“Swimmer’s Shoulder” is a broad term describing shoulder pain in individuals who engage in regular swimming. This condition is not a single diagnosis but rather an umbrella term encompassing several potential injuries to the joint and surrounding soft tissues, nearly always resulting from overuse. Up to 91% of competitive swimmers will experience shoulder pain at some point in their careers. The repetitive overhead nature of aquatic sports makes the shoulder joint vulnerable to the microtrauma that causes this pain.
The Biomechanics of Overuse
The shoulder’s extensive range of motion, crucial for effective swimming, also makes it inherently unstable and susceptible to injury. Competitive swimmers often train intensely, sometimes logging over 4,000 strokes per shoulder per day. This high volume of repetitive movement leads to chronic fatigue in the stabilizing muscles of the shoulder, especially the rotator cuff and the muscles that control the shoulder blade.
Muscle imbalances frequently develop, with internal rotators and adductors becoming overly strong and tight compared to the weaker external rotators and scapular stabilizers. This imbalance compromises the dynamic stability of the joint, causing the head of the humerus to move improperly during the stroke cycle. Faulty mechanics, such as a hand entry that crosses the midline of the body or a dropped elbow during the pull-through phase, further stress the joint capsule and surrounding tendons. This combination of high volume, muscle fatigue, and poor technique results in the repetitive stress injury known as Swimmer’s Shoulder.
Identifying Common Symptoms and Underlying Conditions
The term Swimmer’s Shoulder most commonly refers to Shoulder Impingement Syndrome or Rotator Cuff Tendinopathy. Impingement occurs when the rotator cuff tendons are compressed within the narrow space beneath the acromion bone. Symptoms often include a deep, dull ache in the front or side of the shoulder that worsens with overhead activity, both in and out of the water.
Pain may be specifically felt during the hand entry or the mid-pull-through phase of the swimming stroke, when the shoulder is internally rotated and elevated. Rotator cuff tendinopathy involves inflammation or degeneration of the rotator cuff tendons, often presenting as generalized weakness and pain when lifting the arm. Swimmers may also report a clicking, popping, or grinding sensation within the joint, along with a decreased ability to sustain their usual training intensity.
Diagnosis and Acute Management
A healthcare professional diagnoses Swimmer’s Shoulder through a detailed patient history and a thorough physical examination. The physical exam includes specialized orthopedic tests designed to provoke pain by intentionally narrowing the space where the tendons are compressed. The clinician will also assess the shoulder’s active and passive range of motion, strength, and the stability of the scapula.
Imaging studies are often used to confirm the diagnosis and assess the severity of soft tissue damage. X-rays can help rule out bony issues, while an MRI or ultrasound can visualize the rotator cuff tendons and bursa to detect tears, inflammation, or impingement. Acute management focuses on reducing pain and inflammation immediately. This initial phase typically involves a period of rest or significant activity modification, along with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and ice application.
Long-Term Prevention and Technique Correction
Long-term recovery and prevention require a shift from acute pain management to addressing the underlying causes of the shoulder dysfunction. Physical therapy is a primary component of this phase, focusing on strengthening the muscles that provide dynamic stability to the shoulder joint. Specific “dryland training” exercises target the scapular stabilizers and the weak external rotators of the shoulder.
Strengthening these muscle groups helps to correct the muscular imbalance that contributes to improper shoulder mechanics during the stroke. Technique modifications in the water are equally important; swimmers should be coached to maintain a high elbow catch and avoid letting the hand cross the midline of the body during the pull-through phase. Gradual increases in training volume and incorporating dynamic warm-up routines are essential to ensure the joint can tolerate the high demands of the sport without recurrence.