Shoulder Pain Swimming Is Very Common
As the weather warms up, the beaches and pools across Sydney’s eastern suburbs are packed with swimmers. As a result, the physio clinics in the area are often packed with swimming shoulder pain complaints. Swimming is a great exercise for cardiovascular fitness, but it should be no surprise that the shoulders do a lot of the heavy lifting. Problems arising from swimming can result from a whole host of issues. Here we will talk through some common and more easily manageable contributors to shoulder pain swimming.
- Improper load management That is to say: ramping up too quickly – which we are all guilty of when the weather is good. As it is low impact, patients often feel they can ramp-up swimming load much faster than they would for running, for example. This can create fatigue and overuse in small muscles that haven’t been conditioned for long work.
- Pre-existing shoulder injuries Underlying injuries such as labral tears, rotator cuff strains, and subacromial bursitis can all contribute to shoulder pain with swimming. Understanding underlying injuries can help to formulate an appropriate rehab plan, and sometimes requires a slower ramp-up period starting swimming.
- Insufficient strengthening work For many people,. Swimming is their only upper body strength work. IF the winter months are spent with minimal strength training, then a return to swimming can be a shock to the system. Maintaining an adequate baseline of upper body strength work is a simple way to ensure a safe and healthy return to swimming.
- Range of motion limitations Limited range of motion in the shoulder is a huge driver of shoulder pain with swimming. If shoulder reach overhead is limited, then repeatedly stretching into the end of range can be quite aggravating. Likewise, if there are restrictions in rotation, the shoulder can lack the necessary glide required to perform repetitive movement through a full range without irritating the tendons and capsule.
- Increase in open water swimming in the summer months A common and often overlooked driver of swimming shoulder pain is the change from pool to ocean swimming. We take for granted how flat and even pool water is. Due to the chop in ocean swimming, there is an unpredictable recovery phase. This sometimes requires much more time spent in activer external rotation and abducted positions. Ultimately it can create a lot more fatigue in some of the muscles of the rotator cuff. Further to this, ocean swimming provides less chance for rest. With hard work, our muscles often require periods of rest. Especially when the work is harder than usual. This is an important consideration when planning for summer open water swimming conditioning.
- Stiffness and reduced movement in the thoracic spine Swimming requires lots of movement – particularly extension, rotation and lateral flexion – from our spines. These are movements that are often lacking from gym routines and running. This deficit is compounded by desk work. Loss of spine movement shifts the onus for reach in each stroke onto the shoulder. And the neck picks up some of the slack – particularly on the breathing side.
Shoulder Pain ConditionsFrom the above-mentioned contributing factors, a variety of conditions can arise. We won’t deep dive into each of these but will go briefly through them. Remember: this doesn’t replace a thorough assessment and diagnosis for swimming shoulder pain. But it can be helpful for swimmers to understand the way that a variety of different factors can influence our bodies.
- Impingement – Impingement is not a diagnosis or an injury per se. It is a process in which tightness around the shoulder can result in soft tissue at the top of the shoulder being pinched between two bony prominences in the shoulder. Each of the above variables can make impingement more likely. Management often focuses on restoring shoulder range of motion. Particularly for shoulder internal rotation. Strength of the cuff and scapula stabilisers are also important. As is restoring thoracic mobility. And finally – finding a consistent and achievable load of training.
- Anterior shoulder laxity / hypermobility – This can be an underlying condition, or result from an acute trauma, or sometimes from repetitive use. Rehabilitation for this is often focused on strengthening work. The focus here is to restore active control around the ball and socket joint of the shoulder.
- GIRD (glenohumeral internal rotation deficiency) – Usually an adaptive tightness process in which the shoulder loses range of motion into internal rotation. This is most easily assessed by looking at hand movement moving up behind the back, but there are better more swimming specific assessments your physio may look at. This issue requires specific stretching for the shoulder capsule. Strength and technique changes may be necessary as well.
- Labral irritation – Underlying labral damage can be aggravated by nearly all the above variables. The labrum is the cartilage rim that runs around the lip of the socket of the shoulder. If the labrum has been damaged then repetitive movement can cause irritation here. Likewise, swimming related changes to the dynamics of the shoulder can make underlying labral issues flare-up. Strengthening the cuff and ensuring adequate movement at the glenohumeral joint is often effective at restoring pain free swimming in the case of labral injuries.
- Cervical spine pain – Neck pain will often result from thoracic spine stiffness. Lack of torso rotation means the neck has to turn more for breathing. Likewise the neck requires more movement in open water swimming. Adjusting technique and working on thoracic rotation are the key fixes here.
How do we recommend our patients stay healthy during the summer swimming season?It can sound like a contraction, but we recommend a balance of consistency and variety. Training consistency Athletes of all levels need to keep up a consistent work load, or at least work hard to iron out peaks and troughs in workload. This ensures we avoid sharp increases or decreases in loading. Safe increases in loading should be around 10-20% of our previous 4 week rolling average. So if you are used to swimming 3km a week over the past month, a safe increase this week would be adding 300-600m to your amount.
- When returning to swimming from time off, we can use body weight exercises, weights and therabands to simulate loading for the shoulder.
- Mix up the types of swimming between open water and pool.
- Likewise, spend time doing longer swims and shorter swims with rest periods.
- Mix up the strokes to help build up distance without overworking certain muscle groups.
- Add in weight training, band work, flexibility and land based cardio work.