When a swimmer comes to my clinic for an injury, I always like to ask the question “What do you think caused this injury.” There are a couple of common answers I hear, but one of the more common answers is poor posture. Posture has received a lot of press over the years, with popularization of the phrases “text neck” and “forward head posture (FHP).” These postures are characterized by increased thoracic kyphosis (increased rounding in the upper back) and when your neck is positioned ahead of midline. Swimmers are notorious for having forward head posture, rounded shoulders, and slumping while seated. But do this mean anything? Does bad posture cause injury? Can correcting a swimmer’s posture improve performance and prevent injury?
The Relationship between Posture and Pain
It is not clear that having forward head posture increases the risk of developing shoulder pain. For adolescents, there is no relationship between posture and neck pain. Meaning, those who do not have FHP are just as likely to develop neck pain. For adults, there is some evidence of FHP being associated with neck pain, but there is no evidence showing that FHP is the cause of neck pain. Whether decreased range of motion or the forward head posture is a cause of pain or a result of pain is unknown. We do know that neck pain is complex and can be attributed to multiple factors such as decreased activity levels and decreased neck range of motion as people age (Mahmound, 2019).
For shoulder pain, the amount of thoracic kyphosis is similar in people with and without pain (Barrett, 2016). There is some evidence that thoracic kyphosis is associated with shoulder impingement syndrome, but it should be noted that this study only looked at participants older than 40 and was a cross sectional design. So, the results of that study must be interpreted with caution and cannot be applied to younger swimmers.
For younger swimmers, there is no solid evidence that poor posture increases the risk of shoulder or neck pain. For master swimmers, there is evidence that working on posture may decrease the risk of neck pain. Antidotally, masters’ athletes with neck pain have decreased cervical range of motion and decreased thoracic spine mobility. When both cervical and thoracic mobility improve, there symptoms often improve, but I may not see a significant difference in resting posture pre and post treatment. Instead, having the dynamic mobility to move out of a “slumped” posture may be what helps masters swimmers get rid of their neck pain.
Does a Swimmers Posture Impact Performance?
We do know that increased thoracic kyphosis decreases overhead mobility, which is needed for swimmers. We also know that the muscles that help “improve” posture, such as the trapezius and rhomboids, need to be strong for optimal shoulder function. But in many cases, having strong traps and rhomboids does not mean better posture. Therefore, it isn’t clear if posture impacts performance.
What does improve performance? Having the required overhead mobility required for proper technique in addition to strong scapular muscles. If working on those two variables lead to “better” posture, that is great. But if it does not lead to “better” posture, I would not be worried.
Should We Correct a Swimmers Posture?
The answer is it depends. If a swimmer has poor posture that is limiting their overhead mobility, then making a change to their posture to increase their mobility may be warranted. Another situation where I would change a swimmer’s posture is if they were dealing with an injury and changing their posture improved their symptoms. Typically, the changes in posture are temporary but allows for the swimmer to get back in the water faster, getting them back to peak performance faster as well.
Would I try to change a swimmer’s posture just because they slouch or have forward head posture? Definitely not, unless changing posture changed an injured swimmers’ symptoms.
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References:
Barrett E, O’Keeffe M, O’Sullivan K, Lewis J, McCreesh K. Is thoracic spine posture associated with shoulder pain, range of motion and function? A systematic review. Man Ther. 2016 Dec;26:38-46. doi: 10.1016/j.math.2016.07.008. Epub 2016 Jul 21. PMID: 27475532.
Hunter DJ, Rivett DA, McKeirnan S, Smith L, Snodgrass SJ. Relationship Between Shoulder Impingement Syndrome and Thoracic Posture. Phys Ther. 2020 Apr 17;100(4):677-686. doi: 10.1093/ptj/pzz182. PMID: 31825488.
Mahmoud NF, Hassan KA, Abdelmajeed SF, Moustafa IM, Silva AG. The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis. Curr Rev Musculoskelet Med. 2019 Dec;12(4):562-577. doi: 10.1007/s12178-019-09594-y. PMID: 31773477; PMCID: PMC6942109.