Shoulder pain in swimmers

Understanding Shoulder Pain in Swimmers: Causes and Prevention

Swimming is enjoyed by an estimated 100 million participants worldwide, spanning all levels of skill and competition. As a low-impact activity, swimming offers numerous physical benefits with relatively few inherent risks. However, like many sports, overuse injuries are a common issue, particularly affecting the shoulders. The shoulder’s critical role in swimming makes it especially vulnerable to repetitive strain, which can lead to chronic pain and injury over time.

The Importance of Shoulder Function in Swimming

In swimming, arm action provides the primary propulsion for most strokes, contributing about 75% of the forward movement in all strokes except the breaststroke. Each stroke has four distinct phases:

1. Reach: The arm extends forward, preparing to catch the water.
2. Catch: The hand enters the water, and the swimmer begins to pull.
3. Pull: The arm moves through the water, generating forward propulsion.
4. Recovery: The arm exits the water and returns to the starting position.

Elite swimmers, especially those competing at a high level, depend heavily on their shoulder strength and endurance to perform well. On average, these swimmers cover approximately 13,000 meters per week in training, swimming six days a week over a 10-month period. This adds up to around two million strokes per year, with the shoulder bearing the brunt of the movement and stress.

Shoulder Injuries in Swimmers: Overuse and Microtrauma

Given the extreme range of motion involved in swimming, it’s not surprising that swimmers are prone to shoulder injuries. The glenohumeral joint (GHJ)—the ball-and-socket joint of the shoulder—requires both flexibility and stability to perform optimally. However, the repetitive motion of swimming can lead to joint laxity, a condition where the ligaments become overstretched, causing the joint to become unstable.

This instability can result in cumulative microtrauma, where small, repeated injuries to the tissues around the shoulder accumulate over time, leading to more serious issues. The repetitive nature of swimming, combined with the extreme shoulder movements, predisposes swimmers to a range of mechanical and anatomical deficiencies, including:

• Increased joint laxity: The shoulder becomes too loose, increasing the risk of dislocations or subluxations.
• Tendonitis: Inflammation of the tendons, particularly in the rotator cuff, due to overuse.
• Rotator cuff impingement: The tendons of the rotator cuff become compressed or pinched during shoulder movement, causing pain and inflammation.

These conditions, often grouped under the term “swimmer’s shoulder,” are common in both competitive and recreational swimmers and can significantly impact performance if not properly addressed.

Glenohumeral Joint Laxity and Shoulder Pain

One of the most common issues faced by swimmers is glenohumeral joint laxity, where the shoulder joint becomes overly flexible. This can occur due to the repetitive stretching of ligaments and muscles around the shoulder, especially during the reach and pull phases of the stroke. The swimmer’s shoulder must repeatedly move through a wide range of motion, which, over time, can cause the joint to become unstable.

GHJ laxity can lead to shoulder instability, where the joint does not remain securely in place during movement. This instability increases the likelihood of microtrauma—small tears or injuries to the tendons, ligaments, and muscles around the joint. If left untreated, these small injuries can accumulate and result in chronic pain or more serious conditions like rotator cuff tears.

Overuse Injuries: Tendonitis and Rotator Cuff Impingement

Two of the most common overuse injuries in swimmers are tendonitis and rotator cuff impingement:

• Tendonitis: The rotator cuff tendons, responsible for stabilising and moving the shoulder, are particularly susceptible to inflammation in swimmers. Tendonitis often results from the repeated stress placed on these tendons during training. The inflammation can cause significant pain, particularly during overhead movements like the reach and pull phases of the swimming stroke.
• Rotator cuff impingement: In some cases, the tendons of the rotator cuff become impinged or pinched during shoulder movement, particularly during the recovery phase of the stroke. This impingement can lead to swelling, pain, and reduced mobility, severely affecting a swimmer’s ability to perform.

Both conditions are painful and can become chronic if not properly managed, leading to long-term issues with shoulder function.

Preventing Shoulder Injuries in Swimmers

Given the heavy reliance on shoulder strength and mobility in swimming, it’s important for swimmers to take steps to prevent overuse injuries. Key strategies include:

1. Strengthening the shoulder muscles: A balanced strength-training program focusing on the rotator cuff and surrounding muscles can help stabilise the shoulder and reduce the risk of injury. Strengthening the muscles that stabilise the shoulder blade is also crucial for improving shoulder mechanics.
2. Proper stroke technique: Ensuring proper form during each stroke can help minimise excessive strain on the shoulder. Coaches should focus on technique refinement to prevent mechanical deficiencies that may lead to injury.
3. Stretching and mobility exercises: Swimmers should incorporate flexibility exercises into their training to maintain optimal shoulder mobility. However, it’s important to strike a balance between flexibility and stability, as excessive laxity can increase the risk of injury.
4. Adequate rest and recovery: Like any other sport, swimming requires periods of rest and recovery to allow the body to heal. Overtraining can lead to fatigue and increase the risk of injury. Swimmers should ensure they get enough rest and recovery between intense training sessions.
5. Cross-training: Incorporating other forms of exercise, such as cycling or strength training, can help balance out the muscular demands on the shoulder and reduce overuse injuries.

Treatment and Management of Shoulder Pain in Swimmers

When shoulder pain does arise, early intervention is key to preventing more serious injuries. Some common treatment options include:

• Physical therapy: A targeted rehabilitation program can help address muscle imbalances, improve mobility, and reduce inflammation.
• Anti-inflammatory medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain and reduce inflammation, allowing swimmers to continue training with reduced discomfort.
• Rest and activity modification: Taking a break from swimming or reducing training volume can give the shoulder time to heal and prevent further injury. Gradual reintroduction of swimming with proper form is critical.
• Chiropractic care: Chiropractors can help address alignment issues in the spine and shoulders, which may contribute to shoulder pain and dysfunction in swimmers. Chiropractic adjustments and soft tissue therapy can help restore proper function and relieve pain.

In more severe cases, where conservative treatments are not effective, surgical intervention may be necessary to repair damaged structures such as the rotator cuff or labrum.

Conclusion: Balancing Strength, Flexibility, and Technique to Prevent Shoulder Pain

Shoulder pain is a common issue for swimmers due to the repetitive nature of the sport and the extreme demands placed on the glenohumeral joint. While swimming is a low-impact activity, overuse injuries such as tendonitis, rotator cuff impingement, and joint laxity can develop from the repetitive motion and strain on the shoulder.

By focusing on proper technique, maintaining a balance of strength and flexibility, and allowing adequate rest between training sessions, swimmers can reduce their risk of injury. Early intervention, combined with appropriate rehabilitation and preventive care, can ensure that shoulder pain is managed effectively, allowing swimmers to continue enjoying the sport while minimising long-term damage.

With the right approach to training, treatment, and injury prevention, swimmers can maintain healthy, pain-free shoulders and continue to perform at their best in the water.