Shoulders are designed for mobility - not stability. Your shoulders let your arms move forward, back, across your body and in a 360-degree circle. Unfortunately, that mobility comes at a price. Shoulders are fragile - held together by soft tissue like ligaments (bone to bone) and tendons (muscle to bone.) An estimated 80% of swimmers, age group through college, experience shoulder pain, with up to 47% of age group swimmers reporting seeking healthcare treatment or missing significant practice time.
To understand why shoulders are so susceptible to injury, start by having a look at the anatomy of the shoulder (lower left.) You can imagine your shoulder as a basketball (head of the humerus) balancing on the end of a plunger (glenoid). Now picture adding rubber bands across the basketball to help hold it tightly to the plunger. Those rubber bands are like our shoulder ligaments. As you keep stretching them they start to lose their elasticity, just as rubber bands do with use. Once they get stretched out they cannot hold the basketball on the plunger as well. Picture a swimmer who carries a heavy backpack over one shoulder at school all day. That backpack is pulling the basketball from the plunger. Now add poor posture - so that the swimmer sits with shoulders slumped forward. By tilting the plunger forward, gravity stops helping keep the basketball on top of the plunger and helps to pull it off. The 24-Hour Athlete knows that good posture, attention to technical form, strong supporting muscles, and a good recovery strategy can help keep shoulders healthy.
Soreness or Pain?
Swimmers Functional Pain Scale
A good workout challenges your body, which responds by building muscle. This will result in some muscle soreness. So how can swimmers, parents and coaches help swimmers distinguish between shoulder soreness and pain? One useful tool, recently updated, is the Swimmer Functional Pain Scale (SFPS). This self-administered questionnaire is designed to measure pain and the functional status of a swimmer's shoulders.
Swimmer Functional Shoulder Pain Scores - report scores of 4 and higher to coach
- 1-3 Swimmer is experiencing normal muscle soreness associated with competitive training
- 4-6 Swimmer's strokes are evaluated. Decrease the duration and/or intensity of shoulder work. Use adaptations such as a longer warm-up and cool down period, switching strokes more frequently or kicking with fins instead of pulling or using a kickboard
- 6-8 72 hour period of rest and reevaluation. Swimmer may consider evaluation by a healthcare professional
- 9-10 Evaluation and care by a healthcare professional before returning to practice
Common Causes of Shoulder Problems include the top two - sudden increases in training intensity and poor technique - and contributing factors such as poor posture, poor or uneven flexibility or strength, or inadequate rest and recovery. The 24 Hour Athlete knows swimmers need healthy shoulders to swim fast and enjoy it. They protect their shoulders in and out of the pool by doing all of the things below.
A sudden increase in training volume or intensity is the number one cause of shoulder problems. Swimmers whose entire shoulder joint system have balanced length, strength, and timing can have healthy shoulders despite heavy training loads. However, a sudden spike in training will stress some muscles more than others. When shoulder muscles, particularly those of the rotator cuff, become fatigued they cannot protect your shoulder from the force your upper back and abdominals generate. Either other muscles compensate, trying to stabilize the shoulder even though they were not designed for it, or you change your stroke dynamics, causing your shoulder moves in ways it was not intended to do. The humerus will migrate, causing impingement (pinching) of the tissue (especially the bursa) between it and the AC joint. If you have been out of the water, even for a short time, listen to your body. Once you cannot maintain good form it is time to back off. Excessive shoulder muscle fatigue leads to a downward spiral of chronic inflammation and further muscle imbalances. The resulting pain or lost range of motion causes you to reduce training volume or intensity, which can have a rebound effect when you try to make up for lost time.
Your coach can help you with good stroke technique. Some guidelines for healthy shoulders include
- Maintain a horizontal body line in all four strokes - no swimming uphill. The tops of the ears should line up with the hips.
