Swimmer’s Shoulder: Signs, Symptoms, Causes, Treatment, And Prevention
One of the most intricate joints in the human body is the shoulder. It is made to allow a broad scope of movement. Swimming is a one-of-a-kind sport in that it relies on movement from the shoulders to drive the body forward through the resistance caused by the water.
To achieve the best possible performance in swimming, you need to be able to move to the full extent of your range and possess a high level of suppleness. At times, this may cause the shoulder to become looser or more unsteady.
Around 90% of the issues that swimmers need to consult a healthcare specialist about are concerning their shoulders, with a swimmer’s shoulder being a notable health issue.
Swimmer’s Shoulder
Swimmer’s shoulder, also known as shoulder impingement, often occurs when swimmers are doing their strokes, due to the continuous movement of the joint.
Your shoulder is a highly active joint and must be kept stable by the tendons and muscles that are located around it. You can overwork your ligaments and muscles with things like:
- Poor technique
- Over-training
- Fatigue
- Previous shoulder injury
- Hypermobility
- Use of too-large hand paddles
If you continue doing this, certain injuries can occur like:
- Rotator cuff tears
- Ligament and capsule damage
- Tendonitis and rotator cuff impingement
- Bursitis
- Cartilage damage
You can turn your shoulder thousands of times in just one hour by doing the freestyle swim stroke. Repeating the same motion tires the rotator cuff muscles and can cause the nearby tissues and muscles to be placed incorrectly, causing them to rub together.
If you persist with swimming, then the irritation and inflammation that follows can cause pain. Your shoulder will remain in this condition until the inflammation is reduced and the rotator cuff muscles are stretched and trained appropriately.
Causes of Swimmer’s Shoulder
A swimmer’s shoulder can be an enigma for someone performing all the correct swimming techniques. They will keep on swimming like they have been for some time, and then suddenly, something unexpected will happen.
What happened? Why now?
Causes include:
Shoulder fatigue
Researchers collected feedback from 100 college swim teams and another 100 masters swim teams inquiring about the participants’ experience with swimmers’ shoulders. Almost half of the swimmers in both groups reported having shoulder pain for more than three weeks.
The interesting thing was that shoulder pain was not indicated by the use of paddles, the range of motion and flexibility, or the side the person was breathing on.
More than half of the swimmers from the two teams noted that shoulder pain got worse the more they trained or covered more distance, suggesting that being exhausted was what mostly caused shoulder pain for swimmers.
Tiredness is a generalized term that can include a lack of proper rest in between sessions or exercises, excessive exercise, and doing too much.
Muscular imbalances in the shoulder
A different set of highly competitive swimmers with shoulder aches had a similar range of motion and muscle strength to non-swimmers of the same age, gender, and leading arm.
The swimmers demonstrated considerably greater strength in their internal rotation muscles than the members of the control group.
Swimming with poor technique causes problems in the shoulder
Swimmers understand the importance of swimming with excellent technique. Using the correct technique to swim doesn’t only make you swim faster, but also stops you from getting hurt.
Body roll is the big one when it comes to the swimmer’s shoulder, with too much or too little body roll causing issues for the shoulder:
- Too much body roll means the hand is going across the mid-line during the hand entry, placing the shoulder at a mechanical disadvantage.
- Too little body roll forces the recovering arm to jam up the shoulder joint.
You can be more powerful and agile by properly controlling your body roll, avoiding any unnecessary strain on your shoulder.
Poor posture
Swimming is an anterior-dominant activity. The focus is mainly on the front of our body, leading to us becoming strong there, but the muscles in our lower back, glutes, and hamstrings are being forgotten.
When we add our usual bad posture from sitting and slouching to the mix, it makes the perfect situation for getting hurt while swimming.
Being in a poor posture for the majority of the day except for when we are swimming has an effect on our swimming form.
When we don’t maintain proper form in the water, we are setting ourselves up for a shoulder injury.
Swimmer’s Shoulder Signs
Pain experienced in the muscles in the region of the back of the shoulder is a typical symptom of a swimmer’s impingement, and it has a sensation of being deeply rooted. In certain instances, you may also feel discomfort on the front side of your shoulder.
Consistent upper body stretching, similar to what is done when swimming, may cause this distress to worsen. The more you swim for one session, the more pronounced your discomfort will be. This condition is known as shoulder tendonitis, which is an inflammation of the biceps and supraspinatus shoulder muscles.
You may experience a variety of pain when swimming due to an injury in one of the parts of your shoulder. The pain may be close to the shoulder joint or it could move up the neck/shoulder or down the arm.
Symptoms of Swimmer’s Shoulder
The most common swimmer’s shoulder symptoms include:
- Reduced range of motion in your shoulder compared to your other shoulder.
- Increased joint laxity than with the other shoulder.
- Reduced strength when compared with your other shoulder.
