severe, irreparable rotator cuff tears.

Understanding the balloon arthroplasty procedure

Inspace balloon arthroplastyBalloon arthroplasty is a relatively-new keyhole surgery technique which involves inserting a balloon into the shoulder to replace the irreparable rotator cuff tendon.

Prior to the introduction of this treatment, the only other option for irreparable tears was a procedure known as a reverse total shoulder replacement. This major operation involves completely repositioning the muscles so that the arm can move again, involving a long and painful recovery time. The balloon arthroplasty, on the other hand, is a much less invasive technique with reduced downtime.

Known as InSpace™, the procedure is largely beneficial for elderly patients who currently experience significant shoulder pain. The balloon comes in numerous sizes and is made from biodegradable polymer. The size used will depend upon the subacromial space available.

The balloon is inserted into the subacromial space via an arthroplasty procedure. It is then filled with a saline solution once it is in position. The surgeon then takes the joint through a range of different motions to ensure that the balloon is securely in place and isn’t likely to become dislodged.

As the procedure is performed via keyhole surgery, it can be carried out under local anaesthetic. This means patients can have the procedure and return home the same day.

What are the benefits of balloon arthroplasty?

Although balloon arthroplasty is a new procedure and isn’t yet approved by NICE, it has shown promising results in initial testing. The fact it is a fairly straightforward and non-invasive procedure compared to a reverse total shoulder replacement is a major benefit. It’s a low-risk option for patients who are reluctant to undergo major surgery.

It is worth noting that it isn’t necessarily a permanent solution. The balloon will naturally break down within six to twelve months. This means it can either be used as a temporary solution until the patient undergoes a reverse total shoulder replacement, or a new balloon can be inserted as and when it is required.

As far as scientific evidence goes, due to the infancy of the procedure, very little is known about its exact benefits and effectiveness. Some current scientific papers even suggest physiotherapy could be just as effective at helping to restore a good range of motion. However, that is based on rotator cuff tears which are reparable. It is therefore largely designed to treat irreparable injuries in older patients.

The recovery time is the most notable benefit, with patients requiring the use of a sling for around a week following the procedure. With reverse total shoulder replacement, the recovery takes an average six weeks.

Balloon arthroplasty has shown some promising early results for patients suffering with irreparable rotator cuff tears. However, further studies do need to be carried out to establish just how viable and effective the procedure is.

Don’t let shoulder pain derail your new year resolutions

Now that the new year is upon us, you may now be determined to shape up in 2017. However, if you’re suffering with shoulder pain, your new year’s get fit resolution may seem like an impossible task.

working out with shoulder painThe shoulder is an incredibly complex joint and an injury can cause severe pain not just within the shoulder itself, but across the upper back, neck and right down the affected arm. This obviously causes issues when it comes to working out, as any movement and pressure placed upon the injury can intensify the pain significantly.

So how can you get fit if you’re suffering with shoulder pain?

Should you work out if you have shoulder pain?

There are a lot of different types of shoulder injury and some are more severe than others. If you haven’t already, you need to get the cause of the shoulder pain correctly diagnosed. Minor injuries may simply require good physiotherapy, while more severe injuries may require surgery.

In some cases, you may need to rest the shoulder and avoid working out until it has recovered and the pain has subsided. However, there may still be some exercises you can do which won’t cause further problems or worsen the pain experienced.

What exercises can you do with a shoulder injury?

While it is advisable to avoid heavy lifting and above the head exercises while you have a shoulder injury, that isn’t to say you have to stop exercising completely. It is possible to continue to work out the muscles of the back and shoulders without the risk of further injury and pain. Some of the best exercises to consider include:

  • Side lateral raises – Using dumbbells to ensure a more natural motion, side lateral raises help you to tone up the lateral deltoids in the shoulders.
  • Front raises – If you’re looking to bulk up the anterior or frontal parts of the deltoid muscles in the shoulder, front raises can help. For this exercise a plate is recommended rather than dumbbells, as it enables your shoulders to work together rather than signalling one out which could increase the risk of further injury.
  • Leaning shoulder shrugs – This one is great for the middle of the back and helps to give you a more polished look. To perform it properly, bend over a little at the hips and then do it like you would with a regular shrug. This leaned position helps to target the area and builds it up quickly.

