Welcome to the series Swimmers Shoulder, What is the Cause? Where each post I will break down common findings I see in swimmers that come to my clinic with shoulder pain, reasons why they started having pain, and how I go about getting them back to performance level. This blog will focus on what is swimmers’ shoulder and what it looks like if you or one of your swimmers has it.
Swimming is complex. There is not another sport that is close to replicating the demands of swimming. What other sport requires close to 1,000,000 overhead rotations a year, trains 5-7 days a week with doubles done at least a couple of times a week and has virtually no off-season besides a couple weeks off in August. The answer is none. Swimming is unique, but also awesome at the same time.
With swimming being such a demanding sport, there is no surprise at the high rate of injury. Studies have shown anywhere from a 27-87% injury rate in swimmers. Even at the 27%, that is a lot. It is also no surprise that the shoulder is the most injured body part in swimming given the number of overhead rotations a swimmer takes each practice.
What is Swimmers Shoulder Anyway?
Swimmer’s shoulder is best described as a “spectrum of maladies of the shoulder.” The common pathologies associated with swimmers’ shoulder are shoulder instability, biceps tendinopathy, rotator cuff tendonitis, subscapularis tendinopathy, labral tear, SLAP tear, and shoulder impingement. This is quite the list of different pathologies, making swimmers shoulder a very non-specific diagnosis.
What are the Common Symptoms in Swimmers Shoulder?
Since swimmers shoulder can vary significantly between swimmers, it is hard to say which symptoms are the most common. Based of the research and my own experience, here are some of the more common symptoms. Note, this is not an all encompassing list.
- Pain in the front of your shoulder
- Dead-arm feeling
- Feelings of instability
- Decreased internal rotation range of motion
- Pain with raising arms overhead
- Weakness in infraspinatus, supraspinatus, and anterior deltoid
- Stiffness in the neck
When in Your Stroke is it Painful?
There are two common points in the freestyle stroke that are painful in the injured swimmer.
1) Hand entry and early pull through phase of freestyle.
During hand entry of a swimmer with a painful shoulder, there is typically increased superior humeral translation. With this increased translation, there is less subacromial space, and the humerus can impinge on the rotator cuff or long head of the biceps tendon, which can lead to shoulder pain over time.In a swimmer without shoulder pain, the muscles surrounding the shoulder are able to control the superior humeral translation, avoiding going into the impingement position.
2) Recovery phase of freestyle, typically right after the hand exits the water.
The rotator cuff and scapular muscles (trapezius, rhomboids, serratus anterior, etc.) help depress the humeral head and retract the scapula, keeping the shoulder stable and allowing it functional properly. Once a swimmer fatigues, it become less efficient, making it harder for the muscles to stabilize the shoulder. This can result in increased anterior translation of humeral the head, which can result in impingement of the supraspinatus and infraspinatus.
Swimmers shoulder can impact other strokes as well, and sometimes does not cause discomfort during freestyle too. From my experience, breaststroke is often the least painful stroke and butterfly hurts the most/takes the longest to get back too.
When does it hurt during practice?
This tends be a more variable between swimmers. For some swimmers, their should may be painful to start but then goes away after warm up. This indicates either a tendon or another soft tissue structure is irritated. Other times, their shoulder may be pain free to start but then becomes painful after 30-40 minutes, which may suggest either a form of instability or impingement.
In either scenario, it is common to see the pain start earlier, doesn’t go away, becomes more intense, or lasts longer after practice. This is when a swimmer while seek out help from a medical professional typically. This highlights the important of staying ahead of minor aches and pains, in order to avoid missing time in the pool.
Summary:
- Swimmers shoulder is a large umbrella term and can be a variety of different diagnosis
- Some symptoms are more common than others (anterior shoulder pain, limited ROM, etc.) but can vary significantly between swimmers
- Swimmers typically have pain during hand entry or during their recovery, sometimes during both
- Shoulder pain during workouts can be variable
- Some strokes may not be painful
I hope you have enjoyed part 1: Stayed tuned for Part 2. As always, if you are interested in working with me, head over to my services page!
Alex
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