Fitness Makeover: Dealing with rotator-cuff pain

Credit: Al Bello/Allsport
Februarys Fitness Makeover subject is Kathleen Morris, a 33-year-old Seattle-to-New York transplant and masters swimmer who is suffering from rotator cuff bursitis and tendonitis.

Although last Octobers Fitness Makeover focused on a swimmer with a broken arm, suggesting ways for him to stay in shape while his limb was in a cast, Kathleens situation is different because she has a nearly inevitable injury that we all could face at any moment in our swimming careers.

While swimming is widely known to be the safest, least-injury-prone sport one can do, rotator cuff inflammation is a common condition that plagues the most dedicated swimmers. It strikes suddenly, and is usually the result of overtraining, bad stroke technique, or just plain bad luck.

A sharp pain that inflames the shoulder with every stroke, it usually flares up whenever the arm extends forward or above the head.

Such shoulder pain can be chronic. Taking time off might allow the tendons in your shoulder to heal, but eventually they will become inflamed again with intense training leaving you sidelined once more.

So when rotator cuff tendonitis strikes, what can you do to salvage your season and more importantly your shoulders?

Kathleens physical therapist advised her to be cautious of the yardage she covered in the pool and to stop swimming immediately if she felt any pain. She also has been counseled on plenty of rehab exercises and stretches, which are an essential part of her recovery.

Accustomed to six to eight workouts per week at 3,500 to 4,000 yards per session, Kathleen is reluctant to pare down her yardage because shes hoping to compete in a few one-mile (and longer) ocean races this summer.

Clearly, she should not be swimming when her shoulders flare up, and indeed the most difficult part of her recovery process might be forcing herself to quit when her body tells her that she should. But Kathleen need not forgo athletic conditioning, or even proper preparation for her summer goals, just because she cant swim as much as shed like.

There are plenty of dry-land exercises she can do that will not put pressure on her shoulders exercises that can still serve as a base for her upcoming ocean-racing season.

First, Kathleen writes that she lifts weights twice a week in addition to her swim program. While weight training is an important part of a swimmers strength conditioning, it is also the first thing you should stop doing when dealing with rotator cuff discomfort. Although Kathleen did not specify what types of weight exercises she was doing, it is a safe bet that some of them are inflaming the very tendons that are causing her so much grief.

Any exercises where the arms are raised above the head (lat pulldowns, overhead triceps extensions) are a definite no-no. Dips and chin-ups also can have disastrous effects on already-ailing shoulders.

Light repetitions with featherweight dumbbells are the only drills that can serve as a rehabilitative exercise if done correctly, but they should be closely monitored by a physical therapist (at least initially) to ensure proper form (bad form can exacerbate the problem). Again, if working with dumbbells, no matter how light, they should not in any way be raised above your head.

According to Debra Lieberman, OTR/L, an ergonomic consultant at an orthopedic rehab center in Washington D.C., internal and external rotation exercises with the elbow close to the body are a great way to start building up strength without aggravating the inflamed tendons.

Internal rotation is the motion bringing your arm toward the body, and external rotation is bringing the arm away from the body, Debra explains. The exercises should be done with a towel roll in between the elbow and body, while swinging the arm out to the side and back in again.

She adds, Icing down the shoulder for 5 to 10 minutes after your workout may decrease the inflammation and soreness as well.

Also important to remember is that any prescription or over-the-counter drugs (such as Naproxin or Advil) can be effective in masking shoulder pain, but they dont cure the problem. Take these medications in moderation when recommended by a professional, but do not rely on them to hide the pain in order to continue training at intense levels. Your body is telling you it needs to heal, and painkillers can be extremely detrimental in the overall healing process and your long-term health.

I strongly advise Kathleen to increase her dry-land cardio training. Choosing exercises that leave the pressure off her shoulders will allow her to heal quickly while maintaining her conditioning. She is already a regular on the Stairmaster, doing up to 75 minutes per session. She admits she hates running, but I would venture to guess that 75 minutes on an indoor machine could be no worse than braving the elements for an outdoor jog!

