Swimming is generally considered one of the safest sports and is recommended for all kinds of health benefits including improving cardiovascular ability, improving muscle tone, rehabilitation after injury, rehabilitation for back pain sufferers or people with arthritis. In fact, swimming is one of the very few activities that actually use all the main muscles in our body. When we swim, most of our body weight is displaced, and so swimming is an optimum choice of activity for overweight people. Swimming is easy on joints and muscles and the water can bring on a relaxing feeling.
Having painted a very rosy picture of swimming as the health boosting sport that it is, why do we often hear about swimmer’s shoulder and its painful and debilitating side-effects. How can a relaxing feel-good sport sometimes hurt so much? Swimming, you see, does not come naturally to us humans. Every other mammal on the planet can swim naturally, however, we humans need to learn to swim, and herein lies the problem. Many of us lack proper lessons and techniques in swimming, we lack in practice and develop our own bad technique and habits which often lead to injuries such as swimmer’s shoulder tendonitis.
Let’s take a look at the biomechanics of swimming to help us better understand what can go wrong and why swimming shoulder problems may arise.
During the activity of swimming, many different shoulder movements are carried out. Many, if not all, are performed during circumduction in clockwise and anti-clockwise directions. Each movement has a degree of internal and external rotation and scapular protraction and retraction. These movements, carried out in all four of the different swimming strokes, freestyle, breaststroke, backstroke and butterfly, are what can lead to swimmer’s arm and shoulder injuries.
Swimming is unique in that the upper body is used for 90% of the force needed also requiring maximum shoulder flexibility and range of motion. Considering that a competitive swimmer might swim anywhere from 5-9 miles per day, usually 7 days a week , it is easy to see how injuries to shoulders and arms might occur. During all that training many thousands of shoulder revolutions are carried out, with no rest for the muscles to recover. Of course, this continuous movement and unnatural demands means the shoulder becomes stressed, fatigued and can lead to injuries from repetitive microtrauma. It is estimated that nearly 70% of swimmers have swimming shoulder injuries.
What is Swimmer’s Shoulder?
Swimmer’s shoulder is a general, broad term which is used to describe a musculoskeletal injury brought on by the overuse of the shoulder. It encompasses a fairly wide spectrum of injuries as the shoulder itself is a complex joint allowing unusual and varied movement possibilities. Pain can be anything from mild discomfort following a training session, to the more debilitating problem where the pain affects the swimmers ability to train. Pain can travel from the shoulder to the neck and also arms. There is usually acute inflammation present which causes much pain and discomfort. The intensity and frequency of training is a contributing factor to swimmer’s shoulder symptoms. A visit to a sports doctor is highly recommended.
Symptoms of Swimmer’s Shoulder
Swimmer’s shoulder symptoms are localized to the general shoulder, neck and arm area and once recognized swimming with shoulder injury should be avoided. Symptoms include:
- Night time pain in arm or shoulder – ranging from mild to severe with sleep disruption and difficulty lying on affected arm
- Pain, during swimming, at the front of the shoulder or down outside of arm
- Pain, in the shoulder or arm after swimming
- Feeling of dead arm
- Difficulty lifting objects or carrying out simple tasks
- Difficulty reaching behind your back, with pain
- Headaches and neck pain
Swimmer’s shoulder is caused by overuse involving the supraspinatus tendon. This is a tendon in the rotator cuff muscle. It can be caused by lack of technique in swimming strokes resulting in overextension of the tendon which leads to joint instability. When the arm is out of the water a loss of blood supply of the tendon during the pull phase of the stroke can further increase the overuse. In order to avoid having swimmer’s shoulder pain a specific swimming technique is advisable. This will avoid injury while at the same time helping maintain pace.
How to Prevent Swimmer’s Shoulder
Sometime a slight change to your swimming technique may be enough to avoid swimmer’s shoulder and associated injuries. A keen eye from a good coach or watching a video of yourself may help understand where mistakes are being made.
Attention should be given to posture as it is of vital importance in and out of the water. Bad posture, rounded shoulders can lead to sore shoulders and eventually more complex problems. Strengthening exercises for muscles in the back of the shoulders will help prevent injury.
Focus should be given to the way your hand is placed in the water during swimming. If the palm of the hand is facing outwards when entering the water this can lead to excessive internal rotation within the shoulder joint. This type of overuse injury will eventually lead to pain and movement restriction. The hand should be flat, with the palm facing towards the bottom of the pool upon entry, to avoid shoulder injury.
Of course, exercise to strengthen muscles and core strength all help to build up resistance to injury. Specific exercise with bands for rotators are an excellent way to build strength reducing the possibility of injury. Seek the advice of a physiotherapist on what are the best exercises for you.
How to Fix Swimmer’s Shoulder
As with most injuries and to optimize pain management, the earlier you seek medical attention the better. If the swimmer waits until pain has set in then inflammation has already started. Many of the techniques suggested in the prevention of swimmer’s shoulder injuries can also be used to actually fix the problem. Tweaking technique, posture, muscle strengthening and sleeping on your back are all recommended for fixing swimmer’s shoulder issues.
Ice packs on the shoulder area for 10 minutes twice a day will help alleviate pain and inflammation. Rest to allow recovery of tired, injured muscles might seem counterproductive but will get you back into the water sooner than you realize.