Running Header: IMPINGEMENT SYNDROME

Swimmers Shoulder: Impingement Syndrome

Baylee Howe
College of Southern Idaho

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Abstract

The average competitive swimmer swims approximately 60,000 to 80,000 meters per week.
With a typical count of 8 to 10 strokes per 25 meter lap, each shoulder performs 30,000 rotations
each week (Cosgarea 2010). This places tremendous stress on the shoulder girdle and
glenohumeral joint, and it is why shoulder pain is the most frequent complaint among
competitive swimmers. In the first half of this research assignment, Impingement Syndrome is
thoroughly described and explained. Impingement Syndrome is also known as Swimmers
shoulder because it is a very common injury affecting competitive swimmers, especially high
school swimmers. In the final half of this research assignment, many techniques that swimmers
can use to recover and prevent this injury are described and also my personal reaction to this
assignment and what I have learned from it. Swimmers shoulder can be a very painful injury,
but with the proper technique and proper form, it can be avoided.

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Description

Impingement Syndrome can be defined as shoulder pain that is caused by connective

tissue rubbing against the shoulder blade. This syndrome is most commonly known as
Swimmers Shoulder because it occurs in athletes who swim on a regular basis and overwork
their shoulder muscles. Impingement Syndrome was first discovered in 1978 and was used to
describe shoulder pain during and after swimming workouts (Cosgarea, 2010). The muscles
mostly involved with this injury are the rotator cuff muscles, particularly the supraspinatus and
the infraspinatus muscles. The supraspinatus muscle is located superiorly on the greater tubercle
of the humerus and is used to hold the head of the humerus in the glenoid fossa and the
infraspinatus muscle can be found on the posterior surface of the scapula, just below the spine of
the scapula, and is used to rotate the shoulder (Floyd, 2014, p.131).
The biomechanical process of Impingement Syndrome is if one were to go swimming
and have pain in the shoulder area but continues to swim, ignoring the pain, the tendons become
irritated and tear from all of the pressure. Since the tendons start to tear away from the rotator
cuff, the tendons pass through the subacromial space between the acromion process of the
scapula and the head of the humerus, they become inflamed, making the tendon unable to slide
easily through the acromion process. This then causes pressure on the tendon that connects to
the humerus because it cannot easily move since it is inflamed, resulting in pain, weakness, and
can even cause loss of movement at the shoulder joint. With the loss of movement and strength
in the rotator cuff, this causes the humerus to move superiorly, resulting in the Impingement
Syndrome (Floyd, 2014, p.131).
Explanation

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Impingement Syndrome is a very common injury in swimmers, hence the name

Swimmers Shoulder, because it happens so frequently to swimmers. According to National
Athletic Trainers Associations journal titled Risk Factors Associated with Shoulder Pain and
Disability Across the Lifespan of Competitive Swimmers they state, High school swimmers are
the most symptomatic and incur the greatest load in terms of hours swum per week and per year
(Tate, 2015). Since high school swimmers are training so hard for their meets and for their state
competitions, this makes them a key candidate for Impingement Syndrome because they spend
so much time (about 16 hours a week) in the water. Between the many hours practicing and the
intensity of the meets, this is causing much ware on the shoulder joint and muscles, and is
leaving these swimmers in pain.
Pathomechanics
To dive more into depth into Impingement Syndrome, lets break down the steps of how
this injury actually happens. First, if a swimmer is swimming the freestyle stroke, their
shoulders are constantly rotating as they pull their arms through the water to move. Now if the
swimmer has overworked their shoulder muscles, including the deltoid, the subscapularis
muscle, the supraspinatus, the infraspinatus, the teres minor muscle, and even the pectoralis
major and minor muscles, or are placing their arms too medial than necessary, this can cause an
imbalance on these muscles. This imbalance then causes the infraspinatus and supraspinatus
tendons to tear from the humerus making the bone move superiorly to the shoulder, stretching
these muscles and tendons even further. Since these muscles, mainly the supraspinatus and
infraspinatus, are being stretched and torn from the shoulder girdle and glenohumeral joint it is
causing them to become irritated. Now we all know that when something like our muscles or
tendons become irritated, from being overworked or worked in the wrong way, they can become

