I recently treated a 19-year-old male client who is a regular swimmer. He was complaining from pain and stiffness in his right shoulder. The affected joint presented stiffness and tension at the insertions of some muscles crossing over the joint. Range of Motion (ROM) test on different planes confirmed restriction of movement.

It is common on swimmers to suffer from rotator cuff tendonitis or shoulder impingement due to a combination of factors such as overtraining or/and lack of rest, poor stroke mechanics, lack of stretching and/or warm up, insufficient “off-pool” activities such as weight lifting to strengthen rotator cuff muscles, etcetera.

Repetitive motion of the shoulder when performing backstroke, freestyle and butterfly strokes is the most common factor that contribute to this type of injury. When the joint gets overused muscles such as deltoids, rotator cuff, trapezius, latissimus dorsi and pectorals may be badly affected. The tissue becomes rigid and the fibers of the muscles adhere to one another due to the reasons mentioned above. It is important to treat the affected tissues as soon as possible to prevent further injury.

In this case client’s shoulder presented restriction on lateral rotation. Palpation revealed the existence of adhesions along some fibers of the pectoralis minor as well as tenderness of the subscapularis muscle. These 2 muscles internally rotate the shoulder and when they are tight they can limit external rotation of the joint.

It is important to emphasize that massage is contraindicated directly on the injured area in the acute phase. The patient often presents pain, the tissue is inflamed and the existence of fluid around the affected structures is common. However the surrounding tissues can be massaged as this will reduce edema and inflammation.

The strokes are best applied from distal to proximal starting above the swelling which will decrease the amount of fluid in the area. Once inflammation has decreased more invasive techniques (see below) can be used.

Techniques such as friction are effective in breaking down adhesions and scar tissue which restrict movement of the joint, loosening tight tissue and increasing blood circulation.

Muscle Energy Technique is another useful technique that helps to stretch and strengthen muscles as well as to break down adhesions whereas Soft Tissue Release (STR) relieves tissue congestion, improves elasticity and increases muscle length, making the muscle more mobile and increasing joint functionality.

Applying these techniques over a few sessions along some strengthening and stretching exercises for the shoulder allowed me to get the client back to the pre-injury state. The tissue of the affected joint became looser and more mobile, adhesions were broken down and those shortened muscles were lengthened.

Client confirmed by the end of the treatment sessions that he can now swim pain free.

I advised client to have regular treatment sessions not only to prevent injury but to maintain his muscles, tendons and ligaments in good health.

Remember Sports and Remedial massage can improve the quality of muscle tissue meaning less tension, less pain, less stiffness, more functionality, better performance… and the last but not the least: better quality of life!