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Nancy Ridout
October 29th, 2007, 10:21 PM
I'm putting together an article on shoulder problems for USMS Swimmer with a different slant. With your help, I hope to identify different types of typical shoulder problems swimmers encounter, symptoms, treatment, and your experience with the outcomes for these problems - a resource for swimmers who experience shoulder problems and how other swimmers have dealt with them and managed them.

If you'd like to be a part of this article, please respond to me with answers to the following questions.
1. Diagnosed name of injury and date it occurred (or how long ago it happened).
2. Initial symptoms.
3. Initial diagnosis - by self, PT, MD, other?
4. Initial treatment - as prescribed by self, PT, MD, other?
5. Additional treatment (including surgery).
6. Length of time out of the water. Please include type of training when resumed.
7. Length of time until back to previous level of training.
8. After treatment do you feel you're at the same level of training and performance as before your injury? A higher level? Have not reached previous level of training and performance.
9. Any other useful comments.

Thank you for your feedback. I appreciate your taking the time to help!

Nancy

sspiker
February 13th, 2008, 11:53 PM
1. Diagnosed name of injury and date it occurred (or how long ago it happened). impingement and Tendonitis 20 yrs ago
2. Initial symptoms. pain in left shoulder from swimming. chronic
3. Initial diagnosis - by self, PT, MD, other? MD
4. Initial treatment - as prescribed by self, PT, MD, other? PT
5. Additional treatment (including surgery). surgery trimmed acromium.
6. Length of time out of the water. 3 yrs. Please include type of training when resumed. swimming 4x week.
7. Length of time until back to previous level of training. 1 yr after surgery
8. After treatment do you feel you're at the same level of training and performance as before your injury? no A higher level? no Have not reached previous level of training and performance. no
9. Any other useful comments.

The Fortress
February 14th, 2008, 12:07 PM
1. Diagnosed name of injury and date it occurred (or how long ago it happened).
2. Initial symptoms.
3. Initial diagnosis - by self, PT, MD, other?
4. Initial treatment - as prescribed by self, PT, MD, other?
5. Additional treatment (including surgery).
6. Length of time out of the water. Please include type of training when resumed.
7. Length of time until back to previous level of training.
8. After treatment do you feel you're at the same level of training and performance as before your injury? A higher level? Have not reached previous level of training and performance.
9. Any other useful comments.

Thank you for your feedback. I appreciate your taking the time to help!

Nancy


Good luck with the article, Nancy. Sounds like a great idea.


1. Abnormal frayed labrum/SLAP lesion. Original RC injury occurred in college 28 years ago. Rehabbed it then and never noticed it again until I started masters swimming over 2 years ago. Immediately came down with chronic tendonitis and pain.

2. Initial symptoms: pain at back of left shoulder, dull aching pain at rest, pain in trap (which I now understand can indicate a labrum problem)

3. Initial diagnosis: Tendonitis by MD. This was accurate, but he missed the labrum problem.

4. Initial treatment: Cortisone shot and PT. Ineffective. Pain came back.

5. Additional treatment: Did some research and decided to try ART (active relief therapy) for the tendonitis issue, www.activerelease.com. This was much more effective for me than PT, although I continued to do my RC exercises. Still had pain at the back of the shoulder and trap. My ART doc ordered an arthrogram, which revealed the frayed labrum and a SLAP lesion in the supraspinatus. Not really a surgical issue. Since then, I've been doing prolotherapy and plasma regeneration therapy ("PRP") to attempt to regrow and strengthen the tendons. Prolo takes a very long time. PRP seems to be quicker and more effective. After 2 treatments, I have significantly more stability in the shoulder. I understand from a recent WSJ article that PRP is now being used in rotator cuff surgery to prevent re-tearing. I still go to ART 2x+ a month. I plan to have 2 more PRP treatments.

6. I was never out of the water for any extended period. No more than a few days at any point. If my shoulder was bothering me, I did more kicking. PRP treatments keep me out of the water because they are very painful. (You're getting injections directly into the tendon.) I have never done high yardage workouts. Depending on my schedule, I swim 4-5 x a week, between 10,000 and 14,000 max. I cross train a fair amount. Haven't increased the yardage because I'm leery of worsening the injury. Use fins a lot amount to avoid stressing the shoulder while it's healing.

