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Here at Precision Performance, we work with many triathletes that are looking to improve race
time but are limited by the shoulder. In fact, swimmer’s shoulder is a condition that is not just
for primary-sport swimmers. This issue can arise in triathletes as well, particularly those who do not have a background in swimming. Why? Well, if you have a history of swimming, it is much
more likely you have had some sort of coaching and/or training in the past that has set you up
for success. For those of us who have not had this training, swimming can become a very
challenging pursuit.
In a clinical commentary printed in the North American Journal of Sports Therapy, the author
examined the condition known as swimmer’s shoulder.(1) Typically, this will present as pain on
the front, outside part of your shoulder, up high near the joint. You may have been diagnosed
with bursitis, impingement or AC joint issues previously in this area. Usually, this pain will
happen as you reach overhead or when at the very top of your swimming motion.
But what causes this issue? It can be caused by a multitude of factors that will vary based on
your unique shoulder. Typically, though, we can break it down into four separate categories:
overuse, misuse, abuse or disuse. Let’s discuss these.
Overuse
This one may seem straightforward, but it often has subtle changes to blame. As a triathlete,
you cannot dedicate hours upon hours to swimming throughout your already busy training
routine. So, it may be tempting to increase your volume or intensity within-session to make up
for lost time. This is a mistake. Your tissues respond to graded-loading, and adding too much,
too fast can cause your already vulnerable shoulder to give you problems. Looking back on your
training plan to see any rapid changes in volume (increasing yardage) or intensity (speed work)
can be very helpful.
Misuse
Form, form, form. Remember when we discussed a history of being a swimming athlete? Well,
chances are if you have been a swimmer for some time you have had some sort of coaching or
form training. If you haven’t, you may be misusing your body and causing shoulder pain.
Getting coached on your form by someone who is educated about the practice and physically
present while you swim can result in dramatic improvements.
Abuse
As a triathlete, you are used to training through pain and discomfort. Often, these sensations
may let you know you are challenging yourself adequately. Aside from training through pain
being a dangerous mindset, it can cause more long-term dysfunction than you may realize. In
regard to swimming, training with paddles or kickboards too often can lead to abuse of your system. Additionally, winging a training plan or workout can predispose you to abusing your
shoulders. This is when listening to your body and following a professional plan can make a
huge difference.
Disuse
Ah, the ole use-it-or-lose-it. As endurance athletes, we are likely used to training at a certain
level. So, when a busy season of life happens and you cannot train as much as you need to
*cough* holiday season *cough*, then when you jump back into training, you go right back to
the same intensity and volume. But, that’s not how physiology works, unfortunately. With time
off, your body will start to reduce the resiliency of your tissues. When you come back to
training, you cannot expect to go back to the same level immediately. Doing so can predispose
you to injury.
Alright, so we’ve covered the potential training-related causes for swimmer’s shoulder. What
about the anatomy and physiology of it?
Swimmer’s shoulder can be caused by:
- Weakness of your shoulder or shoulder blade
- Thoracic spine stiffness
- Thoracic spine weakness
- Lumbar spine weakness
- Improper training regimen out of the water
- Repetitive stress throughout training
- Muscle tightness
- Muscle imbalance
- And many more…
Do you think you may be experiencing swimmer’s shoulder? If so, a qualified PT needs to take a
look. That person should discuss your goals, training plan, coaching, history and unique
personal factors. You should be receiving care that progresses steadily and gets you back into
the water as soon as possible. If you’re doing the same exercises over and over and over, that’s
a problem. At Precision, we often get those patients who haven’t gotten better elsewhere.
Let us know how to help you get back into the water!
Thanks for reading,
Ryan
1. Tovin, Brian J. "Prevention and treatment of swimmer's shoulder." North American journal of sports
physical therapy: NAJSPT 1.4 (2006): 166.
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