Swimmer’s Shoulder

“Swimmer’s shoulder” is a non-specific, painful shoulder common in the swimming athlete. It can be caused by pathology of the acromioclavicular joint, rotator cuff, long head of the biceps, labrum, or any shoulder instability. The typical excessive laxity of swimmer’s shoulder leads to increased susceptibility of impingement and related problems. Rotator cuff and scapular muscle fatigue are other common causes of “swimmer’s shoulder.” The high volume of training, with over 20,000 shoulder revolutions and 6-8 miles of training per week, puts swimmers at greater risk than other overhead athletes. Golfers, tennis players, baseball players and softball players rarely complete above 1,000 revolutions per week. This overuse coincides with an increased injury rate in swimmers, with 66% reporting injury in a year, compared to 57% of pitchers and 7% of golfers.

Coaches, parents, and swimmers should be aware of certain signs of fatigue that can lead to shoulder pain, which include a dropped elbow and wider hand entry. This indicates insufficiency of the serratus anterior and the subscapularis muscles. Additionally, difficulty staying in the center of the lane, early hand exit, and excessive body roll indicate decreased force production of the symptomatic arm.

Conservative treatment has been shown to be successful in reducing pain and returning the athlete to sport. Minimal stretching is required in these athletes due to the general laxity swimmers develop. The main focus is on strengthening and increasing the endurance of specific deep shoulder muscles to improve the mechanics of the freestyle stroke, which is the most common training stroke. The serratus anterior and subscapularis muscles are the deep muscles shown to fatigue the earliest in swimmers, which leads to less than ideal muscle activity in the rhomboids and infraspinatus. These muscles attempt to substitute or “help out” the arm moving through the water, resulting in mechanic breakdown. Scapular stabilizing, strengthening, and endurance training of specific deep muscles will assist the swimmer in returning to sport.

If you are a swimmer and experiencing shoulder pain, come in for a consultation. With an individualized exercise program, along with athlete and coach education, physical therapy can benefit the painful “swimmer’s shoulder” and get you back in the water.


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