Swimming is a sport enjoyed by athletes of all ages. Although it is not commonly associated with a high risk of injury, swimming does have its own problems. For swimmers, the biggest source of sidelining injuries is the shoulder. While there may be a number of underlying causes for shoulder pain, the condition is commonly referred to as swimmer’s shoulder or rotator cuff tendonitis. The symptoms associated with this condition include pain in the anterior shoulder and pain that increases with shoulder elevation.
The shoulder is a unique joint, similar to a golf ball on a tee, or a ball and socket joint. The ball is the head of the arm, medically termed as the humerus bone. The socket (or tee) is called the glenoid fossa. The design of the shoulder joint allows the least amount of restriction to movement, which enables the use of arms with greater dexterity than legs. However, this makes the shoulder relatively unstable and prone to injury. A group of four muscles called the rotator cuff, are involved with fine movement of the shoulder. The muscles that comprise the rotator cuff help to correctly position the humerus in the glenoid fossa.
Swimmers can have muscle imbalances due to over development of their chest and relative weakness of their back muscles. This can cause the humerus to come out of proper alignment causing injuries such as impingement (pinching of tendons), overstretching of ligaments, or tightness in the joint. These problems can sideline an athlete and, if not cared for, eventually lead to more serious problems such as chronic tendonitis, labrum or tendon tears.
Incorrect training techniques can also be the cause of these injuries. Methods such as reaching too far, over rotating, or crossing over in freestyle are examples that can lead to shoulder pain. Your elbows should be bent when underwater during the pull to decrease the strain on the shoulder. It is also critical to vary your swim stroke during workouts since constantly swimming freestyle can put a lot of stress on the shoulder joint causing an overuse injury.
Suddenly increasing your distance or your intensity can also cause injury. It is important to gradually increase your workouts to allow a safe progression. Training tactics such as using buoys and hand paddles can increase the strain on the shoulder and should be avoided. As your training intensity increases, it is necessary to appropriately strengthen the shoulder complex to ensure proper mechanics.
Proper strengthening of the muscles that surround the scapula and the rotator cuff is an important step to preventing injury. Seated rows and lat pull downs are examples of exercises that target the scapula stabilizers. Rotator cuff strengthening should be done with light weights or resistance bands since these muscles are small and fatigue easily. Examples of these exercises include internal and external rotation of the shoulder. Strength training should be done separately from swim training since the muscles will be too fatigued if performed in conjunction. However, gentle stretching before swimming can be beneficial.
The most important thing to remember is to always train properly. It is necessary to perform a warm up and cool down, stretch, and correctly strengthen your shoulders. Never attempt to work through the pain. Let your coach know if you have an injury and seek proper treatment to avoid further, more serious problems. These basic steps will allow optimal performance throughout the season. If you have questions or problems, contact an Excel Physical Therapy location closest to you or visit our website at excelpt.com.
Kurtis Keller is a Physical Therapist at Excel Physical Therapy of Nebraska.