7. N/A

8. My shoulder is significantly better than 2 and 1/2 years ago. I rarely ice, there is no chronic pain. I just have to be somewhat cautious. My times have continued to improve.

9. I think more swimmers should consider treatments other than conventional PT. Triathletes seem far ahead of swimmers on this score.

Slowswim
February 14th, 2008, 04:35 PM
1. Torn Rotator Cuff

2. Pain in the Bicep and delt especially while make lateral hand movements(to include steeering a car).

3. MD

4. Cortisone shot and 2 weeks rest.

5. X-ray and Doctor recommended Surgery. I asked for and got an MRI. MRI showed no tear, new Diagnosis: Strained Bicep tendon. PT and gradual weight training.

6. From time of Cortisone shot to diagnosis and treatment of bicep tendon strain and initial PT: about 5 weeks

7. 6 weeks for swimming; 6 months for weight training; no time of for running, biking and other non-arm weight bearing exercises

8. Have not reached previous level for weight training hae surpassed previous swimming level, but that was not too difficult to do.

9. Always get a second opinion and exhaust test before surgery. The needless rotator cuff surgery would have cost me a lot in time, pain, and therapy for a mis-diagnosis.

JimRude
February 14th, 2008, 06:27 PM
I'm putting together an article on shoulder problems for USMS Swimmer with a different slant. With your help, I hope to identify different types of typical shoulder problems swimmers encounter, symptoms, treatment, and your experience with the outcomes for these problems - a resource for swimmers who experience shoulder problems and how other swimmers have dealt with them and managed them.

If you'd like to be a part of this article, please respond to me with answers to the following questions.
1. Diagnosed name of injury and date it occurred (or how long ago it happened).
2. Initial symptoms.
3. Initial diagnosis - by self, PT, MD, other?
4. Initial treatment - as prescribed by self, PT, MD, other?
5. Additional treatment (including surgery).
6. Length of time out of the water. Please include type of training when resumed.
7. Length of time until back to previous level of training.
8. After treatment do you feel you're at the same level of training and performance as before your injury? A higher level? Have not reached previous level of training and performance.
9. Any other useful comments.

Thank you for your feedback. I appreciate your taking the time to help!

Nancy

Nancy -

I am a work in progress, having injured my shoulder in mid December. So my answers will be partial until I visit the orthopedist on 02-25-08:

1. Mid December 2007. Either (a) bursitis, or (b) impingement of acromion, or (c) labral tear, or...

2. Intense pain, on top of shoulder, decreased range of motion especially across body (deltoid stretch) and overhead extension.

3. Self and GP. Orthopedist in 10 days(!).

4. Ice, heat, rest, RC exercises.

5. Added massage and chiropractic myself, with limited benefit.

6. 2 weeks nothing. Kicking and limited swimming since.

7. Not there yet (typical is 3-4,000 meters/day).

8. TBD

9. Getting older is a bummer! In all my years of age-group and college swimming, never any shoulder problems. Then, within 6 months of starting masters, BOOM!

geochuck
February 14th, 2008, 07:49 PM
1. Frayed tendons, both shoulders.
2. Injured during a 28 mile marathon swim July 9 1964. Could not lift my arms for 1 week. When I drove a car I had to lift my hands and arms up with my knees. Swam in 7 more races but swam a style so they did not hurt.
3. Diagnosed Aug 16th by an Orthepidic Surgeon
4. Injected with Cortizone by surgeon. He suggested that I quit swimming. I told him I had to race a 32 mile race next week. He told me not to pull during the catch phase. I took it easy came in third.
5. I went to Egypt and treated by a Dr. there. He told me the tendons were nearly torn in Half and made suggestions of a swim stroke change. Injected both shoulders with novicane just before a twentyfive race in Alexandria.
7. Never changed the training schedule changed my swimming technique so I did not have pain.
8. After the novicane injection and complete change in swimming stroke I swam faster and better.
9. Never a problem with my shoulders after.

Ian Smith
February 14th, 2008, 10:18 PM
1. Diagnosed name of injury and date it occurred (or how long ago it happened).
Right shoulder only. Ultimately determined to be Impingement. Summer 2006.

