"Swimmer's shoulder" - tips, training and technique
Wish you were here? This is the Queensland pool I grew up swimming in and one of my favourite places. As anyone who swims knows, the freedom of swimming is addictive and a mastering it is a great life skill.
Now that pools are repoening post lockdown, I'm seeing more swimmers with shoulder pain. The term 'Swimmer's Shoulder' has been been applied to many complaints of shoulder pain in swimmers, and most commonly pain at the front of the shoulder from therotator cuff muscles, but doesn't necessarily refer to specific structures.
'Swimmer's Shoulder' and the Rotator Cuff
The ball and socket component of the shoulder joint aren't a particularly great fit, so the rotator cuff muscles - supraspinatus, infraspinatus, subscapularis and teres minor - stabilise the joint and help control the complex movement of the arm. They enable you to reach trhough the water and give you the control the power to pull the arm through. They are also most common source of pain at the front of the shoulder, but other structures, such as the biceps tendon, can cause issues. The serratus anterior and subscapularis are active throughout the entire freestyle (front crawl) swimming stroke. The serratus anterior helps to position and stabilize the scapula, and the subscapularis muscle rotates the arm inwards and controls the arm throughout the stroke. Their repeated contraction can cause microtrauma and makes them prone to fatigue and injury.
4 top tips to swim well and eliminate pain
1. Manage your training and plan ahead
Studies show that excessive training, rapid increases in training and training in different environments (e.g. open water when you are used to swimming in a pool) can all lead to muscle fatigue and increased injury risk. This is most common in more experienced and elite swimmers. Gradually increase training an mix sessions between the pool and open water when transitioning to more open water swimming. Plan rest days and recovery days between heavy sessions. You need days when your shoulder msucles can repair.
Injured? Rather than quitting the pool, shorter sessions as a short term measure and mixing different strokes can help reduce fatigue and keep you in the water. Shorter, more frequent sessions are better for novices mastering technique, as you won't overdo it or 'unlearn' technique between sessions.
2. Maintain mobility
Make sure you have good shoulder, neck and upper back movement, as reduced flexibility and stiffness can put more pressure on the front of the shoulder as you pull through the water. Spinal and neck stiffness can also make swimming less efficient and breathing to alternate sides more difficult, Here are some stretches from Swimming Australia
3. Top technique
Swimming is highly technical and getting it right can be tough. This is more of an issue for novice swimmers, who would benefit from 1:1 or small group coaching. For more advanced swimmers, old habits are hard to change, but small improvements can make huge differences, not only to injury, but to speed and, endurance. If you have had treatment and swimming less but still have problems, this may need review. Speedo have some excellent technique tips for all strokes.
4. Dry land training and daily habits
A programme of swimmming specific exercises from a physio or trainer who understands swimming technique and your goals can help strengthen you without making pain worse. I often see swimmers do very general shoulder exercises in the gym, including deadlifts and shoulder presses above the shoulder level. It's usually better to focus on the rotary and postural components of swimming first.
Can I still swim?
Be guided by pain. Reduce the amount you are doing and apply the tips above. If you are still in pain, stop and consult a Physio with sports specific skills.
It's been suggested in a couple of studies that women may be more prone to injury simply because their reach is shorter, but evidence is limited. Swimming is a great exercise for pregnant women (the weightless feeling is a relief!), or if you want to stay fit but keep the pressure off your joints.
1. Struyf et al. Musculoskeletal dysfunctions associated with swimmers’ shoulder. British Journal of Sports Medicine. 2017. 51 (10) https://bjsm.bmj.com/content/51/10/775
2. Heinlein, S. and Cosagrea, A. Biomechanical Considerations in the Competitive wimmer's Shoulder. Sports Health 2010 Nov; 2(6): 519–525. doi: 10.1177/1941738110377611