Due to the complexity of the shoulder movement, when considering the training distances of endurance athletes, and propulsive demands required of the joint it is not surprising that shoulder problems are noted in approx. 66% of swimmers.
During front crawl, the stroke of triathlon the large external muscles important for the stroke and power create a sheared force through the shoulder. If the balance or centration of the glenohumeral joint is not achieved, injury in particular impingement occurs .Compression is a significant force generated by the supraspinatis and infraspinatis (two of the SITS). The infraspinatis combined with the teres minor also provides a downward pull to oppose the upward displacement of early deltoid action. With training muscles incorrectly either through overuse or poor technique, balance of these muscles is affected and injury results. It is also suggested that within swimmers laxity of the shoulder joint is very common and a combination of the repetitive and endurance nature of swim training is largely responsible for injury. In fact it is suggested that the impingement noted in swimmers may not be subacromial impingement but secondary to laxity which places increased strain on the SITS tendons resulting in pain and inflammation.
The upper body muscles groups mainly involved in swimming the front crawl are: – Latissimus Dorsi (these are upper back muscles that give swimmers their typical V shape) – Arm adductors (pectoral, front deltoids mainly) – Deltoids as well as Rotator’s cuff muscles (mainly involved in arm recovery as well as maintaining proper technique during the pulling) – Triceps (mainly involved during the second portion of the pull through phase), and lastly but possibly most importantly the serratus anterior
To avoid injury modification of movement patterns and active protection addressing the balance of the rotator cuff and scapular stabilisation through specific strength training is important.
The most likely suggestion for painful shoulders is suggested to be fatigue of the serratus and subscapularis muscles. When painful shoulders in swimmers have been assessed they have found the majority of swimmers demonstrating injury show fatigue within the serratus anterior and fatigue of the subscapularis reducing the scapula stabilisation and resulting in secondary subacromial impingement as previously discussed in a previous article.
The most common part of the stroke to demonstrate pain with approx 70% of reported injuries is the first half of pull through, and then secondly with 18% of reported injuries in the first half of the recovery.
It is extremely important that swimmers listen to their bodies and at sign of pain at the shoulder address it early on. If left, altered movement patterns occur and have an affect globally and chronic shoulder injury is much more difficult to treat.
So things to look out for in swimmers would be a change in stroke pattern and reduced performance. Often the hand on the affected side entering the water too early.
So what is good technique?
Swim smooth is an online programme that has some excellent information and coaching advice for swimmers. On their website they have a downloadable app to analyse good technique. This is an excellent tool that can be used to tackle areas of your own stroke as well as providing invaluable advice and coaching including blogs and weekly email updates.
Areas of the swim stoke that are commonly associated with rotator cuff and impingement are as follows.
Thumb first entry.
This is one of the main causes of shoulder pain in swimmers,. This error results in increased internal rotation at the front of the shoulder and with large training volumes using the smaller intrinsic shoulder muscles to a greater degree than the larger muscles such as the lats, pecs results in rotator cuff injury/imbalance.
In order to address this area once the pain has subsided focus on a middle finger first entry with the palm facing down. Pointy paddles have been suggested to me in the past as this was a habit that I had developed and proved to be a good way to try and improve this error.
Old style S shaped pull through.
This technique is no longer taught and is now replaced with the high elbow catch technique. The old style S pull through has been shown to create increased internal rotation in the shoulder and more likely to create over use of the smaller shoulder muscles again resulting in injury and causing significant shoulder injuries in high level swimming. By having a high elbow and avoidance of a straight arm pull through less strain is placed on the shoulder and more powerful upper back and chest muscles are used helping prevent injury.
There are many different drills available to practice which will help correct these technique errors. Under water video analysis is an excellent way to identify these errors as often it is difficult to recognise this without having a visual aid for your errors.
Body rotation
This has a large component to the overload of the shoulder. For good technique you should be looking for approximately 45-60 degrees of rotation. Body rotation within the stroke allows us to engage the larger stronger, more endurance muscles such as the lats, pecs and core muscles to create power for the stroke. Without body rotation and swimming flat, we use the smaller shoulder muscles for power, they become fatigued resulting in rotator cuff injury. Pointy paddles have been suggested to and using the Freestyle (pointy) paddles to try and correct your hand entry so it is middle finger first, with palm angled down as opposed to facing outside. You might have noticed Rebecca Adlington’s hand entry….specifically engineered to prevent shoulder pain with large training volumes. It’s also noted here that bilateral breathing is important to maintain symmetry and prevent muscular imbalance.
Posture and affect on stroke (midline cross over)
As a Chiropractor one of the common issues we see in the general population is that of poor posture. The slouched posture which often results in weak scapula stabilisation and often rigid mid back from the continual rounded posture which often results in particular a condition we call upper crossed syndrome (please see my next blog)
As well as causing pain and dysfunction If a swimmer has this posture the lack of upper back and shoulder flexibility can cause difficulty with stroke technique often through a severe cross over at the front of the stroke.
This can easily be improved by working on flexibility of the muscles at the front of the shoulder and chest. Doing this together with improved stabilisation of the muscles at the back of the shoulder improves posture and removes cross-over at the front of the stroke This maximises the power of the pull through phase and provides a much more efficient stroke.
In order to improve these areas of your stroke there are may drills available to practice such as those suggested on swim smooth. If you get the chance to be filmed this is also an excellent visual tool to work out areas of your stroke that need to be improved.
If you are suffering with shoulder injury and are interested in learning more about your injury and how we can help contact us on 0151 648 7878 for our Wirral clinic.
