Health & Safety Resources

PREVENTING AND MANAGING SHOULDER PAIN IN SWIMMERS
WITH PROPER TRAINING TECHNIQUES

Swimming is one of the most popular sports today.  It has many benefits including total body strengthening and cardiovascular conditioning.  Swimming, however, leads to a high rate of shoulder overuse injuries.  Fortunately, many of these injuries can be avoided with proper conditioning.

The road to overuse injuries begins early.  It is very common for children to start competitive swimming at the age of five or six.  The demands of swimming, high volume workouts and overhead strokes, combined with inadequate shoulder strength are the main contributors to shoulder pain.  In a typical two hour pool session, the average, elite-level swimmer may swim 6,000-7,000 yards (3.5-4 miles).  This is about 20-40 miles/week which is the aerobic equivalent to running 80-160 miles (The Physician and Sportsmedicine, 33:9, Sept. 2005).  With this workload, it should be no surprise that shoulder pain is one of the leading injuries in competitive swimmers, and why the training program is crucial to prevent overuse injuries to the shoulder.  The two most common shoulder injuries are (rotator cuff) tendonitis and shoulder instability (“loose” joint).  Factors contributing to these injuries include:  gender, swimming experience, (daily) training distance, stroke choice, mechanics, workout intensity, upper extremity (rotator cuff) and core strength, stretching technique, and the use of hand paddles. 

Shoulder pain, frequently referred to as swimmers shoulder, is due to the selective strengthening of the anterior (front of the body) shoulder musculature and the internal rotators of the shoulder.  When combined with the repetitive movements of the stroke, an imbalance in the dynamic stability of the joint can occur.  This may lead to glenohumeral (shoulder joint) instability and/or impingement injuries.  Impingement syndrome is caused by the compression of the tendons of the rotator cuff between a part of the shoulder blade and the head of the humerus.  This condition is painful and can become chronic and may lead to more weakening of the rotator cuff muscles.  Comprehensive training programs that include both stretching and strengthening are crucial in swimmers of all ages.

Stretching programs in swimmers should be very individualized because most swimmers already have increased laxity/instability (“looseness”) of the shoulder joint.   The stretching should be done with one arm at a time and within the individual swimmer’s tolerance and range of motion.  Buddy stretching routines are discouraged.  Stretching should be avoided for those swimmers with increased laxity (multi-directional), and a dynamic warm-up should be designed and implemented. 

Strengthening programs should emphasize the scapular retractors, lower trapezius, the glenohumeral external rotators, and the core muscles (abdominals and low back).  A program that encompasses these components will decrease the strength imbalances between the internal and external rotators of the shoulder and improve total body strength and control.

Although shoulder pain is often experienced by most competitive swimmers, early intervention of a comprehensive training program is the best treatment regime.  Coaches and swimmers need to become familiar with these training techniques and recognize the multiple factors that may attribute to shoulder dysfunction.  Proper training habits lead to healthier swimmers in the future. 

For more information on conditioning for swimmers, please contact us at 313-972-4216 or visit our web site at www.henryford.com.

Henry Ford Health System’s Center for Athletic Medicine offers a comprehensive approach to sports medicine, including surgical and non-surgical care, sports rehabilitation, injury prevention, and performance enhancement programs.  The HFHS treatment team includes sports medicine fellowship trained orthopedic surgeons, sports medicine fellowship trained primary care physicians, as well as certified athletic trainers and physical therapists.  These health care professionals are supported by the HFHS nationally recognized bone and joint research facility, including the prestigious Herrick Davis Motion Analysis Lab.  HFHS is proud to be health care providers to the Detroit area’s premier sports programs including professional, collegiate, and high school athletes.