- Good body rotation in freestyle and backstroke. Even sprint freestylers must have some shoulder rotation to distribute the stress at the shoulders evenly. Rotate from the core in freestyle and backstroke - do not set the catch and then use your shoulders to pull yourself onto your side. Hips move first - hips are much stronger than shoulders.
- Use snap-back breathing in freestyle. Long or late breathing can make neck and shoulder muscles pull in different directions, causing shoulder stress. Start the head turn just before the forward arm enters the water. Return the nose to the water before the recovering hand crosses the face.
- Hand entry in freestyle and butterfly should be fingertip first, not thumb first. Hands must enter just outside the shoulder - not in too close or out too far. The pull should be an anchor, with the strong core muscles moving the body past the hands. If hands do not appear to travel straight back - but move in toward the midline or slide out to the side - a swimmer may be trying to pull themselves along with their hands instead of anchoring with their hands and using their core strength to move their body forward.
- Freestyle - be sure you recover your arms with a natural throw of your elbow like a gate opening, instead of lifting your elbow close to your body so that your lower shoulder blade pulls away from your ribs.
- Using a kickboard? Be sure you are not hanging your weight on your arms. Instead, engage core to hold your weight.
Bad posture is not just gravity pulling your shoulders forward and making your chin stick out. Your muscles are actually working to make bad posture happen. Your chest muscles are gently contracting to pull your shoulders forward. Neck muscles contract to make your chin jut forward and up because of a righting reflex - your brain's need to keep your eyes level on the horizon for balance. So your chest and front neck muscles gently contract and your brain sends low-level inhibition signals to the muscles in the back of your neck and shoulders to relax. Over time, these muscles get long and weak. Eventually, they get hypertonic. That means they tense up, trying to prevent you from going any further. They feel tight, not because they are too short, but because they are too long and weak and they are struggling to keep things from getting worse.
Learn to feel how your shoulders should be aligned. Shrug shoulders toward your ears. Now, draw them back toward the wall behind you. Be sure you feel your shoulder blades getting close together. With your chin in, guide your shoulder blades down toward your waist. Your chest should feel a little taller, and you should not have to pinch your shoulder blades together. Instead, let the bottoms of your shoulder blades press into your back and spread out a little. They should be flat against your back - not sticking out. Coach David Marsh tells his swimmers to "put your shoulder blades in your back pockets," - a good way to think of where your shoulders should be. Develop a habit of good posture to reduce fatigue and the chance of shoulder and neck pain.
Post-Workout Recovery - A good workout challenges your body and your body adapts to the challenge by becoming faster and stronger. Muscle soreness is a natural part of that process. Learning to use nutrition, ice, massage, and myofascial release and other recovery strategies to keep your shoulders healthy. Following the right recovery plan will make you more comfortable and increase your body's adaptation to training.
Injury Recovery - "Swimmer's Shoulder" is a general diagnosis that refers to injuries such as rotator cuff tendonitis, labral tears, arthritic changes, bursitis, etc. If you suspect that you have more than workout soreness, see a sports medicine specialist, ideally one with experience treating swimmers. Swimming puts unique demands on the shoulders, even compared to other overhead sports. Also, the year-round nature of the sport means our training cycles and competing cycles overlap, which can also complicate a recovery plan. Professionals who have successfully treated swimmers know that not all shoulder abnormalities are the cause of pain. Some of them are adaptations to training that may occur in swimmers that are symptom-free. Often the right healthcare provider can significantly shortening recovery time.
Swimmers who are out of the water for longer than 72 hours will need to return to practice gradually since a sudden increase in exercise duration or intensity can exacerbate injuries or create new problems. Unless their healthcare provider prescribes specific guidelines, swimmers will be asked to return once they have a reasonable expectation of completing 25% of a normal practice. They will be asked to increase their yardage by no more than 100 - 200 yards per practice. They may be asked to increase warm-up and cool-down time, to substitute strokes or drills in some sets, etc. The more patience a swimmer shows during the recovery period, the sooner they will be able to return to a normal practice training load.