Hi there,
This is my first post on this forum and I'm really hoping someone out there has been through this. I am an open water swimmer, generally averaging about 25 thousand yards a week and gearing up for this summer when I finally get to swim outside!
In February, my family and I went on vacation in the Caribbean and I swam like crazy every day. Since that time, i have been having pain on my right side, in the back, basically under my right shoulder blade. I didn't cut down on my volume, which I know I should have done, and the pain has gotten worse over the past few months.
I saw my orthopedist/sports medicine doctor today, at long last, after pain since February. I've been having therapeutic, aka painful, massage from the massage therapist who works with the local college swim teams. I'm also doing chiropractic Active Release Therapy and have had only brief, very temporary respites from pain, with time off from swimming, etc. I'm doing all the other normal things--ice, ibuprofen, exercises, etc.
Today I was diagnosed with subscapular bursitis. Both the chiropractor and orthopedist think that my pec muscles are pulling my scapula over and out of place, but that it also may be rubbing against my ribs. I also seem to have developed swimmer's posture--rounded shoulders, etc.
Of course this was just a few weeks before Chesapeake Bay, which I am set to do for the first time after getting in through the lottery! I was extremely dismayed as this is finally the start of the season, and what I've been working for all these months. I typically race up through October, ending with the St. Croix 5-mile swim.
For anyone who has experienced this, how long was your recovery and what did you do for recovery? How long was it before you got back in the water, and after that, did you experience pain when you swam? I tried a kick set today, with fins, and even that caused pain. I am running a ton--because otherwise, my mood is bad enough that someone will die! But I am dying to get back in the pool. At this point, I am having pain when I go to sleep, pain when I sneeze, cough, etc--anything that strains that area at all.
The doctor has recommended twice a week physical therapy for 8 weeks, a re-evaluation, and if that doesn't work, a possible cortisone shot. Of course, he said that carries a 50% risk of nicking my lung, and I'm not interested in that. If those two didn't work, he would recommend surgery as a last resort.
Any thoughts? Suggestions?
Thank you in advance.
Sydne
I've never been diagnosed with subscapular bursitis, but I have had scapular pain. There are many causes of scapular pain, and I am not a doc. It could be referred pain from another primary cause (such as the labrum). It could be that you are overusing the scapular muscles to protect another joint involved in the shoulder motion. You mentioned that you are doing ART. I've an ART devotee. It doesn't necessarily "cure" a condition, but it can minimize the problem for quite awhile and materially reduce inflammation. How often were you going? Twice a week? And, have you been doing rotator cuff exercises during this time? You didn't mention that, except to say you were headed to PT and doing "exercises." It's critical to do both scapular and rotator cuff exercises, perhaps in addition to ART. Muscular balance is key. If you're dong all those things, and it sounds like you are because you're so interested in a cure, perhaps the source of the problem is somewhere else. Have you had an MRI or arthrogram on the shoulder? But if you haven't been doing the Buchberger type exercises, that could account for the continued pain.
As for a cortisone shot, I'm told a first time shot in the bursa of the shoulder joint can do wonders for adult. But typically each injection is less and less effective and degrades the tendons. I have had a shot in my trap in the scapular area after persistent pain about 18 months ago. My orthopod wasn't sure it would be effective. It wasn't. It did nothing at all when injected in muscle. But your target area may be different.
Also, you must fix your posture. A PT will give you posture exercises. Poor posture is definitely stressing your scapular area.
If you are in this much chronic pain, though, it sounds like a break from swimming is in your future. You may have just overdone it on vacation. I hope that's not the case. Good luck!
Former Member
To add to the good advice. Are you doing arm swings before you swim?
What about stretches? There are many specific stretches that are vital to the health of shoulders.
How often are you training and for how long, (both time and distance).
Do you cross train and do shoulder prevention exercises?
Posture is indeed key. As is balance in all muscle groups.
It takes time to heal an injury especially if it is an overuse injury. Be patient and diligent with the advice from your practioners.
Better to swim less with more focus.
Kiwi
Thanks to you both.
I saw my chiropractor again yesterday and she said she has mixed feelings about a "bursitis" diagnosis. She feels like it's become a catch-all phrase.
She really feels like the major issue is one of my ribs being out of whack and is working on getting it back in position.
