Active Release Technique

What's Up With My Shoulder? By Drs Donna McAllister and Michael Schmidt

Triathletes are susceptible to a wide range of injuries. By far, the majority of these injuries stem from the repetitive nature of training regimes resulting in accumulated microtrauma stresses to tissues. Shoulder injuries are a prime example.

What's up with my shoulder?

Shoulder injuries are common with Triathletes, either as a result of direct contact from a collision or fall, or from repetitive overhead motion. By far, the majority of cases stem from repeated stresses that, due to the accumulative effects, lead to mechanical impingement and microtrauma.

Technique, technique, technique

Improper stroke technique is the culprit for most overuse injuries of the shoulder joint in freestyle swimming. Supraspinatus tendonitis, with or without subacromial bursitis, is renowned in long distance swimmers, hence the name swimmer's shoulder. The reason why? It's as simple as looking at the anatomy of the shoulder joint.

Trivia Q: How many muscles attach to the scapula?

Supraspinatus makes up one of the four rotator cuff muscles. As a group, these muscles stablilise the shoulder by compressing the humerus into the glenoid fossa. All four muscles join the scapula to the head of the humerus, with each muscle running a slightly different course to get there.

The supraspinatus muscle is unique in that its tendon must pass under the roof of the acromium, sandwiched between the subacromial bursa and the tendon of the long head of biceps brachii to attach to the humerus.

Repeated overhead motions render the supraspinatus tendon susceptible to impingement between neighboring structures. Before you know it, the supraspinatus tendon is irritated and inflamed becoming a nagging source of pain and discomfort. Here's the clencher: Reduction of supraspinatus function results in compensation from the remaining muscles of the rotator cuff. The subscapularis muscle works hard to prevent the humerus from riding upward towards the acromial roof, while the remaining rotator cuff muscles expend greater energy to stabilise the joint. Overuse of the muscles lead to an excess build-up of metabolites, which the circulatory system cannot transport effectively. The accumulated metabolic waste products soon gel together forming adhesions, the scar tissue that entraps muscles, tendons, ligaments and nerves between fibres.

The cascade doesn't stop here. In fact, with repeated exposure to microtrauma, the entire network of soft tissues around the shoulder complex and spine become affected. Joint capsule inflammation, nerve, vascular and lymphatic supply, are swiftly altered to accommodate for the changes. Ultimately, something has to give - pain and dysfunction prevent the athlete from performing with maximum efficiency.

Supraspinatus tendonitis is only one example of this mechanical imbalance. In fact, dysfunction of any muscle or complex attaching to the shoulder joint may stimulate a similar cascade of events.

How long can this compensation go on?

It all depends on the individual. One thing is certain: the sooner you recognise and address the problem, the better your prognosis. Early detection is important. Prevention is even better.

Treatment

First, consult with the appropriate health care professional to have your condition diagnosed accurately. Secondarily, ensure that your treatment plan addresses the root of the problem, not merely the symptoms. Often the treatment focuses on areas of pain and inflammation without even considering the relationship of neighboring structures and functional integrity. Lastly, do not discontinue treatments just because the pain has subsided. Strive to attain maximal functional capacity by incorporating specific rehabilitation exercises and technique enhancing drills.

One of the most effective forms of treatments for repetitive strain injuries is a unique form of soft tissue therapy called active release techniques. Active release techniques in conjunction with neuromuscular re-education is one of the most effective combinations of treatment available. The aim of treatment is to restore functional integrity by breaking up adhesions between muscles, tendons, ligaments and nerves.

The appeal of active release techniques is that functional integrity is often restored within 3-6 treatments without compromising training schedules and regimes.

For the most effective and efficient treatment protocols of soft tissue disorders such as the classic swimmer's shoulder, active release techniques should be combined with spinal manipulative therapy by a certified chiropractor and specific rehabilitation exercises.