Swimmer’s Shoulder: A Triathlete’s Guide to Prevention and Treatment

Swimming is a crucial component of triathlon, but it can also be a source of injury, particularly the swimmer’s shoulder. This condition, common among triathletes and competitive swimmers, can significantly impact training and performance. In this article, we’ll explore the causes, symptoms, and treatment options for swimmer’s shoulder, focusing on how Toronto chiropractors can help athletes manage this condition.

Understanding Swimmer’s Shoulder

Swimmer’s Shoulder: A Common Overuse Injury in Triathletes and Swimmers

Swimmer’s Shoulder, medically known as shoulder impingement syndrome, is a prevalent overuse injury caused by repetitive overhead arm movements, such as those performed during swimming. These repetitive motions often lead to muscle fatigue, ligament stress, and impingement. Weak or imbalanced muscles, poor technique, and overtraining exacerbate the issue, resulting in pain and reduced performance.

Triathletes who engage in high-volume swim training alongside cycling and running are at particularly high risk due to the cumulative stress placed on their shoulders. Swimmer’s shoulder encompasses several related conditions, all stemming from the same root cause: repetitive stress from swimming. Below are the primary diagnoses associated with a swimmer’s shoulder, each with its unique characteristics and impact on shoulder health.

Key Diagnoses Associated with Swimmer’s Shoulder

1. Subacromial Impingement Syndrome

• Definition: Compression of the rotator cuff tendons, biceps tendon, or subacromial bursa between the acromion and the greater tuberosity.
• Cause: Repetitive overhead arm motion leads to irritation and inflammation.
• Symptoms: Pain during arm elevation and internal rotation, often worsening during swimming strokes.

2. Secondary Impingement

• Definition: Impingement caused by increased anterior glenohumeral laxity and poor dynamic stabilization of the shoulder.
• Common in: Competitive swimmers due to repetitive overhead motion and muscle fatigue.
• Contributors:
  • Weak rotator cuff muscles.
  • Over-reliance on ligaments for joint stability.
  • Muscle imbalances in the shoulder and scapular region.

3. Rotator Cuff Tendinitis

• Definition: Inflammation of the rotator cuff tendons caused by repetitive microtrauma.
• Common Tendons Involved: Supraspinatus, infraspinatus, and subscapularis.
• Symptoms: Shoulder pain, weakness, and difficulty with overhead movements.

4. Internal Impingement

• Definition: Contact between the rotator cuff (supraspinatus and infraspinatus tendons) and the glenoid labrum inside the shoulder joint.
• Cause: Excessive shoulder external rotation combined with abduction (common in swimming).
• Symptoms: Posterior shoulder pain during swimming and other overhead activities.

5. Labral Tears

• Definition: Tears in the glenoid labrum, typically resulting from repetitive stress or untreated shoulder instability.
• Symptoms:
  • Pain.
  • Clicking or catching sensations.
  • Potential loss of shoulder stability.

6. Biceps Tendinitis

• Definition: Inflammation of the long head of the biceps tendon, often due to overuse or irritation within the bicipital groove.
• Symptoms: Pain in the front of the shoulder, especially during forward arm movements.

7. Scapular Dyskinesi

• Definition: Abnormal motion or positioning of the scapula disrupting the scapulohumeral rhythm.
• Impact: Poor scapular mechanics increase the risk of impingement and instability.
• Symptoms: Shoulder fatigue, pain, or a sensation of weakness during swimming.

The Interplay of Diagnoses

Swimmer’s shoulder is rarely a single diagnosis. These conditions often coexist or develop in sequence, driven by the repetitive demands of swimming. Weakness in stabilizing muscles, excessive joint laxity, and improper technique create a cycle of pain and dysfunction that worsens over time if not addressed.

Symptoms of Swimmer’s Shoulder

1. Pain:
   • A localized pain in the affected shoulder, often described as a deep ache1
   • Pain may radiate along the back of the shoulder or to the front
   • It can extend to the neck and/or down the arm in some cases
   • Worsens with overhead movements or when resting on the affected side
2. Range of Motion:
   • Decreased range of movement in the affected shoulder
   • Difficulty reaching overhead or behind the back
   • Stiffness, particularly after periods of rest or in the morning
3. Strength and Performance:
   • Decrease in shoulder strength compared to the unaffected side
   • Reduced swimming efficiency and stroke mechanics
   • Presence of ‘lazy elbow’ where the affected arm’s elbow can’t be lifted to normal height out of water1
4. Sensations:
   • Tenderness when the affected area is touched1
   • A “catching” sensation when moving the arm2
   • Pinching and sharp pain that limits arm function
5. Joint Characteristics:
   • Increased joint laxity compared to the unaffected shoulder
   • Swelling of the shoulder joint2
6. Impact on Daily Activities:
   • Difficulty sleeping on the affected side
   • Pain or discomfort during daily activities requiring arm movement
7. Progression of Symptoms:
   • Initially, it may be mistaken for normal muscle soreness3
   • Pain typically increases with the duration of swimming or repetitive movements
   • Symptoms often worsen over time if the condition is left untreated3
8. Associated Symptoms:
   • Muscle fatigue in the shoulder area
   • Possible clicking or popping sounds during shoulder movement

Prevention Strategies for Swimmer’s Shoulder

Preventing swimmers’ shoulder injuries requires a multifaceted approach that addresses biomechanical efficiency, muscular strength, flexibility, and training practices. By integrating the following strategies, swimmers and triathletes can reduce their risk of developing shoulder injuries while improving performance.

1. Optimize Stroke Mechanics

• Proper Technique:
  • Focus on a balanced, efficient stroke to minimize excessive shoulder stress. Common technical flaws include crossing the midline during freestyle or improper hand entry.
  • Work with a swimming coach to ensure correct technique, particularly during the pull-through and recovery phases of the stroke.
• Sighting Techniques (for open-water swimmers):
  • Avoid excessive neck and shoulder strain by learning efficient sighting methods that limit prolonged head elevation.

2. Strengthen the Shoulder and Surrounding Muscles

• Rotator Cuff Exercises:
  • Strengthen the rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) to enhance shoulder stability.
  • Examples: External and internal rotation with resistance bands, dumbbell scaption.
• Scapular Stabilizers:
  • Focus on the serratus anterior, trapezius, and rhomboids to maintain proper scapular positioning during movement.
  • Examples: Serratus punches, scapular push-ups, and rows.
• Core and Trunk Strength:
  • Develop a strong core to reduce compensatory movements in the shoulders.
  • Examples: Planks, bird dogs, and side bridges.
• Balanced Training:
  • Avoid overdeveloping chest muscles (e.g., pectorals) without strengthening posterior shoulder muscles.

3. Improve Shoulder Mobility and Flexibility

• Stretching Exercises:
  • Stretch tight muscles, including the posterior shoulder capsule, pectorals, and upper trapezius.
  • Examples: Doorway stretch (pectorals), cross-body shoulder stretch (posterior deltoid).
• Dynamic Warm-Up:
  • Perform dynamic stretches before swimming to prepare the shoulder for repetitive motion.
  • Examples: Arm circles, pendulum swings, and resistance band exercises.
• Foam Rolling and Self-Myofascial Release:
  • Release tight fascia and improve shoulder mobility by foam rolling the upper back, lats, and chest.

4. Gradual Training Progression

• Avoid Overtraining:
  • Increase training volume and intensity gradually to allow the shoulder muscles and joints to adapt.
  • Follow the 10% rule: Do not increase the weekly swim distance by over 10%.
• Rest and Recovery:
  • Incorporate rest days into your training schedule to allow recovery and tissue repair time.
  • Listen to your body and scale back if you experience persistent pain or fatigue.
• Periodization:
  • Plan training cycles that include phases of lower intensity and cross-training to prevent overuse injuries.

5. Use Proper Equipment

• Swim Gear:
  • Use correctly sized paddles to prevent excessive strain on the shoulder during drills.
  • Avoid overly stiff or large paddles, especially when working on endurance or speed.
• Wetsuit Fit:
  • Ensure your wetsuit allows for free shoulder movement to avoid unnecessary strain.

6. Maintain a Healthy Training Environment

• Pool Conditions:
  • Swim in a pool or open water environment with minimal resistance from currents or waves that might cause compensatory movements.
• Avoid Fatigue-Inducing Drills:
  • Avoid high-resistance drills or high-intensity sets if already experiencing shoulder discomfort.

