Are you a swimmer? Swimmers shoulder- how to avoid it.

With summer on the way the number of recreational and competitive swimmers is expected to increase. When it comes to injuries swimming is usually considered low risk as it is non contact low impact exercise. However injuries do still occur! The shoulder is the most commonly injured joint in swimmers. Approximately 30% of swimmers will need to stop training due to injuries. It is important for physios to work with athletes and coaches to treat these injuries as they occur as well as working together to prevent them from happening in the future. It is also important that treatment occurs early to prevent secondary injuries as a result of technique changes or compensation due to pain.   

With summer on the way the number of recreational and competitive swimmers is expected to increase. When it comes to injuries swimming is usually considered low risk as it is non contact low impact exercise. However injuries do still occur! The shoulder is the most commonly injured joint in swimmers. Approximately 30% of swimmers will need to stop training due to injuries. It is important for physios to work with athletes and coaches to treat these injuries as they occur as well as working together to prevent them from happening in the future. It is also important that treatment occurs early to prevent secondary injuries as a result of technique changes or compensation due to pain. 

When it comes to risk factors for injury, a history of previous injury is by far the largest predictor of future injuries. While scientific evidence does not yet strongly implicate them, technique and training volume are thought to be the next biggest risk factors. So with this in mind let’s think about what we can do to help you stay in the water all season this year!
There is great variability in technique and physical attributes between swimmers. The first simple step is to check the breathing pattern. Swimmers with a unilateral breathing pattern are at increased risk of shoulder and neck injuries due to the increased use of muscles and movement on one side of the body. An increased range of movement generally, but particularly at the shoulders, is thought to be advantageous to swimmers. Research suggests that both trunk rotation and side flexion are important factors to measure and consider in swimmers who may have shoulder pain. A lack of movement in these areas will lead to excess strain being placed on the shoulder joint as the swimmer needs to compensate by moving the shoulder more, and generate more force to overcome the drag created.
 
In order to increase their velocity through the water, a swimmer can increase their force generation by 30% or decrease their drag by 3%. This would suggest that by working with physios and coaches to improve both shoulder strength and technique athletes will not only reduce their risk of injury but also improve their performance. Training aids such as drag suits and elastic cords should be used cautiously and only when technique is devoid of any flaws.
 
I encourage swimmers to have the range of movement around the scapula as well as the motor patterns which control the movement of the shoulder, assessed by a physiotherapist. This is most important in swimmers who currently have shoulder pain, but also important for any swimmers who have experienced pain in previous seasons. This is because the rotator cuff has been shown to be more likely to be overloaded where the scapula does not move correctly. Many elite swimmers will have their movement assessed and monitored as opposed to changed if there is no current pain. This is well worth while as the athlete and the physiotherapists are then able to pick up any deviations from “their normal” as soon as they happen and address issues before they become injuries. Any poor shoulder mechanics tend to worsen with fatigue so it is important that athletes are not increasing training volumes when these issues exist.
 
The stereotypical look of a good swimmer is one with strong shoulders. Currently the best way we can measure strength is with a dynamometer which is a digital pressure gauge. The internal rotation strength of the arms should be 20-30% of body weight and the internal to external rotation strength should be of ratio <1.5. You can have your physio check to see that these strength tests are optimal. Should these things need addressing a program will then be created for injury prevention and performance enhancement. Good core strength and control is important for keeping the body in a streamlined position and therefore reducing drag. While there are no scientifically validated tests for core stability we tend to use a bridge, a plank and a superman position as the most relevant and reliable tests.
 
It is likely that training volume plays a role in injury risk. Current research suggests that spikes in training load or high variability of training load may be more important as a risk factor than overall load. A safe increase in load is considered approximately 10%. Anything beyond this correlates with an increased risk of injury. The introduction or increased use of paddles should be slow for this same reason. Overall load of more than 15hours per week or 35km per week is considered excessive and may contribute to overuse injuries.
It is very common for physios or coaches to advise athletes to decrease freestyle and arm drills while increasing time on kickboards and leg drills. The problem with this is that the arms are often in an outstretched position on the kickboard which commonly aggravates shoulder pain. Alternative options might be using a pull buoy to significantly slow the stroke rate and reduce the load on the shoulder as well as correcting any stroke mechanics.
 
Ideally each swimmer, recreational or competitive would perform individualised programs with range of movement, muscle balance, motor control and core stability exercises. After an injury regular monitoring of key factors which were identified in the assessment become important for early identification of future potential injury. In summary, my advice is to make sure you ask your physio why you may have been susceptible to this injury in the first place and to implement a program to prevent future injuries.