Swimmer’s Shoulder: Best Friends and Mortal Enemies

Athletes of all ages and backgrounds thrive on efficient movement, maximizing results with as little energy as possible. In swimming, inefficiency can lead to many injuries, especially shoulder pain. Meet a swimmer’s best friends and mortal enemies. It’s often the enemies—those that pretend they’re friends—who cause the most trouble. ­­

BEST FRIENDS

KISS Principle and the 3 Bs

When it comes to swimming efficiency, we need to establish two simple truths for keeping it simple, swimmer (KISS):

Truth 1: Swimming is not all about the arms. You may have lats (“swimmer muscles”) of steel, but they do more than propel the body in water. They interconnect with the core and are sewn into your glutes. The arm bone is connected to the leg bone after all! But that doesn’t mean it has to do all of the work. Truth 2: Swimming is all about the 3 Bs: balance, buoyancy and breathing. But how do you make those your best friends? Read on to find out how to use them to help your arms and swimming efficiency, specifically in the freestyle (front crawl) stroke.

Be strong and carry a big kick

“I am not a strong kicker” and “I hate kick sets“ are common quotes from swimmers with shoulder pain. We may love-to-hate kicking, so let’s make it more digestible with a metaphor. Imagine you have a beautiful boat that you use each week. You’re thrilled until one day—BAM! The boat starts to slow down and feel sluggish each time you take it out. You take impeccable care of your boat, so you’re baffled. You take the boat to a mechanic, who asks how you drive it. You proudly present two paddles that you hand-carved. He smiles and points at the boat’s motor. “This is a motor boat,” he says. “Have you been paddling it all along?” You answer, “Yes! I don’t want to pay for gas and put in the time to service the engine!”

Friends don’t let friends overlook the importance of having a strong motor in the water. Using your “paddles” to do all of the work is not only inefficient, but it will slow you down and worse—potentially injure you. Dragging your motor along is added weight for your arms to pull. Use that weight to your advantage! Find a precisely balanced use of that motor coupled with good body rotation (twist), balance, and buoyancy so that you won’t have sore “paddles.” Want to know more? See this article about efficient freestyle kick in swimmers and triathletes.

Do the twist

There is no one-size-fits-all answer to swim posture and balance, but here are a few guiding principles:

  • Head position: Head position and shoulder pain are related. Poor head posture begets a sluggish hip position and vice versa, leading to a sluggish motor. Gaze through the top of your goggles instead of tilting your head up. Keep the water line at mid-forehead or cap line.
  • Pelvis and hip motion and rotation: drives the kick, which in turn drives the body, then the arms. This requires glute and hamstring strength and flexible hips.
  • Upper back: follows the pelvic and motor motion. You need flexibility and strength into twisting motions in the upper/mid back, shoulder blades, abs, and low back.
  • Knees and ankles: neither held too rigid nor floppy. Kick from the hip, not the knees or ankles.

Utilize your own personal floatation devices

If you don’t breathe well, your motor and 3 Bs will suffer. Swim lessons begin with bubble blowing and floating for a reason: to teach use of the most buoyant part of the body—the lungs—to stay afloat. Diaphragmatic breathing keeps your core engaged with your arms and delivers oxygen to your muscles. And be an equal opportunity breather! Breathe bilaterally to keep the work balanced on each arm/leg.

Swim toys: the good guys

  • Swimmer’s snorkel: Ditch the nose plug. The swimmer’s snorkel may help you with the 3 Bs. It keeps your head and body in line while working on your body rotation and kick. Sure, you won’t breathe to both sides or compete with it, but it does help you sync your inhales and exhales with your strokes. That’s a step toward 3 B success and a best friend for swimming life!

    Photo credit: swimswam.com

    Photo credit: swimswam.com

  • Swim fins: Not only will they help you practice your Little Mermaid impression, but swim fins will also help you run over everyone at practice. While they are no replacement for establishing an efficient motor and 3 Bs on your own, they do boost kicking and, in exchange, take a load off of your arms. Word of caution: if your ankles are stiff, they can cause shin pain.

Hand entry

It’s easy to get caught up on hand entry (pun intended). It’s important, but not everything. Hand entry is akin to a runner’s foot strike: both are dependent on body position. This has less to do with your arms and more to do with—you guessed it—kicking and the 3 Bs. With these in check, the hand should enter fingertips first, just wider than the shoulder. Too wide or too narrow likely means there’s under- or over-rotation in the hips and torso, respectively. This can lead to technique issues and stress the shoulder.

Training terrain

This is mainly applicable for triathletes and open water swimmers, though pool swimmers can benefit from this part, too. Just as trail runners need to train off road and road cyclists need to train on the road, swimmers need to train in their competition “terrain.” Accessibility, weather and water temperature pose a challenge here. For open water races, train where you can’t see in front of you. Vision affects the 3 Bs, so practice lifting your head too look for race buoys, support crew, and other competitors. Just remember keeping your head up too long will affect your 3 Bs and motor. If a current or waves are involved, train in choppy water. Wear your wetsuit before race day to ensure fit, comfort, and no change in your 3 Bs.

MORTAL ENEMIES

Improper FITT

That’s not a spelling error, and I’m not referring to swimsuit fit. That’s training Frequency, Intensity, Type, and Time. Too much or too little of each can be problematic. Periodic muscle soreness is normal, but should taper with experience and improved technique. Increase training distance or duration by no more than 10-20 percent per week and vary your strokes to allow for this gradual change. Having stroke variety (e.g. breastroke or backstroke) in the back of your Speedo can be handy if you need to change your position or speed in a race.

Swim toys: the bad guys

  • Kick boards: Kicking is essential to healthy shoulders, but kicking with that 12-inch piece of foam is not. It puts the shoulder in the “impingement” position, pinching your rotator cuff and other structures against your scapula. That’s PT-speak for “ouch.” Kicking with no board helps master the 3 Bs. Kick on your side with one arm up or on your back or stomach with both arms down.
  • Hand Paddles: These are a privilege, not a right. Added resistance is great for building shoulder strength and to the swimmer who paddles the motorboat. Remember what I said about the arms? It’s not about them! Unless you have no pain, a good kick and the 3 Bs, just don’t even go there.
  • Pull buoys: Why would you take away your motor especially when your shoulder hurts?

Poor ergonomics in other activities

What you do out of the pool is just as important as in the pool. Poor cycling and running posture can beat up a shoulder. That goes for workplace, school, and car ergonomics, too. Habits accumulate quickly and can catch up to you when you least expect them.

IN SUMMARY:


Now that you’re armed with a checklist, you’re ready to dive in and make lots of new best friends. But if you find you’re having trouble with them, don’t wait until you’re in pain to ask for help. Sports physical therapy is not just for when you’re broken. We can identify factors that may put you at risk for injury not only in swimming, but in other activities too. Video stroke analysis can be key to help identify and correct errors that may strain a shoulder.