If you’re having discomfort in your shoulder while swimming, it’s a smart idea to seek out the advice of a shoulder expert promptly so that the situation doesn’t deteriorate, also, suspending swimming and allowing your shoulder to rest can help ease the swelling.
Technically speaking, some common characteristics of a swimmer’s shoulder are:
- There is swelling of the bicep and supraspinatus tendons situated beneath the acromial muscles which is resulting in shoulder impingement syndrome.
- Making mistakes when practising, like too much exercising, too much practising, and particularly incorrect form.
- Signs of the issue commonly correlate with changes in shoulder joint flexibility, posture, muscular operation, or nerve-muscle regulation.
- Many swimmers have a natural looseness of ligaments combined with unsteadiness of the shoulder joint in different directions, or in simpler terms, more range of motion.
Despite its benefits, swimming can cause disproportionate growth of the arm’s inner rotators and adductors. This can create a lack of strength in the muscles responsible for stabilizing the shoulder blades and providing external rotation since those muscles are not being sufficiently exercised.
The use of poor technique and/or excessive muscle imbalances can result in a weakening of the front of the capsule. These all elevate and permit the humeral head to slide forward and up, resulting in an obstruction in the subacromial space and irritation.
Swimmer’s Shoulder Treatment
Discovering what tendons or muscles are implicated, assessing the intensity or phase of the condition and getting the right evaluation will result in the most effective cure. A proper plan of treatment includes:
1. Applying ice. Apply the product to the shoulder area about 20 minutes after exercise.
2. Use anti-inflammatory medications. Try it for a few days after the injury to decrease swelling.
3. Rest. This could require a considerable period of inactivity, with no swimming, which may last anywhere between one and two days, depending on the seriousness. You may be able to swim, but reduce the distance you are swimming and avoid butterfly, backstroke, and swimming with just your arms at your side. Delay your swim training until your discomfort is gone.
4.. Get professional passive care. This might include things like:
- Interferential current
- Ultrasound
- Trigger point work
- Cross friction tendon massage
- Adjustments to your neck or shoulder
- Post-isometric relaxation of the muscles involved
5. Do rehabilitation exercises. This will boost the strength of your weak muscles, especially the ones located on the outside of your shoulders. With the lightest of weights (those weighing at least three to five pounds), carry out the exercises very deliberately and precisely.
Do these exercises regularly if you have had difficulty with your shoulders in the past. It is generally accepted that if you swim with an injured shoulder, you will need to spend one day recovering for every day you spend in the pool.
6. Modify your swimming training. It is often advised that using hand paddles should not be done as they can lead to injury in the shoulders. But, Zoomers and other types of fins can help to lift your body up in the water, which might be beneficial if you have slight issues with your shoulders while swimming.
Enlist the help of a coach or buddy to assess your body and arm placement. They might even want to get footage of you so you can go back and analyze it and the trainer can go over your stroke mechanics with you.
Physical Therapy
Physical therapy can be a helpful addition to one or more of the treatments typically used to manage a swimmer’s shoulder. It can also be a necessary part of the healing process.
A physical therapist or orthopedist can manually stretch and massage the rotator cuff muscles, which can be difficult to access. This releases tension and helps prevent further irritation.
The orthopedist could have you do personalised exercises if you are healed enough, to work on your rotator cuff muscles. Strengthening these muscles can give the shoulder joint more protection while being active, reducing the chance of injury in the future.
Your shoulder orthopedist might also assist you in strengthening your shoulder to avoid it from becoming a vulnerable area later on.
Sports rehabilitation often helps athletes, allowing swimming to be done while the injury is healing and incorporating different strategies to keep tension off the shoulders’ joints. You should exercise your muscles before and after swimming to make sure everything is loosened and conditioned.
Preventing Swimmer’s Shoulder
Sleep on your back
Feeling shoulder discomfort is unavoidable during our swim journeys.
It’s already difficult for them that they are exhausted and aching after a rigorous exercise, yet things get a lot worse when they spend the night in an ill-suited position, causing further pain.
It doesn’t matter if you snuggle with a pillow while still in a semi-upright position or if you go full-out fetal, side sleeping is typically the way that most of us sleep.
Swimmers are prone to sore shoulders due to the act of raising their arms over their heads or rolling their shoulders forward.
Sleeping with your shoulder out of its normal position can make the pain worse, which can lead to you awakening in the middle of the night and feeling intense discomfort.
The answer?
Sleep on your back to prevent any pressure on your shoulder and to make sure your neck and shoulder are properly aligned.
To get your arms and shoulders back into the correct position, lay your hand across your chest. If your arms aren’t moving back far enough, place a cushion beneath your elbow to raise it slightly.
This job opportunity could be especially advantageous to those who are currently dealing with a painful shoulder.
Improve your t-spine mobility
We, swimmers, know that being flexible in the shoulders, chest, ankles, and hips is extremely vital. We are taught from the very beginning that it’s important to include stretching and movements of the arms and legs, beginning in childhood and continuing beyond that.
