I went to see an orthopedist in early January and based on her functional exam, she thought I may have bursitis, caused by my soft tissue getting impinged by one of the bones in my shoulder joint. The common, generic term for this is not-surprisingly – shoulder impingement.
Here’s a shoulder joint. The rotator cuff is a group of 4 muscles: supraspinatus (shown), infraspinatus (not shown), teres minor (not shown), and the subscapularis (not shown). The job of these 4 muscles is to stabilize the top of the humerus and control the movements of the shoulder. There is also a bursa protecting it that lies in between the rotator cuff and the acromion process. The blue arrow points to the muscles of the rotator cuff and the space where the bursa is. These soft tissues can get impinged between the acromion process and the top of the humerus. Some people are more prone to it than others based on the shape of the bones in question and our risk increases with age and certain activities where you put your arms over your head (i.e. swimming).
Since she suspected some of the soft tissue in there was really inflamed and aggravated, my doctor gave me some good NSAIDS and suggested I rest for a few weeks to see how it responds. I did that through the month of January and tried swimming again at the beginning of February. Then, after 3 swims, it flared up again. I went back to the doctor. We decided that I’d make an appointment with the orthopedic surgeon for potential MRI/evaluation in about a month, but in the interim go to physical therapy to see if we could get the issue addressed prior to the next appointment and be equipped and informed to make a better decision.
Naturally, in my head, I’m thinking I’ve got to go see Mike Beretta (www.berettapt.com) -- if you live in our area, he is the best PT around. He’s an athlete himself and really understands the fundamentals and the best way to approach getting you back to activity. And conveniently, the Orthopedist mentioned Mike without me saying anything. After looking at my shoulder and assessing me, he basically concluded that my left shoulder is unstable and “all over the place.” He went on to explain that my scapula is moving around way too much and the top of my humerus is not as stable in the ball/socket joint as it needs to be. In addition, years ago, I got injured in a basketball game when a big dude body-blocked me from the side when I was reaching my arm(s) out for a steal on a cross-court pass. I felt my shoulder crunch, but didn’t really think that much of it at the time and just let it heal naturally. I haven’t had any trouble swimming since then, but it seems perhaps that injury in combination with some severe weakness and instability probably came together to cause this issue. Tweaking it in the gym and exacerbating it by starting on the swim project didn’t help matters. It also explains how I may have developed some weirdness over the last few years in my swim stroke. I had been working hard to try to correct a hitch / in-swing on my left side catch and pull and my left shoulder apparently had a hard time with this.
To address the core issue, Mike has a strategy and I am working hard to implement it. Our objective is to significantly improve the strength in my rotator cuff and back/shoulder muscles that stabilize the scapula, etc. Though most of it is beneath bone and not easily accessible, he is doing some direct stimulation of the tissue as best he can to get the inflammation under control (ASTYM, electrical stim, and laser), but our main focus is “pummeling” my shoulder with very specific, focused exercises to build strength and stability. And boy am I feeling muscles I’ve never felt before!
All of this is makes sense and brings a new meaning to the idea of “functional strength.” It has really been a buzz-word lately in triathlon and to be honest, for a busy age-grouper with limited time, you often get more return on investment (i.e. time invested and race performance return) from additional swimming, biking or running. Strength is a nice bonus that I consider to be an activity to incorporate into your training when you have time. Having said that, I do think it is important to do some strength in the off-season and if you have the time, perhaps some basic maintenance through the race season, but the bottom line is that it takes time and usually it’s more beneficial to use that time for more sport-specific skill and fitness development.
Except now I find myself in a position where my body didn’t seem to have the “functional strength” to provide the foundation on which I could start building more swim fitness… and I paid for it. I am working hard to remediate the issue and rehab it as quickly as I can, but the body’s processes and adaptation take time. The aggravated tissue needs to heal and I need to do my exercises every day. Now, instead of having specific goals for swim session frequency, volume, and benchmarks, I have turned those goals into specifics for frequency and consistency of my strength exercises. In addition, the whole situation has caused me to rethink my race goals for 2012. I went from having ambitious swim-split goals to just having the goal of being able to swim pain-free (and cover the distance) in my early season races. I am cautiously optimistic I’ll be able to do that, but am developing a backup scenario.
The bottom line is that this sport continues to teach me that the enjoyment comes from the process, setting goals, working towards them, but also being able to change courses when circumstances call for it. It’s all about continuous improvement and making short term decisions that are always contributing towards your long term goals and the big picture.
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