There are also exercises you can do which can help to speed up your shoulder recovery. Internal rotations using dumbbells is a great starter exercise. Always ensure you start off with the lighter weight when you’re starting out. After working on internal rotations, you can then progress to external rotations with dumbbells. These exercises are great for the rotator cuff muscles.

Overall, there are numerous exercises you can still perform while suffering with a shoulder injury. However, it is important to seek advice from a shoulder specialist to establish the cause of the pain and the type and severity of the injury before you begin working out.

Could supplements reduce shoulder fracture risk?

Shoulder fractures, particularly clavicle fractures, are a common and very painful injury suffered by athletes. Contact sports in particular carry a high risk; though they can also be caused by a bad fall or injury. Fractures can take months to heal and for keen athletes they can have a devastating impact on their career.

Recent evidence provided by an ESCEO-IOF expert panel suggests calcium and Vitamin D supplements could play a key role in minimising the risk of a fracture.

Supplements prove effective at promoting healthy musculoskeletal ageing

shoulder fracture and supplementsThe European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases (ESCEO) along with the International Foundation of Osteoporosis (IOF) recently came together to analyse the evidence that vitamin D and calcium supplements can help promote healthy musculoskeletal ageing.

They specifically wanted to address whether such supplements could reduce the risk of fractures. Using all current knowledge and evidence presented for both the benefits and adverse reactions reported, the board came to the following conclusions:

  • Fracture risk is slightly reduced – taking calcium and vitamin D supplements together do appear to slightly reduce the risk of fractures. However, calcium alone hasn’t proven to have the same effects so the supplements would need to be combined.
  • Vitamin D reduces the risks of falls – obviously not all falls can be prevented, particularly if you’re taking part in contact sports. However, studies show that vitamin D when taken alone, can reduce the likelihood of patients suffering a bad fall. This discovery was surprising given the fact that calcium is more closely linked to muscle physiology.
  • Those at risk of calcium and vitamin D insufficiency receive most benefits – in terms of fracture reduction, vitamin D and calcium supplements tend to work best for those at a high risk of vitamin insufficiency.

So, it appears supplements do have some positive effects in terms of reducing fracture risk and they’re also promoted for osteoporosis treatment. However, further in-depth studies are required to establish just how much of an effect they have on the muscular and skeletal system.

Understanding shoulder fractures

There are several types of shoulder fractures to be aware of. These include clavicle, scapula and proximal humerus fractures.

In general, clavicle fractures tend to be the most common and are typically the result of a fall. Scapula fractures are the least common and are mostly caused by high energy traumas such as a car accident or a high fall. Finally, proximal humerus fractures occur in older patients, usually over the age of 65.

Diagnosis varies depending upon the type of fracture experienced. Some require a simple X-ray, while others may need to be analysed in depth via a CT scan. If you suspect you have a fracture it’s important to seek diagnosis and treatment as soon as possible. If you take part in sports you will need to wait until the shoulder is fully healed before you can start playing again.

Overall, using supplements to reduce your fracture risk certainly won’t harm you. However, those at high risk would be much better off working to build up the shoulder muscles which help to protect the bones. Calcium and vitamin D supplements would also be better suited to older patients, particularly as traumatic clavicle fractures have been linked with a doubled mortality rate for patients over 65 years, as evidenced in a 2011 study published in the Journal of Orthopaedic Trauma.

Give snowboarding injuries the cold shoulder

common snowboarding shoulder injuriesAlthough snowboarding’s ‘coolness factor’ might be melting slightly with more and more of us embracing two boards rather than one, snowboarding is still a hugely popular winter sport with a high risk of injury.

Snowboarding places a lot of pressure onto the body. Unlike skiing, which sees the lower limbs most at risk of injury, it’s the wrists, shoulders and upper body which can fare the worst when snowboarding. Shoulder injuries are especially common and can be incredibly painful and take months to heal. If you’re planning to strap on a board this winter, it helps to be aware of the common snowboarding shoulder injuries that can occur and how to avoid them.

