Shoulder injury is highly prevalent among elite swimmers. It occurs due to microtrauma caused by repeated overhead movements and high training load and is often described as an overuse injury.
Shoulder pain is the most reported musculoskeletal injury in swimmers, often referred to as the swimmer's shoulder(1-3). Swimmer's shoulder occurs due to pathology in the shoulder's anterior lateral aspect, often but not always confined to the subacromial region(4, 5). The conditions associated with this condition include impaired posture and increased glenohumeral joint mobility, decreased neuromuscular control, or hampered muscle performance(4, 5). Mechanical factors influencing this pathology include overuse, misuse, abuse, or disuse(4, 6). In few advanced cases, swimmers with this condition may even have the pathology of the rotator cuff, long head of the biceps, or glenoid labarum(5-8).
Is it common among swimmers?
The most common musculoskeletal pain reported in swimmers is shoulder pain. Prevalence of disabling shoulder injury in competitive swimmers ranging from 27% to 87%. The shoulder injury prevalence rates among swimmers have increased over time; it was 3% in a study published in the year 1974, 42% in 1980, 68% in 1987, 73% in 1993, 40-69% in 1994, and 5-65% in 1996(1, 8-12). A more recent study conducted by Sein et al. in the year 2008 reported a 91% prevalence of shoulder pain in swimmers(5).
Why does it occur?
Biomechanics of swimming constitute overhead movement involving continuous humeral circumduction(rotation) in clockwise and anticlockwise directions. At the same time, the shoulder is minimally internally rotated and excessively externally rotated while the scapular is protracted and retracted(4). A competitive swimmer does an average of 4000 strokes per arm in a single workout session, leading to excessive strain on the shoulder(4).
Over time, the swimmer may develop the swimmer's shoulder due to intrinsic factors such as abnormal acromial morphology or tight posterior capsule, which leads to primary sub-acromial impingement(13, 14). Alternatively, it could occur from a series of impairments, which often arises due to an increased anterior glenohumeral laxity which results in secondary acromial impingement(1, 15, 16). Extrinsic factors contributing to this pathology include training overuse, misuse, abuse, or disuse(5, 6, 16).
Watch this space to find out more about the swimmer’s shoulder.
Dr Sneha T
MBBS, M.Sc. Sports Medicine (UK)
References
1. McMaster WC, Troup J. A survey of interfering shoulder pain in United States competitive swimmers. Am J Sports Med. 1993;21(1):67-70.
2. Walker H, Gabbe B, Wajswelner H, Blanch P, Bennell K. Shoulder pain in swimmers: a 12-month prospective cohort study of incidence and risk factors. Phys Ther Sport. 2012;13(4):243-9.
3. Weldon EJ, 3rd, Richardson AB. Upper extremity overuse injuries in swimming. A discussion of swimmer's shoulder. Clin Sports Med. 2001;20(3):423-38.
4. Tovin BJ. Prevention and Treatment of Swimmer's Shoulder. N Am J Sports Phys Ther. 2006;1(4):166-75.
5. Sein ML, Walton J, Linklater J, Appleyard R, Kirkbride B, Kuah D, et al. Shoulder pain in elite swimmers: primarily due to swim-volume-induced supraspinatus tendinopathy. British Journal of Sports Medicine. 2010;44(2):105-13.
6. Hill L, Collins M, Posthumus M. Risk factors for shoulder pain and injury in swimmers: A critical systematic review. Phys Sportsmed. 2015;43(4):412-20.
7. NEER CS. Impingement Lesions. Clinical Orthopaedics and Related Research®. 1983;173:70-7.
8. Allegrucci M, Whitney SL, Irrgang JJ. Clinical implications of secondary impingement of the shoulder in freestyle swimmers. J Orthop Sports Phys Ther. 1994;20(6):307-18.
9. Kennedy JC. Swimmer's Shoulder. Phys Sportsmed. 1974;2:34-8.
10. Richardson AB, Jobe FW, Collins HR. The shoulder in competitive swimming. The American Journal of Sports Medicine. 1980;8(3):159-63.
11. Johnson JE, Sim FH, Scott SG. Musculoskeletal injuries in competitive swimmers. Mayo Clin Proc. 1987;62(4):289-304.
12. Bak K. Nontraumatic glenohumeral instability and coracoacromial impingement in swimmers. Scand J Med Sci Sports. 1996;6(3):132-44.
13. Greipp JF. Swimmer's Shoulder: The Influence of Flexibility and Weight Training. The Physician and Sportsmedicine. 1985;13(8):92-105.
14. Ozcaldiran B. A relation between static flexibility and shoulder pain in competitive age-group swimmers. The Pain Clinic. 2002;14(2):159-63.
15. Bansal S, Sinha AK, Sandhu J. Shoulder impingement syndrome among competitive swimmers in India - prevalence, evaluation and risk factors. Journal of Exercise Science & Fitness. 2007;5:102-8.
16. Tate A, Turner GN, Knab SE, Jorgensen C, Strittmatter A, Michener LA. Risk factors associated with shoulder pain and disability across the lifespan of competitive swimmers. J Athl Train. 2012;47(2):149-58.
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