Benjamin Franklin famously said…
“An ounce of prevention is worth a pound of cure.”
While he was referring to fire safety, it’s the best piece of advice for any swimmer when it comes to the shoulder.
The ideal solution for swimmers shoulder is to stop pain before it begins. This is done by noticing early signs of those at risk for swimmer’s shoulder. This can make prevention a priority, rather than struggling for a cure later.
Here are some early warning signs that shoulder trouble may be looming:
1. Identify Stroke Changes
Stroke modifications can occur before pain sets in and are tell-tale signs that subconscious changes are happening to avoid damage (1).
1. Elbow Drop- Most often the elbow drop is attributed to lazy swimming, or ignorance to stroke mechanics. But this is also a modification to avoid positions that are more provocative for damage.
2. Wide Hand Entry- This decreases the amount of upward rotation needed by the scapula, again a modification to avoid provocative positions.
3. Early Recovery and Excessive Body Roll- These are modifications to avoid the hyperextension needed in the recovery phase.
4. Asymmetric Pull- Drifting in the lane and changes in rhythm can all be signs of avoiding stress on one side.
If these stroke changes are observed, look for a positive test for impingement. The FMS Impingement Test is easy to self perform and a positive test is a big affirmative that swimmer’s shoulder is already en route.
To perform this test, bring your hand across the body and place the palm on the top of the shoulder.
Then elevate the elbow as high as possible looking for pain or discomfort.
2. Test Joint Laxity
With swimming comes shoulder laxity. It’s an adaptation to the sport and allows for the range of motion needed to be successful in the pool. However, it can be a problem if stability is not enough to overcome the looseness in the shoulder (1,2).
The sulcus sign is a commonly used indicator of shoulder instability that’s easy to perform. In this video I talk more about the sulcus sign as well as other signs of shoulder instability.
→ Self Screen for Shoulder Instability
Again, laxity is not an issue in itself, as long as it is accompanied by the necessary control to keep it stable. But it’s a key indicator for risk of swimmer’s shoulder and a reason to seek prevention.
3. Look for Signs of Weakness
Muscular weakness predisposes an athlete to pain. This can be related to shoulder imbalances or fatigue that sets in with training. The scap stabilizers are the key links to look for when assessing for signs of weakness (1).
To do this try the Crossover Victory Test to help pick out breakdowns in stability that may be occuring.
Start by performing 10 reps of the CS Victory Exercise before practice (you can also do this with dumbbells). Look for tight upper traps or protrusion of the scapula away from the spine.
Then after practice re-test the CS Victory for 10 reps. This is an important step because often instability doesn’t show up until fatigue sets in.
→ Watch the Victory Test
Crossover Symmetry Victory Test from Crossover Symmetry on Vimeo.
Plank Challenge
Another quick assessment is the plank. All together it’s a great indicator of strength and endurance of not just the core, but performance of the shoulder as well. A 2012 study on swimmers showed trends between poor plank performance and risk of shoulder pain (especially in younger swimmers) (3).
For an accurate assessment the plank should be held on the toes and elbows. It’s not just a test to see who can hold themselves up either, quality is important. The shoulder blades should be flat against the rib cage, and shoulders, back, and hips should be aligned.
Swimmers younger than 14 should be able to hold for at least 30 seconds, and swimmer’s high school and older want over a minute (3).
The Greatest Risk Factor of All
You may have found that you don’t meet any of these risk factors. That’s great! However, there is still the number one risk factor for swimmers shoulder that we haven’t addressed, and it’s the only one that has concrete evidence…
You are a swimmer.
You put more stress on your shoulder than any other sport and this puts you at high risk for pain. In fact, it’s been reported that 40-90% of swimmers will run into shoulder pain in their career (3).
Thus the reality is every swimmer needs some element of injury prevention for the shoulder.
Prevent Pain Before it Starts
Don’t fret these risk factors for swimmers shoulder too much. The important thing is to recognize this early and start down the path towards managing the underlying issues.
The Crossover Symmetry System develops the strength and stability in your shoulders needed to maintain proper stroke mechanics and prevent or relieve impingement issues.
Crossover Symmetry is not designed to replace your training, but is a dryland workout to complement you training program for bulletproof shoulders.
It includes programs for warming up, recovery, speed, strength, and mobility, (each program only takes 5 minutes to complete.) These programs are delivered in a complete online training and education platform, making it a complete system to end your shoulder pain and take your training to the next level.
How does Crossover Symmetry Work?
The Crossover Symmetry System is the perfect adjunct to time spent in the pool. It’s not designed to replace your training, but rather a necessary prerequisite and accessory dryland work to be incorporated into a complete training program. It includes programs for muscle activation, recovery, speed, strength, and mobility, (each program only takes 5 minutes to complete.) The Crossover Symmetry System includes a complete online training and education platform, making it a complete system to end your shoulder pain and take your training to the next level.
About Crossover Symmetry
BORN FROM SCIENCE – VALIDATED BY ATHLETES Crossover Symmetry is an evidence-based shoulder health and performance system, developed by top sports physical therapists, athletes and coaches. The programs are designed to facilitate safe and efficient shoulder mechanics in order to eliminate pain, reduce the risk of injury and optimize performance. Over 75% of Div 1 University athletic programs and thousands of rehab facilities use Crossover Symmetry on a daily basis.
References
Pink MM, Tibone JE. The painful shoulder in the swimming athlete. Orthop Clin North Am. 2000 Apr;31(2):247-61.
Hill L, Collins M, Posthumus M. Risk factors for shoulder pain and injury inswimmers: A critical systematic review. Phys Sportsmed. 2015 Nov;43(4):412-20.
Tate A, Turner GN, Knab SE, Jorgensen C, Strittmatter A, Michener LA. Risk factors associated with shoulder pain and disability across the lifespan of competitive swimmers. J Athl Train. 2012 Mar-Apr;47(2):149-58.
Swim Gear News courtesy of Crossover Symmetry, a SwimSwam partner.
Shoulder injuries, if serious like a torn tendon, must be taken very seriously. Soreness is common and requires rest. But realistically, full recovery from surgery takes 9-12 months and is tedious. I had tendon surgery in Dec and was just able to get back in the pool – gently – in April! I’ve been using the Crossover program, though, since mid-Feb [no relationship to the company] and it seems excellent, much more effective than the PT visits I had been going to. When you add the plyometric aspects the workouts can get pretty intense! But they’re convenient and I do them in my garage if there’s no time to go to the gym. The basic rotator cuff muscle exercises need… Read more »
In 1.3, do you mean that early recovery is a modification to avoid the hyperextension needed in the propulsive push phase, not the recovery phase?
Given that, not everyone agrees that early recovery (in freestyle) is a flaw in stroke mechanics.
Also, for clarity, numbering your references would help.