Swimming is a fantastic sport that combines all body strength, flexibility and endurance, but unfortunately, swimmers are prone to overuse injuries affecting the shoulder, neck, lower back and knees. An average high school swimmer performs 1 to 2 million strokes annually with each arm, leading to overuse conditions. This is made worse with incorrect techniques.
Poor stroke mechanics applied in freestyle frequently leads to the development of shoulder problems. Similarly, the arm pull in butterfly and breaststroke can cause stress syndromes in the elbow and knee.
Swimmer’s shoulder is the most common injury seen and has the following characteristics:
Shoulder Impingement Syndrome: Inflammation of supraspinatus, biceps tendon and bursae within the subacromial space from repetitive overhead shoulder motion.
Poor posture with rounded shoulders: This decreases the subacromial space exacerbating shoulder impingement. Onset is associated with altered posture, shoulder joint mobility, neuromuscular control or muscle performance.
Overtraining: Training error such as overtraining, overloading or poor technique contributes to repetitive stress and contributes to this condition.
Muscle imbalances: Most swimmers develop strong adductors and internal rotators of the arm due to nature of swimming strokes and have relative weaker external rotators and scapular stabilisers. This muscle imbalance and overuse leads to capsular laxity at the front of the shoulder, allowing the humeral head to move up and forwards comprising the subacromial space causing impingement and rotator cuff tendon irritation.
Ligamentous laxity: Many swimmers are inherently lax and often will have multidirectional shoulder instability. Essentially, their shoulder joint is sloppy can move into extreme end range of motion increasing the risk of bony impingement.
All the above culminates to allow the humeral head to move up and forward in a already compromised subacromial space where the supraspinatus and bicep tendon run through causing irritation/impingement and ultimately rotator cuff and proximal long head of bicep injuries.