Many triathletes turn to the pool when the legs pick up niggles and strains. But what happens when the shoulder goes too? With competitive swimmers executing up to one million shoulder rotations per week, swim injuries are becoming more commonplace. But there are things you can do to help yourself.
By Nathan Koch
When dealing with an overuse injury, typical triathlete might not be able to ride or run, but can find solace in the fact that he can at least continue to swim. This gives one a chance to work on swim technique and maintain some level of fitness. But what happens when an injury affects the shoulder?
In triathlon training, the most common shoulder injuries are swimming-related overuse injuries and shoulder separations or fractures suffered in bike crashes. Beware of what we call the double whammy, an overuse shoulder injury that occurs because your swim volume has increased as a result of a lower extremity injury that doesn’t allow for running and cycling. The double whammy has been known to destroy the psyche of the most mentally tough triathletes.
If an overuse injury in swimming occurs in the shoulder, it typically develops over time and is related to a sudden increase in volume or faulty stroke mechanics. A study by Kammer and Young in the Physician Sports Medicine Journal reported that competitive swimmers train 10,000 to 20,000 metres per day, using primarily the freestyle arm stroke. At an average of eight to 10 arm cycles per 25 metres, a swimmer completes more than one million shoulder rotations each week. While the typical triathlete may not train with that much volume, you can understand the necessity of maintaining body balance and symmetry within your stroke to avoid injury.
Like most overuse injuries, swimmer’s shoulder is avoidable with a keen sense of early symptoms, preventive training and instruction in proper technique. Early recognisable symptoms are generalised soreness or ache. It may progress to a sharp pain or popping in the shoulder that limits daily activity as well as swim workouts. Overuse injuries of the shoulder are typically described as anterior or posterior impingement syndrome, rotator cuff or bicipital tendinosis/tendinitis, bursitis, glenohumeral instability or labral tear.
Here are five exercises that create balance within the shoulder complex and utilise the core:
1. SIDE PLANK WITH SHOULDER EXTERNAL ROTATION WITH DUMBBELL.
First, get into a side plank position with your weight resting on your forearm. Keep your head, neck, spine and legs in a straight line. Your top arm should be bent to 90 degrees. Place a rolled towel between your arm and body to ensure proper alignment. Using a light dumbbell (0.5 – 3 kg), raise and lower your arm. Perform two sets to fatigue.
2. “T” ON THE BOSU OR PHYSIOBALL WITH BACK EXTENSION.
Rest your abdomen over a Physioball. Keep your back extended and core tight. Place your arms straight down in front of you in the start position. Raise your arms to form a “T” while pinching your shoulder blades together. Keep your head and neck in line with the rest of your spine. Slowly lower your arms back to the starting position. Perform two sets to fatigue.
3. HALF FOAM ROLLER SCAPULOTHORACIC STRETCH.
Place a foam roller perpendicular to your spine and across the shoulder blades. You can use a pillow under your head for support. Raise both arms over your head and keep your elbows as close to your ears as possible. Hold the position for five seconds and repeat 20 times. There shouldn’t be pain—you should only feel stretching in the spine and shoulders.
4. DYNAMIC GLUTE WITH SHOULDER D2 FLEXION.
Stand on one leg, then lower your body into a single-leg squat without letting the knee dip inward. Keep your chest high and slowly stand while executing upper extremity movement. Place your hand at your belt-line with a rolled band facing toward the ceiling. Begin the arm movement with the active arm straight near the stationary hand. Slowly move the arm diagonally across the body and above the head just outside of the shoulder. Keep the motion slow and controlled. Keep the thumb of the moving arm pointing in the direction of the movement at all times. Perform two sets to fatigue.
5. 45-DEGREE CRUNCH HOLD ON PHYSIOBALL WITH REVERSE FLY.
Sit with your lower back supported by the ball and your torso at a 45-degree angle to the ball while keeping your head back. Keep your elbows straight, hands shoulder-width apart and hold onto a resistance band. While keeping your arms straight, slowly bring hands straight out and back until arms are perpendicular to body. Keep the motion slow and controlled. Perform two sets to fatigue.
The final key ingredient in preventing swimmer’s shoulder is stroke analysis. While there are different theories on proper freestyle stroke technique, stroke assessment can be critical to determining the cause of an overuse injury in swimming. An educated swim coach with significant video analysis experience can be extremely helpful by providing the education necessary to reduce stress on the shoulder while increasing efficiency in the water. A slight breakdown in the chain of movement can create abnormal stress on the shoulder over those millions of shoulder rotations, resulting in an injury. Possible contributors to shoulder injury in the swim stroke are hand entry that crosses the mid-line, thumb-down entry, asymmetric body roll and unilateral breathing. As in cycling and running, body symmetry and balance in swimming are crucial to efficiency and reducing injury risk.
In the event that your shoulder injury has progressed past the point of self-help techniques, the next step is seeking the proper medical care. Expect a thorough review of your injury and swimming history, assessment of shoulder/ scapular mechanics and strength, and specific testing to rule out neck issues.
Always inform your practitioner of all previous injuries since the whole human body has to work in harmony during your swim stroke.