2. Initial symptoms.
Relatively sudden occurrence built up very quickly
Pain on freestyle recovery only. Did not hurt during the pull.
Could lift the arm up from the front but not from the side (backstroke recovery was OK)
Have a 6 speed manual shift car and even had trouble changing gears

3. Initial diagnosis PT:
Rotator cuff tear and calcification of the tendon.

4. Initial treatment - as prescribed by PT:
Theraband (sp?) exercises for the rotator cuff and ultrasound.
This made almost no difference over 6 weeks.

5. Additional treatment (after lack of progress from PT)
Surgeon took xrays and diagnosed impingement causing tendonitis
Gave a cortisone shot.
Immediately after the cortisone it was possible to swim again
Iced the shoulder after each swim as a precaution
Took ibuprofen if things flared up.
At a 6 week follow-up to the surgeon he said if the shoulder could be managed with the with the occasional ibuprofen, he would not recommend surgery (scraping the acromion). Surgery only if it was getting worse.

6. Length of time out of the water. Please include type of training when resumed.
Trying to rest the shoulder there was no swimming for about 3 weeks
Careful build up in swim training over time
Same careful build up with weights (not just shoulder stuff)

7. Length of time until back to previous level of training.
Probably about 4 months

8. After treatment do you feel you're at the same level of training and performance as before your injury? A higher level? Have not reached previous level of training and performance.
Am at more or less where I figure I might be without it but am being very careful with shoulder now odd movements can hurt.
(as you get older it is tougher to reach previous levels regardless of shoulder)

9. Any other useful comments.
I think what helped the most (other than the cortisone which kick-started things) was weights. I could do some weights at the same level as before but others I had to start from a much lower level.
My shoulder has always been touchy but from a lot of competitive tennis and squash, not from the swimming. Swimming never bothered it - Im not a huge trainer anyway (3x per week) sticking to racing 50s with an occasional 100.
I still dont know what precipitated such a sudden shoulder problem it did not build up over a long time as I would have thought it would with impingement.

jim thornton
February 14th, 2008, 10:49 PM
Nancy, if i am not mistaken, i read about your shoulder travails in a recent Swimmer magazine, right?

I think one of the most important aspects of this kind of injury is attention to the psychological dimensions, especially if swimming is very important to you as a source of stress relief, competitive pride, even self definition.

I had a very hard time of it several years ago after much overuse--as Ian said, tennis serving really can aggravate things, and this on top of a 10K open water swim, then trying to do butterfly too intensely when i was back in the pool--all added to give me quite a depressing case of shoulder-itis.

I wrote about it, and sports medicine in general, in Men's Health. I don't know if this would be helpful at all to read, but you can find it here:

http://www.menshealth.com/cda/article.do?site=MensHealth&channel=fitness&category=sports.injuries&conitem=041c17b4ffa84010VgnVCM100000cfe793cd____

I guess if I had to sum up the three top bits of advice, they are these:

1) realize that the vast majority of these problems get better if you give the shoulder time to rest and de-inflame. this doesn't mean putting it in a sling and not moving it at all--that makes things worse. but getting fins and taking as much weight off as possible, just letting your arm go through the motions with out actually pulling forcefully, is the way to go.

2) stay in the pool with your teammates--camaraderie is so key to the psychological well being of an athlete, and any sense of exile just makes an injury seem that much worse. if zoomers don't let you kick hard enough to keep up with your lane mates, get larger, more flexible flippers. tell yourself -- and this is true-- that you are getting a harder aerobic workout kicking fast than swimming, since the legs have so much more muscle mass than the arms and shoulders. plus your ankles will gain in flexibility. you hear it all the team: injured swimmers forced to kick for weeks or months often swim PRs once they are allowed to swim normally again.

3) surgery and elaborate therapies of one sort of another are probably necessary for traumatic injuries and some overuse injuries, but for the latter type, which the vast number of swimming shoulder problems fall into, relative rest, pt, ice, and patience will get you back. Note: patience is the hardest thing of all for me to practice, particularly when you're not really sure it's ever going to get better. I think people jump to surgery out of frustration to feel better faster, before the clock can tick away one second longer! In the long run, though, considering the time you have to rehab the surgery itself, I would bet a large chunk of surgical patients would have healed on their own faster than it takes to schedule, undergo, and heal from the surgery itself.

From back surgery to prostate removal, I think there's a groundswell of thought in parts of the medical community now that an awful lot of conditions are being overtreated by means that do not have a demonstrated record of providing more cure than harm--and all extracting money and pain from you to enrich the legions of orthopods who need to pay their dues at the country club.

rtodd
February 14th, 2008, 11:09 PM
Good article.

