We treat lots of Shoulder injuries here at Cornwall Physio in swimmers and non-swimmers alike. With the Olympic games currently taking place it seemed like a great time to bring forward our very own Olympian, to give his top tips on treating and preventing shoulder pain…
Rob Bale is our Shoulder Specialist Physiotherapist here at Cornwall Physio and also has unique experience in dealing with his own shoulder injuries back in his former life as an Olympic Swimmer.
The most common issue faced by both novice and elite swimmers, has always been shoulder problems.
Here Rob gives us a unique insight into what’s involved in training to be an Olympic swimmer, the kinds of problems this can create for the shoulder joint and the steps that swimmers can take to look after their Shoulder’s.
My names’ Rob and in a former life, back before I became a Physiotherapist, I represented ‘Team GB’ at the Olympic games in London 2012. Like many swimmers, I had shoulder problems on and off throughout my career and this was actually a catalyst in me wanting to become a Physiotherapist.
Why do Swimmers Get Shoulder Pain?
Looking back to my club level swimming days as a teen, I remember my training, even then, being affected by shoulder pain. I was a Freestyle (front-crawl) swimmer, and for most training sessions the majority of those would be freestyle based. Thousands upon thousands of meters, week-in week-out, my shoulders always moving the same direction and working the same muscles in a very specific movement pattern.
A 2010 study highlighted club swimmers, averaging 6000 to 10,000m per day during training sessions, generally held over 5-7 days with sessions twice a day, roughly equating to 60,000 to 80,000m per week, with an average stroke count of 8 to 10 per 25m, swimmers will perform in the region of 30,000 rotations of the shoulder each week!
This is a clear factor for introducing imbalance into the joint. The action during the catch phase of all strokes is internal rotation of the shoulder in an overhead position – a very weak and unstable position for our shoulder if not supported correctly. Therefore, over time and with improper warmups or training to combat those forces, a majority of swimmers can inevitably experience pain in their shoulders from swimming. I certainly did!
So, just how much does an Olympic Swimmer train?
At the most intensive point, my training schedule consisted of 10 swim sessions of 2.5hours a week, we would average around 75,000 - 85,000m over the course of those 10 sessions. We then had weights training after morning sessions and dry land conditioning before each afternoon session. My coach would then also have the (not so) wonderful idea of giving us what he liked to call ‘Hell Week’, a week in which our sessions increased to 3 hours each and hitting 9,000 – 10,000m per session.
How do elite swimmers prevent shoulder pain?
As you can imagine, our bodies broke down under such intensive work. Thankfully for me at the level I was training and competing at, we had a team physio who would be present for every session on poolside to provide treatment. I spent a lot of time with them working on my shoulders. We had access to high level testing equipment that could test the force output of each muscle group. There was a big discrepancy between the internal rotation strength and external rotation strength, highlighting an imbalance. The physios and gym staff worked together to develop detailed rehab plans and adapt any other exercise to minimise niggling the affected shoulder any further.
Regular soft tissue release was a big help for me to keep on top of the tension that would build up during the swim sessions.
In the majority of cases shoulder pain in swimmers is caused by an overload on the rotator cuff muscles. Muscles at the front of the shoulder are over worked and strong, whilst those at the back are lengthened, and weak. This develops an imbalance of the intricate system that stabilises the shoulder. Therefore, over time it can lead to tendon issues, potentially degenerative tears or wear and tear on the cartilage within the joint itself.
How Physiotherapy can prevent and treat shoulder pain
Swimmer’s shoulders certainly take a lot of strain. However, problems can be prevented with a good programme of strength work to improve the muscular imbalance and stretching to improve the mobility of the shoulder.
My approach as a Physiotherapist when I treat any swimmer is to first address the tightness around the shoulder. By releasing the soft tissues acting on the shoulder we can also influence the space inside the joint, if everything is tight this space can become less, couple this with irritated and inflamed tendons or a bursa this space becomes very compact and leads to what is termed, impingement.
Warming-up before you swim
It is vital to perform a structured warm up routine before going swimming. Warming up the shoulders is a key step in reducing the chance of injury. The warm-up ensures the correct muscles are warmed, with blood flowing to them and are activating in the right way. A warm-up should consist of several elements:
- 1Blood flow – actions like arm swings, skipping and even some light shadow boxing can get the blood pumping around the muscles of the shoulders.
- 2Activation – use resistance bands to perform specific movements to activate the stability muscles of the shoulders, also think about position of the arm during the stroke, when you catch the water you are generally in an overhead position so consider, if able, doing some activation in overhead positions.
- 3Stroke Specific – similar to arm swings but stroke focused, use these exercises to simulate a few stroke cycles to practice technique and warm-up to stroke specific demands.
If you experience any discomfort or pain following a swim, take some time to do some stretching and release work with a ball. At elite level, we had to do 30 mins of dry land cool down following every session. While you might not be able to spare 30mins after each swim, it is certainly important to fit in some form of stretching post swim.
Trigger-point release and dry needling are effective treatments to release of the tight muscles. This will reduce pain felt in the shoulder and allow you to start to strengthen the muscles to combat the imbalance. You can do trigger point release at home with a tennis ball or lacrosse ball and ‘dry-needling’ (a form of Acupuncture) is one of the most popular treatments that we do here at Cornwall Physio.
See a few of the exercises for swimming related shoulder pain I use with my patients below.
If you are taking part in regular swimming or surfing and have had issues with your shoulders in the past, regular physio will be incredibly beneficial. We’ll be able to diagnose why you’re getting shoulder pain and get on top of this for you as quickly as possible so that you can continue swimming. For anyone whose work or hobbies involve lots of shoulder work, regular ‘maintenance Physio’ is also a great way to keep any tightness out of the muscles and reduce the chance of future injuries of your shoulders.
If you’ve been experiencing shoulder pain, from swimming or just from everyday life…