Swimmer’s Shoulder: Causes, symptoms, treatment and prevention tips for shoulder impingement

Swimmer’s Shoulder: Fitness experts reveal the causes, symptoms, treatment and prevention tips for shoulder impingement

Swimmer's Shoulder, also known as shoulder impingement, is a prevalent health condition that affects swimmers of all skill levels, from beginners to advanced and is characterised by inflammation in the shoulder joint, primarily caused by repetitive shoulder movements associated with swimming. Swimming is a sport, which requires repetitive shoulder movements involving various types of strokes predisposing the joint to injuries thus, the term Swimmer’s Shoulder can represent a wide variety of conditions.

Swimmer’s Shoulder: Causes, symptoms, treatment and prevention tips for shoulder impingement (Photo by 𝙂𝙧𝙚𝙜𝙤𝙧𝙮 𝙂𝙖𝙡𝙡𝙚𝙜𝙤𝙨 on Unsplash)

An important thing to note is that the condition is not restricted to only swimmers but also in sports like baseball, volleyball and even in occupation demanding repeated overhead activity like construction workers and electricians. In an interview with HT Lifestyle, Dr Harishchandran, Senior Consultant - Sports Medicine (Shoulder Surgery) at Cosmopolitan Hospital in Trivandrum, said, “Swimmers have significant susceptibility for shoulder injuries due to the involvement of the shoulders required for various strokes and the high volume of repetitions required during training. Impingement syndrome, rotator cuff tendinitis, labral injuries, ligamentous laxity or muscle imbalance causing instability, muscular dysfunction and neuropathy from nerve entrapment are the common problems.”

He revealed, “Plain radiographs are obtained initially to rule out any abnormal anatomic variations. MRI may be ordered to better identify pathology in the muscles, tendons, ligaments, and cartilage or to exclude other structural causes, such as labral cysts. An MRI arthrogram can be considered when a labral or tendon tear is suspected. Stretches that focus on the posterior capsule are important for preventing and reversing impingement. Rotator cuff strengthening will lead to muscular balance restoration and surgery is appropriate for structural pathologies. For swimmers with persistent multidirectional instability, a capsular plication or inferior capsular shift procedure should be considered. Sub acromial exploration and removal of the hypertrophied, inflamed, and scarred tissue (thereby maintaining the structural integrity of the shoulder) is an option for athletes who obtain only limited relief from physical therapy.”

Causes and symptoms:

Dr Ayyappan V Nair, Consultant - Shoulder Surgery, Sports Medicine and Arthroscopy at Manipal Hospital in Bangalore's Whitefield, Sarjapur and Jayanagar, explained, “Swimming demands a heavy work load from the shoulder where 90% of body’s propulsive force is generated by shoulder. The chief muscles helping in producing such massive force are latissimus dorsi and the pectoralis major. The subscapularis and serratus anterior also play a major role in freestyle strokes. To provide such a massive propulsive force repeatedly a properly balanced muscle is required.”

He elaborated, “A sudden increase in training or poor techniques can lead to a wide variety of Injury to the shoulder. Repeated over the head activities such as swimming strokes and spiking in volleyball can lead to this condition. The repeated activity induce strains in muscle and tendons around shoulder leading to inflammation, micro tears which can end up in scars tissue formation, thereby leading to abnormal mechanics and muscle imbalance damaging further tissues. You might be suffering from swimmers shoulder if you have deep shoulder pain radiating along the back of your shoulder, which gets worse after swimming or any repetitive overhead activity. It can also present as reduced movement in one shoulder compared to other, loss of strength, pain during overhead activity, difficulty in reaching behind you back or if your stroke pattern has changed (lazy elbow).”

According to Kunwar Vishwajeet Singh, Sustainable Fitness Lifestyle Coach and Founder of Body Architects in Dehradun, “The main cause of Swimmer's Shoulder is the repetitive nature of swimming, particularly movements that involve overhead arm rotations combined with high force and frequency. This constant strain on the shoulder joint can lead to inflammation and pain. However, several other factors contribute to the development of this condition. Weakness or imbalance in the muscles surrounding the shoulder, especially the rotator cuff muscles, can increase the risk of Swimmer's shoulder.”

He emphasised, “When these muscles are not adequately conditioned or are imbalanced, they fail to provide proper stability and support to the shoulder joint during swimming. Incorrect swimming techniques can also lead to excessive strain on the shoulder joint, contributing to the development of Swimmer's Shoulder. Poor body positioning and improper arm movements increase the stress placed on the shoulder, making it more susceptible to injury. Additionally, inadequate warm-up routines before swimming and insufficient cool down exercises after training can contribute to the occurrence of Swimmer's shoulder. Failing to prepare the muscles and joints adequately before activity or neglecting to promote proper muscle recovery afterward can increase the likelihood of shoulder issues.”

Treatment and Prevention:

Dr Ayyappan V Nair shared, “It is recommended to consult a medical professional especially a sports physician or surgeon if you are suffering from the condition even after giving rest to the joint for at least a period of 1 to 3 weeks following an episode of pain or discomfort. Your medical professional will take detailed history of your complaints from the onset or the time you noticed the symptoms first and will conduct a series of physical examination to come to a provisional diagnosis. Tests can vary from basic blood tests, X-rays, ultrasound or even MRI.”

He added, “Majority of conditions encompassing Swimmer’s Shoulder is treated conservatively with rest, anti-inflammatories and physiotherapy. In fact, physiotherapy is the main stay in prevention as well as cure for this condition where you will be undergoing various stretches and strengthening of different muscle groups depending on the site and pathology diagnosed. Other recommendations include ergonomic adjustments and steroid shot. Surgery is usually recommended in patients who are not responding to 3 to 6 months of physical therapy or where the injuries are not expected to heal by itself like high grade rotator cuff tear, those with multidirectional instability, or even sub acromial decompression and in cases where bursitis is not responding to long term anti-inflammatory medication, rest and physical therapy.”

To prevent Swimmer's Shoulder and promote shoulder health among swimmers, Kunwar Vishwajeet Singh recommended the following measures -

• Focus on proper swimming techniques: Swimmers should pay attention to maintaining correct body positioning and arm movements to minimize stress on the shoulder joint. Coaches and trainers can provide guidance on proper technique and form.
• Incorporate strength and mobility exercises: Regularly performing exercises that target the shoulder muscles, particularly the rotator cuff muscles, can enhance overall shoulder stability and reduce the risk of injury. Working with a qualified fitness professional or physical therapist can help develop an appropriate exercise program.
• Prioritise warm-up and cool-down routines: Before swimming, engaging in a dynamic warm-up routine helps prepare the muscles and joints for the activity, increasing blood flow and flexibility. After swimming, a proper cool down routine should be followed, including stretching exercises to improve muscle recovery.
• Avoid overtraining and prioritise recovery: Overtraining can lead to increased stress on the shoulders and heightened risk of injury. Swimmers should allow their bodies’ adequate time to rest and recover between sessions. Incorporating rest days into the training schedule and listening to the body's signals are essential for injury prevention.
• If swimmers experience any discomfort, pain, or recurring issues in their shoulders, it is crucial to seek medical attention or consult with a physiotherapist promptly. Early intervention and proper care are vital to effectively manage and prevent the progression of Swimmer's Shoulder or any other shoulder-related conditions.