Ask almost any coach “what is the main cause of swimmers shoulder,” and the answer you will get is poor technique. Although sport injuries are complex and multifactorial in nature, poor technique plays a large part. Whether a swimmers technique caused the injury or whether their technique changed as a result of injury is yet to be determined. What we do know though is that there are common freestyle mistakes in swimmers that are experiencing shoulder pain and that correcting them will allow a swimmer to get back to performance faster. Here are the top three that I have seen as both a coach and a physical therapist.
#1 Hand Entering the Water Past Midline
One of the common freestyle mistakes I see is when a swimmer’s hand enters the water beyond their midline. When a swimmer’s hand enters the water beyond midline, they are placing their shoulder in the classic impingement position. If there was a performance advantage in swimming like this, then going into that impingement position may be worth it, but entering the water past midline significantly decreases a swimmer’s efficiency. You are not able to pull in a direct line from this position, using valuable energy just to get their hand in a position where it can propel the water backwards, instead of just starting in that position to begin with. Reaching beyond midline can also lead to medial/lateral sway, which also increases drag in the water and increased energy expenditure to go the same speed.
#2 Arm Crossing Midline During the Pull Phase
ENTIRE SCREENSHOT OF PICTURE
Pulling across midline is another common freestyle mistake many I see in swimmers dealing with shoulder pain. Reaching across midline puts the shoulder in a flexed, adducted, and internally rotated position, which is puts the shoulder in an impinged position and places the muscles in the shoulder at a mechanical disadvantage. When a muscle is at a mechanical disadvantage, it is forced to work harder to get the same result or is unable to activate at a high level due to the position it is placed in.
#3 Elbow and Hand Entering the Water at the Same Time
Another common freestyle mistake I see is when a swimmers hand and elbow enter the water at the same time. There are a couple of reasons why we do not want this. First, when the elbow and hander enter as the same time, the force from the water on the forearm increased the superior translate of the humerus, causing impingement. While a swimmer may be able to control the superior translation most of the time, once the rotator cuff and/or scapular muscles become fatigued, it becomes more difficult for their muscles to control the superior translation, which can place stress on passive restructures (Acrominion, ligaments, labrum, joint capsule, etc.) or result in compensation from other muscles such as the biceps.
In addition, entering the water with hand and elbow enter the water at the same time leads to a swimmer pulling with a dropped elbow. This will make a significant difference on how much water a swimmer can pull. This pattern can also be developed when a swimmer is dealing with shoulder pain. The subscaparlis muscle can become irritated and painful when a swimmer is going into shoulder internal rotation. Swimming with a dropped elbow decreases the amount of internal rotation the shoulder goes into, helping the swimmer avoid using the painful and irritated muscle, allowing them to keep swimming.
Putting it all together:
When dealing with an injury, a swimmer will present with a musculoskeletal impairment, such as instability, biceps tendinopathy, etc.,but may also have technical errors in the pool. Fixing the musculoskeletal impairment is not enough and will lead to incomplete rehab. It is critical for health care professionals to work with coaches to make the right changes in the pool in order for the swimmer to return to their desired performance level. Helping correct some of these technical errors are some of the modifications I make to help keep a swimmer in the pool. For my reasoning on why it is important to keep a swimmer in the pool, check out a my recent blog post, Should You Keep Training When You Have a Swimming Injury?
Main Points:
- 3 of the most common freestyle mistakes I see in swimmers dealing with shoulder pain are 1) hand entering the water past midline during hand entry 2) hand pulling across midline during the pull phase and 3) Hand elbow entering the water at the same during hand entry
- Sometimes these mistakes can lead to injury but they can also be a result of having shoulder pain
- When rehabbing a swimmer, working on making technical changes in addition to working with their musculoskeletal impairments is critical