The painful overuse injury called swimmer's shoulder, common in competitive swimmers, may be caused by excessive swimming distance during training along with a culture in competitive swimming that sublimates pain, according to new research being presented at the American Academy of Pediatrics (AAP) 2019 National Conference & Exhibition.

The research abstract, "No Pain, No Gain: Normalizing Attitudes Associated with Shoulder Pain in Adolescent Swimmers," will be presented at the Ernest N. Morial Convention Center during the American Academy of Pediatrics (AAP) 2019 National Conference & Exhibition in New Orleans.

The research team surveyed high school and youth club competitive swimmers and found that many children were suffering with shoulder pain, which seemed linked to the distance they swam each day. Simultaneously, swimmers almost universally felt pain was necessary to succeed. The research found that swim clubs were more associated with pain than high school teams, in part because those club workouts were longer in time and distance swum.

"This research showed that pain was normalized for both high school and club swimmers," said study author Eli Cahan. "Additionally, we found that nearly half of the athletes in our study know peers who use medication to address swim-related injuries, so we worry about the exposure to medications especially in the context of the opioid epidemic."

Researchers surveyed 150 youth ages 13-18 and found that 76.7% of swimmers reported experiencing shoulder pain within the last 12 months, and 66.0% agree that "mild shoulder pain should be tolerated" if they want to become successful swimmers and 61% that "taking time off from swimming is not ideal." Fifty percent reported knowing a competitor who used pain medication.

The research also shows clear links between distances swum and pain. Of those who report no shoulder pain, median practice distances ranged from 1,568-3,513 yards, while those who reported pain swam between 2,001-6,322 yards per practice.