Most common snowboarding injuries

It is estimated that shoulder injuries account for around 15% of all snowboarding injuries compared to 10% in skiers . There is an increased risk for first-day participants. There is also an increased risk for those using rented or borrowed equipment, because it might not fit properly and this also may be an indication that the participant is a recreational or a beginner (and not a professional) boarder. Other positive risk factors include alcohol and drug use.

The more advanced snowboarders are also at risk as they not only travel faster but also may incorporate jumps and aerials. If they suffer a fall, the higher velocity makes them more susceptible to shoulder instability.

Here’s most common snowboard shoulder injuries that we see at the London Shoulder Specialists at the Fortius Clinic.

1. Broken bones

Collarbone: a break in the clavicle, or collarbone of the shoulder, occurs during a fall onto the affected arm. It can also be caused if the clavicle is directly hit at force. As well as causing severe shoulder pain, a broken collarbone can also be tender around the break and may lead to a bony deformity or swelling. Some clavicle fractures require surgical intervention.

Humerus: the upper arm can be broken at a number of sites. Treatment depends on the position of the fracture, whether the bones move apart significantly and your demographics.

2. Dislocation

Glenohumeral dislocation: the ball of the shoulder comes completely out of its socket. This is an extremely painful injury and can occur while you’re on the slope. Sometimes it is possible to relocate the shoulder yourself, however it is advisable to seek medical assistance. Keeping the shoulder immobilised will help to reduce pain and inflammation. Ultimately some shoulders will need to be stabilised surgically, dependent on your age, occupation, sporting demands and the exact nature of the injury.

AC joint dislocation: this occurs when the collarbone dislocates from its joint on the top of the shoulder. This is usually less painful than a glenohumeral dislocation and the bones do not have to be manipulated back into position. There is often pain and swelling, and the arm becomes difficult to lift upwards. Again, some dislocations will need surgical intervention, whilst others can be treated non-operatively.

3. Soft tissue injury

Rotator cuff strains: these types of injuries are the one of the most common shoulder injuries and, depending upon the severity, can require surgery. The rotator cuff comprises four tendons which surround the shoulder joint, and help keep the shoulder stabilised and ensures smooth joint movement. Strains, inflammation and bruising can become very painful and you’ll have trouble lifting the arm to shoulder level.

Rotator cuff tear: if you suffer a significant rotator cuff tear in the tendons, surgery may be needed to repair the injury.

These are some of the main injuries that snowboarders present with. Many injuries can be treated through physiotherapy and other non-invasive treatments. However, it is important to seek advice, review and treatment as soon as possible. Leaving the shoulder untreated could cause the injury to worsen and surgery may end up being your only option. Not obtaining a proper diagnosis at the outset can cause prolonged unnecessary suffering or inappropriate treatment.

How to prevent snowboarding shoulder injuries

While snowboarding will always carry a risk of injury, there are things you can do to prevent the likelihood of them occurring. If you’re just starting out, making sure you research everything there is to know about correct techniques is recommended. Ensuring you have adequate safety gear will also help.

For the more advanced snowboarder, building up the shoulder muscles through regular strengthening exercises can greatly help in the event of a fall. If an injury does occur, seeking treatment as soon as possible will also help minimise the damage caused.

Overall, common snowboarding shoulder injuries can lead to substantial time away from the slopes, as well as excruciating pain. Being aware of the injuries which can occur, along with taking the time to prepare properly for the slopes are key to injury prevention.

How will I know if I need shoulder replacement surgery?

Hope Solo shoulder replacement surgeryJoint replacement surgeries are becoming more common with each passing year. While knee and hip replacements remain the most common procedures, shoulder replacement surgery is quickly catching up.

Performed when non-surgical treatments fail, shoulder replacement surgery is largely used to eliminate pain. However, it can also be required in order to regain full mobility of the shoulder. So how can you tell if you need shoulder replacement surgery?

When might shoulder replacement surgery be required?

