Subacromial Impingement in Swimmers

By Drew Heideman, MPT

What is Subacromial Impingement

Why is shoulder pain the most common musculoskeletal complaint in swimming? A competitive swimmer endures constant joint rotation and exceeds thousands of strokes in a single swim session. Swimmers’ shoulder, also known as subacromial impingement, is a condition with a gradual onset that may lead to microtrauma due to repetitive activity. Subacromial impingement commonly presents as anterior lateral shoulder pain, but, in most cases, the onset of symptoms is commonly related to other underlying musculoskeletal conditions.

swimmer with subacromial impingement

Swimmers’ shoulder, also known as subacromial impingement


Anatomy of the Shoulder

The shoulder complex consists of three main bones. They are the scapula, clavicle, and humorous. These three boney structures conform to make up two main shoulder joints. They are the glenohumeral joint and the acromioclavicular joint. The glenohumeral joint attaches the humorous head to the scapula by a cuplike socket called the glenoid. Surrounding the humeral head, in the glenoid cavity, lies a labrum. The labrum deepens the glenoid socket providing support for the humeral head during joint translation. The Acromioclavicular joint attaches the acromion process, of the scapula, to the clavicle. This joint is held together by ligaments to provide support to the shoulder complex. The subacromial space is created between these two joints, allowing soft tissue-like structures to move freely within the space. The three main soft tissue structures consist of the bicep tendon, rotator cuff muscles, and the subacromial bursa.

JOI Rehab image of the anterior shoulder muscles and anatomy with labels for supraspinatus, long head of Biceps, subscapularis and subacromial bursae

Shoulder muscles Labeled

Causes of Subacromial Impingement

Subacromial impingement results from chronic or acute inflammation of the soft tissue structures that pass through the subacromial space. Irritation and inflammation of these underlying musculoskeletal structures may result in pain, weakness, and reduced motion rage.

Why do these Musculoskeletal Structures get Inflamed?

The onset of symptoms may occur for numerous reasons. A clear clinical assessment is the best way to determine what may be the cause of subacromial impingement. During the clinical evaluation, it is important to address postural impairments, muscle imbalances, range of motion anomalies, neuromuscular control, and joint mobility.

man doing pect stretch in doorway

Pect Stretch or doorway stretch

How do Subacromial Impingement and Swimming Correlate?

In many cases, subacromial impingement is the result of posterior capsule tightness. Posterior capsular tightness is commonly seen in swimmers due to excessive hypermobility while performing an external rotation. Disproportionate anterior translation of the humeral head will occur due to hypermobility during external rotation.  This hypermobile movement produces extra strain and irritation on other musculoskeletal structures to stabilize the joint in alignment. The two main stabilizer muscles working in opposition during anterior translation are the biceps tendon and “Subscapularis,” one of the rotator cuff muscles. Their job is to stabilize and reduced humeral head movement during anterior translation.

How do You Fix Subacromial Impingement

  • Rest is very important for treating a shoulder impingement
  • Physical therapy will help rebuild strength and range of motion
  • Medication such as anti-inflammatories
  • Surgery
Sleeper Stretch

Sidelying Sleeper Stretch


Surgery for Shoulder Impingement

In selected cases, invasive surgical procedures may be necessary to treat subacromial impingement. The surgical procedure is a subacromial decompression and it is done arthroscopically. This surgery involves the shaving/ removing part of the acromion, in addition, to complete removal of the subacromial bursa. As a result of this procedure, the subacromial space will expand and produce more room for the rotator cuff muscles and biceps tendon. Following the arthroscopic procedure, Physical therapy will be necessary to regain the shoulder’s full strength and function. Watch this VIDEO to learn how to properly use a sling at home.

To schedule for physical therapy, please call 904-858-7045. 

Shoulder Impingement Treatment in Jacksonville

You should not have to live with a painful shoulder. The Jacksonville Orthopaedic Institute can help you with your shoulder pain.  JOI has over 20 Shoulder, Orthopedic Shoulder Specialists, throughout Jacksonville, Fleming Island, and Nassau County. Our physicians can diagnose your shoulder condition and provide both conservative and surgical options. JOI Physicians work with the clinicians of JOI Rehab to develop individualized shoulder physical therapy programs tailored to get you back on the road to recovery. Please call 904-JOI-2000 or schedule online for an appointment.

By: Drew Heideman, PT/ATC

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