The Importance of Posture in Preventing Swimmer’s Shoulder
Taylor Millican, PT,DPT,ART
The holiday season is a time for family, friends, parties and (over) eating for most. For the competitive swimming community it’s a little bit different. If you are a Male high school swimmer you are in that lovely time of year that we shall just call “HECK” week. Which means two-a-day practices Monday-Friday and long Saturday practices because you have no school to work around on winter break! For the age group athletes and female high schoolers, just coming off their season, it is also the time to increase their yardage and time in the pool to prepare for the upcoming winter and spring short course seasons. It is common during this ramp up period that shoulder injuries increase. I often get questions on why this happens and how to prevent this condition from reoccurring.
“Swimmer’s Shoulder” (SS) is a condition that occurs from mechanical (physical) impingement between the soft tissues and the bony coracoacromial arch (the bone bridge formed from the shoulder blade). It’s the chronic inflammation of the Supraspinatus muscle of the rotator cuff, the long head of the Bicep, and the Subacromial bursae that are the structures typically involved. Pain is usually deep in the front of the shoulder and is increased with overhead positions and at night. Obviously, not all swimmers get this injury but it affects a high proportion of athletes, possibly up to a 1/3 of swimmer’s during their career. It’s cause is repetitive in nature. It is estimated that swimmers can complete up to 16,000 revolutions per week. Do the math that’s a lot of reps! To put it in perspective a high level baseball pitcher does on average 1,000 pitches per week. While there are factors that can predispose athletes to this condition such as, hypermobile, unstable or "lax” joints, most of the factors are very preventable.
The most controllable factor in SS is posture and scapular-thoracic positioning. Weak scapular stabilizers (Serratus Anterior and Middle and Lower Trapezius) lead to the forward “slouch" that is seen in most adolescents. The problem is this position brings the delicate soft tissues into contact with the bony acromium and can irritate the soft tissue. Without proper scapular positioning overhead shoulder motion is compromised as well. Overhead motion is made up of 180 degrees; 120 degrees from the glenohumeral joint (shoulder) and 60 from the scapulothoracic joint (shoulder blade and rib cage joint). If the scapular rotators are not strong enough to rotate the scapula up, the only available motion will be from the shoulder itself and be limited by a significant amount. This will lead to altered strategies to force the arm overhead—often the neck and lower back with swimmers.
High yardage or base building is often necessary at the beginning of a season. When dealing with younger swimmers it is important to monitor athletes for changes in their strokes to avoid over fatigue and stroke compensations. Slow increases in training loads and intensities are critical. Training paddles and extensive pulling sets are not typically suggested for younger athletes as this puts to much stress on the underdeveloped adolescent shoulder. Avoiding unbalanced strength development can also be helpful by mixing in strokes other than freestyle to aid in over development of anterior structures.
A dryland program that incorporates scapular and core strength, pectoral stretching, posterior cuff stretching and thoracic (mid back) mobility is crucial for swimmers. Often it is hard to find time or even space to fit this into a busy practice schedule but even at a few times a week it is a great prevention strategy for avoiding this injury.
Taylor Millican is Achieveʼs Endurance Sports Medicine Physical Therapist. Taylor has an extensive competitive aquatic background, swimming and water polo, and has also completed in short and long distance triathlons, road races and marathons. Her hobbies include triathlon, swimming, running, golf, reading, and following University of Michigan athletics. Her professional interests are pediatric and adult athletic injury, endurance sports medicine, performing arts medicine and surgical rehabilitation. Taylor works out of both Achieve Sports Medicine clinics, Naperville and Burr Ridge. If you would like to schedule an appointment with Taylor, please call the appropriate clinic.