Shoulder overuse in swimmers and triathletes is primarily a training-load problem — volume spikes and equipment misuse are the modifiable risk factors, not technique alone
Interpretation
Feijen et al.'s systematic review (12 studies, N=1,460) found volume was associated with shoulder pain in adolescent and masters swimmers — the primary modifiable variable is avoiding sudden load increases, with technique correction secondary. Schorn et al.'s triathlete-specific observational study (193 amateur triathletes) found a 0.33/1,000-hour overuse rate and a specific association between paddle use and overuse injury — the only study in this batch conducted specifically in amateur triathletes rather than competitive pool swimmers.
Practical implication
When addressing swimmer's shoulder risk for triathletes, lead with load management (avoid sudden volume jumps) and equipment caution (especially paddles before the shoulder is conditioned), not only technique correction. Flag that the evidence base in triathlete-specific populations is thin — Schorn et al. is the primary source for triathlete-specific risk factors.
Sources
2 sources, independently verified.
J Athl Train 55(1):32–41. 12 studies, N=1,460: training volume was associated with shoulder pain in adolescent swimmers (level II evidence); exposure differed between painful and pain-free groups in both adolescent and masters swimmers. Primary modifiable variable is avoiding sudden volume increases — technique correction is secondary. Includes masters swimmers, making the findings relevant beyond the youth populations most swim injury research targets.
PLoS ONE 13(6):e0198168. 193 amateur triathletes; 36 overuse injuries (rate 0.33 per 1,000 training hours); paddle use was significantly associated with overuse shoulder injury. The only study in this batch conducted specifically in amateur triathletes (not competitive pool swimmers or elite populations) — making it the most directly transferable source for both the shoulder article's load advice and the kick/tools article's paddle risk warning.