7. Early Detection and Intervention

• Monitor for Warning Signs:
  • Be aware of early symptoms such as shoulder pain, fatigue, or reduced range of motion.
• Regular Assessments:
  • Schedule periodic evaluations with a healthcare provider or sports chiropractor to check for imbalances or early signs of overuse.
• Address Imbalances Immediately:
  • Correct muscle imbalances or faulty mechanics as soon as they are identified.

8. Recovery and Maintenance Practices

• Post-Swim Recovery:
  • After swimming, perform light stretching and mobility exercises to maintain flexibility and prevent stiffness.
• Cold Therapy:
  • Apply ice to the shoulder for discomfort or inflammation after training.
• Massage and Soft Tissue Therapy:
  • Use professional massage or self-myofascial release tools to address muscle tightness and improve circulation.

9. Incorporate Cross-Training

• Variety in Training:
  • Incorporate non-swimming exercises such as cycling, running, or resistance training to prevent repetitive overuse of the shoulder.
• Swimming Alternatives:
  • If experiencing shoulder pain, consider kick sets with a kickboard or pool buoy to rest the upper body.

10. Seek Professional Guidance

• Regular Check-Ups:
  • Consult a sports chiropractor or knowledgeable coach to ensure your training plan is well-balanced and addresses all aspects of injury prevention.
• Custom Rehabilitation Plans:
  • If you have a history of shoulder pain, work with a healthcare professional to develop a personalized prevention and strengthening program.

Comprehensive Chiropractic Care for Swimmer’s Shoulder:

Chiropractic Assessment and Diagnosis

Chiropractors start with a comprehensive evaluation to pinpoint the root causes of a swimmer’s shoulder:

• Range of Motion Testing: Identify restrictions or asymmetries in shoulder movement.
• Strength Assessments: Evaluate rotator cuff and scapular stabilizer strength.
• Postural Analysis: Detect postural imbalances contributing to shoulder strain, such as forward head posture or rounded shoulders.
• Scapular Movement and Stability Assessment: Analyze scapular control during simulated swimming motions.

A thorough assessment helps create a personalized treatment plan to target specific impairments, ensuring faster recovery and injury prevention.

Manual Therapy Techniques for Swimmer’s Shoulder

Chiropractors use evidence-based manual therapies to alleviate pain, improve mobility, and restore function:

1. Spinal Adjustments:
   • Focus on the cervical and thoracic spine to enhance shoulder biomechanics and improve range of motion.
   • Correct spinal misalignments that may contribute to poor posture and swimming mechanics.
2. Shoulder Joint Mobilization:
   • Gentle, targeted manipulations to improve joint mobility and address restrictions.
   • Enhance fluid movement in the shoulder joint, reducing impingement symptoms.
3. Soft Tissue Therapy:
   • Active Release Technique (ART): Breaks down scar tissue and adhesions in overused muscles and tendons.
   • Graston Technique: Uses specialized tools to address muscle tightness, adhesions, and inflammation.
   • Focus on the rotator cuff, pectorals, and scapular stabilizers.

Rehabilitation Exercises for Swimmer’s Shoulder

Customized exercise programs are essential to restore strength and balance in the shoulder girdle. Chiropractic care emphasizes exercises tailored to the unique demands of swimming:

• Rotator Cuff Strengthening:
  • Internal and external rotation exercises using resistance bands or weights.
• Scapular Stability Training:
  • Exercises like serratus punches, wall slides, and scapular push-ups to improve scapular control.
• Postural Retraining:
  • Strengthen the lower trapezius and rhomboids to correct rounded shoulders.
• Functional Movements:
  • Mimic swimming strokes to ensure smooth integration of strength and mobility gains.

These exercises are designed to address muscle imbalances and improve swimming efficiency.

Posture Correction

Improving posture is vital for triathletes to reduce strain on the shoulder and enhance performance:

Biomechanical Analysis

Chiropractors may perform a detailed analysis of the triathlete’s swimming technique:

• Identify inefficiencies in stroke mechanics that place excessive stress on the shoulder.
• Provide corrective strategies to optimize swimming form and reduce injury risk.

This analysis is particularly valuable for triathletes looking to enhance performance while protecting their shoulders.

Preventive Care and Maintenance

To prevent recurrence, chiropractors provide ongoing care tailored to the demands of triathlon training:

1. Regular Check-Ups:
   • Monitor shoulder health and address issues before they escalate.
2. Training Program Adjustments:
   • Advice on balancing swim, bike, and run training to avoid overuse injuries.
3. Warm-Up and Cool-Down Techniques:
   • Education on dynamic warm-ups and effective cool-down routines to reduce post-training stiffness and inflammation.

Complementary Therapies

Chiropractors often integrate additional therapies to support recovery and performance:

• Kinesio Taping:
  • Provides shoulder support during training while promoting proper movement patterns.
• Ultrasound Therapy:
  • Reduces inflammation and accelerates tissue healing.
• Electrical Stimulation (e-stim):
  • Alleviates pain and promotes muscle recovery.
• Nutritional Guidance:
  • Recommendations for anti-inflammatory diets and supplements to support tissue repair and reduce oxidative stress.

Exercises For Swimmer’s Shoulder For Triathletes and Swimmers

1. Pendulum Swings
   • Purpose: To gently mobilize the shoulder joint and promote blood flow without stressing the rotator cuff.
   • Execution:
     • Lean over slightly, supporting yourself with your good arm on a table or chair.
     • Let the affected arm hang down freely.
     • Gently swing your arm in small circles, about 1 foot in diameter.
     • Perform for 30 seconds to 1 minute, 3-5 times daily.
2. External Rotation Exercises
   a) Sideline External Rotation
   • Purpose: Strengthens the external rotators of the rotator cuff, particularly the infraspinatus and teres minor.Execution:
     • Lie on your non-affected side.
   Bend your affected arm’s elbow to 90°, keeping it against your side
   • • .Slowly rotate your forearm upward, then lower it back down. Perform three sets of 10-15 repetitions.
   b) Standing External Rotation with Band
   • Purpose: Similar to sideline rotation but in a functional standing position.
   • Execution:
     • Attach a resistance band to a fixed point at elbow height.
     • Stand sideways to the band, elbow bent at 90° and pinned to your side.
     • Rotate your forearm outward against the resistance, then slowly return.
     • Perform three sets of 10-15 repetitions.
3. Scaption Exercises
   • Purpose: Strengthens the rotator cuff and deltoid muscles in a position that minimizes impingement.
   • Execution:
     • Stand with arms at your sides, thumbs pointing forward.
     • Raise your arms at a 30° angle from your body (between the front and lateral raises).
     • Lift to shoulder height or slightly above, maintaining thumb-up position.
     • Slowly lower back down.
     • Perform three sets of 10-12 repetitions.
4. Wall Slides
   • Purpose: Improves scapular stability and shoulder mobility.
   • Execution:
     • Face a wall, forearms against the wall, elbows at shoulder height.
     • Slowly slide your arms up the wall, then back down.
     • Keep your core engaged, and avoid arching your back.
     • Perform three sets of 10 repetitions.

More Exercises For Swimmer’s Shoulder

1. Shoulder Blade Exercises
   a) Scapular Arm Reaches
   • Purpose: Improves scapular control and stability.Execution:
     • Stand or sit with arms at your sides.
   Pinch your shoulder blades together, then reach your arms forward. Return to the starting position
   • • .Perform three sets of 10 repetitions.
   b) Wall Push-Ups
   • Purpose: Strengthens serratus anterior and improves scapular stability.
   • Execution:
     • Stand facing a wall; arms extended at shoulder height.
     • Perform a push-up against the wall, focusing on squeezing your shoulder blades together as you push away.
     • Perform three sets of 10-15 repetitions.
2. Internal Rotation
   • Purpose: Balances external rotation exercises and strengthens subscapularis.
   • Execution:
     • Stand sideways to a resistance band attached at elbow height.
     • Hold the band with your affected arm, elbow bent at 90°.
     • Rotate your forearm towards your body against the resistance.
     • Slowly return to the starting position.
     • Perform 3 sets of 10-15 repetitions.

Remember to start with light resistance and gradually increase as strength improves. Always perform these exercises pain-free. If you experience pain, stop the exercise and consult a healthcare professional. Proper form is crucial throughout each exercise to ensure effectiveness and prevent further injury.