January 25th, 2013

Health N' Sports: Common Swim Injuries

Staff Report

Health N' Sports: Common Swim Injuries
photo courtesy of 1vigor.com

 Louisville Orthopaedic Clinic shares insight on recovery

As a part of the Louisville Orthopaedic Clinic, the Sports Rehab Team physical therapists are knowledgeable and trained in the latest advancements and techniques available in sports rehabilitation.


On a weekly basis, the Health N’ Sports Update will give information on prevention, recovery, and include special offers, as well as general health tips that would be beneficial to all. If there is a specific topic you’d like to know or hear more about, email future suggestions to editor@catholicsportsnet.com.


Feature by: Jordan Tinnell and Comments by Mercy Academy Head Swim Coach Aaron Cooper

Swimming involves repetitive overhead movements that cause people who swim on a consistent basis to be more susceptible to shoulder pain.  Elite swimmers on average perform up to 2,500 repetitions of overhead shoulder revolutions per day (5).  Research suggests that shoulder pain can occur in up to 73% to 91% of swimmers at some point during training (1, 2).  The phenomenon behind this sports prevalent injury history has been researched extensively, but the exact mechanism behind the injury is not clearly known. 

Cooper’s comment on swimming injuries: “The most common injuries that I have seen from being around the sport of swimming over the last 15ish years are a lot of shoulder injuries, especially shoulder tendonitis. The main cause of shoulder soreness is that swimming puts a great deal of stress on your shoulders, a lot more stress than many of the other sports.  Swimmers put pressure on their shoulders with every stroke that they take.  Compound that with the fact that they take a couple thousand strokes every time they practice, those types of things add up very quickly.”


Risk Factors

Early research suggests that joint laxity due to repetitive and forceful overhead activity, resulting in the stretching of the joint capsule, is the primary suspect behind shoulder pain in swimmers (3).  This research has been the basis of shoulder strength and stabilization protocols for swimmers, but recent evidence has suggested another proposed mechanism of shoulder pain.  Supraspinatus tendinitis is described in more recent research, as a more reliable source of pain in swimmers (2).  The Supraspinatus tendon is 1 of 4 rotator cuff tendons that help with shoulder stability.  In a study using 52 elite swimmers, 69% showed evidence of some level of supraspinatus tendinitis and 5% showed some type of labral involvement(3).  Research has also suggested that swimmers with a history of shoulder pain, or extremely low/high end points in their range of motion are more susceptible to shoulder injury.  Also, postural factors may play a risk including rounded shoulders or an increased forward head angle (4).


Shoulder strength and stability training should incorporate not only scapular therapeutic exercises, but also rotator cuff strength and stability.  These exercises can be shown to you by your orthopedic Physician or Physical Therapist. With the prevalence of shoulder injury in this sport, a shoulder resistance training program should become standard in swimmers of all ages and be considered just as important as time spent in the pool.  Also, swimmers should keep in mind volume.  Just like a baseball pitcher keeps a pitch count to prevent being over worked, swimmers should be regulated on a similar scale to prevent over training.

Cooper’s comment on prevention: “There are a couple of things that I have my swimmers do to help prevent shoulder issues.  One of the things that we do is that we try and develop the shoulder muscles as much as possible.  There are two ways that we try and accomplish this task.  First, we try and stretch before practice to loosen up the shoulder muscles before we get in the water.  We also do some shoulder exercises in our dry land workouts to try and build the shoulder muscles up.  Another way that we try and prevent shoulder injuries at Mercy Academy is that we really focus hard on having good stroke technique in the water.  We have some swimmers who have been swimming for many years and we also have those who are new to the sport.


From the very start of the season, we really focus hard on their stroke techniques and develop good stroke habits to try and limit the stress the athletes are putting on their shoulders.  I believe that having proper stroke technique is the easiest and most effective way to preventing injuries and limiting the pressure that swimmers put on their shoulders.  These are the ways that we try and prevent injuries from happening in the first place.


If an injury does occur, our swimmers will go see the trainer. We can work out the best recovery program for them, whether it is ice the shoulder after workouts, do some extra shoulder exercises to build/loosen the shoulder muscle, or simply rest the shoulder for a while.”


Louisville Orthopaedic Clinic & Sports Rehab Center

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Physical Therapy: 502-897-1790


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(1)             McMaster WC, Troup J. A survey of interfering shoulder pain in United States competitive  swimmers. Am J Sports Med 1993;21:67–70.

(2)             Sein, M.L., Walton, J., Linklater, J., Appleyard, R., Kirkbride, B., Kuah, D., Murrell, G.  Shoulder Pain in Elite Swimmers:  Primarily Due to Swim-Volume-Induced Supraspinatus Tendinopathy.  Br J Sports Med 2010; 44: 105-113.

(3)              Jobe FW, Kvitne RS, Giangarra CE. Shoulder pain in the overhand or throwing athlete. The relationship of anterior instability and rotator cuff impingement. Orthop Rev 1989;18:963–75.

(4)             Lynch, S.L., Thigpen, C.A., Mihalik, J.P., Prentice, W.E., Padua, D.  The effects of an exercise intervention on forward head and rounded shoulder postures in elite swimmers. Br J of Sprts Med 2010; 44: 376-381.

(5)             Pink MM, Tibone JE. The painful shoulder in the swimming athlete.  Orthop Clin North Am 2000;31:24761.


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