Shoulder pain in triathletes, called “swimmers shoulder,” is probably the most common upper-body injury seen in triathletes. The pain from swimmers shoulder can limit swim training, but can also impact staying in an aero position on the bike.
What is Swimmers Shoulder?
“Swimmers shoulder” is a pain in either the front or the back of the shoulder during or after swimming. The pain is typically gradual in onset and worse with overhead activities or sleeping on the affected shoulder.
What causes Swimmers Shoulder?
There are several factors that can lead to a triathlete developing shoulder pain and swimmer’s shoulder. The primary factors being poor swim stroke mechanics and overloading or overtraining.
There is also an association with the use of swim paddles in triathletes that develop shoulder pain while swimming. 1 The use of swim paddles places a larger force on the muscles of the shoulder and may also magnify the effects of poor swim stroke mechanics.
Swimmers’ shoulder can be due to instability and weakness or fatigue of the shoulder and upper back muscles as well as impingement within the shoulder joint. 2 The instability and hypermobility of the shoulder joint can lead to microtears in the muscles and tendons.
One study from 1991 measured the scapular muscle function in swimmers both with and without shoulder pain demonstrated that swimmers with shoulder pain had abnormal muscle function of 7 of the 12 muscles of the shoulder which included the anterior deltoid, middle deltoid, infraspinatus, subscapularis, upper trapezius, rhomboids, and the serratus anterior muscles. 3
What if my pain isn’t from Swimmers Shoulder?
If you have a history of trauma to the shoulder, your shoulder pain from swimming may be due to damage to the labrum, which is the soft tissue cuff of the glenoid that surrounds the humeral head in the shoulder joint.
Cervical disc issues such as a herniated disc and nerve impingment can cause referred pain into the shoulder as well as numbness and weakness into the arm. Arthritic changes to the shoulder (glenohumeral) joint or to the acromioclavical joint can also cause shoulder pain that mimics swimmers shoulder. Thoracic outlet syndrome, which is entrapment of the blood vessels or nerves in the shoulder can also cause shoulder pain
What should I do if my shoulder starts to hurt?
If you are starting to notice shoulder pain either during or after swimming, its important to address the issue sooner rather than later. While you might be tempted just to swim thru the pain, you make end up doing more long-term harm to the shoulder and ultimately, your triathlon training.
Assess your swim volume and intensity since poor form, a sudden increase in swim volume, or a change in swimming stroke technique can exacerbate the condition. If you notice that the pain comes on towards the end of a swim workout, consider changing your swim workout to either a slower pace or giving yourself more time between swim sets to better recover. Muscle fatigue can lead to changes in swimming stroke mechanics. Finally be sure to concentrate on your swimming stroke, with a high elbow and smooth hand entry into the water as well as proper hip rotation thru the catch portion of the stroke to prevent impinging the shoulder joint.
Stretches for Swimmers Shoulder
Stretching before and after your swim workouts can help prevent swimmers shoulder, or help prevent the pain from getting worse and limiting your future swim workouts.
Best Stretches for Swimmer Shoulder Pain
- Pectoralis stretch (The Doorway or Stop Sign Stretch
- Thoracic spine mobility (with a foam roller)
- Shoulder External Rotators Stretch
- Lats Stretch
Pectoralis stretch (The Doorway or Stop Sign Stretch
It’s important to focus on stretching the pectoralis (chest muscles) since tightness in the chest muscles can pull the shoulder forward and increase the risk of shoulder impingment. This forward shoulder posture can also lead to the poor scapular movement that can also lead to swimmers shoulder pain.
The Pectoralis Stretch is usually done in a doorway with the shoulder and elbow at a 90 degree bend. The one problem with the doorway pectoralis stretch is that most athletes only stretch one side at the time. This one-sided pec stretch can put a lot of torque and stress across the shoulder joint instead of stretching the pectoralis major and minor muscles. I prefer performing the pec stretch in a corner with both arms on each wall as you lean into the corner.
You should feel the stretch in the chest instead of the shoulder joint. You can slide your arms up and down the wall to change to focus of the stretch on different parts of the chest muscles. A stretch with the arms lower will target the upper pectoralis major and pectoralis minor while moving the arms higher will focus the stretch on the lower fibers of the pec major muscle.
Thoracic spine mobility (with foam roller)
Mobility and rotation of the thoracic spine are important for a proper swim stroke as well as decreasing stress across the shoulder joint. The focus of your foam rolling should be on the upper back (thoracic spine) and not the lower back (lumbar spine).
Shoulder External Rotators Stretch
The external rotator stretch focuses on the smaller rotator cuff muscles (supraspinatus, infraspinatus and trees minor) that help externally rotate the shoulder. Since the shoulder spends a majority of the swim stroke mostly in internal rotation, there is added stress on the external rotator muscles since they are in a lengthened position and also at risk for impingement under the acromion.
Stretching of the upper back (latissimus dorsi) can also help prevent the pain from swimmers shoulder. The lat stretch is probably one of the more overlooked stretches for any overhead athlete, especially triathletes and swimmers. Proper stretching of the lats requires making sure to put the lats under tension while lengthening the lats with the arm in an overhead position, dropping the hips and rotating the spine.
When to see a sports medicine specialist
If you have been doing these four shoulder and upper body stretches for several weeks and you’re still having shoulder pain when swimming, its probably time to see your sports medicine specialist to get an accurate diagnosis of what’s causing your shoulder pain.