by Lindsay Shermann, PT, DPT
Swimming is one of the most effective and efficient full body workouts anyone can enjoy. Swim lessons typically start with our young children, but the joy of swimming can be appreciated and beneficial for people of all ages. As people progress in their swim fitness, competitive sport with up to 2hrs of training a day can become the norm. Swimming is a much better activity for protecting the ankle, knee, and hip joints as compared to other high impact activities like running, but the shoulders unfortunately become more prone to injury. Pain in the shoulder region is a common complaint of both competitive and recreational swimmers, and the symptoms can manifest at a young age due to repetitive stresses placed on the shoulder.
The increased stresses on the shoulder are a result of water being 800 times more dense than air. Swimming requires repetitive motions of both arms performed against the resistance of the water in the pool. When swimming any of the four strokes, a lot of shoulder rotation occurs. During freestyle shoulder internal rotation dominates and is required to propel the body forward when the arm is under the water. This internal rotation is the motion that occurs when you place your hand behind your back towards your lower spine. Backstroke requires more external rotation of the shoulder, occurring when your arm first enters the water above your head. But to propel your body through the water, backstroke requires a forceful internal rotation motion when your hand is by your waist just before it exits the water. External rotation is the opposite motion, such as when reaching up and behind to put your arm in the sleeve of a jacket. This repetitive motion occurring against resistance can lead to pain and wide array of shoulder injuries. The most common are related to conditions of the rotator cuff and can include impingement syndromes. The rotator cuff muscles are comprised of four muscles which stabilize the shoulder joint, including those of which the primary action is to internally and externally rotate the shoulder. Impingement syndrome is a broad term used when the muscles or tendons located above the shoulder joint become compressed by the boney structures during repetitive overhead activities. There are multiple factors that may have caused one athlete to develop a shoulder injury, but the early phases of shoulder injury can be managed with appropriate rest, ice, anti-inflammatory over the counter medications, and an appropriate exercise program to address muscle imbalances.
One of the best ways to prevent shoulder injury in swimmers is with participation in an appropriate dryland program. Sometimes too much focus is put on training in the water. A dryland program is a common term coined by swimmers and involves training outside the pool. It is not only important for the swimmer to develop appropriate strength of their rotator cuff muscles, but in the muscles in the back of their shoulder to provide additional support and movement for this joint.
The dryland program should consist of 30-45 minutes of stretches, aerobic activity, and strengthening exercises. It should target the entire body with a focus on the arms, but also including legs and core strength, which an essential component in every sport. Stretching should not only include static stretches, but dynamic stretches as well. A dynamic stretch involves muscles moving throughout some or all of their range of motion.
Lindsay is a physical therapist at Riverside Regional Medical Center. She was a Division I College Swimmer for the University of Maryland. To book an appointment with Lindsay call (757) 534-6126.