The main sign you may need shoulder replacement surgery is prolonged pain around the shoulder joint. Of course, pain in the shoulder can be caused by a wide range of conditions and not all of them will require surgery. Therefore, it is vital you receive a proper diagnosis to determine the root cause.

Shoulder replacement surgery is typically required if:

  • The shoulder is fractured – If you’ve suffered a significant injury that has resulted in a shoulder fracture, it is possible the bone may be too damaged to repair. Either a full or a partial replacement may be recommended, dependent upon how healthy the socket is.
  • You have arthritis of the joint – If you’re over 50 and experiencing a lot of stiffness as well as pain in the joint, it’s likely you’ve developed arthritis of the shoulder. Anti-inflammatory medication is usually prescribed as the first course of action. However, if this, along with other non-surgical treatments don’t work, a replacement of the shoulder is worth considering.
  • There is a rotator cuff tear – The upper part of the arm bone has four different muscles wrapped around it. Injury to the shoulder can cause any of these muscles to tear, causing severe pain and mobility issues. The rotator cuff tear itself can be repaired without shoulder replacement; however, if left untreated it can develop into arthritis.

These are the main conditions which can lead to shoulder replacement surgery. A consultant orthopaedic surgeon that specialising in treating the shoulder will be able to diagnose the problem and identify the best course of treatment. Replacement surgery is provided as a last resort.

Identifying the problem

While it is essential to get yourself assessed by a shoulder specialist as soon as possible, there are a few questions you can ask yourself to determine whether you may need shoulder replacement surgery.

  1. Consider the level of pain in the shoulder. Is it consistent and does it prevent you from carrying out normal, everyday activities? Everybody has a different pain threshold, but shoulder replacement surgery is most commonly used to combat severe pain. That is, the pain will constantly be there. If it hurts to the point where it stops you from doing things you would normally do, a replacement surgery will likely be required.
  2. Does the pain keep you up at night? A tell-tale sign you could need surgery is if the shoulder hurts even when you’re resting. So, if you find it keeps you up at night and there is no relief even when you’re doing very little, it is best to get the problem checked out.
  3. Have you tried non-surgical treatments? As mentioned earlier, shoulder replacement surgery is used as a last resort when nothing else has worked.

The two-time Olympic gold medal winner and national team goalkeeper Hope Solo has just revealed that she has undergone a shoulder replacement procedure at age 35 and announced: ‘I’m filled with excitement knowing how life-changing this is and I look forward to coming back healthier and stronger than ever.”

Overall, shoulder replacement surgery is a very successful procedure that can help patients return to the full range of activities they enjoyed before they started experiencing problems with their shoulder.

Serena Williams and the curse of tennis shoulder

After being forced to pull out of yet another tournament last month, questions are being raised over the future of tennis star Serena William’s career. By William’s standards, 2016 has been a disappointing year as a persistent shoulder injury affected her performance in the Rio Olympics and the US Open. In fact, her loss in the semi-finals of the latter competition set back her shot at breaking the record of 22 Grand Slam Titles which she currently shares with Steffi Graf.

Serena Williams and tennis shoulderHaving recently turned 35, will her shoulder affect her chances of ever beating this record? As she has recently commented, she is “tired of playing tournaments unhealthy and taking losses I would never lose”. Currently, the world number two tennis player in the world, Williams is now following doctor’s orders to rest the shoulder to ensure she can play next year.

Tennis players are certainly no stranger to shoulder injuries. Commonly dubbed ‘Tennis Shoulder’, injuries are caused by repetitive stress to the shoulder joint.

What is tennis shoulder?

Tennis shoulder is a term relating to a range of shoulder conditions. Strokes like the overhead smash, serve and high forehand can place significant stress on the shoulder joints over time, causing them to become inflamed and unstable.
The most common tennis shoulder injuries include:

Shoulder bursitis/impingement

The most common tennis shoulder injury, shoulder bursitis develops when the small sac of fluid known as the bursa becomes inflamed. Its sole purpose is to reduce friction between the bone and the tissue and, when inflamed, it can cause severe pain. In serious cases, the bursa could become impinged between the bone and the muscle, resulting in pain whenever the arm is lifted.

