Swimmer’s Shoulder: Cause, Prevention & Getting Rid of It!

The most common shoulder injury in swimmers is subacromial impingement (known as ‘Swimmers Shoulder’). Such impingement occurs when the tendons of the rotator cuff catch and rub against the nearby humorous bone in the upper arm.

The pain experienced during any swimming stroke is a direct product of this ‘catching’ and can be exacerbated as you perform hundred and hundreds of swimming strokes during your workout. Three out of the four strokes in swimming are predominantly powered by the upper body, and the shoulder works hard when we propel though the water.
 
Causes

Swimming puts the shoulder joint through a large range of movement. Even though such movement is relatively low impact as exercise goes, the sheer number of rotations of the shoulder joint has the potential to irritate the shoulder if the swimmer is not performing their stroke technique correctly. In fact, all Strictly Swimming London coaches will teach our clients the correct swimming technique with this in mind and create better swimming technique to avoid such issues. Please be aware that using a kick board or swimming hand paddles can further exacerbate ‘swimmer’s shoulder’.

Although classed as a ball and socket joint, the shoulder has a very shallow socket compared to the hip joint.  Even though a healthy shoulder of a swimmer should have no problems going through a full range of motion without any issues in the swimming stroke, the small size of the socket allows for this impingement and can lead to swimmer’s shoulder if recurring issues in the stroke are not corrected.

Shoulder impingement in the competitive swimmer is mostly caused by altered kinetics (movement and technique) due to muscle fatigue after hours and hours in the swimming pool. Strictly Swimming London coaches know this feeling only too well. Excessive training without adequate rest can cause swimmer’s shoulder.
 
Symptoms

Symptoms of subacromial impingement can be sudden or gradual and can be different from individual to individual. A decrease in some movement may be experienced but the shoulder will still be easy to move and won’t be stiff (like a frozen shoulder). Symptoms can include:

• Localised pain on the top of the shoulder (on the outer side)
• Pain that increases as you lift your arm
• Constant pain in the arm (dull rather than sharp pain)
• Pain may extend to the neck and/or down the arm in some cases
• Aching that gets worse at night affecting sleep
• Aching that gets worse whilst resting
• Weakness in the arm

 
Swimmer’s Shoulder Test

There is a very simple arc test to check if your shoulder pain is due to subacromial impingement. Stand with both arms by your side, then lift the arm out to the side all the way above your head. If you feel pain around 40 to 60 degrees after raising the arm to the side, and then for the pain to disappear at 120 degrees then you can bet its due to impingement. When performing this test, the palm of the hand must always face towards the body which means the shoulder has to rotate half way through this lift of the arm to keep the palm facing inwards at all times.
 
Contributing Problems in Freestyle Swimming Technique

Incorrect swimming mechanics are the leading factor in creating shoulder problems. Some freestyle technique problems leading to impingement include:

• A thumb first hand entry in freestyle or frontcrawl stroke which produces internal rotation of the shoulder and closes the socket
• Repetition of bad technique
• Inadequate (lack of) body roll in freestyle
• Swinging the arm behind the body (midline) during the arm recovery phase increases stress on the shoulder
• Pulling wide during the pull phase (outside the width of the body) whilst the body is rotating downwards
• Hand entry crossing the midline can stress the shoulders
• Overtraining is often associated with contributing to swimmer’s shoulder
• A sudden increase in the training load can bring on impingement
• Rounded shoulder posture in the freestyle swimming stroke can bring on impingement
• Timing issues in the freestyle stroke with delayed body roll to the arm stroke can further stress the shoulders
• A lack of warming up slowly in the pool and warming down contribute to shoulder injuries

 
Our Strictly Swimming London coaches will aim to identify the exact part of the stroke where the pain occurs and will work on making adjustments in your technique during lessons.
 
Diagnosis and Seeking Medical Advice

Seeking medical advice is important if you are experiencing shoulder pain in your swimming training or lessons after a few weeks.  If not treated appropriately, the rotator cuff tendons can start to thin and tear. X-rays and other imagining techniques may be needed to assess the changes in structure of the joint. The presence of ‘lazy elbow’ where the elbow on the affected side cannot be lifted to the normal height out of the water.
 
Preventing and Managing Swimmer’s Shoulder

There are numerous exercises you can search online for all of the following:

• Sleep on your back - take the pressure off your shoulder and keep your neck and shoulders in alignment.
• Application of ice packs may be recommended to reduce pain and inflammation
• Increase mobility in your upper spine (thoracic) – this will help in rotation and body roll, rotation to breathe, undulation in the butterfly stroke and help your dolphin kick.
• Improve scapular stability – strong scapular muscles in the shoulder can increase power and speed in the water and reduce the chance of injury.
• Strengthen your rotator cuffs – outside your swim training or lessons work with some stretch cords during your dryland training
• Perfect your swimming technique – apart from having fantastic technique and mechanics in the swimming pool, it is also vital to have good posture and body position to avoid shoulder injuries. Our London coaches are equipped to help you with this.
• Bilateral breathing when swimming freestyle can create symmetry on both the right arm and the left arm of the stroke.  It can also distribute stress on both right shoulder and left shoulder (and eliminate one shoulder taking the most impact and stress).

 
Treating Swimmer’s Shoulder

• Avoid movement and swimming strokes that are making the pain worse.
• Temporarily reduce training/lesson frequency and distances.
• Alter training routines so that different strokes are used more often throughout your lesson or workout. Alternating swim strokes will reduce this repetitive pattern and allow the muscles to function differently.
• Use swimming fins to enhance the propulsion from the legs and reduce the stress on the shoulder and upper body.
• Avoid the use of hand paddles and kickboards 
• If the pain does not subside, rest the shoulders and ask your physiotherapist when you can restart your swimming workouts.
• Poor swimming technique needs to be rectified and our Strictly Swimming London coaches will help you correct any issues and focus on the stress in your shoulders (and other injuries) whilst swimming any of the four strokes.
• Carry on with normal daily activities so that the shoulder doesn’t become weak or stiff.
• Take anti-inflammatory pain killers
• Have periods of rest to aid recovery
• Focus rehabilitation efforts on rotator cuff and scapular strengthening (numerous exercise can be found online)
• Follow your physiotherapists exercises to help improve posture, strengthen the shoulder and increase your range of movement.
• Steroid injections can help relieve pain if rest and exercises on their own don’t help.
• If all else fails, an operation called a subacromial decompression is available which involves widening the space and socket around the rotator cuff tendon so that it doesn’t rub or catch.

Summary

Competitive swimmers are estimated to take well over a million arm strokes in just one year, and this repetitive motion puts swimmers higher at risk of developing shoulder pain. With a high likelihood of injury if you swim many hours per month, it is important to be aware of the ways to prevent this injury from occurring and what to do if it does happen to you.  The easiest and possibly most effective treatment is rest.  Take time off from swimming to allow the inflammation to reduce before returning to the pool.  While resting, it is important to use ice to aid in decreasing inflammation of the tendons in the shoulder. And anti-inflammatory pain killers. You can also decrease the amount of overhead movements of the arm and stop any movement that brings on the pain. It is also vital to modify your stroke mechanics in the swimming pool to emphasize correct technique with each stroke to eliminate the element that is causing the pain. Our Strictly Swimming London coaches can show you all of the above in our private or group lessons and take a proper assessment of your problematic swimming stroke.

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