Shoulder Injuries in swimming – Common cause and Prevention

Shoulder injuries are unfortunately a common occurrence in competitive swimming, often sidelining athletes and disrupting their progress. As a Physiotherapist with a keen interest in aquatic sports, having worked with international swimmers for nearly 8 years, I’m here to shed light on the most prevalent shoulder issues affecting swimmers, their common causes, and, most importantly, evidence-based prevention strategies. Our goal at PMC Physiotherapy is to keep you in the water, performing at your peak, and free from pain. This blog is an overview for competitive swimmers, triathletes, coaches, trainers, and anyone invested in optimising performance and minimising injury risk in the sport.

The repetitive overhead motion inherent in all swimming strokes places immense stress on the shoulder joint. The most common culprits behind shoulder pain in swimmers include: 

• Rotator Cuff Tendinopathy/Impingement: The rotator cuff muscles help stabilise the shoulder and facilitate arm movement. Overuse can lead to inflammation and degeneration of these tendons (tendinopathy) or compression of the tendons as they pass through a narrow space (impingement). This often presents as pain during the catch and pull-through phase of the stroke, reaching overhead, or even at rest. 
• Biceps Tendinopathy: The long head of the biceps tendon runs through the shoulder joint. Repetitive arm motions can overload and irritate this tendon, causing pain in the front of the shoulder, especially during the recovery phase of the stroke. 
• Shoulder Instability/Labral Tears: While less common than tendinopathies, these injuries involve damage to the ligaments and cartilage that help stabilise the shooulder. This can result from acute trauma or chronic microtrauma, leading to feelings of apprehension, clicking, or even dislocations.

Understanding the root causes is crucial for effective prevention. Several factors contribute to the high incidence of shoulder injuries in swimming: 
• Overuse and Training Load: This is arguably the biggest factor. High training volumes, especially in adolescent swimmers whose bodies are still developing, can exceed the shoulder’s capacity to adapt. Sudden increases in distance, intensity, or the introduction of new drills without adequate acclimatisation can quickly lead to overload. 
• Poor Stroke Technique: Inefficient or incorrect swimming technique places abnormal stresses on the shoulder. For example, a “dropped elbow” in freestyle can lead to excessive internal rotation and impingement, while an incomplete catch can overwork the rotator cuff. Fatigue often exacerbates technique breakdown, increasing injury risk towards the end of a long training session. 
• Muscle Imbalances and Weakness: Swimmers often develop strong internal rotators and adductors due to the nature of the stroke, but can have relative weakness in the external rotators, scapular stabilisers (muscles around the shoulder blade), and posterior shoulder muscles. This imbalance can lead to sub-optimal control, leading to impingement and tendinopathy. 
• Limited Shoulder Mobility: While extreme flexibility can sometimes contribute to instability, restricted mobility, particularly in external rotation and thoracic spine extension and rotation, can force the shoulder into compromised positions during the stroke, increasing stress on surrounding tissues. 
• Inadequate Warm-up and Cool-down: Skipping or rushing these crucial elements means the muscles and joints aren’t adequately prepared for the demands of training or given a chance to recover effectively afterwards. 

Now for the good news – many shoulder injuries are preventable! Here are evidence-based strategies to protect your shoulders: 
• Optimise Training Load: Work closely with your coach to ensure a progressive training plan. Avoid sudden spikes in volume or intensity. Incorporate regular deload weeks to allow for recovery and adaptation. Listen to your body and don’t push through persistent pain. This is a cornerstone of injury prevention. 
• Prioritise Technique Refinement: Regular video analysis and feedback from an experienced coach are invaluable. Focus on maintaining a long, efficient stroke with proper hand entry, catch, and recovery. Address any asymmetries or compensations immediately. Good technique leads to reduced rates of injury and a reduced burden of injury. 

This is non-negotiable for competitive swimmers. Focus on:  
• Scapular Control: There are many muscles which help stabilise and control the scapula, depending on the point of the stroke. Common exercises include Y’s, T’s, I’s, band pull-aparts and protraction/retraction canstrengthen the muscles that control your shoulder blade, providing a stable base for arm movement. 
• Rotator Cuff Strengthening: External rotation and internal rotation exercises either resistance bands, cable pulleys or dumbells are vital for balancing muscle strength around the shoulder. 
• Posterior Chain Strength: Strong muscles at the back of the shoulder, leading down to the back muscles help support good posture and shoulder mechanics. 
• Core Stability: A strong core provides a stable platform for all limb movements, including those of the shoulder. 
• Enhance Mobility: Incorporate regular stretching and mobility drills. Focus on thoracic spine extension and rotation, shoulder external rotation, and pec minor stretches. Foam rolling and dynamic stretches can also improve tissue extensibility. 

• Warm-up: Start with general cardiovascular activity, followed by dynamic stretches, and then specific swimming drills to prepare the shoulder for the demands of the session. Incorporate band work for rotator cuff activation. 
• Cool-down: Include static stretches for the shoulders, chest, and back, along with light swimming to aid recovery and lactate clearance. 
• Listen to Your Body and Seek Early Intervention: Don’t ignore niggles or persistent pain. Early assessment by a physiotherapist knowledgeable in swimming injuries can prevent minor issues from escalating into chronic problems. 

By proactively addressing these factors, competitive swimmers, coaches, and support staff can significantly reduce the risk of shoulder injuries, ensuring more time in the water, stronger performances, and a healthier athletic career. Remember, prevention is always better than cure when it comes to shoulder injuries in swimming.