Swimming is great sport which allows people of all ages to participate4. It incorporates upper and lower limb strengthening as well as cardiovascular fitness3. It has low impact/stress on joints and muscles and can be enjoyed as a recreational or competitive sport3.
Swimmers, however, are prone to numerous injuries, particularly related to overuse and poor biomechanics4. The most common swimming related injuries are related to the shoulder and the neck4. In this blog we will provide some insight into shoulder injuries related to swimming also known as “Swimmer’s Shoulder.”
Swimming injuries and types of shoulder pain
Shoulder pain is very common amongst swimmers and injury occurs due to shoulder subacromial impingement involving the rotator cuff tendons, biceps tendon or the subacromial bursa4 and rotator cuff tendinopathy2.
There are several causes of shoulder impingement. These include
- muscle weakness;
- dynamic muscle imbalance;
- overloading of muscles and poor biomechanics2;
- poor breathing techniques
- poor flexibility of the neck and lower back
- hyperflexibility of joints and insufficient scapula and glenohumeral joint stabilisation;
- insufficient core strength/stability and insufficient rest periods4.
In terms of rotator cuff tendinopathy, repetitive overloading particularly of the supraspinatus tendon is common in swimmers at a competitive level5.
Preventing injury related to swimming
To prevent shoulder injuries, swimmers and their treating practitioners should focus on ensuring the following2:
- That the swimmer has adequate strength and control of the scapula (shoulder blade) stabilising muscles;
- Shoulder internal and external rotator strength ratio is optimal for the stroke they need to perform;
- Encouraging swimmers to stretch the rotator cuff muscles, particularly the infraspinatus, teres minor, subscapularis muscles;
- Improving the mobility of the thoracic and cervical spine.
Here are some examples of technical errors related to specific strokes which predispose to injury2:
• Butterfly: Entering the arms into the water too far outside the line of shoulders or with the arms too close together.
• Backstroke: Pull through the water with elbows extended. This results in the arms being fully extended during the pull-through phase (instead of in an S-shape) and insufficient body roll.
• Breaststroke: Excessive elbow extension.
• Freestyle: A line of pull-through which crosses far beyond the body’s mid-line, reaching for too much length in the stroke and insufficient body roll.
Freestyle, which is the most popular stroke performed, is made up of four phases of movement. The diagram demonstrates these phases5 :
- the hand entry phase;
- early pull through phase;
- late pull through phase; and
- recovery phase.
The table shown here demonstrates the specific muscle activation during each phase of the freestyle stroke5.
Physiotherapy, along with a therapeutic exercise plan, can address modifiable risk factors to prevent the development of Swimmer’s shoulder2. It is recommended that swimmers who train more than five times per week should engage in a dry-land exercise programme incorporating stability, strengthening and stretching to mitigate the risk of injury especially of the shoulder joint complex1.
A few exercises demonstrated by Bradley et al. (2019) describe the Swimming Shoulder Kinetic Chain exercises (SSKC) which is a series of strength and conditioning exercise appropriate for competitive and recreational swimmers. These exercises described focus on strengthening and supporting the shoulder girdle and allow for sufficient mobility of the upper limb together with incorporating functional movements of the whole body1.
References
- Bradley, J., Kerr, S., Bowmaker, D. and Gomez, J.F., 2019. A swim-specific shoulder strength and conditioning program for front crawl swimmers. Strength & Conditioning Journal, 41(4), pp.1-17.
- Khan, K. and Brukner, P., 2012. Clinical sports medicine. McGraw-Hill Medical, Sydney.
- McKenzie, A., Larequi, S.A., Hams, A., Headrick, J., Whiteley, R. and Duhig, S., 2023. Shoulder pain and injury risk factors in competitive swimmers: A systematic review. Scandinavian Journal of Medicine & Science in Sports, 33(12), pp.2396-2412.
- Physiopedia contributors, ‘Swimming Overuse Injuries’, Physiopedia, ,14 May 2024, 14:44 UTC, <https://www.physiopedia.com/index.php?title=Swimming_Overuse_Injuries&oldid=354338> [accessed 1 December 2024]
- Wanivenhaus, F., Fox, A.J., Chaudhury, S. and Rodeo, S.A., 2012. Epidemiology of injuries and prevention strategies in competitive swimmers. Sports health, 4(3), pp.246-251.