Swimming is a great sport for all ages and is one of the top competitive sports in Dubai, UAE. Recreational swimmers are not so susceptible to injury but if you are a squad swimmer, training for a triathlon or have children who train and compete 5 to 6 days a week then shoulder injuries can happen.
A lot of people talk about swimmers shoulder, what exactly is it?
Swimmer’s shoulder is a term used to describe pain and disability caused by overuse of the rotator cuff tendons due to long sessions or intense sessions of swimming. It mostly occurs with freestyle and butterfly strokes. A competitive swimmer will perform about 20 strokes per 50 meters which equates to 400 strokes per kilometer and for regular competitors almost 10000 in a week so you can see how an overuse injury can occur in the shoulders.
The swimming stroke – in simplistic terms starts with the hand entry followed by the catch (early pull phase), mid pull, late pull and then recovery. Freestyle stroke also needs body roll.
A swimmer needs lots of shoulder mobility to complete this stroke efficiently. In butterfly there is no body roll to aid the reach of the arms so even more shoulder and spinal flexibility is needed if this is the favoured stroke. Strain to the tendons of the shoulder can occur then if the cuff muscles and the muscles around the shoulder blade do not fire correctly, a situation that can occur in fatigue caused by a sudden increase in training. Other factors are loss of joint range and muscle tightness both of which can occur in the growing child.
When the shoulder starts to become painful the swimmer will then try to avoid the painful position. They tend to shorten the stroke so by altering the mechanics will leads to a loss of power. Initially the pain will only be with swimming or after getting out of the pool but as it worsens will lead to pain with their dry land activities and sometimes is painful at night indicating and inflamed shoulder.
Rest helps initially but if the cause of the injury is not addressed the pain will return when the swimmer gets back in the pool. If the swimmer then attends the sports doctor or experienced physiotherapist a full assessment is made to see what has caused the shoulder pain and a correct diagnosis can be made so they can return to the pool as soon as possible.
The following are some ways we would treat the swimmer’s shoulder.
- Advice on training – is full rest needed or modified training?
- Cross training will also be needed to keep fitness up if not swimming.
- Modalities for pain such as ice, heat and massage
- Restoring full range of motion in the shoulder and spine
- Restoring strength in the shoulder, core, gluts – don’t forget we use our abdominals and gluts when we swim!
Overall we need to restore normal mechanics – good rhythm between the shoulder joint and the shoulder blade with all the muscles working correctly to prevent reoccurrence.
One of the best ways this can be done is through exercise.
Prevention is also of the utmost importance. Doing an adequate warm up before you train – it can easily happen early in the morning or after work when rushing through Dubai traffic, arriving at the pool late for squad so only a minimal warm up is completed. Muscles fire better when they are warm so less chance for injury.
Doing some work out of the pool to improve strength and flexibility is also worthwhile. A one to two times per week short dry land program consisting of strengthening, flexibility, core and glute work can easily achieve this. Being aware of other lifestyle factors that contribute to injury is also important.
A 2017 study published in the Scandinavian Journal of Science and Medicine in Sports looked at adolescent athletes across 16 different sports and found that the biggest risk factors to injury were increasing training load, increasing training volume and at the same time decreasing hours of sleep.