Friday, February 1, 2013

The Four Classic Causes Of Shoulder Pain And Injury In Swimming

Studies into swimming injury show that 80% of us suffer from enough shoulder pain at some point during our swimming lives to keep us out of the water for at least a few days.

In the past swimmers and coaches thought that some level of shoulder pain or even injury was normal in swimming and something that just had to be lived with. Fortunately with a modern understanding of bio-mechanics we now know that's not the case, with a good stroke technique any swimmer should be able to remain pain and injury free even when training very hard.

If you suffer from any shoulder pain or soreness during or after swimming, or even have a full blown shoulder injury, check your stroke for the four classic causes:



1. Thumb First Entry Into The Water

Entering thumb first with the palm facing outwards used to be taught as a smoother hand entry into the water but it internally rotates the shoulder placing a lot of stress on the joint. This is the most common cause of shoulder injury in swimming and should be avoided like the plague:


Instead of entering thumb first, enter fingertips first with the hand facing downwards, this keeps the shoulder neutral and sets you up perfectly for a great catch and pull through to follow.



2. Stroke Crossover

Crossing the centre line in front of the head places stress on the shoulder joint, the pain often being felt as impingement at the front of the shoulder or an over-stretched numb sensation at the back. Work on improving your posture and awareness of your lead hand (even when breathing) to remove this common stroke flaw:


A crossover combined with a thumb first hand entry is particularly stressful for the shoulder and a full injury surely lies in wait for any swimmer doing this.



3. Forceful Push Downwards During The Catch

This is a classic Arnie stroke flaw and involves pushing downwards powerfully on the water at full reach with a very straight arm:


This can feel deceptively like a good catch because of the feeling of water pressure on the palm of the hand but unfortunately it only lifts you up at the front and sinks your legs downwards. It also places a large stress on your shoulder joint which can easily lead to pain and inflammation. Work on developing your catch so you press the water backwards, not downwards and expect this to feel a lot less forceful.



4. Pulling Through With A Straight Arm (especially pulling wide or crossing the centre line under the body)

A straight pull through places a lot of load on the shoulder joint. Pulling wide tends to cause internal pain while crossing under the body with the arm over-stretches the outside and rear of the shoulder.


This can be quite hard to diagnose without video analysis but can be done by watching a swimmer carefully as they swim towards you at the end of the pool. Work on bending the elbow under the body bringing the hand directly under the shoulder, we call this 'Bending It Like Becky'.



If you suffer from any level of shoulder pain or injury from swimming there's almost certainly a flaw in your stroke technique causing the problem and you need to take immediate action to correct your stroke technique. Once developed a full blown shoulder injury is extremely frustrating and can take a long time to overcome - prevention is far better than cure when it comes to looking after your shoulders.

Swim Smooth!

27 comments:

Anonymous said...

Thankyou swimsmooth - you have just explaned the sudden recurrence of an old rotator-cuff problem with my right shoulder. No more thumbs-first for me

Michael said...

Very apposite post.
I developed impingement in left shoulder, v. suddenly over 2, possibly three sessions.
I'd just finished your catch master class course, bought the book and, feeling confident that my improved stroke technique was fairly robust, (zoning out over 2-3 km had become a breeze), I decided to start to working on swim fitness and increasing stroke rate.
What started as slight discomfort, developed into a grating feeling in the next session and after that I couldn't lift the arm above shoulder height.
Hand entry was fine, no cross-overs, bent elbow, feeling the catch well - plenty of (p-)unco drills. Difficult to explain other than perhaps as I tired, my body rotation might have been decreasing. Could this have been a contributory factor?

That was in August.

Mobility has improved with physio, but still can't lie on my left hand side without pain. Haven't been in the pool since, but would love to try. Is there anything you can suggest I could do in the pool that would aid recovery and not risk a relapse?

Anonymous said...

