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Swimmers Shoulder

Shoulder pain is the most reported area of injury in swimmers from recreational to professional athletes. The ‘swimmer's shoulder’ describes a syndrome with pain over the front of the shoulder both during and after swimming.

Swimming is a demanding sport that combines endurance, strength, and control. Highly repetitive upper extremity overhead movements provide most of the propulsive forces for all four main strokes: freestyle, butterfly, breaststroke and backstroke which places a large demand on the shoulder and body.

The most common causes or contributing factors to shoulder pain in swimmers include a variety of musculoskeletal dysfunctions such as internal factors including:

1. Muscular impairments at the shoulder joint. Such as the rate at which the muscle is activated, the strength, endurance, and control of the rotator cuff (group of shoulder muscle) and associated structures.

2. Restricted shoulder joint range of motion: limited shoulder range of motion may contribute to dynamic impingement of the shoulder joint or compensatory movement patterns which cause pain.

3. Shoulder laxity or instability; meaning extra and unwanted movement of the shoulder joint within the socket. Which can be acquired through microtrauma (swimming, throwing etc) or congenital, which can contribute to instability and pain in the shoulder joint.

4. Shoulder position or scapular dyskinesis; how the shoulder blade moves in relation to the shoulder at rest and during dynamic movements, such as during your swimming stroke.

Shoulder pain in swimmers is multifactorial and may also be caused by external factors. The most common of which include training load errors such as:

1. Volume: A rapid increase in training volume; meaning the number of training sessions or competitions per week over a particular season or training block may contribute to shoulder pain if not appropriately managed.

2. Intensity: how hard do you go in each session, and do you have enough recovery between each one to allow the shoulder muscles and body to adapt and get stronger?

Approach to management:

Managing shoulder pain in swimmers involves diagnosing its cause and contributing factors this involves reviewing with a physiotherapist. The following are common evidence-based management strategies that you will be guided through by your physio:

i) Activity modification: modified rest may be essential for the symptoms to improve. This will involve examining your training schedule and incorporate more recovery periods into your training week for the shoulder to recover and adapt to the training volume.

ii) Range of motion: depending on the person’s individual deficits working on the shoulder range of motion without apprehension or pain is essential to meet the demands of the sports pain-free.

iii) Strength and Conditioning: regaining shoulder strength and rotational stability in order to assist with the propulsive forces needed for swimming.

iv) Thoracic and cervical spine range and function: Involving the whole kinetic chain is essential considering the shoulder joint rarely acts in isolation so it is important to address the trunk and lower limb in the rehabilitation plan.

v) Biomechanical factors: Examining your technique and form with both pool-based and or gym-based rehabilitation is essential as this may contribute to your shoulder pain.

Sorcha is a qualified Senior Musculoskeletal Physiotherapist and Qualified strength and conditioning coach. She has extensive experience working with athletes returning post-shoulder injury from her work at the shoulder lab in the UPMC Sports Surgery Clinic in Ireland. Sorcha has worked with swimmers, rugby players and basketballers with shoulder-related injuries returning them to a high level of sports participation. If you have swimming-related shoulder pain that you would like guidance with, contact the team at PROmotion to start your rehabilitation journey with Sorcha.

1. Struyf, F., Tate, A., Kuppens, K., Feijen, S. and Michener, L.A., 2017. Musculoskeletal dysfunctions associated with swimmers’ shoulder. British journal of sports medicine, 51(10), pp.775-780.

2. Murray, I.R., Goudie, E.B., Petrigliano, F.A. and Robinson, C.M., 2013. Functional anatomy and biomechanics of shoulder stability in the athlete. Clinics in sports medicine, 32(4), pp.607-624.

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