By far, the most common musculoskeletal complaint in the swimming population is shoulder pain. This should make a lot of sense as the repetitive overhead nature of swimming doesn’t allow much room for error. For example, an elite freestyle swimmer can take anywhere between 20 and 25 strokes every 50 meters. Let’s say you train 7,000 meters per day; that’s between 2,800 and 3,500 strokes every single day. If that same swimmer trains six days per week, that’s as many as 21,000 strokes per week and nearly 1,000,000 in a year. One stroke is not typically going to cause an injury, but this many reps, over time, certainly can.

As swimmers fatigue and stroke mechanics breakdown, they lose efficiency and take more strokes to complete a distance. The increased stroke frequency results in increased and slightly different forces on the shoulder that can result in injury (1).

Among several types of shoulder pain, swimmer’s shoulder is a frequent one. Swimmer’s shoulder is defined as “common painful syndrome of repeated shoulder impingement in swimmers” by Kennedy and Hawkins (2). Generally, this is vague pain around the front of the shoulder. There is a multitude of issues underlying swimmer’s shoulder including subacromial impingement, rotator cuff or long head biceps tendinopathy, and even instability of the glenohumeral joint (3). Anyone who has worked with swimmers knows they tend to have shoulder joint laxity whether that’s genetic or acquired due to the act of swimming.

The pain experienced with swimmer’s shoulder can possibly be attributed to two sources of impingement in the shoulder. One type commonly occurs during the freestyle stroke when the pull through phase, which starts when the hand enters the water and completes when beginning to exit the surface. The other type happens during the recovery phase that happens opposite the pull through phase, which is when the hand exits the water and is just about to enter it again (3).

Why does this happen? Well, there are quite a few causes. Muscular imbalances are a very predictable cause. The nature of swimming and the overuse of the shoulder leads to some muscles to get stronger and other muscles to get weaker, relatively speaking. Another cause can be technique-related with improper stroke mechanics causing stress on the shoulder. Overtraining can certainly cause it as more fatigue means less efficiency. Even asymmetrical breathing can cause it. Swimmers who consistently breathe to one side risk shoulder pain on the opposite side (4).

Preventing (Or Fixing) Swimmer’s Shoulder

As fitness professionals, our goal is to reduce the likelihood and prevalence of injuries during swimming. So, fixing a swimmer’s shoulder starts with good training based on a thorough assessment. You really have to treat each swimmer individually as no two swimmer’s shoulders are going to be the same. We could have three athletes with the exact same symptoms, and see three very different assessment results.

First and foremost, we’re looking to create a balance between antagonist muscle groups. Through swimming, muscles that internally rotate the shoulder tend to be considerably stronger than muscles that externally rotate, so some specific exercises that target the external rotators of the shoulder are good places to start. We like simple exercises like the prone 1-arm external rotation or sidelying external rotation to start with. We’ll also include plenty of rowing exercises and scapular stability exercises like 1-arm Y’s and T’s on a table.

In addition to that, instability tends to be an issue with swimmers shoulder. To help with shoulder stability, Turkish get-ups and overhead carries can be great. This is not to say we like overhead pressing for swimmers (we typically don’t), but there is a lot of value in exercises that involve holding a weight overhead. Here’s an example of a stability exercise we would use.

Depending on the swimmer we’re working with and the assessment findings, working on scapular control can be huge, especially if they are lacking sufficient upward rotation. When the arm moves overhead, after about 30° of arm movement, there are 2° of arm movement for every 1° of shoulder blade movement (5). In the event that the shoulder blade doesn’t upwardly rotate enough, excessive movement of the arm without the shoulder blade can lead to issues causing pain. So, working on high-quality movement of the shoulder blade is key. We might choose wallslide variations, reaching exercises, or 1-arm landmine presses, for example.

In the event shoulder pain already exists, our first option is to refer out to a quality physical therapist. We’re lucky enough to have a few PT’s that are fantastic in the area to work with that are familiar not only with shoulder issues but who also work to correct a lot of the asymmetries that are normal to the human body.

We also have a massage therapist at Achieve that does fantastic work with swimmers. The volume of swim training takes a toll on the body, and a few treatments can make a world of difference in how the shoulder functions and feels. If the muscle tissues get beaten up, their function as stabilizers of the shoulder becomes less effective and abnormal wear and tear of the joint can occur. Working on these muscles can restore proper function and ensure the joint stays healthy.

In training, working with a painful shoulder is actually more manageable than it may seem. Most importantly, we don’t do anything that hurts. We have heard countless times that swimmers and other athletes are told to work through pain for one reason or another. This is a terrible strategy. Most often, it’s laziness on the coach or fitness professional to not come up with alternatives. You should never work through pain.

So, in finding exercises that are not painful for the shoulder, we keep it pretty simple. Our previous post on Three Dryland Exercises Swimmers Should Avoid is a good start. For a lot of swimmers, taking out these exercises can reduce or eliminate pain. Next, we’ll look to choose more stability-based exercises like 1-arm cable pressing variations where the athlete can rotate freely through the thoracic spine and reach to ensure we’re working the scapular stabilizers.

Push-up variations also work great assuming they’re coached very well and are pain-free. You’d be surprised how many athletes we get that say how easy push-ups are only to see they are done completely wrong and have never been shown how to do them the right way. There is a lot of value in closed-chain exercises (arm is fixed and the body moves) like push-ups for working the stabilizers of the shoulder.

To reiterate what was said previously, don’t work through pain. It’s a warning sign something isn’t right. A pretty logical approach to training in order to both work pain-free and restore proper functioning of the shoulder is all that’s required.

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References

Allegrucci, M., Whitney, S., & Irrgang, J. Clinical implications of secondary impingement of the shoulder in freestyle swimmers. Journal of Orthopaedic Sports Physical Therapy. 1994; 20(6).
Kennedy, J. & Hawkins, R. Swimmer’s shoulder. The Physician and Sportsmedicine. 1974; 2(4).
Wilk KE, Reinold MM, Andrews JR. The Athletes Shoulder. Philadelphia, PA: Churchill Livingstone/Elsevier; 2009.
Riewald SA, Rodeo S. Science of Swimming Faster. Champaign, IL: Human Kinetics; 2015.
Inman V., Saunder, J., & Abbot, L. Observations on the function of the shoulder joint. Journal of Bone and Joint Surgery. 1944;26:1.