SHOULD I Just Keep Swimming - WHAT IS SWIMMERS SHOULDER?
The weather is warming up and pools are gradually re-opening! After months of walking, running and cycling, many of us are itching to get back in the water and get back into swimming. For many Melburnians, (super keen Winter bay swimmers- we salute you!) it’s been months since we’ve had the chance to turn the arms over. Read on to find out about how to get back into it safely and avoid injury.
Swimming is a great sport for people of all ages. It can provide a gentle, low impact form of exercise for injured athletes, or those who find daily land based exercise too tough on their joints. It can also be a high intensity whole body work out that combines flexibility, endurance and full body strength!
Unfortunately, due to the repetitive nature of the sport, swimmers are prone to overuse injuries, particularly those of the shoulder.
Other common swimming injuries include issues affecting the elbow, neck and knee. However, it is reported that 90% of musculoskeletal complaints that drive a swimmer to visit their physiotherapist or doctor are related to the shoulder!
What is Swimmer's Shoulder?
The most common injury seen in swimmers is often referred to as “Swimmer’s Shoulder”, the common term for pain in the front and/or side of the shoulder. This is an umbrella term rather than a specific “diagnosis” but usually involves some irritation of the tendons (supraspinatus and long head of biceps) and other structures within the subacromial space (the space between your shoulder blade and the head of your humerus or upper arm bone). If left untreated, it can become very painful and start to cause issues and pain outside of swimming (think carrying shopping, reaching overhead, sleeping on your side).
So, what contributes to swimming shoulder pain?
Poor stroke mechanics; poor technique can excessively load the shoulder, especially in the catch position. This may be due to weakness in certain stabilising muscles, lack of endurance, lack of flexibility, poor movement patterns or a combination of the above.
Overuse/Sudden overload; a sudden increase in training load may also contribute to the problem. Much like with running, don’t assume you can go from not swimming for months on end to swimming four times per week! Just because swimming is low impact, that doesn’t make it easy! The muscles that stabilise and move your shoulder require a gradual and progressive overload just like with other forms of exercise. If starting from scratch, begin with a couple of swims per week for three-four weeks, then look to add in another session or slowly increase the duration of your swim. Everyone has a different baseline and capacity for increasing load, so if unsure it’s best to be guided by your Physiotherapist and/or swim coach if you have one.
Muscular imbalance; Swimmers develop muscle imbalances where the adductors and internal rotators of the arm become stronger (due to the nature of swimming as they are the primary muscles involved in pull through against resistance). This leaves a relative weakness of the external rotators and scapular stabilisers rotators (which work to control the position of the humeral head in the socket of your shoulder blade) in comparison to the adductors and internal rotators simply because they don’t get used as much. This muscle imbalance or overuse – combined with poor technique – can change the way the humeral head to moves, potentially irritating tendons and other structures in the relatively cramped shoulder joint.
Instability/hypermobility; This is often linked with other contributing factors. However, as the shoulder complex is designed to achieve the greatest range of motion of any other joint system in the body, it is also at risk of increased laxity, or too much movement that can result in upwards and forwards movement of the humeral head (head of the upper arm bone) against the glenoid fossa (socket of your shoulder blade). This may be due to laxity of the ligaments that support the shoulder complex as a result of continual stress, but also poor control of the rotator cuff complex – hence instability is closely related to muscular imbalance and poor posture/positioning.
What Can I do to prevent swimming shoulder pain?
As mentioned above, trying to do too much too soon is a risk factor for injury (not just shoulders!). When getting back into swimming, give yourself at least one day recovery between and don’t try to better your times every session! Focus on technique and endurance to build your baseline capacity.
Strength and conditioning
As with most forms of cardiovascular exercise (running, cycling, hiking) a little bit of strength work will not only help prevent injury, but potentially improve your technique and make you a better swimmer! Particularly for the shoulder, exercises that focus on back strength as well as rotator cuff strength will be beneficial. As mentioned earlier, the muscles at the front of our body that “internally rotate” are heavily relied upon with swimming, leaving those that oppose the action comparatively weaker. Exercises like a bent over row and lat pull down are a good starting point for back strengthening. Exercises that strengthen the rotator cuff (the group of muscles that stabilise your arm in the socket) are also important for most swimmers (even more so if you think you might be hyper-mobile!) Consulting with your physio is the best way to get an individualised exercise program to keep you swimming pain free and work on your individual needs. Incorporating lower body and core strength is also crucial for swimming as your torso provides the base for which your shoulder works around!
Flexibility- particularly of the thoracic spine or mid back and the pec muscles. If your spine isn’t moving optimally, it could lead to overload at your shoulder. Similarly, if your pec muscles can’t provide enough range of movement for your shoulder they could contribute towards poor stroke mechanics.
How can we help?
A one-size fits all approach generally won’t cut it! If you are experiencing pain or concerned about getting back into swimming due to a previous injury, book in for a thorough assessment and an exercise and management plan tailored to you!
How can we help you at Melbourne Sports Physiotherapy?
At Melbourne Sports Physiotherapy our goal is to get you moving pain free as soon as possible.
But, we also want you to actually move better and live a healthier, more active and fulfilling life!
If your sports, fitness training or work has been wearing your body down, book in with one of our expert massage therapists so we can help you reduce your pain or stiffness.
If you are showing some signs of this condition or simply want help prevent this from happening in the future then book in with one of our highly experienced Remedial Massage Therapists today!