This advice is too late for me but I would urge anyone with shoulder pain to look at your swim technique sooner rather than later, i.e. don't wait. Coming to triathlon in my fifties as a fit lady, used to participating in sport at a good level, I thought my shoulder strength would help me through the early stages of swim fitness; what I didn't realise was that this very strength became my weakness and I didn't realise that I was pulling through on my left with a straight arm. The result has been severe tendonitis throughout my shoulder joint, a shoulder impingement and no frontcrawl swimming for nine months. I'm now very slowly rehabilitating, concentraing on correct technique and hope to be able to do a short course tri this summer. Take the Swim Smooth advice - prevention really is better than cure!

Denaj said...

I love it. Easy prevention tips. I will add these techniques to my blog and my arsenal.
Static stretches will also lead to shoulder injury.

Thank you.

Michael Ralph said...

Good info for shoulder injury, but what about those of us who have developed elbow tendonitis through swimming. Are there any swimming correction techniques for that?

Keith Smith said...

Hi,

All those things are stroke faults that need to be corrected if they are apparent. Because they all potentially lead to inefficiency in the stroke and might lead to injury.

However I have seen videos of some elite standard swimmers with very straight arm movements, over and under the water, especially sprinters.

What I'm not sure of is the comment that "If you suffer from any level of shoulder pain or injury from swimming there's almost certainly a flaw in your stroke technique causing the problem and you need to take immediate action to correct your stroke technique."

In my experience there are swimmers who do not display these flaws but still have problems around their shoulder joints. I feel this can be for a host of other reasons other than their swimming technique. For instance there may be muscular imbalances causing poor scapula stabilization or tendon impingement due to bone growth. The shoulder is a very complex joint and very difficult to diagnose what could be wrong, let alone work out the root cause.

It may also be that the other problems are causing the poor technique and movements? not the other way round.

I also deal with a lot of age group swimmers and these swimmers tend to have shoulder issues that seem to come and go randomly. I think there are also other factors for these kids, like their use of the Wii etc, carrying heavy school books on one side or being hunched over a desk with bad posture. All nothing to do with swimming but are causing symptoms whilst swimming.

I try to get the parents of kids with shoulder problems to see a physio and get screened for movement and muscular imbalances. They then usually get a tailored rehab programme and are able to recover or learn to manage their problems.

Rudolf said...

Glad to see you get back to this shoulder and thus stroke technique issue.

One question i have - why would i only ever get shoulder pain in my left shoulder, never in my right??

I assumed this is because my left hand just doesn't have a good catch at all (sinking, pressing water down) so i tried to pay special focus on my left arm catch - and ended up doing this automatically for about a good year, still the occasional shoulder pain, nothing serious as the Canadian Olympians coach assured me, but still, obvious room to improve.
Now i have refocused to get the bets possible catch also with the right arm - and notice that things go all of a sudden considerably faster ....

Yet, the bent elbow, i sure have and still do work on this one, but this is not as easy as "just do it mate", somehow i can't help it, there must be something to it i have not yet grasped, something other than the arms only, so, question number two, what helps to get this bent elbow technique in for good, different way to kick, more bodxy rotation, how is it with the moment before the begin of the catch, when the arm / hand hits the water, should the arm be stretched out as far as humanly possible, shoulders in the best possible tuck (narrow profile), body roll to the side of the arm that catches the water ??

James Moon said...

Great post - can we have one on "swimmer's elbow" please please please

Adam Young said...

Hi everyone -thanks for the great response to this post, we've had a lot of emails and social media post about it too. :)

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Anonymous(1) - definitely try and work out what's happening in your stroke and be diligent with the rehab!

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Michael - that's not good. Even though you feel that you don't have any of those issues in your stroke it's well worth getting yourself videod (preferably under the water) to check. You've got a chronic problem there and it's vital you understand the cause.

How is your rotation? Do you prefer to breathe to one side? (see conversation with Rudolf below).

---

Anonymous(2) - that's a great story, thanks for sharing. Crossover and push down an issue in your stroke? We see that so often in athletic types!

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Hi Micahel-R and James, normally elbow problems are caused by trying to overly lengthen the stroke at the back. Are you putting in a big push and nearly or completely straightening the arm? That puts a lot of stress on the elbow!

