Biomechanics of Swimming

Freestyle swimming phases:

In the freestyle stroke, the first half of pull-through was most frequently identified as the painful phase
of the stroke (approximately 70% of symptoms were noted at this time). Another vulnerable point of
the stroke appeared during the first half of recovery (18% of symptoms were elicited at these points).
During the first half of pull-through, the arm is unilaterally pulling the body over the arm. The arm
generates the propulsive force.
Toward midrecovery, the humerus is hyperextended and swinging the forearm forward. It has been
suggested that at this point the humerus moves into maximal external rotation, and this has been
equated to the late cocking phase of the baseball pitch. Although it is true that at this point the

humerus is as far into external rotation as it goes during the freestyle stroke, it is nowhere near the
degree of maximal external rotation required during the baseball pitch.
As the freestyle swimmer approaches midrecovery, it is the humeral hyperextension that likely causes
the pain. In this position, the humeral head is pushed anteriorly.
Any anteriorimpingement, labral damage, or inflammation would be aggravated in this position. This
is also know as hyper angulation and can cause internal impingement .
Pathomechanics
It is likely that the serratus anterior fatigues in swimmers with painful shoulders, producing an
unstable scapula. To compensate, the rhomboids contract to stabilize the scapula.
Similar to the serratus anterior , the subscapularis is susceptible to fatigue because of its continual
activity in swimmers with normal shoulders. Swimmers with painful shoulders may have fatigued
their subscapularis . The subscapularis may also diminish its function to avoid the painful extremes
of internal rotation, whereas the infraspinatus increases its activity to rotate externally the humerus
for the same end goal.
There is no significant difference in the muscle firing of the primary muscles of propulsion
(pectoralis major, latissimus dorsi, and posterior deltoid) when comparing swimmers with normal
and painful shoulders. There is no significant difference in the muscle firing of theteres minor in
swimmers with normal and painful shoulders. The muscles of propulsion as well as
the pectoralis major and teres minor force couple are intact. Thesupraspinatus muscle also
functions normally as it compresses the head of the humerus in the glenoid.
This suggests that the key muscles on which to focus for injury prevention and rehabilitation in
competitive freestyle swimmers is the serratus anterior and subscapularis . A stable scapula is
paramount in preventing shoulder injuries.
Originally, swimmer's shoulder, was regarded as a subacromial impingement syndrome, with
impingement of the rotator cuff tendons under the coracoacromial arch. It has been suggested,
however, that swimmers do not have a true impingement but a tendinitis secondary to swimming as
part of the increased laxity translation that is present in this population. Nowhere is the relationship
between impingement, laxity, and instability more prevalent or more confusing than in the swimmer.
The impingement that occurs may not be subacromial impingement but could be impingement
secondary to glenohumeral laxity, which places stress on the rotator cuff tendons. The impingement
may be an internal impingement within the glenohumeral joint, where the rotator cuff impinges
against the glenoid labrum or true subacromial impingement. Also, there is a dysfunction of the
scapular muscles that disturbs the scapular humeral rhythm with improper positioning of the glenoid
platform during exercise. This improper positioning places increased stress on the anterior capsular
structures, causing an increase of anterior translation with a secondary impingement of the rotator
cuff.

Impingement (trapping) of the rotator cuff and labrum by the humeral head in the extreme overhead
position, leading to internal impingement and then progressive injury to the rotator cuff
and superior labrum:

Diagnosis
The clasical sign of a painful or subtely unstable shoulder in a swimmer is a change in stroke pattern
and reduced performance, along with the pain. Typically the 'lazy elbow' is not lifted high enough out
of the water in middle recovery and the hand on the affected side enters the water too early. Pain
during the recovery phase is most likely due to impigement (internal and/or subacromial), whilst pain
during the pull-through phase could be indicative of more significant labral or cuff pathology.
Management
In swimmers there may be a unique complex combination of secondary subacromial impingement,
internal impingement, tendonitis, laxity and muscle dicoordination. These may occur concurrently or in
varying patterns.
It takes a skilled and experienced clinician to recognise and manage this. The approach should
involve the combined input of an experienced shoulder surgeon, skilled therapist and coach. Early
and appropriate treatment can avoid chronic shoulder problems in swimmers.