The #1 Swimming Injury

Photo Credit: We Run Huntsville 

Andrew Walker, PT 

PhysioWorks, Sports and Wellness, Inc 

& 

Ali Meeks 

ReadySetSweat!

Andrew Walker, PT 

www.physioworkshsv.com 

• Owner PhysioWorks, Sports and 

Wellness, Inc. 

• Experience Sports Physical Therapist 

• Worked with professional, collegiate, 

high-school athletes in the US and UK 

• Member of the APTA Sports Section

Bios: 

Ali Meeks 

www.readysetsweat.net 

• Owner ReadySetSweat! 

• Former Div I swimmer 

• USAT Level 1 Coach 

• American College of Sports 

Medicine Certified Personal 

Trainer

Photo credit: akunamatata / Foter / CC 

Contents: 

1. Anatomy and biomechanics 

2. Risk factors for injury 

3. How can it be avoided, assessed, and 

treated? 

4. Basics of technique

1 

The Shoulder is the # 1 

injured body part in 

swimmers 

Let us consider what makes the shoulder so 

susceptible to injury. To help we will 

compare the shoulder with the hip joint. 

What do shoulders and 

hips have in common? 

• They both need to be stable and 

strong 

• They are both ball and socket joints 

Photo credit: Internet Archive Book Images / Foter / No known copyright

What makes the shoulder 

different? 

• It needs to be mobile! 

• Even in extremes (such as the 

splits) the hip only has 1/2 the 

motion! 

Quick comparison of these 

two ball and socket joints: 

Ball 

2012 study of white americans showed federal 

head and humeral head ~same size

Socket 

Deep 

Shallow 

If we rotate our shoulder 

90 degrees we see the 

relationship of the socket 

to the ball. We have a 

small/shallow socket with 

a relatively large ball. This 

creates mobility.

The mobility seen in the last picture is only 

2/3 of the story. The shoulder is not just a 

ball and socket joint, it is a complex 

including two other joints and a pseudo joint 

Acromio-clavicular Joint 

Scapulothoracic Joint 

(pseudo joint!) 

Gleno-humeral 

Sterno-clavicular Joint

To get our full elevation at the shoulder 

movement occurs between the 

glenohumeral joint and the scapula with a 

2:1 ratio 

Evidently we have a lot of mobility in the 

shoulder! What gives the shoulder 

stability?

Several things keep the shoulder stable: 

• Labrum 

• Joint capsule 

• Ligaments 

• Muscles 

Mostly we cannot change the structure 

of the ligaments, labrum, capsule (unless 

they are broken and need to be 

surgically fixed!) 

However we can change the properties 

of muscles, so let us look at this aspect 

of the anatomy in more detail!

We have muscles that are very intimate with 

the glenohumeral joint and control position: 

The Rotator Cuff 

The two rotator cuff muscles not seen in this 

picture are the Infraspinatus and the Teres 

Minor. 

There are also superficial muscles, such as 

the deltoid, which provide more powerful 

movement.

We have muscles both deep and 

superficial that control the movements of 

the scapula 

The muscles of the rotator cuff and the 

scapula have to work well together for 

the shoulder to function properly

2 

 

Three risks of injury: 

• Structural differences 

• Lack of strength/control 

• Overload 

Photo credit: irrezolut / Foter / CC

Structural differences 

• Primary - those that we have from 

birth 

• Secondary - those that we have 

acquired, e.g. poor posture etc 

 

When looking at the 

shoulder from the side 

we can see an example 

of a primary impingement. 

The acromion is part of the 

shoulder blade. Some acromion 

processes are flat whereas some 

are hooked. Impingement means a 

structure such as the rotator cuff is 

pinched between the ball and acromion. 

Someone with a hooked acromion has 

less space and therefore more chance of 

impingement.

Lack of Strength/Control 

• To reach for a cabinet all of our 

joints need to move in a particular 

way. 

• This is true not just in the shoulder. 

For flexion to occur efficiently at the 

shoulder we need all of our joints to 

move correctly, e.g. trunk, legs, etc. 

• This is not just the case in high level 

activity such as swimming, but as 

simple a motion such as raising 

your arm. 

• Recent research showed that to 

initiate shoulder flexion the first 

muscle that contracts is the soleus 

in the calf!

When control is not within the required 

parameters for our planned motion we 

tend to stress certain parts of a joint. 

Below is an example of places that an 

impingement can occur in the 

glenohumeral joint:

Overload 

• The different tissues of the body 

(bone, muscle, tendon, ligament) 

need to have the correct properties 

for the load that will be placed on 

them 

• If load/stress is higher than the 

properties of the tissue you 

increase the risk of injury, 

particularly overuse injury. 

 

Internal impingement is a good example of overload. It is thought to occur 

in sports with repetitive motions where the joint is lax. This leads to 

pinching of the underside of the tendon.

Swimmers Shoulder…. 

We hate this term!!! 

• There are so many possible 

diagnoses: 

1. Rotator Cuff Tendonitis 

2. Labral Tears 

3. Scapula Dyskinesis 

4. Biceps tendonitis 

5. ….. 

• All or any of these injuries are a 

result of a combination of our three 

risk factors: 

1. Structural differences 

2. Lack of control 

3. Overload

3 

How can it be 

avoided, assessed 

and treated? 

 

Photo credit: Borsook D, Moulton EA, Schmidt KF, Becerra

To help avoid injury always use good 

pain guidelines: 

You can read more about pain and 

performance in our blog article.

Always use good warm-up and cooldown 

routines. The videos below give 

some suggestions:

• You can use sensible self-treatment 

when the pain is in the safe or 

caution zones. If pain is 

consistently in these zones it may 

be wise to consult a professional in 

sports medicine 

• When the pain creeps into the 

danger zone you need to get 

attention 

• Orthopedic physicians are very 

good at diagnostics when there is 

an injury. i.e. a tear. Even when 

there is a tear there is growing 

research indicating PT is worth 

trying before surgery (But obviously each case/injury is 

different, discuss with your healthcare provider!) 

• All this being said, it is worth 

considering a biomechanical 

screen in the absence of pain to 

help reduce your risk of injury! 

Physical Therapists are great 

people to see for this!

4 

Technique basics 

- safe form 

Photo Credit: We Run Huntsville

Don’t enter thumb first!

Do enter middle finger first

Don’t downpress or “dig for 

clams”

Do bend the elbow after entry

Don’t use a wise s-pull pattern

Do keep the hand basically 

under the body after starting 

pull

Don’t cross over the center line

….and underwater 

Do stay on the correct side 

over water….

Conclusion 

• The shoulder is a complex structure 

in the sense that it has several 

components. 

• But it is not complex for an 

experienced sports medicine 

professional. 

• Experienced sports medicine 

professionals, especially those who 

work in collaboration can help you 

avoid injury and treat it in the best 

way when it does occur. 

For your Physical Therapy needs: 

Andrew Walker PT 

www.PhysioWorksHSV.com 

For your swimming, and triathlon needs: 

Ali Meeks 

www.readysetsweat.net

Other useful resources: 

moveforwardpt.com 

swimspeedsecrets.com 

swimsmooth.com 

usaswimming.org

The #1 Swimming Injury

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