Picture of Nic doing this, see how the flick at the back is stressing her elbow: http://www.swimsmooth.com/scratch/nic-elbow.jpg

Also read: http://www.feelforthewater.com/2010/08/should-you-emphasise-back-of-your.html

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Keith,

> I have seen videos of some elite standard swimmers with very straight arm movements, over and under the water, especially sprinters.

Certainly above the water yes but below the water not so much. They pull through with a straighter arm than a distance swimmer but there's still elbow bend. Sprinting does place a lot of load on the joints so sprinters do tend to suffer from more injuries than you might expect given their low training volume.

> In my experience there are swimmers who do not display these flaws but still have problems around their shoulder joints.

Are you studying that with video analysis? These things are so easy to miss without... And to be honest if you're working with a child with a shoulder problem I'd make it a huge priority to get their stroke properly looked at in that regard, it's the rest of their swimming life we're talking about after all! Also so many juniors are taught to breathe to just one side and this lack of rotation to the off-side cause them stroke issues and shoulder problems as a result (see comment to Rudolf below).

> The shoulder is a very complex joint and very difficult to diagnose what could be wrong, let alone work out the root cause.

It is a complex joint but we have performed video analysis on hundreds of swimmers with shoulder pain and one of the above issues is present in at least 95% of cases. Of course it's possible to have a cause external to swimming but it really is quite rare, bike accidents in triathletes being probably the most common example.

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Rudolf - do you only breathe to one side or have a strong preference to one side? A lack of rotation to the non-dominant side is going to cause stroke issues and load up that shoulder. Or equally you could have a thumb first entry on one side only or a crossover on that side only etc etc.

On your second question, we've had this conversation and I've made this request before: There are a host of things that could be going wrong here and my feeling is that it's really very likely you're 'overloaded' with things you're thinking about when you swim and this is part of the problem. I could list off a raft of things here and further over-load your brain but some underwater video of your stroke would really help us cut through that clutter and get you working on the right things. It will be something before the pull-through that's causing the problem, I doubt it's a problem of co-ordination as yes you will be able to just-do-it when setup for it correctly. Get that video! :)

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Adam

Anonymous said...

You've opened up a can off worms, I didn't think so many suffered from Rotary Cuff shoulder.
I recently have been suffering with my left shoulder and believe me it's very very painful.
I've tried to rest (no swimming) and on return I'm changing my swim style, but it is O' so painful again.
Do I completely rest for a long time and re-try or just bear the pain and work through it (with the help of pain killers), hoping that the new style will eventually get rid of the pain?

Adam Young said...

Hi Anonymous,

Don't worry, we're swim coaches - we're used to cans of worms! :)

Sometimes pure rest is not as helpful as we might be led to believe so keeping a little bit of swimming going could be a good idea.

Seeking professional help / treatment from a registered physiotherapist would be the best port of call to assist with active rehabilitative recovery.

Well worth getting some video of your stroke too so that you can understand what is going on there, it's a severe problem you have that you need to fix.

Anonymous said...

Hello ,

Can you explain why it appears the injury on left or right side of back?
Some picture with wrong and correct moves will be great if you can add.

Thanks, Mihail

cory josue said...

Thank god that I cam across this entry. This will be very helpful for my boyfriend. I'm not a swimmer but my boyfriend is trying to regain his strength in swimming and although he ignore most of my attempts to give him bits of information about his chosen sport, I sure hope that he will not turn his back around this time.

Cory Josue
Center for Musculoskeletal Science Asia

T5 said...

OK, so just had video done and looks like I suffer from pts 3 & 4. I have the book, so where should I look for drills to correct this?

Signed, a converted over glider

Adam Young said...

Hi T5,

That's great - it helps so much to know what you have to work on.

For the wide pull, doggy paddle can be great, visualising pulling down a rope under your body. If you're pulling wide then you're pulling down two ropes - try and make it one single one directly underneath you.

When does the straight arm press down (3) occur? On every stroke or when you're breathing? If when breathing then this is a matter of focusing on the catch whilst you are breathing instead of thinking "give me that air". A mantra like 1-2-catch will help where the 1 and 2 are on non-breathing stroke and the "catch" on the breathing stroke. This will help shift that focus from breathing to the catch.

