What to Know About Swimmer’s Shoulder

As a dedicated swimmer, Emma had always pushed herself to the limit in the pool. She’d been swimming for years with her local Masters group and loved the feeling of finishing a tough workout with her teammates. Her passion for swimming, however, had begun to decline as she started to have a nagging pain in her shoulder that just wouldn't go away.

Emma found herself second-guessing her every stroke, worrying that she would cause even more damage to her already injured shoulder. This nagging shoulder pain left her feeling worried about her future in the pool. She’d always taken pride in her swimming and the thought of not being able to swim the way she used to was worrying her.

Turns out, Emma was dealing with swimmer’s shoulder. As a physical therapist who specializes in the treatment of swimmers, I’ve seen my fair share of swimmer’s shoulder. Left untreated, the condition can be painful, debilitating, and can affect a swimmer's performance in the water.

Treating swimmer’s shoulder can be intimidating. If you do a quick online search, thousands of articles come up and you’ll find that every article tells you something different. This article aims to make swimmer’s shoulder less intimidating, by defining what it is, what causes it, and what you can do to recover from it.

What is Swimmer’s Shoulder?

First, let's start with what exactly swimmer’s shoulder is. It’s an umbrella term used to describe any injury or pain in the shoulder that's caused by swimming. This can include a range of injuries, such as:

• Rotator cuff tendinitis
• SLAP tear
• Shoulder bursitis
• Shoulder instability
• Shoulder impingement

While each diagnosis requires a slightly different treatment approach, there are some commonalities between each diagnosis. This makes recovering from swimmer’s shoulder a bit simpler.

What Causes Swimmer’s Shoulder?

Swimmer’s shoulder is rarely caused by one thing in isolation. Instead, it’s likely a combination of factors that add up over time result in injury. The latest research has shown that there are four risk factors for developing swimmer’s shoulder. Those four risk factors are:

Technical errors

There are a couple of common technical errors, especially during freestyle, that have been associated with swimmer’s shoulder. Three of the most common errors are crossing your midline during hand entry, crossing your midline during your pull, and a lack of body roll. All three of these errors increase the amount of stress placed on the shoulder, increasing the risk of injury.

Improper dryland training

This can mean one of two things. Either the dryland training you’re doing is too much or too little. If dryland training is the cause of your swimmer’s shoulder, it may be a result of not having a well-balanced dryland program. You might be neglecting certain muscles or muscles groups or doing too much dryland training.

Training errors (overtraining) 

Swimmers are all too familiar with the feeling of fatigue and muscle soreness. Most of the time fatigue and soreness are okay, but too much of either can increase your risk of overtraining. With overtraining, you may find you have less strength and endurance, making it easier to overload the muscles around your shoulder, potentially leading to injury.

Excessive use of hand paddles

Using paddles increases the amount of stress put on the shoulders. There are benefits to using paddles but doing too much may fatigue the muscles around the shoulder faster, increasing the risk of injury. Not using paddles every workout and completing most of your training volume without paddles are two easy ways to ensure that you do not use your paddles too much.

Fixing Swimmer’s Shoulder: Correcting Common Muscle Imbalances

The best way to recover from swimmer’s shoulder is to correct any imbalances around the shoulder that may have contributed to your injury. Regardless of a specific diagnosis, there are a couple of common muscle imbalances:

Tightness in the muscles around the neck

Often overlooked, tightness in the muscles around the neck can play a major role in swimmer’s shoulder. Why? Because in swimming, you must rotate or lift your head hundreds of times a practice. Over time, this can lead to neck tightness. Tightness in the neck can impact how your shoulder moves, which ends up placing more strain on the shoulder. One of my favorite ways to loosen up the neck is by doing chin tucks with rotation.

Decreased strength of the serratus anterior

Often when a swimmer has shoulder pain, a muscle around the scapula, the serratus anterior, can become weaker. The serratus anterior is extremely important as it rotates your scapula upward, helping give your shoulder a stable base from which to move. Without the serratus anterior functioning at 100%, the muscles around the shoulder, such as the rotator cuff or deltoids, will have to work much harder while you’re swimming. A great exercise for the serratus anterior is the push-up plus.

Decreased shoulder internal rotation

Another deficit commonly see in swimmer’s shoulder is a lack of internal rotation at the shoulder. In the pull phase of your freestyle, you must go into 45 to 60 degrees of shoulder internal rotation. If you’re missing shoulder internal rotation, you’ll need to cheat by using different muscles around the shoulder. This can lead to compensation patterns that increase the strain on the shoulder, increasing the risk of injury. One of the best ways to improve your shoulder internal range of motion is with the posterior shoulder release.

The Final Touch

After working with Emma for a couple of weeks, her shoulder pain started to subside and her confidence increased. Fast forward a few more weeks, Emma was back to swimming full workouts and was starting to feel like herself in the water again. What did Emma work on? We addressed her imbalances by increasing her shoulder internal rotation range of motion, strengthening her serratus anterior, and loosening the muscles around her neck.

Although swimmer’s shoulder can be painful, debilitating, and intimidating, knowing exactly what it is and how to treat in coordination with a physical therapist it can give you the tools and knowledge you need to return to the pool with confidence. If physical therapy doesn’t work for you, you might have to undergo surgery.