Musculoskeletal

Physical Therapy

What is the most common shoulder injury you see amongst swimmers? How do you treat it?

Swimmers Beware: The Key to Treating Common Shoulder Injury

The most common shoulder injury that I see with swimmers tends to be a biceps tendinitis and usually that kind of falls under the umbrella of a stability related injury because a lot of swimmers are just really hypermobile. They have a lot of movement in their shoulders, that's not really well controlled and that ends up causing some extra stress to tissues. Namely, your biceps tendon when you're in an overhead position or doing a lot of things that require some external rotation of the That arm and so that that tends to be something that we see a ton of and so how do we treat that? Well, that's kind of a long complicated answer and it depends on where you're starting from and typically speaking a lot of swimmers are going to start with pretty low level. In terms of the stability set that they need to be working on. It's kind of what you think of traditionally with PT banded exercises, internal external rotation, the kind of boring stuff. But if you never progress Press past that and you're never progressing to doing things in overhead position or apply metric work or even things with real weights like kettlebells and barbells and things like that. Then you're not really getting that shoulder to the place that it needs to be to handle the stress that that you're going to be putting on it.

Biceps tendinitis is the most common shoulder injury seen in swimmers, and it is usually caused by hypermobility and lack of stability. To treat this injury, physical therapists typically start with low-level exercises such as banded internal and external rotations. Swimmers should progress past these exercises to incorporate overhead press, plyometric work, and weighted exercises into their routine for proper shoulder strength and stability.

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The most common shoulder injury I see among swimmers is biceps tendinitis, which is often related to stability issues. Swimmers tend to have hypermobile shoulders with excessive movement that lacks control, leading to added stress on the tissues, particularly the biceps tendon during overhead movements or external rotation.

Treating this injury depends on the individual's starting point, but typically, swimmers begin with low-level stability exercises. These may include traditional physical therapy exercises using resistance bands for internal and external rotation. While these exercises may seem mundane, they are essential for building a foundation of stability.

However, it's crucial to progress beyond these basic exercises. Swimmers should incorporate overhead movements, isometric work, and exercises with actual weights like kettlebells and barbells. These advanced exercises help strengthen the shoulder and prepare it to handle the stress placed on it during swimming activities.

In summary, biceps tendinitis is a common shoulder injury among swimmers due to stability issues. Treatment involves starting with basic stability exercises and gradually progressing to more challenging movements and resistance training to ensure the shoulder can handle the demands of swimming.

Any advice on rehab for the Achilles’ tendon?

Rehab Tips: Eccentric Exercises for Achilles Tendon Injuries

So with an Achilles tendon injury, it kind of depends on where the location of the injury is a lot of times with Runners will see the location being either at the very base of the heel at the very bottom part of the tendon or in the middle part of the tendon. So if you have an Achilles injury where the bottom part of attendant is the most irritable and that's kind of the source of the pain, doing a lot of loaded eccentric, work as prostitutes. Probably not going to be where we want to start with that versus if it's in the middle, part of the tendon eccentric, sorry going to really, really help you. But in both cases, we want to stay in a range of motion that isn't necessarily causing more pain. So, typically, typically I'll have people start with both legs the same time on a flat surface. So we're not dropping down into the - as we do that. He'll raise motion as that becomes more. Tolerated and that is no longer painful. We want to progress into more and more negative while working into more Dynamic movement, that requires that same amount of range of motion. For example, if I'm going now into a negative position and I tolerate that, well, let's do a step down that also requires me to go into that movement, but it's a little bit more functional. It's not so isolated to just the calf. That's a really, really nice way to implement Want some functional loading into your rehab.

With an Achilles tendon injury, the recovery plan will depend on where the location of the injury is. Typically, people start with both legs on a flat surface in a range of motion that isn't causing pain. As it becomes more tolerated, progress to more negative movements and dynamic movements that require the same amount of range of motion.

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When rehabilitating an Achilles tendon injury, the location of the injury plays a significant role. For runners, the injury is often either at the base of the heel or in the middle part of the tendon.

If the bottom part of the tendon is the most painful, loaded eccentric work may not be the best starting point. However, if the injury is in the middle part of the tendon, eccentric exercises can be highly beneficial. In both cases, it's important to stay within a range of motion that doesn't exacerbate the pain.

To begin, try performing exercises with both legs simultaneously on a flat surface. Avoid dropping down into a negative heel raise motion that causes pain. As your tolerance improves and the movement becomes pain-free, gradually progress to more negative positions and incorporate dynamic movements that require the same range of motion.

For example, once you can tolerate negative positions, you can move on to step-down exercises that engage the same movement but in a more functional manner. This allows for functional loading during your rehabilitation process.

What do you think is the best way to deal with shoulder pain besides cold and heat?

