Approximately 90% of the complaints by swimmers pertain to the shoulder. The term “swimmer's shoulder” describes the pain a swimmer feels in and around the shoulder during swimming. Clinical research reveals shoulder pain as the major cause of missed practice and slower swim times.
In a recent study, it was found that 26% of National swim team were currently experiencing shoulder pain; 73% of these same swimmers reported a history of shoulder pain. Shoulder pain does not discriminate, it has been found to occur in both men and women, on the dominant and nondominant sides, during all parts of the stroke and all strokes, at all distances, and at all levels of training. Description of the pain varies from minor, nagging pain occurring only with the vigorous use of hand paddles to chronic debilitating pain lasting well past the end of practice. Pain also varies in location about the shoulder, including anteriorly (in front), anterolaterally (in front and outside), superiorly (on top of), posteriorly (in back of), and at the insertion of the deltoid approximately inches on the lateral arm)
It is generally agreed, repetition and/ or overuse are the major factor(s) leading to shoulder pain. But not all swimmers develop shoulder pain, so overuse and/or repetition must be combined with a secondary injury. Given the wide variety shoulder pains in swimmers, it is unlikely that any one cause can adequately explain it. Most shoulder pain is caused by an instability stemming from swimming specific demands. These sport-specific demands, which improve performance yet simultaneously reduce shoulder stability include
(1) increased shoulder range of motion;
(2) increased internal rotation and adduction strength;
(3) prolonged, fatiguing, shoulder-intensive training.
Reduced stability leads to subluxation of the glenohumeral (GH) joint, which, when combined with repetition, leads to inflammation and pain. This inflammation can then lead to swelling and scarring, which can further result in inflammation and perpetuation of symptoms.
Shoulder range of motion
While it is necessary to maintain full shoulder range of motion for proper stroke and form, hyper mobility leads instability and ultimately joint denigration.
Determining one’s shoulder ROM can be done simply by using a manual goniometer or one of the various Apps for your mobile device.
Shoulder Range of motion should be at or close to the following:
- Flexion- 180˚
The main flexors of the shoulder are the anterior deltoid, coracobrachialis, and pectoralis major. Biceps brachii also weakly assists in this action.
- Extension - 45˚ to 60˚
The main extensors of the shoulder are the posterior deltoid, latissimus dorsi, and teres major.
- Internal rotation- 70˚ to 90˚
The internal rotation muscles are the subscapularis, pectoralis major, latissimus dorsi, teres major, and the anterior aspect of the deltoid.
- External rotation- 90˚
Primarily infraspinatus and teres minor are responsible for the motion.
- Adduction 30-50˚
Pectoralis major, latissimus dorsi, and teres major are the muscles primarily responsible for shoulder adduction.
- Abduction – 150˚
The supraspinatus is responsible for the first 0˚ to 15˚of abduction
The middle fibers of the deltoid are responsible for approximately 15˚ to 90˚
Scapular rotation of the trapezius and serratus anterior allow for abduction past 90˚.
Athletes finding themselves able to move past these ranges of motion are hypermobile shoulder should not focus on stretching, but stability exercise(s) instead.
Targeting the rotator cuff requires the athlete to reduce and or eliminate traditional upper body exercises that compress and irritate both the glenohumeral (GH) and acromioclavicular (A/C) joint such. Bench press, rack pulls and lateral arm raises, should be reduced or substituted for more dynamic, exercise-specific lifts that do not compromise joint integrity. Moreover, the idea of lifting heavy should be substituted for lower weight with a focus on proper technique, muscle activation and joint position.
The muscles of the rotator cuff do not work individually to stabilize the humerus about the shoulder joint(s), rather they work together as a dynamic pully system. Therefore, performing exercises that specifically target a specific rotator cuff muscle does not facilitate cuff stability. The following exercises are specifically designed to increase joint awareness and stability. Try them on off days from swimming starting with 1 sent of 4-5 each focusing on form. Weight and repetitions can be increased as tolerated.
Sharapova’s for the Infraspinatus and Teres Minor
- Place an exercise band around both wrists.Plank position against the wall with your arms shoulder width apart- palms facing each other.
- Make sure lower and mid back are straight and not arched
- Slowly drive pressure against the wall with your elbows
- Starting with one arm, move in a “C” shape (up, in, then out).Hold the tension in the band once the arm has moved out.
- Repeat with other arm.Perform this twice in the up direction for each arm.
- Work back down the wall, making reverse “C”
- Remember to always keep tension in the band and continually press your elbows into the wall.
90/90 Prone Row to External Rotation for Mid and Low Traps, Infraspinatus and Teres Minor
- Lie face down (prone) on an exercise ball, arms abducted to 90˚ and elbow bent 90˚ holding a light weight.
- Leading with your elbows, extend (Row) your arms backward ~10˚
- Hold this position and externally rotate the arm(s) to 90˚
- Return to the starting position and repeat
- This exercise can be performed one side at a time by lying face down on a bed or table with one shoulder/ arm hanging off the side
I,’s Y’s & T’s
I’s: Holding weights by your side, palms facing the body and thumbs pointing out. Flex your arms up and over your head while making sure to keep the bottom point of your shoulder blade down and pushing into the ribs. Slowly return to the starting position while keeping the shoulder blade down.
Y’s: Holding weights by your side, palms facing the body and thumbs pointing out. Externally rotate arms 45˚and flex and abduct your arms up and over your head while making sure to keep the bottom point of your shoulder blade down and pushing into the ribs. Slowly return to the starting position while keeping the shoulder blade down.
T’s: Holding weights by your side, palms facing away from the body and thumbs pointing laterally. Abduct arms up and over the head while making sure to keep the bottom point of your shoulder blade down and pushing intothe ribs. Slowly return to the starting position while keeping the shoulder blade down.
Determining the proper amount of both dryland and in water training is always difficult.
In relation to swimmer’s shoulder, prolonged exercise to the point of complete fatigue leads to improper form and ultimately recruitment or ancillary muscle to complete the stroke. The action of moving the arm through a full freestyle stroke requires all of the primary and secondary rotator cuff muscles to work perfectly together. When a muscle fails due to over training, and secondary muscle is recruited to complete the action, the joint is compromised as the secondary muscle is not able to pull from the same angle or generates too much or little power to move the arm through the motion. This in turn creates an instability within the joint space and ultimately an inflammatory response.
Working with a coach that is familiar with training loads and periodization of training cycles will allow you to avoid over training injuries. In addition to periodization and training loads, it should be stressed that Triathletes, as all other athletes need an off season to rest and recover. Lack of recovery ultimately leads to the increased prevalence of injury.
Recovery is both mental and physical in its nature. While it is not to suggest that the athlete stop all activity, recovery is a time to cross train with different activities to reduce the loads and repetitive motion on joints, as well as take time to reduce mental fatigue and return to proper sleep and nutrition habits. In effect recovery is the time the athlete takes for themselves to reduce internal and external stressors; this is the time for the body to build muscle, repair injury and relax mentally.
Taking the time to rehab and recover properly will allow you, the athlete, to continue performing at your highest level, free from injury, mental and physical fatigue.