ALM
February 15th, 2008, 12:31 AM
Injected both shoulders with novicane just before a twentyfive race in Alexandria.

So....

geo "Clemens" chuck admits to doping.... :bolt:

Nancy Ridout
February 15th, 2008, 12:37 AM
SSpiker, Fortress, Bill, Jim, George, Ian, Jim, and Rob,

Thanks so much for your responses. I was surprised and very gratified to get them. I posted this request in October and thought no one was interested. It seems I was wrong and may revive this idea. How did you all find the posting from so long ago and take time to respond?

You all spoke of symptoms and experiences that I can relate to and you all seem to be handling them well. Rob, I wish you luck with your medical appointment and a good orthopedist that you can trust and that knows shoulders and swimming. Thanks to those of you who read the artcle in the latest Swimmer magazine. I was surprised that they wanted to do it but am now glad they did since there have been some positive responses from people who got a message from it. Jim Thornton was right on when he commented on the psychological and emotional component of the effects of having to be out of the water with this injury. The pain and the unknown hurt but not as much as being away from your teammates, your friends.

If you know of others who might be interested in joining this pool of responses, please invite them to respond. Maybe we can get this going again. Many thanks! And Happy Valentines Day!

Nancy

geochuck
February 15th, 2008, 02:55 AM
Nancy I was in Mexico October and December and missed your original post until sspiker replied.

poolraat
February 15th, 2008, 02:16 PM
One more for you, Nancy.

1. Left shoulder impingement, happened in July, 2004. At the time I had only been swimming about 4 years, having taken up swimming in 2000 as a 48 year old. I had no prior swimming background and my technique was not very good at the time.

2. It happened suddenly, one day I was fine and did a normal workout. The next day, I couldn’t lift my arm and swimming any stroke hurt. At that time I was breathing only to my right side. I found that as I turned to breathe I was using my left arm to “help” and it hurt like **** when I would breathe.

3. At first I just thought it was a minor strain or pull and a friend who was a high school coach (not swimming) suggested that I see a chiropractor. I did this for 2 weeks and when there was no improvement the chiro recommended I see an orthopedist. I was finally able to get an appointment to see the ortho in late August.


4. Initial treatment as prescribed by MD was anti-inflammatory medication and 6 weeks PT in September and October 2004.


5. I Have continued with a routine of RC exercises sporadically ever since finishing PT. If it feels good I tend to neglect it but if it gets sore or aches, I resume the daily regimen. I had also begun doing yoga in the year prior to the injury (I don’t know for certain if the injury was the result of swimming or yoga). I have continued to do yoga since, although in the year following the injury was limited in the poses I was able to do until the strength began to return. Within a year I was back to about 90%, and it has gradually improved to where I am now.

6. I stayed out of the water for about 2 weeks then resumed by primarily kicking with limited freestyle swimming. Absolutely could not do fly, and backstroke really hurt. I also forced myself to learn to breathe to the other side and learned to rotate to breathe to both sides without using my arms to help. By the time I began PT (about 2 months after initial injury) I had resumed regular workouts, primarily freestyle. The other strokes still hurt so I did only a limited amount of these.

7. By the end of September, about 3 months after injury, I had resumed full workouts, though I did still favor it a bit and it ached after most workouts. It still aches after a hard workout especially when I’ve done a lot of stroke work.


8. A year following the injury I swam PB’s in the free, fly and backstroke sprints. Since then, I have continued to improve and set PB’s in events from 50 to 500 free and in 50 & 100 fly and back. But this is mainly due to improvements in technique and, in my opinion, not directly related to the recovery from shoulder injury.

JimRude
February 25th, 2008, 12:45 PM
Nancy -

Update on my last posting:

Saw orothpedic surgeon today. Based on x-rays (no MRI done), diagnosis is no RC tears (yeah, hopefully) due to range of motion and strength levels. Instead, acromioclavicular arthritis. Received one very painful cortisone injection, told to resume training slowly and return in 1 month.

Ian Smith
February 26th, 2008, 10:04 PM
Received one very painful cortisone injection.

My orthopedic guy had some kind of local anesthetic (novocaine?) mixed in with the cortisone. He did not want me moving while he injected, which had to be precise, according to him.

