Written by Susan Romano-Silva, MS, OTR/L, BCP
Virtual Hand to Shoulder Institute
Therapy Fellow ‘20
Now that it’s summer kids will likely be participating in swimming activities in some form; whether just for fun, on recreational swim teams, or perhaps they are competitive swimmers all year long. Swimming is a unique sport because it involves coordinating so many body parts simultaneously in order to swim effectively. Swimming involves every muscle group from head to toes, as well as mastering breathing patterns during all these fluid movements. However, one of the most common complaints young swimmers may report is shoulder pain. This is not surprising, since the shoulder is the driving force that propels the body through water.
Swimmers perform a great number of overhead arm motions during practice. Several studies have indicated that shoulder pain has been described as the most common musculoskeletal injury in competitive swimmers causing an impact on training, competition and swimming goals. One study by the National Collegiate Athletic Association revealed that shoulder injuries are the most common among swimmers with prevalence between 40% and 91% depending on the age group and definition. Additional research presented by the American Academy of Pediatrics 2019 conference showed a clear link that the more distance or yards performed at practice, swimmers may report more pain. In a 2006 survey conducted by the American Swim coaches Association, they estimated that a 13-year-old year-round swimmer performing freestyle training could potentially perform 33,600 strokes in a single week. Thus the shoulder is working very hard during swimming making it prone to injury.
What is Swimmer’s Shoulder?
Swimmer’s shoulder is an umbrella term referring to numerous musculoskeletal conditions of the shoulder that can affect swimmers. Researchers originally believed was pain as a result of impingement of the shoulder joint. However, further analysis and research from sports medicine, swim experts, and physiotherapists support that it is caused by many factors including stroke technique, overuse of the muscles surrounding the shoulder, or an unstable shoulder joint. Shoulder pain in swimmers can be vague or specific and can occur in the front or back of the shoulder. Pain can be localized or radiate to areas of the neck, back or down the arm. During swimming the shoulder is highly mobile and there are many joints, muscles, and ligaments that work together so when pain occurs it needs to be addressed to minimize risk of a more severe injury.
Common symptoms of shoulder pain in young swimmers may include:
➤tenderness
➤throbbing
➤clicking sounds
➤decreased arm motion
➤tight or weak muscles
➤nighttime pain
➤swelling
➤ radiating pain in neck, back, or arm
Typical causes for a painful swimmer’s shoulder:
Overuse: This may occur from constant joint rotation and repetitive movements that swimmers must perform that may cause a painful shoulder.
Muscle weakness: Weakness of the surrounding muscles of the shoulder blade and shoulder joint (rotator cuff muscles) can cause the shoulder joints to slip out of its groove.
Improper stroke mechanics: Simply put using the wrong motor patterns and incorrect positioning of your arm and body during swimming may cause a painful shoulder.
Poor Posture: There may be inefficient muscle balance or range of motion issues causing shoulder problems that are causing increased stress on the shoulder joint when swimming.
Developing bones and muscles: Young swimmers may be more susceptible to swimmer’s shoulder because their bones may still be growing, and their muscles may not be developed sufficiently to support the shoulder joint involved with repetitive motions during swimming.
Prevention tips for young swimmers:
Eat healthy and drink plenty of fluids to stay hydrated because
prevents fatigue,
provides proper energy
prevents muscle cramps
Helps with muscle recovery after practice
Performing warm-up stretches for 5-10 minutes helps increase blood flow and prepare the muscles for a workout. Examples of dynamic shoulder and arm stretches such as;
cross body arm swings
arm circles
neck and shoulder rolls
Strengthening your shoulder muscles: perform supervised exercises on dry land that focus on stabilizing the joints around the shoulder girdle, specifically the rotator cuff muscles and shoulder blade, emphasis should be on exercises to help maintain shoulder stability.
Improve your overall posture so the shoulder joint sits in a good position such as standing straight and shoulders back
Listen, observe and correct stroke techniques recommended by your coaches.
Don’t forget to stretch after practice for proper recovery time. Stretch your entire muscle groups after practice since swimming utilizes your entire body from head to toe.
