12.24.2008

Swimmer's Shoulder

Introduction
So what is swimmer's shoulder? Swimmer's shoulder is an inflammatory condition caused by the mechanical impingement of soft tissue between the acromion and the corocoid process of the scapula (also known as the coracoacromial arch). This condition is often caused by repetitive overhead arm motion during the freestyle swimming stroke. Below are more specific causes and the corresponding ways to prevent this injury.

Poor Swimming Technique
If you cross the mid-line upon hand-entry, this is a likely cause of impingement of the long head of the biceps tendon. If your hand enters the water with the thumb pointing down and the palm facing outwards, this can result in the same type of impingement. By addressing proper entry, this condition may be avoided.

Overtraining
This can lead to shoulder inflammation and pain. If you continue to swim with fatigued muscles, the condition may worsen. As the muscles fatigue, they work less efficiently, which has two undesirable consequences. First, the muscles will have to work harder in a weakened condition. Second, the swimmer will have to perform more strokes to cover the same distance, which again overuses the already fatigued muscles, thus perpetuating the cycle. Combined, these two factors can result in swimmer's shoulder. Be sure not to force yourself to swim if you can feel that your muscles are fatigued before you even enter the water.

Unilateral Breathing
Swimmers that consistently turn their head to one side are risking shoulder pain the opposite shoulder. This is because the opposite shoulder has to work harder to support forward movement with the head turned to the side. Bilateral breathing (breathing to both sides equally) transfers this load to both arms.

Overuse of Training Equipment
Using hand paddles that are too large places great strain on the shoulder muscles during the pull-through phase of freestyle. Using a kickboard with arms fully extended in front of the swimmer can place the shoulder in a position of impingement. The more often or longer the swimmer uses these devices, or uses them incorrectly, the greater the risk of shoulder impingement. Thus, use such equipment in moderation and be sure to consult a coach on proper technique.

Strengthening
Swimmers should avoid rapid increases in training distance or frequency of training, as this is likely to over fatigue the shoulder muscles leaving them at an elevated risk for impingement and shoulder pain.

Strengthening shoulder and upper back muscles and stretching the shoulder, chest and neck muscles will help to prevent a swimming posture that is conducive to impingement. The muscle imbalance and inflexibility that typically occurs in swimmers contributes greatly to impingement. The following exercises and stretches will help address these areas.
The external rotators of the rotator cuff muscles play a crucial rule in shoulder stability. These muscles are also inherently weak, and are often the cause of rotator cuff impingement. By strengthening this group, you will have a more stable shoulder joint.This exercise promotes stability in the scapular region and prevents the muscle imbalance associated with swimming. These muscles promote postural alignment and aid in shoulder stability. In swimmers they often become lengthened.This exercise strengthens the rear deltoid and mid back. Swimmers often have shortened pectorals and front deltoids causing a shoulder joint that internally rotates. By strengthening the muscles of the back and rear deltoid, you maintain a more neutral shoulder.

Sources
Beginner Triathlete: Preventing Swimmer's Shoulder, USAT Coach Matt Russ

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