The Stairmaster, while a popular exercise, can put undue stress on the shoulders. If Kathleen is the type who grips the handlebars, locks her elbows, and hoists most of her body weight onto her shoulders while moving her legs up and down, then she is placing a lot of stress on her inflamed rotator cuff (and not getting much of a workout, either).

For the ultimate Stairmaster workout, dont rely on your upper body to lift the weight off your legs. Rather, do the machine with your arms swinging at your sides, or better yet, find a stair-treadmill with actual rotating stairs (this simulates stair climbing a lot more effectively than the common hydraulic machines found on most gym floors).

Rather than using the handlebars to hoist yourself up or pull yourself forward, rely on them for balance only, with a light grip. This will give your legs and heart a great workout while salvaging your shoulders.

Kathleen mentioned that she does a lot of kicking drills in the pool when her rotator cuff acts up, but these drills can contribute to her problems if she is using a kickboard or holding her arms above her head. Remember, using a board forces you to extend your arms in front of you while you rest your upper-body weight on your shoulders. This pressure can inflame already-tender areas in the rotator cuff. Kicking in a streamline position also requires that your arms extend above your head.

The best way to kick when suffering from any type of shoulder injury is with your arms relaxed down by your sides. To breathe, simply twist, or corkscrew, your body to either side without using your arms. This also will teach you to rotate your body in the proper way with each stroke, when swimming correctly.

Kathleen also wondered if backstroke could be an alternate stroke to rely on when shoulder pain strikes. This depends on the extent of her injury and the area of inflammation. Backstroke recovery requires your arms to be raised above your head, so it may not be an ideal solution. However, because you are using a different set of muscles to swim backstroke than you are when you swim freestyle, you may find this option pain-free.

If so, doing backstroke is a good way of maintaining your feel for the water. Try it, but if your shoulder pain persists, then its best to avoid any rotation of the arms, freestyle or backstroke.

Any type of consistent dry-land cardiovascular training can keep Kathleen adequately conditioned to complete her one-mile-plus ocean races this summer. The aforementioned Stairmaster is Kathleens machine of choice, although I recommend a stationary bike or outdoor running because youre less inclined to put pressure on your shoulders.

Kathleen could get away with anywhere from 30 minutes to an hour of cardio several times a week, given that she wants to compete in one- to two-mile distances.

More important than the time she spends on the Stairmaster is the intensity at which she exercises, and where she keeps her heart rate. For at least 20 minutes of each session, she should aim to maintain a threshold heart rate.

Threshold is approximately 70 percent of (220 minus your age). So for example, a 30-year-old athletes threshold heart rate is generally about 133. This is a rough estimate at best, however; for a more accurate and personal analysis, contact a certified personal trainer.

Of course, Kathleen also needs to keep her feel for the water, and she can easily maintain it by swimming a light workout two to three times a week. Kathleens concern is that in order to be successful, she needs to get back to her normal weekly yardage of 25K to 30k.

She need not worry. Just because she competes in 1,500-meter and 2,500-meter races, she does not have to cover twice or three times that distance in every workout. Some of my longest races are 12 to 15 miles, and the most I swim in any given workout is five miles (in fact there are entire weeks when I dont cover the total distance of the races I do).

Remember that racing conditions are different than everyday pool conditions. Currents, salt-water buoyancy, and pre-race adrenaline can all work in favor of a swimmers endurance capabilities.

Most marathon runners have never done a training run that exceeds their 26-mile race distance, yet they complete the distance without any problems. Training longer distances than the races you do can give you the confidence to know that you can finish the race, but its not necessary.

Like plantar fascias (a chronic runners problem that occurs in the ball of the foot), tendonitis in the shoulder may never go away leaving some sufferers with no choice but to live and train with it. But this doesnt mean you have to throw in the towel each time your shoulder flares up.

By scheduling other forms of cardiovascular exercise around a curtailed swimming program, you can maintain great conditioning without succumbing to more serious injury.

If you are interested in being the subject of a Fitness Makeover, please e-mail your questions to Alex, and include a phone number where you can be reached upon your selection.

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