Shoulder Injuries in Swimming

Shoulder injuries make up around 30% of the injuries that we see in swimmers due to the demand on the upper body during the stroke. Swimming is a sport which demands repetitive shoulder movement, with some studies suggesting that the average competitive swimmer completes over a million arm strokes a year (Gracanin et al., 2023).

According to the research, the risk factors which can increase the likelihood of shoulder injuries include:

·       Previous shoulder injuries/pain

·       Higher competitive level

·       Shoulder joint laxity or instability

·       Reduced rotator cuff strength

·       Increased training load

·       Reduced shoulder range of motion

The good news is that many of these risk factors are modifiable – meaning that with the correct training, we can see a change and therefore, a reduced risk of injury.

What shoulder symptoms should I be aware of as a swimmer?

·       Pain in the shoulder at any point of the stroke, or during or after swimming

·       Clicking, clunking or catching of the shoulder that comes alongside pain or significant discomfort

·       Poor confidence of the shoulder during swimming

·       Poor stability of the shoulder during or after swimming

·       Perceived lack of strength during the stroke

·       Restricted pain-free range of motion of the shoulder

·       Shoulder stiffness

·       Neck pain

·       Pain/discomfort lying on the side of the shoulder at night

·       Discomfort in the shoulder doing everyday activities.

What is “swimmer’s shoulder”?

Swimmer’s shoulder is a broad diagnosis given to swimmer’s who may present with one or multiple of the following diagnoses: rotator cuff related pain, shoulder bursitis or shoulder instability. Due to the ambiguity of the swimmer’s shoulder diagnosis, the recovery and rehabilitation may vary greatly between patients.

Which swimming stroke is best for my shoulder?

The answer to this question will be different depending on your personal circumstances, however, it is important to note that swimming is not bad for the shoulder. Freestyle, backstroke and butterfly require the most range of motion in the shoulder and are useful for developing upper limb strength throughout a large range of motion. Comparatively, breaststroke requires a higher ration of lower limb propulsion and uses a lower range of shoulder motion through the shoulder, and therefore, may have a lower incidence of shoulder injury.

What basic information is useful to gather for a Physiotherapist if I experience shoulder issues with swimming?

·       How long has the shoulder issue been going on for

·       How intense the symptoms are

·       How long the pain or discomfort lasts for

·       Previous injury history or other injuries in the body

·       What has the training schedule been like – have there been any changes in technique, distance, speed etc.

·       What activities or which part of the stroke make it feel worse

·       Is there anything that makes the shoulder feel better

References

Gračanin, I., Djurović, M., Stanić, D., Burhaein, E., Demirci, N., Ram, R., ... & Skrypchenko, I. (2023). Prevention of shoulder injuries in swimmers. International Journal of Academic Health and Medical Research (IJAHMR), 7(2), 186-190.

Hill, L., Collins, M., & Posthumus, M. (2015). Risk factors for shoulder pain and injury in swimmers: a critical systematic review. The Physician and sportsmedicine, 43(4), 412-420.

Tooth, C., Gofflot, A., Schwartz, C., Croisier, J. L., Beaudart, C., Bruyère, O., & Forthomme, B. (2020). Risk factors of overuse shoulder injuries in overhead athletes: a systematic review. Sports health, 12(5), 478-487.