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inflamed. With the supraspinatus and infraspinatus tendons inflamed, this makes the muscles
bigger, and therefore makes it harder for them to fit through the subacromial space located
between the acromion process of the scapula and the head of the humerus bone (Floyd, 2014,
p.131). Now these tendons are being pulled (abduction) even more than normal because of the
inflammation and as the shoulder is externally rotating and the glenohumeral joint is extending to
bring the arm around, the tendons start to rub on the scapula, causing pain and weakness in this
joint, resulting in the Impingement Syndrome.
Justification
Like all common injuries it takes time to recover, completely, from Swimmers Shoulder,
but with proper stretching and physical therapy, that time can be shortened tremendously.
Injuries are painful and can become even more painful if not taken care of properly. To recover
from the common injury of Impingement Syndrome, one must immediately cease swimming
before it turns into something more serious, like a torn rotator cuff, which needs surgery.
Through the use of regular shoulder stretches and physical therapy, the recovery process can take
anywhere from 6-8 weeks or longer depending on the damage (Tate, 2012). The recovering
process for Impingement Syndrome is still unclear because each case, of Swimmers Shoulder
recorded, have been so different from one another that sometimes it only takes a couple weeks of
simple stretches or sometimes it takes months and months of intense physical therapy sessions to
overcome this injury. Some injuries have been so severe that the swimmers are not able to return
to competitive swimming.
To prevent ones self from suffering through Impingement Syndrome, proper technique
and proper strength training are required while swimming. The leading cause of Swimmers
Shoulder is lack of proper technique and form while swimming. For example, if one is

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swimming the freestyle stroke and is crossing their arms over in front too far, this is causing the
shoulder to work extra hard because it has to rotate further to reach all the way across, which it
should not be doing in the first place. The right form for freestyle should be keeping the elbows
bent and placing the arms straight out from the shoulder, without crossing them over the body.
This will then prevent hurting the shoulder joint and muscles, and helps to prevent Impingement
Syndrome. Participating in proper strength training can help prevent Swimmers Shoulder as
well. According to the article Biomechanical Considerations in the Competitive Swimmers
Shoulder, Athletes should undergo pectoral and posterior shoulder stretching, strengthening,
core endurance, and cross-training to limit or prevent shoulder injury that might lead to pain and
disability in competitive swimmers (Cosgarea, 2010). Swimmers should strengthen their
shoulder muscles to prevent injuries in the future and should also watch to make sure they have
the proper technique.
Personal Reaction
Through my research of Impingement Syndrome over the past couple of weeks and also
through the Anatomical Foundations class, my knowledge of the body has grown tremendously.
I have loved being able to find out how all of the joints and muscles work together to move our
bodies and how there are so many little nerves and muscles that are so very important to our
anatomy which enable one to get around. My view of the body has changed because now I know
how the joints work and how each muscle has a specific purpose to move a joint a certain way
and to support our bodies. My knowledge of the biomechanical properties of the human body
has also changed my view of the body because while researching Impingement Syndrome, I
discovered that the shoulder girdle and glenohumeral joint go through so much stress when
swimming that they are prone to many injuries, and yet we still continue to put all of that stress

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on our bodies. I have learned that our bodies can handle a lot of pressure and stress, but it is our
responsibility to keep our bodies healthy and strong and know when to stop, so not to allow
injures. I have been swimming for almost 11 years now, and have become increasingly aware of
injuries, like Impingement Syndrome. I realize now how important it is to make sure you have
the knowledge to perform the proper technique related to any sport or exercise.
Conclusion
Impingement Syndrome, also known as Swimmers Shoulder, is a very common injury
for people who participate in swimming competitively or for someone who does not have the
right technique or form while swimming. There is a lot of stress put on the shoulder girdle and
glenohumeral joint during swimming, especially for high school swimmers who are training for
meets and state championships for at least 16 hours a week. This shoulder injury can be very
painful because as the supraspinatus and infraspinatus tendons become inflamed from the
humerus bone rotating superiorly, from misplacement or misuse of technique in swimming, they
start to rub on the sharp scapula bone. To recover from this injury it takes anywhere from 6 to 8
weeks or even longer, depending on how bad the injury is, but with the right stretches and some
physical therapy, this injury can be completely healed. I have learned so much from this
Anatomical Foundations class while researching Impingement Syndrome over the past couple of
weeks. My views of the body and how the biomechanical process work in the human body have
changed completely for the better, so that I am able to understand how all of the joints and
muscles work together to be able to move our bodies.

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References

Cosgarea A. (2010) Biochemical considerations in the competitive swimmers shoulder. Sports

Health. Nov 2010. Vol. 2, No. 6, pp. 519-524.
Floyd, R. (2014). Manual of structural kinesiology. McGraw-Hill Education. 19th edition. Ch. 5.
Tate A. (2012) Risk factors associated with shoulder pain and disability across the lifespan of
competitive swimmers. Journal of Athletic Training: Mar/Apr 2012, Vol. 47, No. 2, pp.
149-158.