Shoulder impingement can also be diagnosed when the supraspinatus tendon is aggravated or pinched. There are two main types of shoulder impingement including subacromial and internal impingement.

This type of tennis shoulder tends to be caused by high forehands and excessive serves.

Shoulder instability

Over time, the joint of the shoulder can loosen, leading to instability. There are varying degrees of shoulder instability that can occur, with complete dislocation being the most severe. It can also go on to develop into arthritis if it remains untreated.

In tennis, strokes that cause repetitive shoulder motions can cause the joint capsule to stretch and loosen. This in turn causes the muscles of the shoulder to weaken and the humerus ball will start to slip. This is when pain in the shoulder will develop.

Rotator cuff tear

Tears to the rotator cuff can develop after a single, traumatic injury or gradually develop over time. Excess overhead activity is a leading cause of this type of injury, resulting in the arm becoming weaker and pain developing around the joint. In some cases, surgery will be required to repair the tear, resulting in a significant recovery time.

Older players experience more severe tennis injuries

The most severe tennis shoulder injuries are typically found in older athletes due to a more advanced play level. Younger players will typically develop milder injuries. However, the problem comes when these mild injuries are not treated correctly. If left untreated, the injury will usually worsen and potentially threaten a player’s career.

Though prevention isn’t always possible, there are things you can do to limit your chance of developing tennis shoulder.

Proper technique during training, along with rotator strengthening exercises can help significantly. Stretching prior to a match is also recommended.

Overall, tennis shoulder is a common issue experienced by players at all levels. The key to minimising the amount of downtime required is to ensure you seek treatment as soon as possible.

What is shoulder impingement syndrome?

Shoulder impingement syndrome is a common injury affecting those who play ‘overhead’ sports and there are a wide range of activities that involve a repetitive movement which elevates the arm above the head, including cricket, tennis and swimming.

Known as one of the most common causes of shoulder pain, the twinge you feel when you execute your tennis serve can quickly become persistent and affect your ability to perform even the most mundane, everyday activities.

Understanding shoulder impingement syndrome

Simply put, shoulder impingement syndrome is diagnosed when a tendon of the muscle catches within the shoulder. This in turn leads to weakness in the arm and pain when the arm is lifted above the head.

It is the rotator cuff tendon that causes the condition; responsible for connecting the shoulder muscles to the very top of the arm, this long, thick tendon is situated within a narrow space, known as the sub acromial space. If it becomes trapped within the space, the tendon begins to rub against the bone, causing pain and sometimes, inflammation.

If inflammation of the tendon does occur, it is referred to as rotator cuff tendonitis. This will develop if shoulder impingement syndrome isn’t treated early enough. There’s also the chance that the tendon could start to wear away and become thinner over time.

What causes shoulder impingement syndrome?

There are actually two different types of causes of shoulder impingement syndrome referred to as primary and secondary.

Primary cause: If you are diagnosed with primary based rotator cuff impingement, it refers to the structural narrowing of the shoulder. It is possible to be born with a naturally narrow subacromial space, significantly increasing your risk of impingement. However, structural narrowing can also develop due to osteoarthritis. The condition can cause bony spurs to develop within the space, further narrowing it.

This type of shoulder impingement syndrome increases the risk of shoulder tendonitis and bursitis.

Secondary cause: This secondary cause of shoulder impingement is referred to as dynamic instability. It occurs when the muscles around the shoulder joint are weak, along with abnormal joint laxity and too much movement in the joints.

It is this type which is most commonly found in athletes, caused by repetitive activity overhead, incorrect posture or injury. The shoulder is required to work much harder if it is unstable, increasing the risk of impingement.

If it is left untreated, secondary rotator cuff impingement will worsen and re-occur.

Identifying the symptoms of shoulder impingement syndrome

There are a number of distinctive symptoms associated with shoulder impingement syndrome including:

  • Weakness in the arms
  • Intense pain when the arm is raised overhead
  • The shoulder is painful to lie on
  • Pain which extends down from the shoulder to the elbow

As the condition worsens, you could also begin to experience pain even when the shoulder is resting. Some patients experience a constant, dull ache, rather than intense pain. The condition will need to be diagnosed, typically with the aid of an ultrasound scan. This is most commonly used to identify dynamic impingement.

