Tendonitis

Aside from swimmer's ear, tendonitis is the most common swimmer's injury. Where this injury occurs often in high impact sports with an associated sprain, or blow, in swimmers this injury occurs simply from overuse of the joints. Take freestyle for example. At high levels of competition, a swimmer will perform around 12 strokes a length. For each hundred yards, this becomes 48 shoulder rotations. Now this doesn't seem like much but if you multiply this by the number of yards a high caliber swimmer does in a day (15-20k) we get somewhere near ten thousand rotations per day or 3 million rotations per year. This sort of repetition is hard on machines, but swimmers are flesh and blood. Their joints just plain wear out.

In reality, there's no way around it, if you compete as a swimmer and do the training required to reach any level of skill, you will get tendonitis. The only real question is how you're going to respond when you do. The most common joint to get tendonitis as a swimmer is the shoulder, but knee and ankle problems are not unheard of. Within the shoulder, swimmers commonly injure either their bicep tendon or rotator cuff.

How do you know you've got it?
When I first got tendonitis I had no idea what it was. The pain was very like a bee sting. It felt sharp after exercising which transformed into a dull ache. The shoulder felt swollen, less mobile, and weak. Between sets I just started rubbing my shoulder and, I suppose, looking worried. An older swimmer looked to me and said, "First shoulder problem eh? Probably have tendonitis." I looked to the coach who motioned for me to keep swimming and I finished the workout. Afterwards I was initiated into the swimmers injury league, given my bag of ice from the drink machine and told to go take some asprin. Little did I know it, but I had just entered a fraternity of walking wounded swimmers who would slog to the ice machine after every practice. I had seen these shadowy figures before, exhausted swimmers with strange bulges over their shoulders reading books and chatting while they waited for their medication to kick in. Now I was one of their number and would remain as long as I continued swimming.

What do you do now that you have it?
The most common remedy for shoulder tendonitis is ice and asprin (or advil, anaprox, or some other nacid) since rest really is not an option for swimmers in training. The ice is supposed to reduce the swelling of the affected tendon while the drug is meant to scour the tendon of any excess scar tissue that might form during recovery (yes it also deadens the pain but that's really just a useful side-effect). You can either massage the tendon with ice for 10 minutes, or so, or put a bag of chipped ice on the area for 20 minutes. Usually this regimen performed after each practice will keep the condition from getting any worse. If not, it's time to go see a doctor and get some physical therapy (PT).

Physical therapists generally have three weapons in their arsenal for attacking a swimmer's tendonitis. The first, and most commonly used is stim. Short for electrical stimulation, the physical therapist puts electrodes on the muscles around the tendon in question and hook them up to a machine. The machine passes a small current of electricity through these electrodes that make your muscles clinch in rhythmic balance, first one side of the tendon will flex, then the other. Usually this goes on for about fifteen minutes then they have you ice and go on your way. It doesn't hurt, and if you can ignore your arm moving of its own accord, pretty restful.

The second method of attacking tendonitis that physical therapists use is ultrasound. The therapist determines the tendon at fault and targets it with a device that looks very similar to the receiver that is put up against an expectant mother's belly when they give her and ultrasound to diagnose any potential issues with her child. Only this ultrasound emitter is a lot more powerful. It?s designed to break down the inflammation of the tendon in question with a focused blast of sound waves. Commonly this only really feels warm at the site of the interaction of soundwaves and the tissues being treated, but in a very small number of patients, the ultrasonic vibrations can set up a resonance frequency with nearby nerves causing the arm and hand to feel like they're on fire. Boy did I feel lucky.

If stim and ultrasound don't work, the therapist may be asked to manipulate the tendon. When I first heard of this I thought, sure this won't be bad, just move some things around and it'll be over in a snap. My shoulders being so loose as to move about on their own accord already, it didn't seem like a big deal. I was wrong. Manipulation of a tendon refers to the therapist using their hands to forcibly rub the inflammation out of the offending tendon. Typical associated medication with this technique is a rolled up towel to bite down upon since bullets are hard to find in the PT office.

Finally, if stim, ultrasound, and manipulation don't work, the doctor may order a cortisone shot. Cortisone is a steroid used to help tendons and connective tissue repair itself and it can reduce the inflammation of tendonitis drastically. Bring that towel though from the PTs cause this shot isn?t a flu shot. The needle they have to use to get into the joint is about four inches long and feels like liquid fire is being poured into your shoulder. If this doesn't work, there's no remedy other than surgery for repairing your tendons.

How do you make sure you don't get it again?
Given all these "remedies" to shoulder tendonitis, it's no small wonder that swimmers with this problem work like crazy to keep their shoulders fit and able to outlast the punishment of swimming practice. Swimmers shoulders are commonly very flexible given the demands of their sport. However, that same flexibility leads to shoulder instability and tendon damage. So in order to avoid recurrences of tendonitis, swimmers have developed a regimen of exercises that strengthen the back muscles near the shoulder to help keep it stable during a full stroke rotation. All these exercises are done with small amounts of weight or with surgical tubing to create resistance. They are also done with a high number of repetitions since the idea is to build endurance as well as strength in these muscle groups that are in opposition to those commonly used in swimming.

The first exercise is to lay on your side with one shoulder up. Keep the upper arm at your side and bend your elbow 90 degrees. While holding the weight in your hand, rotate the weight from in front of your belly to over your elbow while keeping that elbow immobilized at your side. After doing about twenty reps, flip over and do the other side. The second exercise is to stand on the floor with your feet shoulder-width apart. Take a small weight in both hands and bend 90 degrees at the waist so that you're facing the floor. Hold the weights straight out toward the floor and while keeping your arms straight and the backs of your hands pointed towards the ceiling, bring those weights to an equal height with your shoulders. Do about twenty reps this way. These and other shoulder exercises will aid in creating a strong foundation for your shoulders so they won't move about as much during your stroke rotation. Less instability in your shoulder socket leads to less likelihood of developing tendonitis.

An ice and asprin regimen can also be used as a prophylactic measure. Whenever you're done with practice, go get a bag of ice and put it on your shoulder. Take some asprin. After twenty minutes, take the ice off and stretch out the shoulder lightly. I know this extra 20 minutes out of your day is a burden, especially if you?re in school. However, you'll find that it's a worthwhile use of your time considering that the alternative is hours spent in the physical therapist's trying to recover from an injury.

Now, please be advised, I am not a doctor. If anything you're experiencing is worse than what I've described here or if you feel something different, go see a good doctor. Physical therapists also have a wealth of information and exercises that will be tailored to your specific injury so don't be shy in visiting them either. Above all protect your body. It's your only real asset when it comes to this sport.