Swimmer’s shoulder is an umbrella term for shoulder pain that commonly affects aquatic athletes, resulting from the high volume of repetitive overhead arm motions required in the sport. This condition is typically diagnosed as either rotator cuff tendonitis or shoulder impingement syndrome. Both diagnoses involve inflammation and irritation of the soft tissues in the shoulder joint. Given the continuous stress placed on the shoulder complex, experiencing pain is a clear signal that the tissue is struggling with the mechanical load, but this is a highly treatable overuse injury.
Initial Steps for Managing Pain
The immediate response to the onset of shoulder pain should be the complete cessation of any swimming or overhead activity that reproduces the discomfort. Rest is the single most important initial step, allowing the irritated tendons and bursa to begin the healing process. Ignoring the pain and attempting to swim through it will only worsen the underlying inflammation and tissue damage.
Applying cold therapy, such as an ice pack wrapped in a towel, to the painful area for 15 to 20 minutes several times a day helps reduce acute inflammation. For short-term management, over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be used. These medications only address the symptoms of inflammation and should not be used long-term without consulting a medical professional.
Medical Diagnosis and Non-Surgical Treatment
Seeking professional care from a physician, such as a sports medicine doctor or an orthopedic specialist, is necessary to confirm the diagnosis and determine the specific structures involved. The medical evaluation typically involves a physical examination where the doctor assesses the shoulder’s range of motion, strength, and performs specific impingement tests. The physician may order imaging tests like X-rays to rule out bony issues, or an MRI to assess the soft tissues for potential tears in the rotator cuff or labrum, especially if symptoms are severe or persistent.
Physical therapy (PT) is the cornerstone of non-surgical treatment for most cases of swimmer’s shoulder. The goal of PT is restoring the biomechanical balance and strength of the shoulder complex. This involves dedicated exercises to strengthen the rotator cuff muscles, particularly the external rotators, and the scapular stabilizers that anchor the shoulder blade. Strengthening these muscles helps correctly position the head of the humerus within the socket, which increases the space beneath the acromion and prevents the painful pinching of tendons.
A physical therapist also addresses flexibility issues, such as tightness in the posterior capsule or the chest muscles, which can contribute to faulty shoulder mechanics. If pain is severe and significantly limits participation in rehabilitation, a physician may prescribe stronger NSAIDs or recommend a corticosteroid injection. A cortisone shot is a powerful anti-inflammatory measure injected directly into the subacromial space to reduce swelling. Recovery can take several weeks or months to achieve a full, pain-free return to activity.
Preventing Recurrence and Safe Return to Swimming
Preventing the recurrence of swimmer’s shoulder requires correcting the underlying causes and implementing a carefully phased return to the water. Faulty stroke mechanics are a common contributor to the injury, as repetitive errors place excessive stress on the shoulder joint. For example, allowing the hand to cross the midline during the pull-through phase of the freestyle stroke or having insufficient body roll can exacerbate impingement symptoms.
Consulting a swim coach or utilizing video analysis to identify and correct these technical flaws is a necessary long-term strategy. Swimmers must also maintain a consistent dry-land maintenance program focusing on the strength and endurance gained in physical therapy. This work, including exercises for the rotator cuff and core stability, must continue after the pain resolves, as it provides the necessary muscular support for high-volume training.
The return to swimming must be gradual and should only begin once the athlete is nearly pain-free and has full, symmetrical shoulder mobility and strength. The initial phase involves low-intensity, short-distance swimming, often starting with kicking drills. Avoid equipment like hand paddles and kickboards that increase stress on the joint. Yardage and intensity should be increased incrementally, with protocols suggesting a weekly increase of no more than five to ten percent. Any return of pain should immediately signal a need to scale back the training volume and revisit the rehabilitation program.