Swimmer’s shoulder is a broad term for an overuse injury common in aquatic athletes, typically including conditions like rotator cuff tendinitis, shoulder impingement, or bursitis. This repetitive strain occurs because the shoulder is rotated thousands of times during a single training session, leading to irritation and inflammation of the tendons and surrounding tissues. Effective treatment must resolve current pain and implement long-term changes to prevent the issue from returning, allowing the athlete to return to the water without discomfort.
Immediate Steps for Acute Pain Relief
Upon the first signs of pain in the shoulder, the immediate priority is to reduce inflammation and prevent further damage. Initial management often involves the R.I.C.E. protocol, starting with rest and modification of activity to stop motions that aggravate the joint. This might mean avoiding all swimming or changing strokes to those that do not cause pain for at least 24 to 48 hours.
Ice application minimizes swelling and pain, typically by applying a cold pack for about 20 minutes several times a day. For the shoulder, compression and elevation are less directly applicable than for limb injuries, but proper positioning can help keep the joint comfortable. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can be taken for short-term pain relief and to control the inflammatory response. These steps provide temporary symptomatic relief until a professional evaluation can be conducted for a definitive diagnosis and structured recovery plan.
Professional Diagnosis and Structured Rehabilitation
Persistent shoulder pain warrants an assessment from a healthcare professional, such as a physician, physical therapist, or sports medicine specialist. Diagnosis typically begins with a physical examination to test the range of motion, strength, and identify the specific structures involved. Imaging like an X-ray or MRI may follow to rule out structural damage, such as a rotator cuff tear or bone abnormalities.
Physical therapy (PT) is the cornerstone of non-surgical treatment and is structured in phases for complete recovery. The initial phase focuses on pain management and reducing inflammation, often incorporating gentle stretches to restore the full range of motion. Once pain subsides, the next phase concentrates on strengthening the muscles surrounding the shoulder joint to restore stability and endurance.
Specific exercises address muscle imbalances common in swimmers, where internal rotators and chest muscles may be overdeveloped compared to back muscles. Rehabilitation targets the four muscles of the rotator cuff, focusing particularly on external rotation exercises using resistance bands to enhance joint stability. Scapular stabilization exercises, such as “I,” “Y,” and “T” movements, strengthen the muscles that control the shoulder blade, which is necessary for proper shoulder mechanics during the swimming stroke. Strengthening the entire kinetic chain, including the core and upper back, provides a stable base for the arm, reducing stress on the smaller shoulder muscles.
If inflammation is severe and not responding to initial rest and medication, a physician may suggest non-surgical interventions like a corticosteroid injection. This injection delivers a powerful anti-inflammatory medication directly into the joint space to reduce swelling, offering a window of pain relief. Injections are typically used to facilitate physical therapy and should not be considered a standalone treatment. Rehabilitation addresses the underlying weakness and movement patterns that contributed to the injury, with recovery time varying from a few weeks for mild cases to several months for moderate to severe issues.
Correcting Biomechanics to Prevent Recurrence
Long-term prevention requires moving beyond muscle strengthening to address the root causes: faulty swimming technique and training errors. One primary mechanical correction involves avoiding “crossover,” where the hand enters the water past the midline of the body, placing immediate strain on the shoulder joint. Instead, the hand should enter the water in line with the shoulder or slightly outside of it, with the third or fourth finger entering the water first to encourage a more neutral joint position.
A proper freestyle stroke requires adequate body roll, which distributes the propulsive force across the torso and reduces the need for the arm to over-rotate. Insufficient body roll forces the shoulder to extend farther back during the recovery phase, increasing joint stress. High elbow recovery during the overhead phase of the stroke is important, as this position reduces the risk of impingement compared to a straight-arm recovery.
Training load management is an important preventative measure, as many injuries result from increasing volume or intensity too quickly (“too much, too soon”). The general guideline is the “10% rule,” which suggests that total weekly training volume should not be increased by more than ten percent from the previous week. This gradual progression allows the body’s tendons and muscles sufficient time to adapt to the new workload, minimizing the risk of overuse injury.
The use of swimming equipment needs careful review, particularly hand paddles. Paddles increase surface area and resistance, magnifying the force transmitted through the joint, and their overuse can exacerbate strain. Similarly, using a kickboard for long periods can hold the shoulder in an elevated and internally rotated position, which may aggravate an impingement. Working with a qualified swim coach or a physical therapist specializing in aquatic athletes is the most effective way to identify and correct these subtle biomechanical and training errors.