⭐Remember: It is important to perform proper stroke techniques. Swim coaches can help with this so seek them out during practice for advice on proper stroke techniques to help prevent or minimize your risk of swimmer’s shoulder.
Here are a few common stroke flaws commonly observed by swim instructors that you may need to change during practice to get you on the right track:
Hand placement on the entry to water, pay attention to which way your thumb is pointing as this may contribute to shoulder pain
Position of your body during strokes
Position of your elbow during strokes
Head position during breathing
Basic advice if you begin to develop shoulder pain with swimming:
➤ Rest, if you can take a break from swimming for a few days to see if pain goes away. It allows the shoulder injury, an opportunity to heal and then return to swimming once the pain subsides.
➤Vary work out programs in the water to focus on other areas such as kicking or different strokes that don’t cause shoulder pain.
➤Decrease the amount of overhead swimming done at practice by modifying strokes.
➤Have your coach look at your swim strokes to see what may be incorrect and see if the pain goes away.
➤Icing your shoulder after practice may help but make sure to seek this method out in conjunction with your swim trainer to make sure it is done properly.
➤Have your pain checked out by a professional health care provider/trainer, if pain persists.
What happens if pain persists: If your shoulder pain persists consult with a physician to determine the best plan of action. They may recommend a rehabilitation consultation, therapy or prescribe further medical testing if needed to identify more serious issues. It's important to know that treating painful shoulders in swimmer’s can be managed but requires knowledge of body mechanics, movement analysis and therapy techniques that are focused on identifying the problem and addressing the impairments associated with this pain. An Occupational Therapist/Health care provider who specializes in upper extremity function can provide an evaluation and treatment to help alleviate pain in order for you to continue with swimming.
Resources:
Patel, D. R., & Breisach, S. (2017). Evaluation and management of shoulder pain in skeletally immature athletes. Translational pediatrics, 6(3), 181–189. https://doi.org/10.21037/tp.2017.04.06
Shoulder extension strength: a potential risk factor for shoulder pain in young swimmers?
McLaine SJ, Bird ML, Ginn KA, Hartley T, Fell JW J Sci Med Sport. 2019 May; 22(5):516-520.
Shoulder injuries in competitive swimmers.McMaster WC Clin Sports Med. 1999 Apr; 18(2):349-59.
Review of shoulder injuries and shoulder problems in competitive swimmers. Am. J. Sports Sci. Med. 4 57–73. 10.12691/ajssm-4-3-1
Biomechanical Considerations in the Competitive Swimmer's Shoulder.
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AIS Sports Nutrition, 2009, Swimming, Australian Institute of Sport, Australian Government Sports Commission, <http://www.ausport.gov.au/ais/nutrition/factsheets/sports/swimming>
American Academy of Pediatrics. (2019, October 25). 'Swimmer's shoulder,' common in more than three-quarters of swimmers: Research shows that a painful swimmer's shoulder may be due to heavy training load and a 'no pain, no gain' work ethic. ScienceDaily. Retrieved June 18, 2020 from www.sciencedaily.com/releases/2019/10/191025075856.htm
McMaster WC, Troup J. A survey of interfering shoulder pain in United States competitive swimmers. Am J Sports Med. 1993;21(1):67-70. doi:10.1177/036354659302100112
Sein ML, Walton J, Linklater J, et al Shoulder pain in elite swimmers: primarily due to swim-volume-induced supraspinatus tendinopathy British Journal of Sports Medicine 2010;44:105-113.
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Hydration and the swimmer by Joe Buchanan https://www.swimmingworldmagazine.com/news/hydration-for-swimmers/
APA Adams, J. D.; Kavouras, Stavros A.; Robillard, Joseph I.; Bardis, Costas N.; Johnson, Evan C.; Ganio, Matthew S.; McDermott, Brendon P.; White, Michael A. Fluid Balance of Adolescent Swimmers During Training, Journal of Strength and Conditioning Research: March 2016 - Volume 30 - Issue 3 - p 621-625
doi: 10.1519/JSC.0000000000001132
Hamman S. (2014). Considerations and return to swim protocol for the pediatric swimmer after non-operative injury. International journal of sports physical therapy, 9(3), 388–395.