The posture thing I have been working on a lot. Not so easy! But I can feel a difference.
I am also cross-training. Running a lot, which I've always done. And planning on riding as soon as my bike gets its Spring check-up!
Thanks to you both. I appreciate any advice at this point. The hardest piece, as I'm sure all of this know, is the mental one!! But, I'm trying not to think about all those miles logged in prep for the season and instead, just focusing on what I will be able to do when things get better.
Have a great weekend!
Sydne
Thanks to you both.
I saw my chiropractor again yesterday and she said she has mixed feelings about a "bursitis" diagnosis.
I've never heard of bursitis in the scapular area ... but such a diagnosis does exist, although it's apparently relatively rare. Orthopods, even the good ones, can get things wrong sometimes. My frayed labrum went undetected for 18 months until my ART chiropractor said that he thought the trap pain was referred from the labrum. He was right. An arthrogram confirmed I had a frayed labrum, especially on the backside. Scapular pain is apparently a classic symptom of this problem ...
Maybe it's tendonosis? An arthrogram or MRI should show this. Maybe you need a second opinion. I hope you don't have to miss the bay bridge swim. Oh, I see you run. I run for cross training too. I can't swim 24/7.
When my shoulder felt particularly bad last Nov/Dec, I did not stop swimming. Although I did do some restorative/recovery type swimming. I went to ART 2x a week for 4 weeks, then went 1x a week for almost a couple months. I started prolotherapy at my ART doc's rec. It also worked previously on Mr. Fort, who had tendonosis in the hamstring from running. I also did RC/scapular exercises like crazy. That always seems to reduce the pain for me. If I get lazy or busy and stop, the pain comes back.
Thanks for another helpful post.
I'm hoping that my physical therapist will teach me some of the rotator cuff exercises you mention. I'm also curious about the Buchburger exercises. I'm not familiar with that.
My ART person said that my lats were also incredibly tight. I have another massage scheduled for Wednesday, after I get back from being out of town for business. She said she was iffy on the bursitis especially because when she pressed on my shoulder in a certain way, she couldn't recreate the pain. She said my pecs are super tight too.
I've been seeing her 1-2x a week, and then adding therapeutic massage. I go to the massage therapist who works with the swimmers on one of the local college teams and she's incredible. It's definitely not a "spa" massage because she works you hard--and then tells you where you'll be sore afterward. But man, does she get things done!
I'm jealous that you kept swimming. I was doing that, but then the pain just got to be too much. The rotation seems to really bother it. Yesterday, I kicked for an hour and a half but couldn't do flip turns after a little while because it hurt. It's frustrating when breathing in a certain way hurts--or sneezing! I've not done a stroke for a week and I had to get in to at least feel the water yesterday.
If the pain continues, I will insist that they refer me for an MRI. I hate jumping through all the medical hoops just to finally get what you need. I think it's extra frustrating as an athlete because we feel like we know our bodies so well. Sometimes I want to just say "Look, here's what I need. I've done this and this and this. Just give me the referral!"
The running seems to be okay for it, which surprises me. I ran 11 1/2 this morning, and felt great. (I'm in New York for business and there's something about running back and forth over the Brooklyn bridge.) At this point, if that's all I can do for a little while, I will suck it up--and if I can't swim until Chesapeake, I will hope that all those hours over the winter get me through it! (I may, for once, wimp out and wear the wetsuit.)
I have my son trained to say "Mommy, shoulders back. Stand up straight."
Thanks again and have a good weekend,
Sydne
There is a DVD put out by Buchberger with specific exercises for the rotator cuff and scapular area. Dr. Buchberger gives clinics nationwide. Search the forum. There is a thread with the word "Buchberger" in the title where the exercises are described. There are also many shoulder threads which mention and describe the RC exercises. Search for the "whining and complaining" thread started by the Good Smith. In that thread, I reference at least a dozen threads on shoulder injuries which also reference RC exercises. You absolutely must do these exercises to recover/heal.
Since you are in such pain, it could be a tear, although severe tendonitis is very painful too. If your orthopod won't write a scrip for an arthrogram, have your chiropractor/ART guy do it. They are authorized to write such scrips. Good luck! I hope the pain goes away soon.
