Swimmers shoulder is an umbrella term covering a range of painful shoulder overuse injuries that occur in swimmers. You may feel shoulder pain at the point of the shoulder, into the collar bone, down the arm or up into the neck.
Being an overuse injury, it is caused by repeated trauma rather than a specific incident. Over 1/3 of competitive swimmers experience swimmers shoulder pain that prevents them swimming at some point.
What Causes Swimmers Shoulder?
The shoulder is a very mobile joint that needs to be well controlled by muscles around it. If these muscles get out of balance (through tightness, weakness or overuse) the rotator cuff is at risk of being pinched, overloaded and inflamed.
• Over-training: Doing too much volume or intensity too soon will over load the tendons causing inflammation, micro-tears and pain. Ensure you have a sensible program to build up your mileage and intensity gradually
• Poor stroke technique: This is the most common cause of swimmers shoulder. Get your swimming technique sorted first before you start pushing speed or mileage
Most common swimming technique faults:
1) Flat body position
Limited rotation places a lot more stress on your shoulder as you bring your arms through. Think of swimming as rotating from one side to the other. This makes it easier on your shoulders, gives you a more powerful stroke and makes it much easier to breathe.
2) Poor hand placement in the water
Avoid thumb first entry which tends to pinch the rotator cuff. Enter the water with all your fingers tips at once.
A fantastic tool to help your feedback on this is the Finis Freestyle Paddles.
This closely related to crossing over the midline which is also a common fault and can be helped by these paddles. Note these are NOT resistance paddles. They are stroke correction paddles! Entering across the midline or with your thumb tends to pinch the rotator cuff and cause problems. Plus it will result in a weak stroke.
3) High catch and pull through
Without video analysis, most swimmers have no idea how effective their pull is. Many swimmers drop the elbow or pull through with a straight arm. These are weak movements which means your distance per stroke is poor plus you will have to take more shoulder movements to move the same distance.
If good swimmers take 30 strokes per lap (50m pool) and you take 58 strokes per lap you can see you are already increasing your risk of swimmers shoulder right there.
Working with a coach to develop a high elbow catch technique with enhanced swimming posture will really help you utilise the larger, more powerful muscle groups of your chest and upper back, rather than rely upon the shoulders.
High elbow catch is a much stronger stroke, using more chest muscles than smaller shoulder muscle.
• Poor use of hand resistance paddles: Paddles are a wonderful tool and will get you good results IF your technique is good. Most swimmers have poor technique and should never use resistance paddles. They look like this:
If you add resistance of hand paddles before you have good technique, you WILL get injured.
• Poor posture: If you sit in front of a computer all day, you may have weakness posterior shoulder muscles, tight muscles at front of the shoulder and a stiff, rounded upper back If this goes on, for a long time under load, injuries such as rotator cuff impingement and tendonitis, rotator cuff tears, bursitis, capsule and ligament damage, or cartilage damage can occur.
Do chest stretches, maintain good posture during the day.
Improved alignment and posture means that the power of the pull phase is dramatically improved.
How Do I Know If I Have Good Swimming Technique?
You don’t! Unless you have had feedback from a qualified coach. Get feedback. Get video. Get a coach look at you and give you feedback. If you do not want a regular coach- grab an online swim coaching program.
Online coaching is super cost effective- a fraction of the cost of a face to face coach. You will be guided through correct swimming technique, understand what drills are important and why and get help designing a progressive workout. You can ask questions and submit your swimming video for feedback.
If you know your swimming technique is poor, please have someone give you feedback. You can watch all the youtube videos in the world but you won’t really know what YOU are doing until someone watches you then tells you.
If you learn to swim with poor technique and think “I’ll sort out my technique later” you are highly likely to develop swimmers shoulder.
As well as the pain of the injury and being side-lined, the pain of having to go back to basics to re-learn like a beginner is also humbling and painful!
Diagnosis of Swimmers Shoulder
If you have shoulder pain, stop swimming immediately. Continuing to swim through the pain may make your injury take 3 months to heal instead of 3 weeks! You may notice pain when you raise your arm up, put on a T shirt or lie on your shoulder in bed. If it has not gone away with a week’s rest, seek help from a physical therapist.