A key factor in both of these stroke flaws developing can be your breathing pattern, if you only breathe to one side then moving to bilateral breathing will really help balance out the stroke.

Hope that helps,

Adam

T5 said...

Thanks a lot Adam. Your book has already made me a better Triathlete.

Keith said...

Adam

I know I'm at the risk of being controversial here!

I wrote:

> The shoulder is a very complex joint and very difficult to diagnose what could be wrong, let alone work out the root cause.

You replied:

It is a complex joint but we have performed video analysis on hundreds of swimmers with shoulder pain and one of the above issues is present in at least 95% of cases. Of course it's possible to have a cause external to swimming but it really is quite rare, bike accidents in triathletes being probably the most common example.

I do coach a lot and see a lot of swimmers from of all ages. I have not done a study but I would suspect that the percentage of people with at least some degree one of the 4 freestyle stroke faults you have highlighted would be in the high 90% irrespective of whether thay are experiencing shoulder problems or not.

Therefore, it is not surprising that you could spot one of these faults in 95% of people with shoulder problems. That to me does not necessarily mean there is a causal link.

And more importantly just correcting the stroke as best you can may well not cure your problem. I'm not saying don't try to correct the errors, but that is important for everyone. And it may help some that have shoulder problems to recover. But I don't think you can just rely on stroke correction as a cure and need to be prepared to investigate other interventions, and be prepared to see a physio to be screened, tested or treated.

Adam Young said...

Hi T5, fantastic, that's great to hear!

Hi Keith,

OK, the causal link comes from other multiple considerations too:

- Swimmers without those flaws have very low rates of shoulder injury. I think you disagree with this but we

- All of those flaws can easily be shown to place excess load on the shoulder bio mechanically.

- The type, position and severity of the shoulder pain is directly related to the stroke flaw.

- Within a single stroke correction session, removing those flaws from their stroke gives an immediate improvement in symptoms and in the long term has a very high fix-rate for swimmers.

- Michelle Newsome (Paul's wife) is a physiotherapist specialising in the shoulder joint and has been central to our work and policy on fixing shoulder pain and injury.

- Most physiotherapists in Perth now send swimmers with shoulder issues to us for stroke correction because they have found time and time again that while rehab can alleviate the symptoms in the short term it very rarely provides a long term cure, which stroke correction has a much much higher hit rate of doing.

Of course a physio assessment is going to be appropriate too but swimmers should definitely correct their strokes for these issues and as coaches we should feel duty bound to instigate that too...

Adam

Adam Young said...

sorry - hadn't completed my first point:

- Swimmers without those flaws have very low rates of shoulder injury. I think you disagree with this but we have found it to be the case time and time again studying underwater video analysis.

Shoulder Replacement Gurgaon said...

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Avoiding Shoulder Pain said...

Great post! Been reading a lot about ways to get over my shoulder pain. Thanks for the info!

high school swimmer said...

No pain yet, but my right shoulder has been twinging and popping and clicking when I bring my arm forward over the water for freestyle with a semi-high elbow. I primarily breathe left, and my right arm does drop / lose its catch when I take a breath, also sort of crossing over a little bit. Recently I'd been trying to correct this, but I think my attempts actually triggered the shoulder problem. Bad posture may also be a cause.

Is rest the best option right now?

Thanks,
J

Paul said...

What happens if you only breathe right? Any improvements high school swimmer?

Paul said...
This comment has been removed by the author.
high school swimmer said...

My extended arm drops & loses catch when I breathe, more twisting when I breathe left but falling more when I breathe right.

Fall swim season started, and I've stopped trying to fix the lost catch / wider pull and am focusing on breathing less, and now my shoulder is mostly better.

My shoulder does still crackle a little bit when I rotate it though. No pain as of yet, so I'm assuming this is good?

Paul said...

From the sound of it HSS, if you're no longer getting any pain, then yes, these adjustments seem to be beneficial for you - long may they continue!

Paul

Abram said...

Good info for shoulder injury. Thanks for sharing this to us.