Shoulder Pain? Skip the Ice: Active Approach for Long-Term Relief

So what do you think the best way to deal with shoulder pain is besides cold and heat. So actually I don't think cold and heat is a good way to deal with shoulder pain at all. I think that the evidence is kind of been far away. That ice is really only something that we should utilize if the shoulders so painful that is keeping you up at night and you just need to numb it up, but really eyes is going to slow down the healing process. So, what I would recommend rather than Passive modalities is active range of motion or assisted active range of motion. So sliding your arm up a wall or just keeping it in a pain, free range of motion. Even if you can only go part of the way up, we need to start to get that joint moving, get the muscles and tendons. Moving in a way that's not necessarily irritating them. Step 2, once that sensitivity comes down, we need to start to load the muscles around the shoulder so that we can regain the functional mobility and strength that all shoulders require in order for us to stay active. So getting on a good regimented plan of care with either a physical therapist or some other Physical Medicine doctor that can kind of diagnose, which muscles in particular, you need to take care of, is definitely the next step. But active approach is always going to be a much, much better way to get you out of pain long-term and not really allow this to become a recurring thing, which unfortunately is what most people do. When When they just rest and ice.

Instead of passive modalities such as cold and heat, an active approach is better for dealing with shoulder pain. This could include active range of motion or assisted active range of motion, as well as loading the muscles around the shoulder to regain functional mobility and strength. It is recommended to seek out a physical therapist or other Physical Medicine doctor to diagnose which muscles need to be taken care of.

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The best way to deal with shoulder pain, besides cold and heat, is to focus on active approaches rather than passive modalities. Cold and heat may not be effective in treating shoulder pain and could potentially slow down the healing process.

Instead, I recommend engaging in active range of motion exercises or assisted active range of motion. This can involve sliding your arm up a wall or moving it within a pain-free range of motion. Even if you can only perform partial movements, it's important to start getting the joint, muscles, and tendons moving in a way that doesn't cause irritation.

Once the sensitivity decreases, it's crucial to begin loading the muscles around the shoulder to regain functional mobility and strength. Working with a physical therapist or another healthcare professional specializing in physical medicine can help diagnose which specific muscles need attention and create a personalized care plan.

Taking an active approach is essential for long-term pain relief and preventing recurring issues. Resting and icing alone often lead to ongoing problems, so it's important to prioritize active movement and targeted muscle care.

What exercises do you recommend for shoulder rehab?

Effective Shoulder Rehab Exercises: Isometrics, Dynamic Movements & More!

Isometrics are a really good place to start. In this scenario, I'm not allowing the arm to move, but I'm actually just increasing the pressure by walking out with the band. It's allows the muscle to accommodate load a little bit before we start moving into some depth, more Dynamic things like this exercise, I really, really like this exercise. It's kind of a combination of an isometric. Hold with your rotator cuff. External, Rotator muscles and I'm starting to engage some scapular work as well. This is an all-time Everett for sensitive shoulder. Just starting to work in some different planes of motion, but all staying below the height of the shoulder. So nothing is overhead. Closed chain work or work where your hands are on the ground and working through some dynamic range of motion. Like this is fantastic. We're strengthening the rotator cuff, while also working some of the scapular muscles around the shoulder blade and rib cage. This again, also of works on coordinating your rotator cuff muscles with some scapulae muscles into an overhead position and tends to be pretty well tolerated.

Isometrics are a good starting point for shoulder exercises. This exercise is a combination of an isometric hold and engages the rotator cuff and scapular muscles without putting pressure on the shoulder. It's a great exercise for those with sensitive shoulders.

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For shoulder rehab, I recommend starting with isometric exercises. These exercises involve increasing pressure with a band while keeping the arm stationary. This allows the muscles to gradually adapt to the load before moving into more dynamic exercises.

One exercise I particularly like is a combination of an isometric hold with the rotator cuff and external rotator muscles, while also engaging the scapular muscles. This exercise is great for sensitive shoulders and helps work in different planes of motion, while keeping the movements below the height of the shoulder.

Closed chain exercises, where your hands are on the ground, are also beneficial for shoulder rehab. These exercises involve working through a dynamic range of motion. They strengthen the rotator cuff and engage the scapular muscles around the shoulder blade and rib cage. This type of exercise helps coordinate the rotator cuff muscles with the scapular muscles in an overhead position and is generally well tolerated.

Remember to consult with a healthcare professional or physical therapist for a personalized exercise plan tailored to your specific shoulder rehab needs.

What happens when you hear a pop out of a joint?

