In PT right now for “Rotator Cuff Impingement” on my left shoulder.
I started feeling a little pain in the shoulder during a long, open water, wetsuit swim while building up for IMAZ.
I have not swam since November. Still have a little nagging pain and I don’t plan to swim until the doc gives the “all clear.”
I have had x-rays and things appeared okay.
A few questions -
Was this caused by swimming? By swimming with poor form? By swimming too long? By swimming too hard?
Would a sleeveless wetsuit be better for my shoulder? (I know that everyone says that a sleeved wetsuit is faster. I believe that. But - would a sleeveless suit be easier on the shoulder?
Could bike fit have had any impact on this? I can’t pinpoint the exact date, but I did make a change to my fit sometime in October. It was done to relieve some pain in my upper back/traps. With the change, I was more comfortable in the aero bars. This change was also made just before I was doing some longer (5+ hour) rides. Is it possible that the new bike position + long rides had an impact?
The PT seems to be doing a good job, but I wonder if I should be pushing harder with some of the stuff they have me doing. Is it best to take it easy or push harder with this type of issue?
These are all really good questions to ask your PT.
I’m on my second shoulder injury in six months. First one healed up quickly, this one not so much. I do think that doing long rides in aero aggravated the underlying shoulder injury.
My experience with this injury is so-so…I have had this injury for about 4 years now…I have had a fantastic PT here … and she would allow me to be able to complete the race - but it would hurt and my range of motion was very limited - ie no backstroke - no fly (not a bad thing…hehehe…well I actually like it) - and depending on the set - I would have pain afterwards. Luckily I have a swimming background - so my “need” to swim all season is not so much. I am not the first out of the water - but I can swim the IM distance in ~1h +/- 5 mins…Also, even my PT agrees - that this sort of injury requires you to build the muscles around the RC…it hurts the most during the outseason - when I am not swimming at all - because I let all those muscles relax…with a solid program to strengthen the other shoulder muscles and therapy…it actually seems to feel “better” over time…but one little tweak - and I feel like I go back to square one.
I have finally had it x-rayed and go for an MRI next week - doc figures there is a good chance it will require surgery. My xray looked OK - there is a small bone that may need to be shaved - but my doc thinks the MRI is the best bet to show if there is any tendon damage in there…should note he is a very high level triathlete himself.
My point was this…with a good aggressive and consistent therapy - I was able to “race” at IM. I believe that my injury was caused by poor form in the weightroom - and it just never healed properly. Although I do believe that poor form can be a leading cause of the injury - especially if you are over-reaching (for instance - I know that I have to shorten my stroke on entry in order for it to not hurt) and I need to make sure I have a “high elbow” upon entry into the water - I really have to focus on not dropping my elbow.
I actually feel a long sleeve wetsuit is better - it compresses the area - and keeps it tight - and it does work to keep your stroke a bit shorter…I find that personally - swimming in the wetsuit actually makes it easier.
Does it hurt while cycling or just in the water? Hard to guess on this one without seeing you in the water or on the bike - but if you have an aggressive setup - it could be a contributing factor - however, I would guess that you have a less aggressive setup on your bike to take care of the back problems - so I won’t think the position in itself caused the injury…but again…professional bike fitter would definitely be a better option to get advice.
I have absolutely no medical training and this is just speaking from experience and from trying to deal with the same condition for 4 years…so take it with a grain of salt. I can relate that it can be a frustating injury…
impingement can be caused by several factors. Given that you are an athlete competing as a reasonably high level, i think it is appropriate to go ahead and get an MRI. if all you have is tendinosis or impingement then it is reasonable to give therapy a go, same can be said for some rotator cuff tears. however, if you have tried therapy without any relief, and you have impingement, you may be a candidate for subacromial decompression along with a few other options arthroscopically.
basically, you need to emphasize to your doctor, that you are in the middle of training and that you want this resolved once and for all, and i guess before you say that, you may want to make sure that you are ok to take the month or two off it requires to recover.
Thanks so much - I totally agree with you - I am tired of having of deal with this injury every year…and even things like reaching above my head or throwing a ball can cause immense pain…so there is something “wrong” in there…my ortho surgeon is AWESOME - he is the one that pushed for the MRI and he is very good at what he does - good thing he is also a really good friend!!! And yes, those are the technical terms that he used when discussing it with me.
