As a swimmer, you’ll inevitably put a lot of strain on your shoulders which could lead to injury. Get the expert insight on the most common injuries for swimmers, what causes them, how to prevent them, and rehab exercises from James Collinge. James is Director and clinical lead at Invicta Health and Performance – a physiotherapy company based in Cheshire. James has a Masters Degree in Strength & Conditioning and works with England Rugby.
What are the most common swimming injuries?
Research published in the National Library of Medicine states that shoulder injuries are the most common injuries among swimmers, with prevalence between 40% and 91%. Swimmers are more predisposed to shoulder injuries than other athletes due to the fact that swimmers primarily use their arms to generate forward thrust - as opposed to most other sports which require the legs.
According to James, “I commonly see shoulder and back issues amongst swimmers. With shoulders it is classically those associated with overuse, such as subacromial impingements and tendinopathies of the rotator cuff or long-head of biceps.”
The term “swimmer’s shoulder” was first coined in 1978 by JC Kennedy and R Hawkins in a study published in the American Journal of Sports Medicine. It was used originally to refer to anterior shoulder pain experienced by swimmers both during and after workouts.
According to James, “Swimmers shoulder is an umbrella term for pathologies of the shoulder. These pathologies include impingement mechanisms, tendinopathies, labral injuries, shoulder instability due to laxity or muscular imbalance, neuropathies and pain arising from anatomic variation/change.”
James goes on to explain, “The problem with the term “swimmer’s shoulder” is it is anatomically non-specific. As a diagnosis it doesn’t give an indication as to what is causing the pain, which ultimately influences the management. That is why it is important to see a physiotherapist to get a clinical diagnosis which can be confirmed with diagnostic imaging if necessary.”
What causes swimmer’s shoulder?
Research suggests that originally, the cause of pain was thought to be impingement of the rotator cuff tendons under the coracoacromial arch (outlet impingement). However, subsequent studies and continued analysis of shoulder pain found that the cause is multifactorial, including stroke biomechanics, overuse and fatigue of muscles of the shoulder, scapula, and upper back and/or glenohumeral laxity with subsequent shoulder instability.
James explains, “The cause of swimmer’s shoulder really depends on the individual, their injury history, anatomy, physical qualities, and training loads. Often hypermobility, muscular imbalance or poor scapular mechanics can predispose athletes to an increased risk of subacromial impingement for example.”
How to prevent swimmer’s shoulder
Below, James provides the dos and don'ts of preventing swimmer’s shoulder.
DO – begin to understand your own weaknesses, movement restrictions and inefficiencies around the shoulder by seeing a physiotherapist. Then try to remedy these in a gym-based training programme. For example, at Invicta, we would perform an upper body movement screen and strength assessment of the rotator cuff and scapular-thoracic muscles using objective testing, we’d then create a training plan for you with reassessments to monitor progress.
DO – monitor your training loads in the form of external or internal loads.
DON’T – ignore the initial onset of symptoms and continue to swim. Often, the main driver of pain in swimmer’s shoulder is inflammation. If this isn’t respected and managed early enough, a seemingly low irritability injury can be exacerbated through continued training, which means it takes longer to settle down with more complications in the long run. To manage the primary inflammation, take non-steroidal anti-inflammatory medicine and rest. To manage the secondary pain and muscle tone, use ice and see a physio for treatment and guidance on rehabilitation.
Impingement is one of the most common complaints among swimmers. In one study, 91% of the swimmers surveyed reported shoulder pain, and of that 91%, 84% had positive impingement findings.
James explains, “Shoulder impingement falls into two distinct categories: internal and external. Internal impingement is where the rear rotator cuff muscles impinge against the glenoid (socket), with patients reporting pain in the rear and top of the shoulder.
External impingement occurs when the supraspinatus tendon or subacromial bursa is impinged against the underside of the acromion (bony process on the scapula) creating pain at the front and top of the shoulder.”
What causes shoulder impingement?
Internal impingement is usually caused by shoulder instability. This can be caused by a labral tear, which is an injury to the tissue that holds the ball and socket parts of the shoulder together. It can also be caused by ligament laxity or ineffective coordination of the rotator cuff muscles.
James explains, “Due to the training volumes and the number of repetitive revolutions of the shoulder involved in swimming, fatigue of the rotator cuff muscles and altered shoulder girdle mechanics are the main drivers of impingement. Often, age-related change, anatomical variance, and previous injury can predispose swimmers to an increased risk of impingement injuries.”
How to prevent shoulder impingement
James provides the dos and don’ts of preventing shoulder impingement.
DO – invest time in gym-based strength training. Improving the strength and capacity of these muscles is your biggest insurance policy against impingement-type mechanisms.
DO – make informed decisions about your training. Use external and internal load monitoring to influence and reflect on the volume and timing of your training. For example, if your last week’s loading was twice as much as the average of the last four weeks, you rate a 9/10 on muscle soreness and you’ve had a couple of bad night’s sleep – then maybe training today isn’t the answer and a scheduled de-load with some accessory strength work in the gym is the best fit.
DON’T – spend too much time doing overhead activities away from swimming. Positions overhead significantly narrow the subacromial space and increase your chances of impingement. If swimming is your main pursuit four times a week and the other three days you play badminton, that’s a lot of exposure to the mechanisms that preclude impingement. If you’ve built up to this volume slowly over a long time and you are a proficient mover, then you might get away with it for a time but a sudden jump into that volume of activity exaggerates the risk.
Swimming injury rehab
There is certainly not a one size fits all approach to rehab and each individual must be treated as an isolated case with interventions tailored specifically to them.
James says, “Generally speaking, my go-to areas of focus are exercises that aim to restore full functional range of motion in all planes, strength exercises targeting both sides of the rotator cuff (Internal and external rotators), scapulothoracic exercises to improve scapula-humeral rhythm, and proprioceptive exercises which challenge the shoulder girdle to stabilise the ball on the socket during dynamic movement.”
INCUS CLOUD | SWIM can help to prevent injury by improving your swimming technique. Measure your body rotation on both the left and right side independently to make sure you’re swimming as symmetrically as possible, and use swim economy to see how you’re gaining, maintaining or losing speed with every stroke.
About the author: Alex Parren is a Freelance Health & Fitness writer as well as a qualified Personal Trainer and Nutritionist.