Swimmer’s Shoulder: For the Novice Triathlete
As a Canadian living in Australia, I was immediately enamoured with the Triathlon culture. The climate here affords us such great opportunity to be outdoors running, cycling, swimming and much more. Just reminding myself to use sunscreen more than back in cold Canada. Having had no proper training in cycling or swimming and only moderate running training years ago, attempting triathlons for the first time in my life was difficult to say the least. Thanks to having a competitive partner who coerced me into taking my training more seriously, I signed-up for the Mooloolaba Triathlon. With a few months to train I focussed heavily on swimming, especially open water, as it was never a big part of my life back home. Swim training truly brought-on a new level of difficulty as a bothersome pain began. I was developing Swimmer’s Shoulder.
What is Swimmer's Shoulder?
What does Swimmer's Shoulder mean exactly? Swimmer’s Shoulder is an umbrella term that can describe any number of pathologies. Typically included in this diagnosis are shoulder tissue overloading or overuse conditions such as rotator cuff tendinopathies, bursitis, impingement, glenohumeral internal rotation deficit, scapular dyskinesis, laxity and multi-directional instability. In many cases and recent reports, shoulder pain related to swimming is multi-facetted with more than one tissue involved, and a combination of contributory factors such as fatigue, laxity, overuse and poor mechanics of movement. So, Swimmer’s Shoulder really isn’t limited only to swimmers. Any of the above mentioned conditions can happen to anyone, but are just common in swimmers because of the serious amounts of shoulder work being done.
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Swimmer's Shoulder and Swimming Technique
Mechanics of movement are important! Swimming technique is an important factor in avoiding tissue overload or impingements. In freestyle or front crawl stroke, 80% of the power for forward movement comes from the upper limb pull-through, while only 20% comes from the kick. This emphasizes the importance of having smooth biomechanics in the upper body. Having a decreased body roll during the stroke can increase demands on the shoulder joint and cause straining to compensate for a lack of trunk movement. Swimmers experiencing pain during internal rotation of the shoulder can try decreasing elbow height during the recovery or upturn phase of the freestyle stroke to help reduce symptoms, decreasing demand of shoulder rotation and finally trying a wider entry for the hand into the water can help lower pain levels.
Training and Exercise for Swimmer's Shoulder
Overloading of the tissues in the shoulder is the most common reason for pain related to swimming. Triathletes have options for cross-training and the swimmer will benefit from cross-training as well, incorporating other forms of cardiovascular training such as running or cycling however, both the swimmer and triathlete often focus entirely on the endurance/ cardio training and lack a component of strength work. A common occurrence in many endurance athletes, lacking strength training can lead to muscle imbalances in the body. For the swimmer, the front of the internal rotators of the shoulder ie. pectorals and latisimus dorsi tend to be more developed, while the external rotators get neglected. This is where training the rotator cuff comes in handy. Furthermore, maintaining adequate scapular control such as training serratus anterior and lower fibres of the trapezius are integral for optimal stroke power, arm control through the water and avoiding tissue overloading in the upper/front shoulder.
Some Tips to Simmer that Shoulder Down
If you’re keen to try making some adjustments in your swimming routine and swim mechanics to improve your shoulder pain here are some recommendations to start settling that shoulder down a bit.
1. A proper warm-up and cool down are very helpful for preparing your shoulders to meet the high demand of swimming and to help recover fatigued muscles to be prepared for the next training session. Rotator cuff activation exercises are a good starting place for your warm-ups and stretching the pectorals and lats can be a helpful component of your cool-down
2. Having enough body roll is important during the recovery phase of the stroke to lower demand on the shoulder elevating the arm out of the water before beginning the next stroke. As a bonus, this can also help with ease of breathing between your strokes.
3. Only increase your training volume in 10% increments each week. This may involve your time swimming, or distance covered while training. Too much - too fast can lead to fatigue and overloading causing shoulder pain.
4. Mix it up! Try breaking up your swim routine into different bouts e.g., a few sets of standard freestyle, sets using a paddle board to work on kicking, or sets using a pool buoy to help your buoyancy.
Personally, I benefitted quite quickly from including a rotator cuff warm up routine to my swim training and adding some gym days into the overall training for what was my first Tri comp in Mooloolaba. Isolated shoulder strength exercises were very helpful, but also having a strength component for the rest of my body made such a great difference for my running, cycling and swim training performance. I had more energy and felt I was getting more out of every training session and of course research shows the added benefit of having a strength component in the endurance athletes’ program.
How working with a Physiotherapist can benefit your training program.
Working with a Physiotherapist can help to identify the specific painful structures associated with your Swimmer’s Shoulder and will compliment your training program. At PhysioTec, we follow current rehab guidelines, utilize technology and measurement tools for optimal assessment to pinpoint areas contributing to your symptoms and to guide your path to recovery and improved performance. I find great joy in helping my clients get active and return to the sports and recreations they love. Beginning Triathlons for the first time only in recent years, I can attest to the aches and pains that come with the training. Plus having a slightly competitive nature can lead to a little extra pain at times… Sound familiar? We can help guide your path to recovery and being fit for race day.
Do you you need help recovering from an injury? Improving your performance? Or just getting back to doing the things that you love? Visit us at PhysioTec, and let one of our physios assess you and provide you with a personalised program to help you get on-top of your condition, and feel at your best.
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Author
This blog was written by Tyler Cultum, one of our Sports and Strength & Conditioning Physiotherapists. He has broad interests in sports and musculoskeletal physiotherapy, with special interests in strength and conditioning, the shoulder and hip. You can read more about Tyler here.
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