Shoulder Injuries in Swimmers

Swimmer’s shoulder

Shoulder pain is the most common musculoskeletal complaint in swimming. Studies have shown that up to 65 percent of competitive swimmers will experience a problem with their shoulder at some point in their careers. These shoulder injuries are becoming more common, and almost always, are caused by poor stroke technique. So, how do you avoid such an injury, often generically referred to as “swimmer’s shoulder?”

The key is to understand the causes of this condition and to prevent injury. Swimmer’s shoulder is a musculoskeletal condition with gradual onset of symptoms that results from repetitive microtrauma/overuse. The onset of symptoms may be associated with impaired posture, glenohumeral joint instability, altered neuromuscular control or muscle imbalance. Additionally, training errors such as overuse or wrong techniques may also contribute to this condition. In extreme cases, patients with swimmer’s shoulder may also have associated soft tissue pathologies of the rotator cuff, long head of the biceps, or glenoid labrum, which may lead to mechanical impingement.

Practical tips to ensure your swimming stroke doesn’t cause you any injuries

  1. Symmetrical Trunk rotation/Body roll

    It is important to develop symmetrical rotation of the trunk and hips in order to maintain a good body roll as you move through the water.

    The shoulders, trunk and hips should all rotate together. Excellent core strength is essential to maintain symmetrical trunk rotation.

    People who swim with a flat body, i.e poor body roll, put a lot of stress on the rotator cuff muscles as the arm tries to swing out of the water.

  2. Hand entry in to the water

    The hand should always enter the water in a flat position and not the thumb first.

    Entering with your thumb first causes excessive internal rotation of the shoulder joint, thereby straining the rotator cuff muscles.

    Remember to lengthen your stroke by reaching forwards with a straight powerful arm, thereby enabling you to travel further whilst taking fewer strokes, a very efficient way to swim!

  3. Avoid Cross-overs

    When the hand enters the water, the power produced from the rotation of the trunk, is used to propel the body forwards. The lats, pecs and core muscles are working hard at this stage. The leading arm at the front of the stroke should not cross over the midline of the body, but rather pull straight backwards. Poor cross-over of the arm not only causes the swimmer to produce a snake-like pattern of movement which is very inefficient, but also strains the rotator cuff muscles.

  4. Elbow position during the Pull Through Phase

    Most of the power of the forward propulsion of the body during swimming is produced by the arm pulling through the water.Swimmers more often than not, pull through with a dropped elbow. Developing a pull through phase with a flexed, high elbow will reduce the strain on the shoulder muscles and labrum of the shoulder joint. This position of the arm and elbow also encourages the big powerful mobilising muscles i.e biceps, deltoid and triceps to work efficiently.The most effective management of Swimmers shoulder involves a multidisciplinary approach consisting of a shoulder specialist, skilled physiotherapist and experienced coach. Early diagnosis and appropriate treatment will prevent the development of chronic shoulder problem in swimmers.

Elbow Injuries in Tennis Players

Tennis elbow – how to prevent and treat it?

Tennis elbow, or lateral epicondylitis, is probably the most common elbow complaint. It occurs on the lateral side of the elbow joint, the side which is furthest away from the body. The muscles and tendons which are responsible for extending the wrist, opening the hand and turning the palm up are most at risk of this problem. It is commonly associated with playing tennis although other sports such as golf, squash, weightlifting, fly and cast fishing, swimming, track events can also cause a similar injury. This condition is also seen more commonly in certain occupational activities including repetitive computer keyboard and prolonged intensive mouse activity, typing, writing, carpentry, plumbing, meat cutting and repetitive assemble line activity.

Why does it cause pain?

The cause of the pain is no longer thought to be inflammatory. Treatments which have focused at reducing inflammation have had limited success in treating these chronic, painful conditions arising from overuse of tendons. Tennis elbow is best described as a partially reversible, degenerative, overuse tendinopathy of the common extensor origin of the lateral elbow. Tendinopathy is a result of an imbalance between the protective/regenerative changes within the body and the pathologic responses that result from repetitive tendon overuse. The net result is tendon degeneration, weakness, tearing and chronic pain.

How do we prevent it?

Tennis is a sport that comprises of sprinting, lunging, changing direction rapidly, jumping, stopping and starting. The repetitive nature of these movements can unfortunately cause injuries, which can be both very disappointing and frustrating. Most of us don’t have time to exercise daily in order to maintain top fitness and shape, so here are a few practical things to do which don’t take too much time and can prevent disappointing injuries.


Rotator cuff tendonotos may result from excessive overhead serving when the arm is held at a 90 degree angle to the shoulder blade.

Serving - wrong

Elevated technique to protect the shoulder and elbow.

Warming up

General and specific exercises are used to prepare the body for exercise. General exercises may include jogging around the tennis court and general stretching for approximately 5-10 minutes before play. Specific exercises may include upper limb, lower limb and back stretches, gently hitting the ball and practising your serve.

