Hi. I am 14+ months postop and doing great but have a question about swimming. I'm a 49-year-old female, and I had a SLAP 2 tear, detached biceps tendon, subachromial something, fractured clavicle, cracked scapula, and a few other things I can't remember, from a bike crash. (The clavicle and scapula healed spontaneously.) I am finally able to swim enough to get back to triathlons, but I'm having problems whenever I get into streamline position (arms extended with one hand on top of the other - used when coming off the wall after each turn) or do drills with my R arm extended. I start off ok, but after 10-12 laps my streamline becomes a little skewed w/ my R hand pulled back a bit, and I can only do 200-300m of the drills. I talked to my former PT - I don't have PT orders, so he can't officially examine me, but he had me go through some motions and the results make him think I'm having "referred pain" from my neck. My neck has been stiff and tight, but I had a whiplash in 1997 and another in Feb 2008, both on the left side, so that's not unusual. I also only breath on the right when I swim, so now that I'm doing 2500-3000m workouts, that could be more of an issue, as it puts an uneven strain on the L side of my neck. My SLAP etc injury occurred in May 2008, and my surgery was in Nov 2008. I understand the basic concept of referred pain, but I'd swear my shoulder hurts, especially the muscles around the scapula. I got some kinesiotape but have only had the chance to use it once - I can't reach where I need it to go, so of course nobody was in the locker room the last time I went - but it does seem to help.

The reason I'm doing the drills is to try to correct a flaw in my stroke that should help my shoulder, but if the drills introduce new issues, I might need to come up with something else. (I've been letting my forward arm drop too much before I start the pull portion of my stroke.) I had a video swim analysis done (very cool!) and am working with a certified swim coach, and my Tri coach is also a chiropractor, and I know they'll do whatever they can to help. My PT also suggested getting a few sessions for my neck if the pain/stiffness doesn't resolve after I try some home exercises.

Sorry, I know this is long and I've thrown in a lot of information because I'm not sure what's relevant. I hope that one of our experts will be kind enough to take the time to sort out my ramblings and let me know their thoughts And if this does seem like "referred pain," how can I teach my neck to refer the pain somewhere else so I don't get paranoid about my shoulder?

Tridi, A few things to consider. The neck can contribute to trap
tightness via refered pain, but I think it is the other way around. I suspect that either your range of shoulder motion is tight in this position and you are over compensating by using you trap to elevate the shoulder. If the range is full with no tightness, the scapular stabilizers, particularly the lower traps may also be weak. Continuing with the heavy training regiem will not correct this. I would get a script for more PT. Have them evaluate the scap stabilizers and ROM. I would then work on out of water re-training, until you can consistently do the motion without the extra musculature. I believe you neck tightness will resolve with this. You could also have an MRI to rule out any neck issues and of course learn to breath on both sides or try using a snorkel to see if this reduces the problems, but my feelings are that the issues are from tightness, weakness and improper muscle recruitment that need reducation. I hope this helps and will get you back on track. Please keep me posted Sharon

Sharon, thanks so much for the quick reply, as well as all the help over the last 14 months! I am feeling so good and am so excited to be getting back into my sport, but now is not the time to get careless. I signed up for a 1/2 Ironman on April 25 - it's the race I was training for when I got hurt, and I am emotionally committed to doing everything I can to do well in it. I've been working with a Tri coach, a massage therapist, and a registered dietician to try to cover every angle where I've had problems in the past, and it's reassuring to know that there is something I can do to fix this, too, although the time frame concerns me a little. I know I can make the distance in the swim (1.2 miles in open water, so streamlining isn't a factor, but wearing a wetsuit adds another issue), but I want to continue to race for another 10 or 20 years and know I need to address this. Would it be useful for my PT to see the video of my swim session? It's a 3D video with shots from all angles, including under water. I'm sure there are other assessment tools, but maybe seeing exactly what I'm doing while actually swimming would be useful, or is the motion too subtle to pick up that way?

Thanks again for your continued support! Hope things are going well for you, too!

Diane

Well your PT is not a swim coach so he/she would be looking at other things and I think it maybe too difficult to assess which muscles maybe over firing with the video but of course you could ask him/her. You are doing all the right things to be sure you are swimming correctly with the coach, but as I said evaluating you for specific muscles say when lying on a table motioning the involved side may help and being sure the range is free and clear is the best I can think of.
Sharon

I finally got in to see my Sports Med doc, and his diagnosis was "R shoulder pain most consistent w/ posterior impingement w/ tight posterior capsule and w/ forward flexed neck posture and shoulder rounding." I started PT last week to work on scapulothoracic mobilization and stabilization. I was having some "weird" spasms during the PT eval, so we're addressing that as well. I think the neck posture is pretty common among swimmers, even those w/o the shoulder issues, and with my history, I'm just going to have to be super-aware of my form. I've quit worrying (too much) about speed and distance and am concentrating on my technique - I scheduled another session w/ a swim coach next week, and we'll do another video analysis so I (and my coach and PT) can see what I'm doing. (I learn much better that way, instead of having someone try to TELL me what I'm doing wrong.) I am so lucky to have a great support system! Sharon, you've been great, and my PT is a triathlete who helps out sometimes at the Tri shop that my coach, who is also a chiropractor, owns. Now if I can just get my achy knee under control.... 50 days until the Lonestar 70.3 Triathlon!!