Swimming is a common sport and a pleasurable recreational past time. Whether you swim for enjoyment or for competition the proper stroke mechanics of the shoulder are important for prevention of shoulder pain and dysfunction.
One of the most commonly injured areas with swimmers is the shoulder with reports of
incidence of disabling shoulder pain in competitive swimmers ranging from 27% to 84%. When
aquatic athletes have pain located on the front and outer side of the shoulder and arm it can be
referred to as “swimmer’s shoulder. These injuries often result from intense training as many
swimmers in a single training session will average 3,000 to 6,000 meters. This intensity places
an enormous amount of strain on the shoulder.
The shoulder complex is designed to achieve the greatest range of motion with the most
degrees of freedom of any joint system in the body. The excessive mobility of the shoulder at
the glenohumeral and scapulothoracic joint is balanced by the stability of the acromioclavicular
The shoulder is stabilized by a complex ligamentous system as well as an elaborate
muscular system. This support mechanism allows the shoulder to withstand large external
forces, while providing enough mobility for the upper extremity to accomplish complex
The balance between shoulder mobility and stability occurs in many sports
that require overhead motions. Swimming requires several of these movement patterns,
involving continuous arm circumduction(1) clockwise and counter-clockwise directions.
It is important to understand that any complaint causing pain or contributing to abnormal movement at the shoulder complex will disturb the balance of the stabilizing structures around the joint. Shoulder instability is the result — the leading cause of shoulder pain in aquatic athletes.
The shoulder could be compromised due to:
· poor posture
· muscular imbalances (i.e. serratus anterior
· neuromuscular incoordination
· repetitive strain due to faulty training mechanics
· overuse and misuse
The common aliments include:
- rotator cuff tendinopathies (i.e. supraspinatus)
- impingements (long head of biceps)
- glenoid labrum tear
- shoulder bursitis
- acromioclavicular joint dysfunction
- The symptoms and presentation may differ depending on the dysfunction.
Irrespective of whether you are training for a triathlon, or competitions such as Nationals, or
swimming to get healthy you want your body to perform with healthy strong structures.
Athletic performance is predicated on neuromuscular integration, muscular strength, and
structural integrity. Over-use injuries are common if you are doing rigorous weight training
program as well as swimming, without allowing the body enough time to recover. Over-training
can occur when one tries to make up for months of lack of training in a short time period
Possible Symptoms related to Swimmer’s shoulder
- Muscular fatigue
- Changes in the stroke mechanics (dropped elbow, wider hand entry, early hand exit)
- Pain in the shoulder on the front and outer-side of the shoulder and arm
- Lack of muscle strength
- Sharp pain with overhead movement
- Decreased range of motion
Massage Therapy For Shoulder Pain
A regular massage therapy regimen, in conjunction with your physical therapy, is beneficial in
addressing the tight musculature of the body and to re-balance the structures of the shoulder.
Manual therapy lengthens the tissues which enhances the proper mechanics of the shoulder
and facilitates better movement patterns, decreases pain, reduces scar tissue, improves
muscular strength, increases range of motion, restores the length of tissues allowing for a
decrease in postural holding patterns, and improves circulation to the surrounding tissue.
Massage therapy makes muscles more receptive to performance and more importantly,
recovery. If you are having an intense training cycle and have a big competition coming up,
massage therapy can assist you in having a faster recovery and increased flexibility. Speak to
your therapist to formulate an individualized treatment that meets your needs.
How Do I Treat and Prevent Swimmer’s Shoulder?
Swimmers should focus on prevention and early treatment. A proper analysis will lead to the
most appropriate treatment plan for recovery. A good treatment plan includes:
· The best prevention tool is analyzing training methods, stroke mechanics (discuss with
your swimming coach how to improve your stroke mechanics)
· Avoid using hand paddles as this increases stress on the shoulder
· Reducing the inflammation and apply ice to the shoulder for 15-20 minutes after
training. Discuss with your doctor the use of anti-inflammatory medication however it is
not recommended to cover up the pain with drugs to continue to swim
· Depending on severity, rest or modify how many meters during a training session
· Passive care by a registered physiotherapist that may include ultrasound, interferential
current, joint mobilizations, kinesio taping
· Registered massage therapy for cross frictions to break down scar tissue, myofascial
release, trigger point therapy, strain counter strain, positional release, etc.
· Rehabilitation exercises to strengthen the weak musculature, and restore proper
biomechanics and movement patterns of the shoulder
· Self massage using a tennis ball to release trigger points in the rotator cuff muscles
· Self stretching to muscles such as pectorals either with dynamic contract relax
techniques or passive stretching
· Foam roller for lengthening tight muscles both in the upper and lower extremity and
mobilizing the mid back
If pain in the shoulder continues and increases in discomfort or the presentation changes with
diffuse pain or sharp shooting pain throughout the shoulder and upper extremity see your
physician or your physiotherapist.