Some of the important benefits to warming up:

  • Increases the blood flow to the muscles.
  • Increases the speed of nerve impulses to the muscles i.e. speeds up your reactions.
  • Decreases connective tissue stiffness in the muscles leading to decreased likelihood of tears and strains.
  • Increases your heart rate, essential for a healthy heart.
  • Increases the blood flow to the muscles.
  • Increases relaxation and helps you to concentrate.

Start with a gentle jog around the tennis court, followed by a running on the spot, gradually increasing the speed to very quick steps. Progress on to skipping sideways touching down at the side lines and finally, short sprints forwards and backwards. Upper body exercises should start with trunk rotations, gently swinging arms forwards and backwards and circular motions. Then progress on to mini tennis play and practising your serve.


Joints and muscles can become stiff as a result of injury, overactivity or inactivity. Stretching can be done during the warm up as well as part of the warm down after playing. Stretching maintains the flexibility and length in muscles and is also known to reduce muscle soreness and stiffness after play.

Stretches should include both lower limb and upper limb exercises. Dynamic stretches should always be done as this allows the blood to keep flowing through the muscles as you warm up. Lunges, quadriceps and calf stretches, followed by arm and shoulder stretches.

Cool down

Cooling down is essential to help lower the core body temperature whilst continuing to circulate blood and therefore oxygen to the muscles. Always finish off your game with a gentle jog around the tennis court and stretching of all the main muscle groups. Hold the stretches this time for 20-30 seconds.

Tennis players are also exposed to external risk factors that can influence play and cause injury.

Tennis rackets

The impact of the ball hitting the tennis racket produces a significant force, which is transferred to the players’ wrist, arm and shoulder. This is further influenced by how hard the player hits the ball, the incoming ball speed, the quality of the racket and string tension.

There are some useful ways to reduce the impact of the force through your arm and shoulder:

  • Reduce the string tension.
  • Increase the size of the racket head – this increases the centre of percussion or the “sweet spot” when hitting the ball.
  • Increase the grip size – this prevents the player from gripping the racket too tightly.
  • Stroke technique.

Lessons with a coach can be very useful in ironing out any poor habits, enhancing your performance and reducing possible injury.

Early diagnosis and treatment

Aches and pains need early diagnosis and treatment. Don’t let an ache or pain become chronic. Early advice and/or treatment will:

a) get you back on the court quicker and

b) reduce the cost involved in the treatment of chronic, longstanding injuries.

Practical tips to prevent tennis injury

Internal factors

  • Warm up
  • Stretching
  • Cool down

External factors

  • Correct racket size
  • Grip size
  • Racket string tension
  • Stroke technique.

Jaw problems and Headaches

One in four people suffer from TMJ Syndrome. The TMJ is the Temporo-mandibular Joint, which is the joint connecting your lower jaw and your skull. The movement in this joint allows you to open and close your jaw and chew from side to side. Muscle spasm in the muscles connected to the jaw can cause symptoms such as headache, pain behind your eyes, sinus pain and pain in the neck and shoulders.

Some patients clench or grind their teeth either caused by anxiety, or when concentrating on a task, or more commonly, during sleep. This aggravates the muscles around the TMJ. Generally, patients wake up with a stiff jaw and/or a headache.

It is important to see your dentist to rule out any problems withyour bite and teeth. Physiotherapists can be very helpful in assessing TMJ problems.

Physiotherapy treatment may include gentle TMJ mobilisations, trigger points, acupuncture and a home exercise programme to gently stretch these muscles. If the TMJ is the cause of the headache and jaw pain, improvement tends to be rapid following physiotherapy treatment, thereby reducing the worry and fatigue that goes with headaches and pain.




Patients with Low Back Pain should see a Physio within Two Weeks

Doctors who refer patients with low back pain for physiotherapy within 14 days, decrease the overall care costs and reduce recurring visits, according to a study conducted at the University of Utah. The study concluded that early physiotherapy referral halved the need for steroid injections or surgery. (Taken from Frontline, 20 June 2012, vol18, no 11)


Heavy rucksacks cause back pain in children!

A recent study done in Spain shows that one in four children suffer back pain as a result of carrying too much in their school rucksacks. The study of 1403 children aged between 12 and 17 found that almost two-thirds carried rucksacks weighing more than 10% of their own body weight, averaging at 7kgs (15lbs) per bag. Taken from “The Week” Issue no 862.

A problem I encounter regularly with teenagers. This can often lead to shoulder problems too. A regular check of how much is in the rucksack and leaving out books/items not needed for the day could help. Ensure the rucksack is carried over both shoulders too!

Welcome to Total Physiotherapy

We offer specific assessment, diagnosis, advice and treatment of acute and chronic musuloskeletal injuries and sports injuries including:

  • Spinal – Neck and back pain: Whiplash, osteoarthritus, muscle strains, sciatica, prolapsed disk, postural pain and correction.
  • Upper Limb – Shoulder, elbow, wrist and hand pain including repetitive strain, fracture rehabilitation, frozen shoulders, post op shoulder rehab, tennis and golfers’ elbow, carpal tunnel syndrome.
  • Lower Limb – Hip, knee, ankle and foot pain, post op rehabilitation, sports injuries to the knee and ankle, muscle strains and tears, tendon and ligament problems, adolescent knee pain, achilles heel.