Ask the Experts - Injury

Answers from Sean Fyfe:

Q. I have had a clicking noise in my left shoulder for a few years but it did not really affect my exercise routine and i avoided lifts that caused the noise. Towards the end of last year I started to train for a sprint triathlon, I built up slowly but as I started to do more swimming the noise got more frequent, sometimes painful and left me with a dull ache.

I went to my GP who suggested i try anti-inflammatory medication (ibuprofen) but this did not make any difference and gave me digestive problems! I went back and he referred me to a rheumatologist who I have now seen. I had x-rays and I was told I had damaged a ligament in the rotor cuff and needed physiotherapy, this could mean a wait of up to six months on the NHS. I am keen to get back into training but realise that I will have to wait until next year now.

i have searched my copies of your personal trainer and the injury supplement but have not been able to find any reference to rotor cuff injuries. i am doing gentle stretching exercises but wondered if there was anything you could advise.

Any help with this is much appreciated. Thank you for your time.

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In your letter, full details of you shoulder injury history are not supplied. However, from the information provided, I can confidently say that the injury is consistent with a shoulder joint instability. Now whether or not this injury is the result of an acute incident years ago or has built up chronically due to sports you played when you were younger or past occupations is less clear. Nevertheless, I am still able to point you in the right direction.

The shoulder joint is a ball and socket joint. Instability refers to the ball excessively gliding in the socket when the shoulder joint is moved. This is a common cause of clicking. Now avoiding those activities such as lifting that cause the clicking is the correct thing to do. Instability in itself doesn’t cause pain. It’s the instability that leads to pressure being placed on other areas of the shoulder joint that results in a problem. Hence, your swimming caused the ball to repetitively slide too much in the socket and this has led to pain and injury, probably in the rotator cuff.

Now the rotator cuff is a group of four muscle and tendon complexes that start from the shoulder blade, cross the shoulder joint and attach to the ball. They effectively control the ball in the socket while other larger muscles move the shoulder. So as you can now imagine, these muscles are particularly important when there is any degree of instability at the shoulder joint. There are two ways the ball is controlled in the socket. Firstly, passive stabilisers, such as ligaments and capsule, which is what you have probably suffered some damage to along the way. Secondly, the active stabilisers, such as the rotator cuff, which are then increasingly important when the passive structures have been damaged.

With all this in mind, my advice then is to undergo a 3-6 month rehabilitation process under the supervision of a Sports Physiotherapist. The following areas need to be addressed – activation and strengthening of shoulder blade stabilisers, activation and strengthening of the rotator cuff and specific strengthening of these two muscle groups in position relevant to swimming. The exact time frame will depend on what level of strength you are starting from and how well you adapt to the exercises.