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The shoulder is a complex joint that requires more than several paragraphs to explain the mechanisms of injury and injury reduction strategies. For the sake of simplicity, check out the five considerations below for reducing the likelihood of a swimmer’s shoulder pain.
The four points of consideration are workload management, scapular upward rotation, scapular posterior tilt, external/internal rotation, and shoulder flexion.
The golf ball and tee analogy are often used in describing the glenohumeral joint. The golf ball represents the humeral head and the tee represents the glenoid cavity. The role of the rotator cuff is to keep the golf ball centered on the tee. On the other hand, the role of the scapulothoracic muscles, such as the lower trapezius and serratus anterior, are to move the tee wherever the golf ball goes.
Scapular upward rotation and posterior tilt are two critical movements swimmers should train to “move the tee” efficiently. Essentially, they reposition the scapula to allow healthy humeral movement.
Simply put, workload management is management of training volume to ensure there are no sudden volume or intensity “spikes”. There are two ways to do this. First is to gradually increase volume over time. Volume should not exceed 30% of the previous week.
Second is to maintain training consistency. If Athlete A and Athlete B are on the same swim team and Athlete A attends all swim practices their volume over 4 weeks might look something like this:
Athlete A increases volume safely at approximately 6% per week. Contrarily, let’s say Athlete B misses a couple practices in week 2 and their training volume looks like this:
Unfortunately, Athlete B will have had a 51% increase in volume from week 2 to week 3 which places them at risk for injury.
Because humans are not robots, the same concepts will also carry over to resistance training. Resistance training volume and intensity should also be increased gradually over time.
Fortunately, a well-executed and designed resistance training program will reduce the likelihood of volume-induced injuries (Lauersen, Bertelsen, & Andersen, 2013) by increasing the strength and endurance of the musculature associated with the shoulder.
Scapular upward rotation is important whenever the arms are overhead and getting ready to “catch” water. The serratus anterior muscle is responsible for upwardly rotating the scapula for a healthy “catch”. Some exercises to train scapular upward rotation are:
Scapular posterior tilt is important to “reverse” the propulsive motions of swimming and increase subacromial space (Michener, Mcclure, & Kaduna, 2003). The opposite of scapular posterior tilt is scapular anterior tilt and it is utilized to effectively hold water, but can become problematic over time.
Some exercises that can be used to train scapular posterior tilt are:
Swimming is a sport that utilizes shoulder internal rotation to create propulsive forces. A swimmer lacking in shoulder internal rotation mobility will struggle to create an early vertical forearm during the swimming stroke. Conversely, a swimmer with excessive passive shoulder internal rotation and lack of active shoulder internal rotation will benefit from strength training shoulder internal rotation in specific joint angles.
Similar to scapular posterior tilting, most swimmers will benefit from training shoulder external rotation to “reverse” the swimming stroke and help maintain a solid “golf ball and tee” connection.
Some exercises that can be used to train shoulder external rotation are:
Shoulder flexion is the ability of the arms to be placed overhead. Proper shoulder flexion is critical to maintain a good streamline and swimming line. Swimmers lacking in shoulder flexion will typically exhibit compensations elsewhere in the body.
Some exercises that can be used to improve shoulder flexion are: