Swimmer’s Shoulder

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Whether you are a young athlete, an active adult or a sports enthusiast, you know injuries are just par for the course.  Swimmers are no strangers to pain, especially pain associated with swimmer’s shoulder. It is estimated that over 70% of competitive swimmers develop a shoulder injury at some point in their career.   Why is swimmer’s shoulder so pervasive?

Understanding swimmer’s shoulder requires a basic knowledge of the joint anatomy. The shoulder joint is surrounded by several strong ligaments and a thick fibrous structure known as the joint capsule.  Collectively, these static stabilizers support the joint and help keep it snug primarily at rest but also during active movement.  While swimming, support is provided by the rotator cuff muscles and to a lesser extent by the biceps.  These muscles lend dynamic stability to the joint. Sitting atop the joint is a bursa sac which helps decrease friction and provides cushion to the rotator cuff tendons.

Swimmer’s shoulder is an impingement syndrome in which the bicep tendon, the rotator cuff tendon and bursa are compressed between the bony structures of the joint. It is more common among freestyle and butterfly swimmers.  As the soft tissue structures become pinched and inflamed by repetitive overhead motion, the space within the joint decreases which can start a painful impingement cycle.

The causes of swimmer’s shoulder are multi-factorial.  Faulty swim mechanics have been linked to this condition.  Swimmers who cross midline during catch and pull, use a thumb first entry and breathe only to one side greatly increase their risk of injury. Insufficient body roll and swimming with “an eyes-forward position” impedes normal shoulder function.  Hand paddles are popular among swimmers; however, if over used they too can lead to joint strain or impingement.

Posture can contribute to the swimmer’s problem. As a group, swimmers tend to have rounded shoulders which cause the shoulder blades to tip forward and down increasing the risk of impingement.  Swimmers commonly have tight chest and neck musculature and research suggests that this tightness inhibits the shoulder blade dynamics stabilizers resulting in improper shoulder mechanics.

Rotator cuff weakness and fatigue is a major cause of swimmer’s shoulder. If the dynamic stabilizers are weak, then the joint mechanics will be altered and function compromised.

In conjunction with muscle weakness, swimmers typically have more shoulder joint laxity due to an overstretched joint capsule. Years of improper stretching and even a previous subluxation or dislocation can cause the joint capsule to be irreversibly stretched.  Lax static stabilizers plus weak dynamic stabilizers greatly increase the risk of injury.

Avoiding swimmer’s shoulder is possible. Utilizing proper swim mechanics and developing a proper conditioning program is integral.

A stretching program performed 3 to 5 days a week targeting flexibility of the neck and chest is important to offset the typical swimmers’ posture.  Performing a 10-15 minute warm-up prior to stretching is ideal.  Aggressive joint capsule stretches should always be avoided.

An endurance strengthening program that focuses on the rotator cuff and shoulder blade stabilizers performed 2 to 3 times per week is recommended.  Strengthening should be done following a swimming session, never before to avoid fatigue.  The goal is to increase the strength and stability of the shoulder joint and shoulder blade stabilizers thereby promoting normal joint function.

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