Shoulder injuries are very common in both elite and recreational swimmers. Swimmer’s shoulder is an umbrella term given to a range of shoulder problems that many swimmers experience. The large range of motion and high demands placed on the joint with all stroke styles, inevitably places the shoulder at a high risk of injury and damage. Injury is often related to poor swimming biomechanics, reduced shoulder range, poor posture and muscular imbalances. Shoulder pain can also be referred from the cervical spine, thoracic spine or upper arm.
The biomechanics of swimming requires repetitive circumduction of the joint, with the shoulder moving through many planes of motion. Typically, a competitive swimmer will compete approximately 2500 shoulder revolutions a day, and thus most injuries are considered overuse.
Typically, a swimmer’s posture with include rounded shoulders, a forward sitting head and increased roundness of the upper back. A physiotherapy assessment of the swimmers shoulder often finds the joint sitting forwards with an increase in its internal rotation. Swimmers tend to be tight through their chest muscles as well as around the back of the joint, whilst weaker in their shoulder joint stabilising muscles and muscles between the shoulder blades.
A physiotherapy assessment of your shoulder will involve a full functional screening. It will include assessment of your posture, joint range and movement patterns, as well as muscle length and strength.
Your physiotherapist will then be able to provide you with a clinical diagnosis, a prognosis and develop you an appropriate management program. This will likely involve manual therapies such as massage, dry needling, cupping and joint mobilisations to improve joint range. Taping or strapping of the shoulder joint can also help provide short term support and reduce symptoms, especially during training. Your physiotherapist will also prescribe you a tailored exercise program that will involve progressive strengthening, as well as mobility and stretching exercises, to enhance shoulder biomechanics.
As part of your rehabilitation it is also likely that your physiotherapist will recommend a reduced training load. They will be able to work alongside your swim coach in order to progressively increase your training load and may suggest alternative cross-training exercise in the interim to help maintain cardiovascular fitness and global strength. Your physiotherapist will be best placed to guide you through a comprehensive shoulder rehabilitation program that considers physiological time frames for healing, maximises training capacity and aids you to reach your swimming goals as soon as possible.