I did decide to evaluate my health this year - and for the first time in 10 years did not sign up for an IM race - especially after having to miss last year because of the shoulder and a hip (also about to get MRI’d) injury. It hurt to lose the $650 for the race 2 months out…
I also have this injury for about 5 years. I got it on snowboarding… I fell on my shoulder.
I had therapy and it got a lot better. Almost gone. So I opted out for not having the surgery… big mistake.
Now every season I do get some discomfort on it. Interestingly enough, it’s running that makes it worse, not so much swimming. And a bit on the bike.
I also do not get too much pain while training, but it’s afterwards during recovering when the pain hits the worst.
My advice, if you give therapy a try and still fell hints of it… go for the subacromial decompression.
Rotator cuff impingement CAN be caused from weak rotator cuff muscles and weak scapular stabilizers. The head of the humerus needs to be ‘held in place’ so it doesn’t pinch stuff.
I have had shoulder pain with cycling and I don’t think it’s bike fit, but rather the fact that you’re “resting” on the handlebars and something still has to be stabilizing your scapula and humeral head.
possibly swimming with poor form, possibly just age-related.
I would not expect the sleeveless wetsuit to make a difference, but see if you can rent one and test.
As tc says, it’s possible bike fit could affect this, but probably not the proximate cause.
Not sure what your PT has you doing, but typically it’s a lot of rotator cuff and scapular stabilizer exercises as tc says. These are small weak muscles and easily overloaded, so you really don’t want to push it hard. In that case the muscles can’t deal with it and instead of strengthening them, you start doing the exercises with bad form and compensating with other muscles.
Is it common to have no pain at all during exercise but every morning I wake up with left shoulder pain. When I go to open the shower curtain it really hurts then it kinda goes away until the next morning… I am only 27, it seems too young to “just be getting old and stiff”…
Have you been to a doc? Do recall what brought the pain on? I had a rotator cuff tear for years before it was diagnosed. I was repeatedly diagnosed with rotator cuff syndrome, but with all the PT it never felt better. I finally begged for an MRI and two tears were discovered. I’m still on the fence with surgery.
You are not getting “too old” at 27! Go get it checked out. Good luck.
I had shoulder impingement too (MRI showed small tear in Supraspinatus and 3 small tears in Labrum) caused by a fall on an out-stretched arm while trail running. I could not swim for 11 months. I did PT which helped a lot (mostly scapular retraction/stabilization exercises). The biggest improvement came from cortizone shot in the shoulder bursa (I also had inflamed bursa). Surgery was not offered. I am now I am 95% better and swimming Masters 3 x/week. Funny but on my first visit to the Sports Med Dr. he said it will take a year to get better, he was right!
Go get some really good deep tissue work done. Look into ‘fire cupping’ as well. I went through 2 rounds of PT and my ortho had me scheduled for subacromial decompression. Not once did anyone mention deep tissue work until I read about some results online. In short, the massage therapist put me through HELL and the fire cupping ain’t fun either, but no surgery and my shoulder is golden. Got a blast of cortisone from a doc at a small practice whom I went to for a 2nd opinion. He told me surgical intervention was absolutely NOT necessary after looking at my MRI and spending 40 minutes with me, to boot that deep tissue massage was extremely helpful in cases like mine and he even heard good things about the gal I was using! The surgical route was completely unnecessary and I was a number in the herd of sheep at the 800 lb. gorilla OrthoPod practice in town. The doc and PA with the other practice spent no more than 15 minutes total with me over 3 visits between the 2 of them…eh hem.
Good info from CZ and tp. I’ll add that my current GP here in Canada says that there are two “schools” within the sports med community. Those that believe in surgical intervention and those that don’t (generally). I have not been referred for surgery and I prefer not to go that route. My shoulder never feels 100%, but most active people usually experience some type of rotator cuff injury according to the docs.
The same thing happened to me 1 week before IMAZ, while doing yard work. I got a cortisone shot the Friday before the race and it helped get me through the swim. My PT tells me the reason for the impingement is 1. Age (I’m 38) and 2. weak surrounding muscles, particularly upper back. Strengthening exercises were given and this week I’m back in the pool slow and steady. It’s a common injury, so your PT should know the correct exercises to give. I do think the cortisone shot helped get me through rehab without wincing.
And yes, those are the technical terms that he used when discussing it with me.