Ask the Coach - Swimmer's Shoulder Prevention (Recovery to Follow)

Shaun J. from the Twin Cities asks "What's the best plan for recovering from and preventing swimmer's shoulder?"

That's a really timely question as a lot of triathletes are making their way back into the pool after taking some time off.  There's a real temptation to try and pick right up where you left off last season.  "I was swimming 2,500 - 3,000 in my workouts last year so I'll do that again."  Couple the inevitable loss of swim fitness and stroke degradation from the time off and it's a recipe for disaster.  That disaster has a name, and it is swimmer's shoulder.

Before we get to prevention and recovery, we should probably talk about what swimmer's shoulder is. 

Your shoulder joint is stabilized by a group of small muscles which together are called the rotator cuff.  The long head of the biceps tendon also helps stabilize the shoulder joint.  Swimmer's shoulder is the result of inflammation in these muscles and tendons from overuse. 

The inflammation and resulting shoulder instability can cause impingement (pinching) of the biceps tendon.

This pain is typically felt during the early to mid-pull part of the catch phase of the front crawl.  It can also occur during the adduction phase of the recovery (when the elbow moves away from the body).

Initially it presents as a dull ache during training which goes away after awhile.  Eventually the pain may persist and increase in intensity - impacting the athlete's sleep and non-swimming activities.

Prevention

Like most overuse injuries the best treatment is to avoid getting the malady in the first place.   The two root causes of swimmer's shoulder are increases in training volume and poor technique.   Too rapidly increasing your training volume requires the stabilizing muscles to continue to work in a fatigued state.  As you tire, your stroke technique tends to degrade requiring more strokes/lap which causes additional inflammation.

Avoiding excessive volume increases is the simpler of the root causes to eliminate.  The old standard of increasing no more than 10% per week applies to swim training as well as the bike and run.  This is particularly true when getting back in the water after a break.  Caution is advised.  There's plenty of time before the season starts.  That extra 5x100 with 5 seconds rest isn't going to make your season, but it could push you over the edge into over training and wreck your season.  Using hand paddles or gloves can quickly cause over training type fatigue in your shoulder and should be used judiciously.

Muscle imbalances also increase shoulder instability.  Triathletes are particularly susceptible to developing muscle imbalances since we focus almost exclusively on freestyle.  Maybe we throw in some breast stroke to warm up and cool down.  Adding some backstroke and even "gasp" butterfly will make you a more rounded swimmer and help prevent swimmer's shoulder.  It also will help prevent the dreaded freestyler's hunched posture - which the aero  position on the bike also contributes to.  The backstroke is a particularly effective stroke for catching your breath during a race. 

Poor technique is a harder cause to eliminate - but with proper guidance (dare I say coaching), patience and hard work, your stroke will improve.  Stroke issues that can cause impingement include hand crossing the mid-line of the body upon entry, having your thumb down upon entry, single sided breathing, and inadequate body rotation.

Many swimmers crossover upon entry.  Not only is this an inefficient stroke (it's like putting the brakes on every time your arm enters the water), but it puts greater stress on the shoulder joint.  One trick to avoid the crossover is to think of your arms tracking on parallel lines on each side of the black line on the bottom of the pool.  If you've been crossing over in past and now it feels like you're making the "Y" in YMCA, you're probably doing it right.

A thumb down hand entry causes great shoulder rotation and increases stress on the joint.  Focus on flattening your hand as it knifes into the water on entry.

Most of us have a favored side for breathing.  Some breath exclusively on that side.  This puts your other shoulder at risk as it must work harder balancing and maintaining forward motion while your head is turned.  Bilateral breathing spreads this load between both shoulders.  The best way to become a bilateral breather is to force yourself to breathe on your offside.  One of the drills I do every time I go to the pool is swim some 25s breathing only on my offside.  At first it felt really awkward.  With practice it gradually became more natural.

Body rotation is essential for efficient freestyle.  It utilizes core muscles rather than just pecs and lats to provide propulsion and puts less stress on the shoulder.   One drill to focus on this rotation and proper arm position is the fingertip drag drill.  Keeping your elbow high drag your fingertips along the water during your recovery.  This photo shows proper arm position with good body rotation.

 

In my next entry I'll discuss some recovery/treatment methods for dealing with swimmers' shoulder.

Thanks for the question Shaun!  Your hat is on its way.