Shoulder impingement treatment options

The type of treatment required will depend entirely upon where the injury has occurred. Numerous structures can be affected during shoulder impingement syndrome, so identifying the problem area is key to diagnosing the correct treatment.


London Shoulder Specialists’ consultant surgeon Mr Andy Richards
spoke on shoulder impingement syndrome, particularly in relation to rugby players, at last year’s Fortius International Sports Injury Conference:

“Younger rugby players – by which we mean under age of 35 – often have more functional impingement and an inability to control their humeral head with superior translation. They also have a high percentage of sub-clinical instability and standard treatments of injections and subacromial decompression will fail in this group.

“For younger patients you have to look at the pathology and identify labral or partial cuff tears and whether ACJ inflammation is also contributing to the pain they are experiencing. The MRI Arthrogram is definitely the investigation of choice. If there is no structural abnormality, then this group can be rested and rehabbed, with guided steroid injections to the bursa, but if they have a structural abnormality or fail to rehab, then surgery is the best option.”

Stretching is key to avoiding swimmer’s shoulder

Shoulder injuries are thought to affect between 40% to 91% of professional swimmers. This isn’t a surprising statistic considering that competitive swimmers, training for a number of hours, six or seven days a week, will perform many thousands of shoulder revolutions and this continuous movement places great strain upon the joint.

However, while the risk of developing a shoulder injury due to overuse is high for competitive swimmers, studies show there are ways to minimise the risk. In particular, stretching could be the key to prevention.

What is Swimmers Shoulder?

The term Swimmers Shoulder actually relates to a range of different shoulder injuries. Most commonly caused by overusing the shoulders, the types of injuries that can occur are diverse and vary in severity. Three of the most common injuries you are exposed to as a swimmer include:

1. Rotator cuff impingement/tendonitis

The rotator cuff is responsible for keeping your arm within the socket. Made up of numerous tendons and muscles, the rotator cuff is one of the most commonly injured parts of the shoulder.

Rotator cuff impingement occurs when the acromion part of the shoulder rubs against the muscle, causing pain and irritation. It occurs when the arm is lifted to shoulder height. Rotator cuff tendonitis is diagnosed when the tendons are damaged or irritated.

2. Scapular Dyskinesia

This condition occurs when the muscles of the upper back are overstretched and loose. Responsible for keeping the bones of the shoulder in position, the upper back muscles can be affected when the shoulder blade is repetitively rotated. To compensate, the muscles of the upper chest tighten and cause intense pain around the collarbone area.

3. Shoulder instability

In severe Swimmers Shoulder injuries, the joint may become loose or disconnect from the socket completely. This is referred to as shoulder instability.

When you consider that 90% of the force required to push the body through the water is provided by the upper body, you soon realise how vulnerable the shoulders are. There are several muscles and tendons within the shoulder joint and any of them can suffer damage from excessive or incorrect use.

Why stretching is key to preventing shoulder injuries

One of the main reasons swimmers develop shoulder injuries is because of improper training. Due to how much pressure the shoulders are put under in the water, it’s vital they are as strong and healthy as possible. Stretching the muscles prior to getting in the pool is an important key factor in ensuring they stay strong and resistant to injury.

In particular, the posterior shoulder capsule needs to be stretched, along with the scapula stabiliser and rotator cuff muscles. This helps to prevent muscle imbalance, as highlighted by a study published by the American Academy of Orthopaedic Surgeons.

A stretching and strengthening routine will significantly reduce the risk of injury, though it is impossible to fully eliminate the risk entirely. If any pain is noticed in the shoulder area, it should be assessed thoroughly as quickly as possible to prevent it from becoming more severe.

Overall, it is estimated that around one-third of top-level, competitive swimmers suffer with a shoulder injury which prevents them from training. If you want to avoid swimmers shoulder, then stretching and proper training technique is vital.

‘Swimmers Shoulder’, lecture by Mr Ali Narvani of the London Shoulder Specialists at Fortius Clinic