It is no secret that shoulder injuries are by far the most common type of swimming injury. It is estimated that shoulder injuries impacts anywhere between 40-91% of swimmers, making it extremely common. But just saying shoulder injuries is really vague, what kind of specific shoulder injuries do swimmers get? Based off some of the research done on swimming injuries, shoulder instability may be the most common shoulder injury in swimmers, especially swimmers under 18 years old. If you want to know other types of injuries that are used interchangeably with swimmers shoulder, check out this recent blog post, Swimmers Shoulder, What is the Cause?
What Is Shoulder Instability?
Simply put shoulder instability is when your shoulder slightly comes out of it’s socket, or subluxes. A good analogy for this is when a golf ball can’t stay on the tee. They’re a couple of different types of shoulder instability, which can be classified into either anterior, posterior, or multidirectional instability. When you shoulder repeatedly comes out of its socket, it can lead to irritation of the labrum, biceps tendon, or the shoulder capsule itself, leading to a decreased ability to swim.
What Leads to Shoulder Instability?
Many times when a swimmer has shoulder instability, they naturally have increased shoulder mobility. Other times the increased shoulder mobility is a result from the repetitive overhead motions from swimming. It is the natural increase in shoulder mobility in swimmers that leads to their shoulder being loose, or hypermobile, and leads to shoulder instability being one of the most common swimming injuries. When the ligaments, tendons, and shoulder joint itself become stretched out, your body looses its ability to passively control your shoulder, increasing the demand of the muscles around the shoulder.
Once the rotator cuff and scapular muscles become fatigued, your body is no longer able to control your shoulder as well. It is at this point where you shoulder can move excessively, rubbing against other tendons or ligaments that can result in pain, irritation, and instability.
Some training factors that may lead to increased fatigue in the muscles around the shoulder in swimmers are…
- Overtraining
- Inadequate dry land training
- Stroke errors
- Excessive use of hand paddles
How Do you Fix Shoulder Instability?
There are a couple of main deficits that swimmers will present with that have shoulder instability. One of the main ones is a decrease in strength in the muscles that help upwardly rotate the scapula. When you reach your arm overhead, your scapula must upwardly rotate to act as a stable base for your shoulder. This helps promote stability and helps put your rotator cuff in the optimal position to function.
The second deficit you will commonly experience is altered muscle control. Studies have shown that the scapular, rotator cuff, and deltoid muscles have decreased function in those with shoulder instability. Since you rely on your shoulders for propulsion during swimming, any decrease in upper body muscle function will have a major impact on your swimming.
On top of this, your shoulder may adopt inefficient recruitment patterns when moving your shoulder. Inefficient recruitment patterns lead to decreased control and stability during overhead movements. Since swimming involves reaching overhead with every stroke, have proper shoulder stability is crucial.
Lastly, shoulders that are unstable have deceased proprioception, which is a fancy way to say decreased ability to know where your shoulder is in space and how it is moving. With decreased proprioception, your body is not able to activate the muscles around the shoulder as fast compared to someone with normal proprioception. By not being to able to reactively control your shoulder, there is a risk for excessive motion at shoulder, leading to shoulder pain, irritation, and instability.
What Exercises Can You Do to Correct Those Deficits?
#1 Shoulder Shrugs
One of the best initial exercises for swimmers with instability are shoulder shrugs. Since your arms are relatively close to your body, your shoulders are in a more stable position. Recent research supports the idea of starting exercises that keep your shoulders closer to your body before working on stability exercises with your arms overhead. This will help avoid putting your shoulder in positions that may further aggravate your symptoms while working on strengthening the right muscles.
This exercise is also a great choice because it helps promote scapular upward rotation with proper muscle recruitment. By holding your arms about 30 degrees from your side, the recruitment of your scapular muscles is altered so the the upper trap is the primary muscle to help rotate your shoulder upwards.
#2 Wall Slides
Wall slides are great for promoting serrates anterior activation as your reach your arms overhead. Your serrates anterior is the primary muscle for scapular upward rotation and is also active during most of the swimming stroke. By having your elbows bent, there is less force needed from the shoulder muscles to stabilize and move your shoulder, making it one of best exercises to bridge the gap between exercises done below shoulder level and overhead exercises.
#3 Push Up Plus
Exercises where you hands are fixed to the ground (closed chain) are excellent for promoting stability. On top of this, the push up plus is one the exercises with the highest activation of the serratus anterior muscles. Since the serratus anterior is typically weakened in a swimmer with instability, strengthening it is a top priority.
#4 Face Pulls
Face pulls are great for a couple of reasons. First, it is a great intermediate when a swimmer doesn’t have the stability yet to do overhead exercises but can do exercises below 90 degrees well. Second, it is awesome at promoting trapezius, rhomboid, and posterior deltoid activation, all of which are critical for swimmers. One thing to look for doing this exercises is that you are not bringing your elbows back too far, as this will stress the front of the shoulder more than is necessary.
Conclusion:
Shoulder instability is one of the most common swimming injuries. This is due to the micro trauma from repetitive overhead arm motions and that fact that many swimmers are already hypermobile. The main deficits associated with shoulder instability are…
- Weakness in the scapular muscles that are in charge of upward rotation
- Altered muscle control
- Decreased shoulder proprioception
Once these deficits are corrected, the shoulder pain that is associated with shoulder instability should decrease. It is important to follow a structured dryland program that will help maintain shoulder stability and strength after recovering from this injury to prevent any recurrent shoulder instability injuries.
Is your shoulder pain limiting your ability to swim? Are you frustrated of being in pain and not knowing what to do? Schedule a free call today and let’s get it sorted out.
Thanks for reading!
Alex Ewart