As the spring arrives and summer approaches, pools and beaches will re-open — but is your winter body ready for those summer splashes? Swimming is one of the most popular outdoor activities, and with the Olympics right around the corner, it’ll be top of mind.
Eighty million Americans participate in recreational and competitive swimming each year, and along with exercise and enjoyment, injuries can transpire. Of all the anatomical joints in the body, the shoulder is most susceptible to injury. Unlike a single traumatic occurrence or event that may arise in a sport like football, injury to the shoulder and more specifically, the rotator cuff, is a consequence of overuse with swimming.
Sports medicine authority Dr. Scott Rodeo, a former competitive swimmer at Stanford University and surgeon at the Hospital for Special Surgery in New York — who’s also the New York Giants’ head team physician, plus team physician for USA Swimming — expressed his concern about swimming injuries. “An injury that transpires for many of our national swimmers is shoulder tendinitis,” he says. “Tendinopathy of the rotator cuff musculature is primarily an overuse-type syndrome, as the athlete is traditionally required to swim high volumes of prescribed yardage during practice.”
[See: 8 Lesser-Known Ways to Ruin Your Joints.]
Related to this high volume of strain, the arm is repeatedly positioned above the horizontal line during swimming strokes, which are a contributing factor to rotator cuff pathology and, more specifically, “impingement syndrome” of the shoulder. Impingement syndrome occurs when the rotator cuff tendons become “impinged” between boney anatomical structures of the shoulder, i.e. the coracoid as well as the acromion.
“There may be more subcorocoid vs. subacromional type shoulder impingements due to the internally rotated and forward flexed position of the shoulder and arm that occurs with each repeated swim stroke” Dr. Rodeo says. He recommends that appropriate rotator cuff and scapula strengthening exercises, with emphasis on the serratus anterior and subscapularis muscles, be performed during both the on- and off-season. This will help reduce the adverse effects of fatigue that occur with prolonged swimming practice and training.
Rodeo continues: “Many swimmers have an acquired shoulder joint capsule laxity that transpires with repetitive swimming over time. This is analogous to the shoulder adaptations that emerge in the young competitive baseball pitcher. This acquired laxity may enhance competitive performance, but may also set the table for shoulder injury — thus enhancing and maintaining strength levels of the scapula and rotator cuff muscles is important.”
Injuries to the shoulder are not limited to young competitive or recreational swimmers. Middle aged and older swimmers are prone to shoulder injury as well. “I see many middle aged and older swimmers in my practice with shoulder pathology as well. Older individuals with mild wear and tear (i.e. osteoarthritis, rotator cuff fraying) at the acromioclavicular and gleno-humeral joints who perform excessive swimming arm cycles without the appropriate level of shoulder strength may be setting themselves up for an overuse type injury,” Rodeo says.
[See: Osteoarthritis and Activity: Walking It Out.]
As in any competitive sport, adolescents also need to be screened for physiological appropriateness, especially when the adolescent is progressing to a higher level of competition. The sport of swimming is no different, as proper coaching and observation is imperative, especially at the younger age levels. “Be wary of the young athlete who has outgrown their body,” Rodeo says. “The coach should also be aware of individual vulnerabilities such as the lack of swimmer experience, low strength levels and poor swimming technique. It is vital to monitor swimming yardage in these young individuals to avoid injury.”
Shoulder injuries are not the only concern with swimmers. The presence of spondylosis, a painful condition of the lower spine due to the associated repetitive low back extension is also present in swimmers, especially those participating in the butterfly stroke. Rodeo emphasizes the importance of CORE strengthening to assist with spine stability during repetitive stressful swimming activities.
Whether swimming in the pool or at the beach, steps may be taken as a precaution to prevent the possible injury that may occur with participation. Rodeo recommends the following guidelines to assist in a pain-free and enjoyable swimming season experience:
— Establish and maintain an off-season training and in-season scapula, rotator cuff and CORE strengthening program with suitable exercise selection and appropriately prescribed exercise intensity (weight) and volumes (repetitions).
— Monitor the swimming yardage performed in daily practice to avoid overuse-type injuries.
— Swimming athletes should be adequately recovered between prescribed high volume swimming sessions and competitive swimming meets.
— Coaches should take into account each individual swimmer’s differences including skill levels, physiological and strength levels, and age of the competitive swimming athlete.
— Young swimmers progressing to a higher level of competition should particularly be monitored during training and the competitive season.
— Older swimmers should maintain their shoulder and scapula strength levels to avoid the exacerbation of any shoulder pathology that may possibly be present.
— Competitive swimmers, as with any competitive athlete, should partake in an off-season to assist with recovery.
[See: The 10 Best Exercises You Can Do for the Rest of Your Life.]
Water activities, including recreational and competitive swimming, are healthy undertakings enjoyed by millions of Americans annually. Not every swimmer will be injured during their time in the water; however, the guidelines above may assist in the prevention of possible injury for continued swimming participation and enjoyment.
Robert Panariello MS, PT, ATC, CSCS, is a founding partner and Chief Clinical Officer at Professional Physical Therapy. He has bachelor degrees in physical therapy and physical education/athletic training from Ithaca College in New York. He also holds a master’s degree in exercise physiology from Queens College in New York. Rob has more than 35 years of experience in the related fields of physical therapy, athletic training, and the performance enhancement training of athletes. He has published and lectures nationally on these related topics as well as consults to collegiate and professional athletes, coaches, and teams across the country. Rob previously held the positions of Head Strength & Conditioning Coach at St. John’s University of New York, the World league of American Football NY/NJ Knights, and the WUSA NY POWER Woman’s Professional Soccer League. He was the recipient of the American Physical Therapy Association (APTA) Sports Physical Therapy Section 2015 Lynn Wallace Clinical Educator Award and was one of the initial inductees into the USA Strength and Conditioning Coaches Hall of Fame in 2003.
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