Shoulder Injuries

Swimmers, including triathletes, commonly suffer from shoulder pains.  This pain is usually felt either at the rotator cuff or between the shoulder blades.


Stresses in these areas affect the athlete’s performance long before they are even aware that they are having a problem.


Competitive swimmers must swim thousands of meters each day in order to achieve the fitness level required for competition. The front crawl is not kind to the shoulder joint, especially when executed incorrectly.


The majority of injuries suffered by such swimmers is related to the stress involved in the repetitive actions of their limbs while swimming, as many as 20,000 to 30,000 strokes per week for competitive training. In a typical workout of 4000 meters, each arm will rotate 1280 times. Any biomechanical problems at the start of the swim will only get worse with this many repetitions!


The most common injury is Swimmer’s Shoulder – a term commonly used to describe pain in the shoulder, and is almost always caused by the repetitive actions of the front crawl. This injury is also known as rotator cuff tendonitis or shoulder impingement syndrome.

Effects of Repetitive Motion and Shoulder Injuries

The soft tissue stresses caused by the repetitive motions of freestyle swimming is often compounded in triathletes by the constant stress of holding the torso in a fixed position upon the bicycle’s aero-bars.


Pain between the shoulder blades is caused by the constant neck extension and the back position required to support the weight of the cyclist’s torso while bent over in the aero-bar position. This pain is often an indication of several problems in the body’s kinetic chain rather than the usually diagnosis of tight Rhomboid muscles or a Rotator Cuff Tear.


Repetitive motion, constant tension, and pressure often result in inflammation and swelling of soft tissue. The body responds to this inflammation by laying down scar tissue (cross fibers across the tissue) in an attempt to stabilize the affected area. This scar tissue:

  • Restricts motion.

  • Reduces circulation.

  • Inhibits nerve function.

  • Causes ongoing friction and pressure. This results in the production of yet more cross fibers and adhesions across inflamed soft tissues.

Training Techniques and Shoulder Injuries

Poor swim technique, over-training, unilateral breathing, too large a swim paddle, or improper elbow-to-shoulder angle on the bike can easily cause shoulder problems.


Even though these training factors can be modified, the biomechanical restrictions that have been created in the triathlete’s body are seldomaddressed or resolved by just exercise and massage.


These biomechanical stresses lead to future injuries and inhibit the triathlete and swimmer from reaching his or her full performance potential. It is necessary to correct these biomechanical problems at the source (by removing restrictions between the shoulder’s tissue layers) if the swimmer is ever to achieve their full potential.

Muscles Affected by Shoulder Injuries

Equally important, different athletes may present with identical pain patterns, but each athlete may have completely different soft-tissue structures that are impaired or injured.


Before treatment takes place, an extremely specific examination, biomechanical analysis, and diagnosis must be performed. It is important for the practitioner to look past the initial point of pain to identify other structures that are involved in the kinetic chain.


People suffering from rotator cuff injuries (swimmer’s shoulder or impingement syndrome) will often receive treatment for the Infraspinatus, Teres Minor, Supraspinatus, and Subscapularis muscles.


However, this limited focus ignores numerous associated soft-tissue structures (ligaments, muscles, blood vessels, fascia and nerves), which either caused the injury or whose restrictions greatly reduce an athlete’s performance level.  For example, swimmers often suffer from biomechanical restrictions in these primary swimming muscles:


* Latissimus Dorsi – A muscle that inserts into the Scapula and Humerus.
* Triceps – Mostly commonly the outer head.
* Deltoids – Medial, posterior and anterior sections.
* Psoas – Hip flexor that attaches to same general area as Latissimus Dorsi. A tight Psoas can cause a tight shoulder when you follow the kinetic chain of those structures.  The Psoas is also the most common muscle affected during the cycling portion of the race.
* Pectoralis Major/Minor – Flexes, adducts and medially rotates the arm.

It is essential to release the restrictions in these kinetic chain structures in order to fully resolve the problem.

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