The spine in the chest area encompasses the vertebrae located in the area between the base of your neck and lower back.
This item is made specifically for turning, bending, and stretching.
When swimmers lack adequate t-spine movement, it impacts many things besides the chance that they may end up completing the rest of the training session doing vertical kicking in the pool – instead of finishing it with the rest of the team.
It is not possible to turn as much as is necessary to take in a breath, leading to the excessive turning of the hips. Your shoulders and chest roll forward and inwards. It also prevents your body from moving in a wave-like motion, preventing you from dolphin kicking.
Here is a two-pack of simple exercises to incorporate into your warm-up to boost your t-spine range of motion:
Foam roller thoracic spine extension. 8 deep breaths. You will find yourself extending further back. Suck the belly button in. Roll up another vertebra or two and repeat. Use your hands to prop up your head to stop too much strain on your neck.
Quadruped t-spine rotation. Crouch onto all fours with one arm placed behind your head, dipping your shoulder opposite the arm while letting your elbow lead the way. Maintain an upright posture and don’t shift your hips; keep them still. Move your elbow first and then twist your shoulders so that eventually, your elbow is pointing at the ceiling.
Improve scapular stability
What are your scaps? And why are they important? Why is it so enjoyable to pronounce the word “scaps”?
In my time, they were disregarded in comparison to more care being given to the rotator cuff.
In recent years, research has illustrated how important shoulder scaps are. Underdeveloped shoulder scaps lead to the tension of the anterior shoulder capsule, greater risk of rotator cuff compression, and decreased neuromuscular functioning of the shoulder.
The scaps supply a strong foundation allowing the shoulder joint to then generate extra force and energy.
Having sturdy, robust scaps will result in increased power and velocity in the pool. (And less likelihood of injury.)
Incorporating a basic upright row into your warm-up program is an effective way to improve shoulder stability. An elastic band, a cable machine, or my personal preference, the TRX apparatus can be used.
Keep your arms close to your body, engage your shoulder muscles when you reach the completion of each repetition, and go through the exercise deliberately.
Strengthen your rotator cuffs
Be careful not to excessively perform strengthening exercises for your rotator cuff.
Undertaking activities to strengthen the rotator cuff muscles does not always fix shoulder problems. It is advisable to employ it as a precautionary measure, and one that is less important than having a full range of motion in your thoracic spine and staying balanced.
Dr Erik DeRoche, USA Swimming’s team chiropractor on the 2012 and 2014 World Championship teams as well as the University of Michigan’s team chiropractor at NCAA in 2012, backs this up:
I often come across swimmers performing strengthening exercises on their rotator cuffs to address any shoulder discomfort they might be having.
I save this as one of the ultimate steps in my treatment process.
Establishing mechanical deficits is primary…”
This leads to probably the most important step you can take to prevent shoulder injury…
Swim with excellent technique
Maintaining good posture when not in the water is wonderful and will be beneficial.
If you do not pay attention to maintaining good posture when swimming, you are more likely to hurt your shoulders in the future.
Recall that swimming is a form of strength training like any other, and proper form and technique should be your priority before increasing the load (either intensity or total amount) with your swimming.
The hazards posed to your shoulder are further compounded by a bad technique in swimming, robbing you of an impressive amount of strength.
Move your shoulders forward and try to reproduce the movement of your stroke. Are you getting a good range of motion? Nope. Are you making the most of your abdominal muscles, back and arms? Certainly not.
Make pre-hab routine
Swimming is a big investment of time.
Aside from school, a job, and limited social life, it is difficult to make time to guarantee our shoulders are healthy and in an optimal state.
You can take the time to prioritize your body and shoulders with only a few minutes each day before your workout. This is a great way to boost your swim performance as well as make your movements less probable to cause injuries.
This means making your pre-hab work habitual. Routine.
Include pre-hab into your usual morning warm-up like it’s a reflex, and that will help you to remain free of swimming injuries this season.
Stay positive and do what you can with what you have
While you are recovering, there are measures you can take to improve. Natalie Coughlin, Michael Phelps, and Caeleb Dressel all worked through their injuries to come back stronger and faster than before.
There are lots of options for training around, up, and under your injury, but here are a couple of my favourites:
- Swim with fins. Adding fins to your swimming increases the propulsion coming from your legs and reduces the demands and stress on the shoulders. Warming up with fins is an especially smart move as it will ease your shoulders into the work.
- Vertical kicking. You need little space in the water to do it, can use fins/DragSox/weight belt to increase difficulty, develop the up and down phases of the kick more evenly, and don’t risk aggravating your shoulder using a kickboard.
Conclusion
Start with solid mechanics in the water. Have killer posture in and out of the pool. Consult with your coach and a professional therapist to address your individual situation.
Go out with lighter hearts, my chlorinated pals.
