Swimmer’s Shoulder (it’s NOT an overuse injury)

Shoulder injuries are the most common injuries in swimmers. Typically, swimmers experience pain due to the rotator cuff tendons being pinched and becoming inflamed – this is known as shoulder impingement. Due to its frequency among swimmers, this particular condition is often referred to as “swimmer’s shoulder”. In more severe cases, the tendons can wear down (degenerate) and eventually tear. Swimmer’s shoulder is often described as an “overuse injury”. This term is problematic though, as it implies that the only issue is swimming too much. It also implies that the only way to get better is to swim less or stop swimming altogether. Swimming is a whole body activity, and the forward propulsion of your body in the water requires co-ordination between your arms, legs and torso. A deficiency in other parts of your body means that you will rely more on your shoulders to pull yourself through the water. In these cases, the shoulder is overloaded. It is therefore more appropriate to think of swimmer’s shoulder as an “overload” injury, rather than an “overuse” injury. While training volume can be a part of the issue, it is not the whole problem. Common causes of overload include:

• Shoulder internal rotation limitation Your shoulder is a ball and socket joint. If certain muscles are tight, the ball can sit forwards in the socket, limiting the ball’s ability to move freely in the socket. When you try to rotate the ball inwards (as occurs when you pull through in all 4 swim strokes), then the tendons end up being pinched.
• Thoracic spine (upper back) stiffness Swimming well requires you to be streamlined. Not being able to rotate your body creates more resistance and hence you have to work harder to pull through. It also means you can’t get your shoulder in the best position to pull through the water.
• Core weakness Without adequate core strength, your body is floppy in the water – you may even feel your hips moving from side to side. This creates an increase in drag, which you need to overcome by pulling harder with your arms.
• Weak scapular muscles (muscles surrounding your shoulder blade) – When the muscles that stabilise your shoulder blade aren’t functioning correctly, your shoulder muscles don’t have a stable base to pull off. Hence they need to work harder and will fatigue more quickly.
• Hip mobility limitation Kick is an important part of swimming. It not only assists in propulsion, it also helps to keep you balanced (and hence streamlined) as you stroke. Poor hip mobility can make this difficult, again, forcing the shoulders to compensate.

Addressing these issues is an important part in recovering from “swimmer’s shoulder”. A period of rest from swimming may be required as part of the initial management, but properly addressing any biomechanical issues will help to unload your shoulders, allow you to return to your full volume of training, and even improve your swimming performance!