III. The Swimmer’s Shoulder: Overuse Injuries

As in any sport, injuries happen. Injuries occur not just by accident, but many injuries occur because of poor training technique, unsafe practices, and overuse. Especially in swimming, proper stroke technique is the key to both prevention and treatment of musculoskeletal injuries. Proper stroke technique greatly reduces the chances of injury in swimmers.

Commonly in swimming, problems occur with a swimmer’s shoulder. Swimming brings the shoulder into an overhead arm position probably more that many other sports. In a 10,000-yard training session, each arm may complete 4,000 or more strokes. According to Kramer et al., 10% of 13-14 year olds and 13% of 15-16 year olds reported current interfering shoulder pain with 47% of 13-14 year olds, and 66% of 15-16 year olds indicated having had shoulder pain associated with swimming in the past.

Let’s examine freestyle: The elbow should remain above the hand when the arm is out of the water. Rolling the body aids in this elevation, however rolling the body can also put stress on the shoulder if done incorrectly. Breathing only to one side causes one shoulder to endure more of the effort than the other creating further overuse stress. During entry, the hand should be in line with or just outside the position of the shoulder because entering with either the hand too far to midline or too far out to the side are less efficient positions and put a greater load on the shoulder. Also, if the hand enters the water with the thumb pointing down and the palm facing outward, shoulder injuries can also occur. The little finger should enter first with the palm of the hand facing inward. Using paddles for training that are too large or do not have drainage holes puts an undue amount of stress on the shoulder and can cause injury as well.

Good technique is the key to prevention. Swimmers should also avoid rapid increases in training distances or frequency of training because this will increase the use of the shoulder musculature past the point of muscle fatigue possibly causing injury. With increased fatigue, swimmers begin to use poorer technique that can lead to injury. Stretching is also a good preventative measure, and swimmers should include stretching the shoulders, chest, and neck muscles. Inflexibility at the shoulders and chest could indicate an imbalance between the muscles that could result in injury. Swimmers should carefully warm up and stretch before each workout and meet. Regular rest periods should be integrated into the training regimen.

Treatment of shoulder injuries focuses on icing, relative rest, physical therapy, and modifying the swimming technique and workout regimen to prevent further injury and decrease overuse issues. As with any injury, your physician should be consulted.

Coaches, parents, clinicians, and physicians should monitor factors that place a swimmer at increased risk for injury, and modify these factors to avoid and prevent injury.

References:

http://www.nismat.org/traintip/swimmershld/

Kammer CS, Young CC, Niedfeldt MW. Swimming injuries and illnesses. Physician and Sportmedicine 1999 Apr. 109-11 passim; 27(4):51-54.

Keohler SM, Thorson DC. Swimmer’s shoulder: Targeting treatment. Physician and Sportmedicine 1996 Nov. passim;24(11):39-40.