Very often you will have developed a muscle imbalance around the shoulder and will need to have instruction in some stretching and strengthening exercises to correct this.
The shoulder joint is so complex, it is foolish to try to diagnose this and start an rehab programme by yourself. The quickest way back to the pool and competition is to get the right help straight away.
If you return too quickly or keep swimming through the pain your swimmers shoulder may develop into rotator cuff impingement, bursitis, subluxation or brachial plexus syndrome.
Treatment for Swimmers Shoulder
Firstly, reduce inflammation and pain.
Rest from swimming. You may benefit from ice or anti inflammatory to reduce internal swelling. Be guided by your doctor or physical therapist.
Avoid all activities which cause pain. Some people may require a sling or have supportive shoulder taping.
Your physical therapist may suggest massage, acupuncture or dry needling to assist you during this painful phase.
Then restore full function.
Once the initial pain has gone 1-2 weeks typically, some patients with swimmers shoulder jump right back into the pool- wrong!
You have not yet corrected the problem!
If you return to swimming too soon, your pain will typically return within 7-10 days!
Instead the rehab must begin.
You will be advised on relevant stretches. You will start strengthening stabilisation exercises to restore scapula humeral rhythm (normal shoulder join and shoulder blade control).
The therapist will also check neck and back function as sometimes a stiff upper back and poor neck mobility also place more stress on the shoulder joints.
You will be advised on good posture.
Postural correction is very important. Ensure you are not hunched all day at work. Remind yourself to do chest stretches daily. Lie on a lacrosse ball or foam roller for 1 minute in the evening. Do not slump at work. Take regular breaks from your desk. Consider a standing desk.
Strengthening and Good Swimming Technique
Strengthening the rotator cuff muscles is a key component to a successful rehabilitation program. Many competitive swimmers who have a coach routinely do a rotator cuff program to prevent swimmers shoulder (as it is so common).
These programs involve strengthening the back of the shoulder, and stretching the chest and anterior shoulder to maintain balance around the shoulder joint.
If you are injured already however, you need specific exercises depending on which rotator cuff muscle is injured and whether or not you have a secondary condition such as bursitis.
As you improve, start to increase load and speed of movement. Continue to work on technique. You may be able to get in the pool and do kicking drills to keep your feel of the water and do some leg and core fitness.
Time Frame To Return To The Pool After Swimmers Shoulder
It depends on:
• how inflamed it was at first
• how poor your technique is
• how poor your posture is
• your level of competition and training
• how fit you are
It could take anywhere from 3 weeks to 3 months (or longer in some cases)
Some cases of swimmers shoulder or shoulder pain may require surgery depending on the extent of the damage. Learn good swimming technique NOW to prevent problems developing.
When you do return start slowly. Do drills. Hopefully you have identified which areas of your technique to focus on. Forget about speed and distance until your technique is vastly improved. Once you are certain you have corrected the underlying problem, gradually begin introducing swim workouts again. Keep very aware of your shoulders position and any signs of pain. Do not swim to the point of muscular fatigue as that is when your form tends to suffer and injuries are not far away.
Prevention Tips for Swimmers Shoulder
Prevention is by far the easiest way to deal with this swimmers shoulder:
• Maintain good posture. Sit up straight at work with your shoulder back.
• Have regular sports massage to reduce tightness (once a month)
• Good swimming technique and video feedback
• Proper training principles i.e. warm up and down, gradual increase in intensity, frequency or distance. Do a preventative rotator cuff strengthening program
• Avoid use of resistance hand paddles
By far the most common cause of swimmers shoulder is poor technique. If you intend to be a skilled triathlete,you need good swimming technique. Elite swimmers swim more than 5 miles per day. Poor technique will place huge strain in the joints, tendons and ligaments.
It will prevent swimmers shoulder.
It will make you a faster swimmer with much less effort.
It will deliver you to T1 with much less draining of your energy supplies
Get a coach to look at you, provide feedback and make sure you do your drills!
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