Shoulder Pain in Swimmers

Are you are swimmer with shoulder pain? If so, you’re not alone. The shoulder is the most commonly injured body part resulting from swimming, with reports of shoulder injury rates up to 91% in competitive swimmers.

Why the shoulder? In swimming there is a high volume of repetitive overhead movements (more than any other overhead sporting activity, including tennis or cricket) so overuse injuries are more likely to occur. While a professional tennis player may perform approximately 1000 shoulder revolutions in a week, a competitive swimmer can move their arms overhead 16,000 times in a week, and perform over a million total shoulder revolutions per year. That is a huge demand on any shoulder! Adding to this repetitive load in swimming, 90% of the propulsion effort is generated by the arms to move the body through the water. Really, it is not surprising that shoulder pain is commonly reported by swimmers. The good news is there are many ways that you, as a swimmer, can help reduce your risk of developing shoulder pain.

How to reduce your risk of shoulder pain:

Ask a coach to assess your technique. One of the most common reasons shoulder pain develops in swimmers is due to poor technique. Some common faults that are easier to correct are arms crossing the midline at hand entry, and hand entry with the thumb pointing down and palm facing outwards. These actions can irritate the tendons at the front of the shoulder, especially when performed repeatedly.

Try to enter the hand opposite the same shoulder with the fingers first and palm facing down, and avoid over reaching. The body should ideally rotate side to side as you alternate your strokes. Imagine a skewer running from the top of your head down the trunk to your feet. Your body should roll as one with the skewer.

A good coach will be able to assess your movement through the water and make the right corrections to help reduce strain on the shoulders, avoid injury and even assist your performance.

Prevent overtraining by avoiding sudden increases in distance or intensity, and be aware of fatigue. This is when technique can fall apart. Even if you have a great swim stroke, if you are pushing the limits and training when fatigued your injury risk is increased.

If your technique is poor then the shoulder tendons are under more strain. Similarly, if your legs are tired or if your core muscles are fatiguing early, then the shoulder is under an increased load. Using hand paddles can also increase the risk of shoulder pain through excessive load, particularly in the weaker shoulder.

Maintain flexibility of the shoulders, spine and hips. If you’re not sure of what is adequate flexibility for swimming then consult your physiotherapist. For example, if the muscles around the shoulders (like the latissimus dorsi) are too tight then it could be tricky when reaching to the hand entry position, and the shoulder tendons may be placed under excessive strain.

Adequate shoulder flexibility is needed for propulsion during pull-through, and to help maintain a high elbow in the recovery phase of the stroke. If the thoracic spine is not optimally extending then it may be more difficult for your shoulders to reach easily into the streamline position. The hips and lower back also need to be flexible enough to allow for an efficient kick, which will assist the shoulders in propulsion of the body through the water. A physiotherapist will be able to assess your flexibility and provide stretches where required.

Develop adequate shoulder strength. This can be tricky to determine yourself, as you do not necessarily need to be super strong, but it is helpful to have reasonable strength and good muscle balance around the shoulder. Again, your physiotherapist will be able to assess this and guide you with exercises in the direction that is right for you.

Ideally, the muscles at the front and back of the shoulders should be balanced appropriately in strength (with the front muscles stronger than the back of the shoulder). This best supports the very mobile shoulder joint throughout the range of the entire swim stroke. Muscles that position and move the scapula or shoulder blade (serratus anterior and the trapezius group) are also very important and often undergo fatigue in swim training, increasing the risk of shoulder pain developing. The shoulder muscles require adequate endurance, meaning, they can work for as long as you need during the swim session. If they tire early then it is difficult to maintain your best technique, performance reduces and injury risk increases.

What to do if you have shoulder pain. Do not ignore shoulder pain, as it is more likely to get worse if you continue swimming without addressing any changes that need to be made. Remember, ongoing pain can change stroke mechanics leading to more pain. If you have shoulder pain then please seek advice from your physio and coach.

When should I see a physiotherapist? For injury prevention, a physiotherapist can assess and provide a swimmer with exercises specific to their needs. This is very helpful for swimmers of any age and level.

If you have shoulder pain it is a good idea to have your swimming technique checked as well as consult with a physiotherapist sooner rather than later. Here is a good checklist of questions that can help guide you:

Do you have pain at rest?

Does the pain occur with reaching and/or lifting activities that are unrelated to swimming?

Is the pain interrupting your sleep?

Has it continued for 3 or more days/sessions?

Have you had this pain before?

If you answer “yes” to any of these questions, it is strongly recommended that you consult a physiotherapist. A thorough assessment will help identify and address the factors contributing to your shoulder pain and help you on the way to recovery. It may not be necessary to stop swimming if treatment is sought early; rather modifications to training, advice about managing the injury and specific exercises will help you achieve your swimming goals.

Look after your shoulders and maximise your swimming enjoyment!

References:

Hill, L et al. (2015) Risk factors for shoulder pain and injury in swimmers: A critical systematic review. The Physician and Sportsmedicine: 43 (4):412-420.

Magnusson SP, Constantini NW, McHugh MP et al. (1995) Strength profiles and performance in masters’ level swimmers. Am J Sports Med: 23(5):626-631.

Pink MM, Tibone JE. (2000) The painful shoulder in the swimming athlete. Orthop Clin North Am: 31(2):247-261.

Sein ML, Walton J, Linklater J et al. (2008) Shoulder pain in elite swimmers: Primarily due to swim-volume-induced supraspinatus tendinopathy. Brit J Sport Med: 44(2):105-113.

Tate, A et al. (2012) Risk factors associated with shoulder pain and disability across the lifespan of competitive swimmers. Journal of Athletic Training: 47 (2) 149-158.

Walker H, Gabbe B, Wajswelner H et al.(2012) Shoulder pain in swimmers: A 12-month prospective cohort study of incidence and risk factors. Physical Therapy in Sport:13(4):243-249.

About the Author:

Sally is a Physiotherapist at Physiotas

Sally is an APA Sports Physiotherapist with a special interest in sports injuries and the shoulder. After studying and working in Melbourne, Sally moved to Tasmania and then achieved the Sports Physiotherapy title in Perth, W.A. She is a member of Sports Medicine Australia and Shoulder & Elbow Physiotherapists of Australasia.

Sally is currently a PhD candidate at the University of Tasmania where she is investigating shoulder strength and pain in young swimmers. Working at the Sydney 2000 Olympics, Melbourne 2006 Commonwealth Games and with several sports teams has been among her career highlights.

Sally also has a passion for running and has completed (and enjoyed!) a marathon in every Australian state!