There is no doubt that Swimmer’s Shoulder is one of the most common injuries competitive swimmers will ever have to deal with – and up to 35% of elite and senior level swimmers reporting Swimmer’s Shoulder that interferes with training and performance.
Ian Pope, Head Coach at the Melbourne Swimming Club, and trainer of more than 70 medallists including Michael Klim, Giaan Rooney, Matt Welsh and Grant Hackett says that while Aussie swimmers such as Michael Klim and Leigh McBean endured crushing shoulder injuries during their careers, that severe shoulder injuries in the pool, are becoming far fewer with intensive screening programs, better strength and conditioning programs as well as teaching swimmers tips to injury-proof their stroke techniques.
And a shoulder injury doesn’t have to be career-crippling either. Tokyo legend Ariarne Titmus is a case in point.
The 20-year-old felt a twinge in her upper shoulder during the 2020 State Championships, and scans revealed an injured subscapularis tendon, the largest of the four rotator muscles.
She took 14 weeks of full training to get herself in form for Tokyo; only returning to full training in March 2021, just a few months before defeating American superstar Katie Ledecky.
So, what’s the best way to prevent shoulder injuries in both experienced and amateur swimmers?
“Water is 800 times denser than air, which means a great deal more resistance for the shoulders in the water,” says Pope.
“One issue we see, and this is more in inexperienced swimmers is crossing that all important midline – the invisible line through your body. You really need to make sure you don’t cross over to the opposite side when your hand goes back in the water.
“With more experienced swimmers, leading with the elbow will aggravate the shoulder. It’s really important to keep the elbow above the hand when pressing backwards and not fall into “struggle stroke” where the elbow drops in the pulling pattern.”
“All of these things can seriously impact the biomechanics of the shoulder so it’s important to train the shoulder to work the best neuromuscular pathways to prevent injuries and train the shoulders to be strong with technique.”
A recent study reported to the American College of Pediatrics National Conference found that 76.7% of adolescent high school and youth club competitive swimmers suffered from shoulder injuries in the past 12 months – often because of excessive distance training, and a “culture that sublimates pain” the authors found.
At least half of the swimmers had peers who medicated for their shoulder pain and 66% said “shoulder pain should be tolerated” if they wanted to become successful swimmers.
“Thankfully, I’m not seeing these numbers today,” says Pope.
“Our focus at MSC is for swimmers to get medical help and advice for pain right away – not months down the track. In fact, I think I may have only seen one really bad shoulder injury in the last two years, and I think technique training is a big part of shoulder injury prevention.”
Shoulder, elbow and knee Surgeon Dr Jonathan Herald, who has worked with elite athletes such as Adam Ashley Cooper through “accelerated recovery programs”, agrees that shoulder injuries are the most problematic joint for swimmers.
“The shoulder is our most mobile, yet least stable joint. Because it has such a tremendous range of motion, this makes the shoulder inherently less stable, and it is generally more prone to injury and dislocation than our other joints.
“And because swimming involves so much shoulder work, Swimmer’s Shoulder (impingement syndrome) is very common. It usually involves pain that radiates along the back of the shoulder and neck, sometimes felt at the front, and worsens with overhead reaching or reaching behind the back.
“Usually, it can be treated conservatively, and swimmers can be back in the water in 2 to four weeks. But it’s important to train with a plan that prevents further injury, as the general healing time is three to six months to heal completely, or longer in severe cases.”
He uses the accelerated recovery program for athletes and injured workers alike, and has also recently joined a chorus of medical experts in endorsing accelerated recovery to help cancer patients “get back to exercise”, rather than staying wrapped up in cotton wool after cancer treatment.
“Getting back in the game quickly after an injury is important. The key is knowing when to stop and when to start.
“If you have a shoulder injury it’s important to assess and treat quickly. If you get back in the pool without a proper recovery, (e.g. it still hurts and isn’t getting better), you risk further damage or possibly tearing a rotator cuff.”
“Anti-inflammatories often help but you need to take the full course, not just two or three tablets or the pain will rebound.”
He said the good news is that with accelerated physiotherapy often works effectively, and when surgery is occasionally needed, many athletes can recover even before a big event like the Olympics.
“The worst thing you can do is bury your head in the sand or hope it’s a niggling thing that will go away. Anything that is painful or where there is a loss of range of movement for more than a few days, needs to be seen by a doctor.”
On the upside, Herald says often what an athlete thinks is career-damaging may not actually be as bad as they think.
“Swimming is a whole-body activity and a weakness in other parts of the body means extra load for the shoulders, so while training volume (overuse) maybe an issue, sometimes it’s simply overload, which is often easily fixable.
“The underlying culprits for this could be a weak core, a stiff neck, or weak scapular muscles that surround and support the shoulder blade.
“The athletes who get scans quickly, get the physio and psychologically adjust their goals based on their rate of progress during the rehabilitation process always report feeling more successful during their return to sport than those who do not adjust their goals.
“It’s also important to stay positive and keep thinking ‘wellness,’ not ‘illness’.
“Quite often athletes will tell me that injuries have been their best teachers.”
MSC President David Brandi, said that MSC would soon be expanding its services to the City of Yarra’s Richmond Recreation Yard 50m pool, which would encourage “learn to swim” graduates, to be part of a swimming club that would assist with coaching technique and swimming techniques to prevent injury.
“For our elite athletes it will provide new opportunities to train in both 25m and 50m pools.
“For the Yarra community, currently learn to swim graduates have nowhere to go. So, this provides a pathway for little kids to join a club and be part of a squad.”
- Recover from frozen shoulder, swimmer’s shoulder, shoulder injury, or shoulder surgery using common household objects – Dr Jonathan Herald Shoulder Surgeon
- Three shoulder protecting exercises to do in the pool – Bob and Brad Physiotherapists
- How strengthening and conditioning can fix wonky shoulders – Alan Thrall