Swimmer's shoulder: How to avoid the pain

With triathlon season in full swing and local pools opened, everyone from the weekend warrior to the elite athlete is heading to the water to train.  Yet, increased time and distance in the water can mean increased risk of overuse injuries.

In swimming, the shoulders are a key spot for overuse injuries and also the most common area of pain complaints by competitive swimmers.  The demands of swimming force changes to the shoulder joint that are similar to that of overhead throwing athletes.  These changes are then amplified as the shoulder muscles start to fatigue with increasing time, distance and effort in the water.

Shoulder, rotator cuff or subacromial impingement (all of which describe the same condition) is a result of the rotator cuff muscles getting impinged where they pass between the portion of your shoulder blade that sits on top of your shoulder, called the acromion, and the top of your arm, called the humeral head.  This condition can be caused by intrinsic or extrinsic factors.  Intrinsic issues refer to internal factors that predispose a swimmer to impingement, including imbalances in the muscles associated with controlling the shoulder blade as well as the rotator cuff muscles.  Extrinsic issues include poor technique and overuse/overtraining.

In order to prevent intrinsic factors from becoming a problem, swimmers should focus on muscle training, postural strengthening and stretching.  Maintaining good scapular stabilization strength is a key for good posture both in water and on land.  The 'Jobe' shoulder exercises are an excellent strengthening routine for the rotator cuff muscles.  To increase shoulder range of motion and flexibility, try the 'Sleeper' stretch used by throwing athletes to counter the deleterious effects of excessive swimming.

Poor technique is also a major culprit of shoulder pain in swimmers.  Excessive rotation or lack of rotation can lead to impingement.  Swimmers should avoid having the thumb side enter the water first at hand entry, as it forces excessive rotation up the arm and into the shoulder.  Also, during the pull through, avoid crossing the midline and instead focus on pulling straight back.

Overtraining and excessive fatigue when training predisposes the shoulder to impingement.   With high volumes of training, swimming form may start to breakdown, placing the shoulder tendons under increased stress leading to worsening pain.  This can result from too many meters in the pool per set or too much intensity.  Also be careful while using a kickboard. While it may seem like rest, the position of holding a kickboard may lead to impingement simply from the rotation of the arm while holding it.

As the summer season gets into swing, a few minutes spent assessing fitness and form can help prevent those triathlon-related overuse injuries.  If you have some nagging shoulder pain that doesn't seem to improve with rest, it may be worth seeing a sports medicine specialist with some swimming or triathlon-related expertise.

Todd McGrath, MD, is a sports medicine specialist at the Aria 3B Orthopaedic Institute, where he specializes in endurance athletes.

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