Shoulder pain is a very common problem in the swimming athlete. The shoulder joint is so vulnerable to injury and problems during swimming because it is an inherently unstable joint and upper extremity force provides the vast majority of propulsion. As a result, swimmers are particularly prone to shoulder injuries.
Injuries to the shoulder joint as a result of swimming can usually be attributed to one of three factors or a combination. Overuse or over-training is usually a factor. Poor mechanics and technique may also contribute to the problem. And finally, anatomic or genetic characteristics may contribute as well.
Structures inside the shoulder which may be injured include the rotator cuff, the labrum and/or capsule, and the long head of the biceps tendon. The rotator cuff may become irritated as a result of "impingement" of the muscle tendons underneath the acromion during the swimming motion. Excessive loads may be placed on the labrum surrounding the shoulder socket as muscles become fatigued resulting in injury. The biceps tendon which runs along the front of the shoulder joint may become inflamed or partially torn as well.
Prevention of these injuries involves several approaches. First, a sensible training regimen is important. Most of these injuries are related to muscle fatigue due to over-training. Cross training to maintain cardio fitness can reduce stress at the shoulder joint. Second, a strengthening program should be incorporated for the rotator cuff muscles and muscles that stabilize the scapula (shoulder blade). This will reduce hypermobility of the shoulder joint which may result in inflammation and injury. Core strengthening is also important because abdominal as well as upper and lower back musculature are needed during the swimming motion. Attention to proper mechanics during the stroke, especially freestyle, butterfly, and backstroke, are essential as well.
The good news is that in most cases "swimmer's shoulder" will respond to simple treatment. Complete rest or decreased training is the first step. Ice is recommended to reduce inflammation along with anti-inflammatory medication such as ibuprofen. After pain subsides, an exercise program to regain motion and strength followed by a gradual increase in swimming will usually be successful. If pain persists, it may warrant an evaluation by your orthopedic surgeon.
Don't let "swimmer's shoulder" keep you out of the water! Prevention is the best way to avoid these problems whether you are a recreational swimmer or training for your next triathlon! Be safe in and around the water and enjoy your summer!
Malcolm Stubbs, MD