Swimmer's shoulder overload symptom

When swimming, the shoulder joint in particular is exposed to the greatest stress intensity due to the different swimming styles such as crawl, dolphin, backstroke and breaststroke. Overload and non-functional loading (usually due to incorrect technique) can quickly cause pain in this complex joint structure. In this article, orthopaedist and sports physician Uli Nieper shows the causes and treatment options for the so-called swimming shoulder.

If the technique is incorrect and if the circumference is increased too quickly and too much, certain anatomical structures will be overstressed and painful inflammation will occur. One-sided training and too little gymnastics and stretching exercises can also lead to muscular imbalances (imbalance of strength) in the various muscle groups. Instability of the shoulder joint through years of training with recurring expansion of the shoulder joint capsule (this holds the humeral head together with the shoulder joint socket) can also lead to stress-related pain.

Impingement syndrome: Pain in the bursa and tendon

The most common injury in swimming, especially in front crawl and dolphin swimming, is the so-called impingement syndrome. Here, the maximum lifting (abduction) and external rotation of the arm causes the bursa between the head of the humerus and the acromion (acromion) to be slightly pinched together with the tendons of the supraspinatus muscle (abducts the arm all the way up). Training stretches that are too long or increasing the intensity too quickly combined with poor technique also lead to inflammation of the bursa or the supraspinatus tendon. Too high a load with oversized paddles can make these symptoms even worse.

Only train with paddles to a limited extent

The important first step after the diagnosis is to have a trainer correct the technique and reduce the amount of training. Adjusting the paddle swimming is often enough here and it is generally true that this takes up a maximum of 20% of the entire training volume. Also, the paddles should not be too big.

Common problem: the wrong sequence of movements

This sequence of movements trains almost only the internal rotation muscles and the chest muscles (e.g. pectoralis muscle), while the opponents - external rotation muscles on the back and shoulder blade (e.g. trapezius muscle) or the rear part of the deltoid muscle (deltoideus muscle) - atrophy.

Strength training in moderation

Often only the chest muscles, which have already been strengthened by swimming, are trained further during strength training, which means that the internal rotators are additionally shortened. The imbalance of forces and the shortened muscles then lead to a change in the mechanics of the shoulder joint. The head of the humerus is guided incorrectly in the joint and is no longer centered in the shoulder socket. As a result, it increasingly presses against the acromion and irritates the bursa and the supraspinatus tendon, which is why the painful impingement syndrome occurs again.

Elimination of one-sided training

The duration of stretching and gymnastics should increase in proportion to the training time spent in the water. The daily strengthening of the back muscles and the external rotators prevents any imbalances and can be achieved by exercises with the rubber band (also called THERA-Band).

Don't ignore imbalances

While imbalances can still be corrected through targeted training, chronic instability of the shoulder joint is difficult to treat. Untreated imbalance of forces leads to overstretching of the shoulder joint capsules with their ligament parts (ligamenta glenohumeralia), which is why the humeral head is no longer stable in the shoulder joint socket. The result is the unilateral use and stretching of the cartilage lip (labrum), which is normally intended to stabilize the humeral head. The labrum can then tear or be sheared off. Medically, this is referred to as a SLAP lesion, which can be divided into several degrees of severity depending on the size of the tear. It becomes noticeable in athletes through the "snapping phenomenon" when moving the shoulder, which is usually accompanied by pain. Here, too, the instability again leads to the impingement syndrome, although a SLAP lesion can be diagnosed by clinical examinations by experienced physicians. If there is any suspicion, an additional MRI examination is also recommended.

Last option: the surgery

If the "swimmer's shoulder" is diagnosed, the first step should be targeted sports physiotherapeutic treatment combined with muscle building training. A training break and/or reduction/change of the training content is also a matter of course. If these measures are still unsuccessful, the only option is surgery. Here, an arthroscopic intervention can stabilize and fix the labrum again and a stretched shoulder joint capsule can also be tightened again. However, such an operation should only be performed in a specialist center for shoulder arthroscopy by experienced surgeons. To be on the safe side, the diagnosis should be made by an orthopedist or sports physician who knows and understands both swimming styles and the associated movements, and who is confident in the shoulder examination. If the symptoms have been present for a long period of time, an MRI examination can also help to avoid misdiagnosis.

Final tip from the expert

If shoulder pain occurs for the first time during training, it should not be ignored, but taken seriously. Immediately take a short break, stretch, and then continue at ease. If the pain is still there, it is best to stop training for today and take a break of several days. During this exercise, you should do the above-mentioned exercises to strengthen the external rotators and only then continue with the training, initially with a low intensity and scope.