Fixing Swimmers Shoulder – Subscapularis the Missing Link

Trying to pick up the pace in the pool and that familiar ache starts in the shoulder, that horrible pinch on your downward stroke – we’ve heard it many times – the dreaded swimmers shoulder! You might go see a therapist and get the stock standard external rotation exercises and the pain persists.

So what has been missed? In most cases of chronic pain in the front of the shoulder we identify the subscapularis as the primary pain generator in swimmers.

What is this subscapularis muscle?

The subscapularis is one of four muscles that make up the rotator cuff alongside supraspinatus, infraspinatus and teres minor. The action of these muscles is to control the stability of the shoulder.

The subscapularis sits underneath the shoulder blade travels under the arm pit to the front of the shoulder. Its job is to control internal rotation of the shoulder – often seen in pressing motions or swimming freestyle and butterfly.

What leads to injury in the subscapularis?

There are three main ways this muscle becomes susceptible to injury.

1. Poor posture with chronically internally rotated shoulders – the muscle adopts a shortened position and becomes spasmed changing its ability to contract correctly

2. Sudden increase in training volume. If you have been training two times a week then ramp it up to five your body doesn’t have the ability to adapt that quickly and often injury follows

3. Catching a heavy falling object, the sudden jolt while you are contracting the muscle cancause a tear in the tendon

How to know if the subscapularis is involved in your pain?

Simple – there is a great test called the lift off test which will indicate if there is dysfunction in the muscle.

If there is weakness or pain this could indicate a tear or tendinopathy of this muscle.

How to fix this?

To fix your subscapularis muscle we need to work on posture of the shoulder as well as stretch the subscapularis itself and following that rebuild strength in it.

To resolve the shoulder posture I recommend loosening up the latissimus dorsi and pec major muscles then mobilising the thoracic spine with these stretches shown in this video.

Following that my two favourite stretches for the subscap require a broomstick or dowel. Check out this video to follow along.

Once you have comfortably opened up the shoulder over a week continue doing those exercises but add in some strengthening with a theraband with these exercises

1. Internal rotation at the side

2. Internal rotation at the shoulder

3. Internal rotation with punch up

Watch the exercise here.

If you are still having trouble after trialling this for three weeks I would suggest having someone work into the muscle with soft tissue therapy. Our method which sees results from just your first session involves a combination of active release technique and dry needling.

Let us know through the contact form if you need any help with your shoulder and we are always to have you in the clinic to help you out.