Swimming is an activity that burns lots of calories and is an ideal recreational sport for all to enjoy regardless of your level of ability or fitness. Its benefits on the human body are wide ranging owing to the buoyancy effect of the water. Even 20-30 lengths a couple of times a week can be an excellent way of building muscular strength and endurance whilst also improving your cardiovascular fitness.
Swimmers are unfortunately prone to picking up overuse injuries, just like any other athlete would be. I’m sure many of you swimmers out there have experienced pain at some point either during or after swimming. You will therefore be able to relate to how frustrating it can be having to spend time out of the water trying to nurse yourself back to full fitness again.
Having worked with elite junior swimmers over the last five years I have seen an abundance of different injuries present in my clinic. Owing to 90% of the propulsive power coming from the upper extremity however, a large majority of swimming injuries us physiotherapists tend to see involve the shoulder.
The prevalence of shoulder pain in elite level swimming has been shown in some studies to be as high as 66%. On average a competitive swimmer performs somewhere in the region of 2000-4000 strokes cycles per 2 hour session in the pool. That’s a total of 16000 cycles plus in one typical training week. Many of these revolutions are often done at high speeds and involve highly complex movement patterns involving both the scapula (the shoulder blade) and the shoulder joint itself (the glenohumeral joint).
To add fuel to the fire, the shoulder joint is a relatively unstable joint owing to its supporting ligaments and capsule being fairly lax. The progressive stress of loading and stretching the joint beyond its functional range can therefore inevitably lead to muscle and tendons becoming susceptible to repetitive micro-trauma.
The longer the micro-trauma goes, the greater the risk there is of the tendon tearing/rupturing. This can subsequently lead to even greater instability.
There are many pain sensitive structures housed within the shoulder joint, which can make a specific diagnosis difficult. If you ignore the pain, which many of us often do, inflammation can rapidly set in and cause the pain to become more widespread. This can subsequently make a simple problem much more difficult to treat. Early diagnosis and management is therefore key.
Key muscle groups used in swimming
In the majority of cases that I have treated over the years, a significant proportion of shoulder pain is a direct result of inflammation of one or more of the rotator cuff tendons. The Rotator cuff muscles are essentially the ‘core stability’ muscles of the shoulder and are vital for keeping the ball of the joint centred in its socket. This is of paramount importance in any sport involving repetitive overhead movements as it prevents excessive movement within the joint. The location of these tendons makes them susceptible to being compressed onto the bony surface of the acromion (top of the shoulder blade).
Injury patterns can vary hugely depending upon the swimmer’s age, gender, stroke technique, training distance and training schedule/intensity. Taking all of these factors into account is therefore vital in achieving a good outcome.
So why might shoulder pain affect some people but not others?
- Poor biomechanics and in particular altered timing in how the shoulder blade moves in relation to the glenohumeral joint.
- Poor technique e. not maintaining bend in the elbow during pull phase.
- Repetitive overhead movements together with the resistance of the water. Particularly common with freestyle and butterfly strokes
- Weakness of the rotator cuff muscles. Poor endurance of the primary torque producing muscles (such as the deltoid, serratus anterior or bicep)
- Muscular imbalance between anterior and posterior muscle groups.
- Poor posture.
- Lack of joint flexibility in the thoracic spine as well as the shoulder
In my clinical experience the majority of swimmers rarely have one clinical feature outlined in the above list. More often than not it tends to be a combination of factors that are contributing to the impingement/tendinopathy. It takes a skilled and experienced physiotherapist to recognise and manage this.
If you have any questions or require any further information than why not get in touch with Stephen our in-house swimming expert. Richmond Physiotherapy also offers a ‘swimmer screening service’ and injury prevention programme to help optimise your technique and performance in the pool. Please contact us for more information.