Surprising Truth: Joint Pops Just a Gas Exchange, Not Realignment

All right, Carlos. Thanks for asking. What happens when you hear a? Pop out of a joint. So they actually did a study and they used functional MRI. So it's kind of like a live recording of an MRI of someone cracking their Knuckles. And what they discovered is that that pop is not something going back into place or anything like that. It's actually just a gas exchange in the joint. So, your joint is kind of a closed space. There's little micro bubbles of air. In there. And when you create more tension in the joint, you close down that space a little bit more. Those bubbles, kind of For lack of a better term collapse into each other and you get this pop so you know if you get your neck popped or your back popped don't think that that is putting things back into place. It's simply just a gas exchange and actually what happens is the muscles that kind of pop and vibration stimulus that it puts through the joint and The receptors in the joint. It actually causes muscles around the joint to start to relax a little bit. So that's kind of why if I go and crack My neck, my neck will feel a little bit better for a little while because muscles around that spot will actually start to relax a little bit more.

When you hear a pop from a joint, it is actually caused by a gas exchange. It does not put things back into place. The vibration stimulus caused by the pop can cause muscles around the joint to relax, which is why people often feel some relief after "cracking" their necks or backs.

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When you hear a pop out of a joint, it's not actually something going back into place. A study using functional MRI found that the pop is due to a gas exchange in the joint. Joints contain micro bubbles of air, and when you create tension in the joint, these bubbles collapse into each other, resulting in the pop sound.

So, if you crack your neck or back, it's not about realigning anything. It's simply a gas exchange phenomenon. The popping and vibration stimulate the receptors in the joint, causing the muscles around the joint to relax. That's why you may feel some temporary relief after cracking your neck or back, as the muscles in that area start to relax a bit more.

Can you discuss any successful case studies or anecdotes of athletes you've worked with who have made a full recovery and returned to their sport at a high level?

From Shoulder Surgery to Olympic Trials: an Inspiring Comeback Story

So, one of my most recent cases of this where an athlete had a pretty significant injury and returned to competing at a really high level. We had an athlete who was a top eight finalist in Rio at the Olympics and prior to Tokyo came to us with a pretty terrible shoulder injury and judging by his MRI, this is a surgical case most likely, a pretty significant labral tear with a cyst and partial rotator cuff tears and we've got a couple months leading up to trials and they were kind of under this time crunch to fix this thing and he comes in and he's lifting his arm halfway up and it's not looking good but through consistent work with it and talking with the coach about it we're able to kind of create this holistic plan for him and really get him to a place where he can compete and he was able to qualify for his country for the Olympics again in Tokyo which was really exciting and he didn't swim quite as well as he did in Rio but he was still able to compete where six months prior to that we were looking at not even going so that was a really cool experience and I think that a lot of things can be rehabbed in that way if you have a really good plan and really good communication with everyone that's involved with that athlete.

We had an athlete who was a top eight finalist in Rio with a shoulder injury and were able to create a holistic plan to help him qualify for the Olympics again despite the time crunch.

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I recently worked with an athlete who made a remarkable recovery and returned to competing at a high level. This athlete was a top eight finalist at the Olympics in Rio and came to us with a severe shoulder injury just before the Tokyo Olympics. Based on the MRI, it seemed like a surgical case with a significant labral tear, a cyst, and partial rotator cuff tears. With only a few months before the trials, there was a time crunch to address the injury.

Initially, the athlete could only lift his arm halfway, and the situation looked challenging. However, through consistent work and collaboration with the coach, we developed a holistic plan for his recovery. We were able to get him to a point where he could compete, and he successfully qualified for his country in the Tokyo Olympics. While his performance in Tokyo wasn't as exceptional as in Rio, the fact that he was able to compete at all was a significant achievement. Just six months prior, it seemed unlikely that he would even be able to participate.

This case demonstrates the power of having a well-designed plan and effective communication with all parties involved in an athlete's recovery. With the right approach and collaboration, many injuries can be rehabilitated, allowing athletes to make successful comebacks.

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Nick Hadinger answers your Physical Therapy questions. See all the advice Nick Hadinger has and get answers to your own Physical Therapy questions.

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Dr. Nick Hadinger is an Arizona native and licensed physical therapist with expertise in orthopedic and sports rehab. He holds a Doctor of Physical Therapy from Northern Arizona University and an undergraduate degree from the University of Arizona. As a former Division I athlete, he competed at the US Olympic Trials in 2012 and now races in triathlons. Nick specializes in non-operative and post-operative injuries involving the shoulder, back, hips, and knees, aiming to keep his clients active. He is certified in various techniques, including Dry Needling, Blood Flow Restriction Therapy, and Functional Movement Screen (FMS). He is also a certified USA Weightlifting Coach and a member of the NSCA and the USA Swimming Sports Medicine Network. He has been a Clinical Instructor for doctoral students at George Fox University and the University of the Pacific.