He did it quite slowly and it did not hurt. Afterwards, the shoulder was numb, which was probably a good thing. It felt like instant cure.
Ian.

Slowswim
February 29th, 2008, 03:40 PM
My orthopedic guy had some kind of local anesthetic (novocaine?) mixed in with the cortisone. He did not want me moving while he injected, which had to be precise, according to him.

He did it quite slowly and it did not hurt. Afterwards, the shoulder was numb, which was probably a good thing. It felt like instant cure.
Ian.

Same here from my cortisone shot. Didn't feel a thing.

Karen Duggan
February 29th, 2008, 07:49 PM
Hi Nancy-
Contact Kerry too. We have a ton of people on our team dealing with shoulder injuries right now. There have been at least four surgeries that I know of in the last year. Ken Burr, John Roemer (although I think his was due to H2O polo), Jim DeLacy, and I can't remember the other one at the moment. I know Leianne is also having troubles...
Hope this helps :)
Karen

cdrcld
February 29th, 2008, 09:07 PM
1. Diagnosed name of injury and date it occurred (or how long ago it happened).
2. Initial symptoms.
3. Initial diagnosis - by self, PT, MD, other?
4. Initial treatment - as prescribed by self, PT, MD, other?
5. Additional treatment (including surgery).
6. Length of time out of the water. Please include type of training when resumed.
7. Length of time until back to previous level of training.
8. After treatment do you feel you're at the same level of training and performance as before your injury? A higher level? Have not reached previous level of training and performance.
9. Any other useful comments.


1. a. SLAP Lesion (1996), b. surgical knife blade stuck in shoulder (1996), c. torn rotator cuff (1999), d. rorn rotator cuff (2006

2. pain in shoulder when swimming or lifting arm.

3. Initial diagnosis by Orhto Surgeon (for all 4 injuries)

4. Initial treatment - surgery for all 4 injuries - treated by Ortho Surgeon (for all 4 injuries)

5. Physical Therapy after surgery and continuing self therapy in the gym 3 x per week forevermore.

6. Out of water a. 4 months after SLAP lesion surgery, b. 4 months after having knife blade removed from my joint, c. 8 months after rotator cuff repair number one, and d. 7 months after rotator cuff repair number two.

7. To reach the same level of TRAINING (not performance), it is about a year.

8. Never really reached the same level of performance. Despite my best efforts, I lose a few seconds a hundred after each surgery.

jim thornton
March 3rd, 2008, 11:56 PM
Nancy, inspired by your post, I am going to attempt a poll. Perhaps it will help you gather more data.

Dennis Tesch
March 4th, 2008, 12:50 AM
Good Luck on the article Nancy! Here are my answers.

1. Diagnosed name of injury and date it occurred (or how long ago it happened). I had two doctors and couple PT"s tell me I had a labrum tear. This happened about 5 years ago - 2002
2. Initial symptoms. I had changed my stroke a little and noticed a bit of pain in my shoulder. I was also a first time father and I think the constant carrying of the baby/car seat played a roll in injurying my shoulder.
3. Initial diagnosis - by self, PT, MD, other? Dr. Burk - University of Utah Hospital
4. Initial treatment - as prescribed by self, PT, MD, other? I first tried PT. It didn't seem to help at all. I iced and took Ibuprofin and that would help a little. Doctors suggested surgery after MRI. They couldn't see anything on the MRI, but all test seemed to say there was a tear. I refused surgery since no one could tell me what it was and they just wanted to go in and find out.
5. Additional treatment (including surgery). I decided to take up yoga and pilates and see if this could help. With in a month I was pain free and back to swimming.
6. Length of time out of the water. Please include type of training when resumed.
7. Length of time until back to previous level of training.
8. After treatment do you feel you're at the same level of training and performance as before your injury? A higher level? Have not reached previous level of training and performance.
9. Any other useful comments. It is hard to say where I would be if I had gone through with the surgery. Maybe I would be perfect and back to great training. Sometimes I think we are so eager to get fixed right away and not look for other solutions beside western medicine. I very happy that I decided to refuse the surgery!!!

ViveBene
March 4th, 2008, 08:25 AM
The latest issue of American Family Physician has a general article on shoulder injuries ("see your doctor," "it all depends"), including rotator cuff injuries, in case you need a quote or two.

Regards,
VB