Swimmer’s shoulder, medically known as rotator cuff impingement, is a common overuse injury affecting the shoulder joint. It often arises due to the repetitive overhead motions involved in swimming, particularly during strokes like freestyle, butterfly, and backstroke.
Swimmer’s shoulder occurs when the tendons of the rotator cuff muscles become compressed or irritated as they pass through a narrow space between the shoulder bones.
Over time, this repetitive motion causes inflammation, pain, and a decreased range of motion, making swimming and other activities increasingly uncomfortable.
Anatomy Of The Shoulder And Muscles Involved
This condition primarily affects the rotator cuff tendons and the subacromial bursa. This small fluid-filled sac reduces friction between the rotator cuff and the acromion (part of the scapula).
When the shoulder is repeatedly strained without sufficient rest, the tendons can become inflamed, leading to impingement, which is the hallmark of swimmer’s shoulder.
Who Is At Risk?
While shoulders are the primary group affected by this condition, swimmer’s shoulder can also occur in other individuals involved in repetitive swimming activities.
Athletes in sports like tennis, volleyball, and baseball frequently experience similar shoulder issues. Additionally, individuals who engage in jobs or hobbies that require repetitive arm movements above the head, such as construction workers or painters, may also be at risk.
Swimmer’s Shoulder Causes
Swimmer’s shoulder results from a combination of factors that, when left unaddressed, can contribute to inflammation and pain in the shoulders. This can be a common occurrence for beginner swimmers with incorrect technique.
Below are the most common causes of this condition:
Repetitive Shoulder Movement And Overuse
The most significant cause of swimmer’s shoulder is the repetitive nature of swimming strokes. Constant overhead arm movements stress the shoulder joint, particularly the rotator cuff muscles and tendons.
This repetitive motion, combined with inadequate rest, leads to muscle fatigue and eventually causes irritation or injury.
Poor Stroke Technique
Incorrect swimming form is another major contributor to swimmer’s shoulder. A poor hand entry angle, crossing the arms too far in front of the body, or inadequate body rotation can cause excessive strain on the shoulder muscles.
Over time, these biomechanical errors lead to wear and tear on the shoulder, increasing the risk of developing swimmer’s shoulder.
Inadequate Warm-Up Or Stretching
Failing to properly warm up before swimming can leave the shoulder muscles stiff and unprepared for the physical demands of swimming. This can increase the likelihood of injury as the muscles are not sufficiently loosened or activated.
Stretching and dynamic warm-up routines are essential for improving flexibility and reducing the risk of swimmer’s shoulder.
Muscle Imbalances And Fatigue
Muscle imbalances, particularly between the front and back of the shoulder, can cause improper joint alignment and contribute to swimmer’s shoulder.
For instance, the pectoral (chest) muscles may become overdeveloped in comparison to the weaker rotator cuff muscles, leading to instability. Over time, these imbalances result in fatigue and an increased likelihood of shoulder injury.
Shoulder Instability Or Poor Posture
Shoulder instability is a condition in which the joint moves excessively or slips out of place, often due to weak supporting muscles or ligaments. Swimming can exacerbate this instability, further irritating the rotator cuff.
Poor posture, such as slouching or rounded shoulders, can also change the alignment of the shoulder joint, making it more vulnerable to impingement.
Environmental Factors (Cold Water, Excessive Training)
External factors can also play a role in the development of swimmer’s shoulder. Cold water can cause muscles to tighten and become less flexible, increasing the likelihood of strain or injury.
Excessive training without proper rest or recovery can also cause the shoulder muscles to become fatigued, making them more prone to injury. Swimmers who train intensively without taking time off to recover are particularly susceptible to developing this condition.
Common Swimmer’s Shoulder Symptoms
Swimmer’s shoulder can present with a variety of symptoms that affect both the shoulder and surrounding areas. Recognising these early signs is crucial for addressing the condition before it worsens.
Pain During Or After Swimming
One of the most common symptoms of a swimmer’s shoulder is a dull or sharp pain that occurs during or after swimming. This pain typically manifests during overhead movements like the freestyle stroke.
Initially, the discomfort may only appear during strenuous training sessions, but it can become more persistent over time, even during everyday activities.
Limited Range Of Motion Or Stiffness In The Shoulder
As the condition progresses, swimmers may experience limited range of motion or stiffness in the affected shoulder.
This stiffness can make it difficult to fully extend the arm during a stroke, affecting swimming performance. Reduced flexibility is often most noticeable when trying to raise the arm above the head or behind the back.
Muscle Weakness Around The Shoulder Joint
Swimmer’s shoulder can lead to muscle weakness in the shoulder and upper arm. This weakness is particularly apparent during overhead movements, such as lifting or throwing. Muscle weakness may also cause swimmers to struggle with completing their usual training routines.
Swelling Or Tenderness In The Affected Area
Some individuals with swimmer’s shoulder may experience visible swelling or tenderness around the shoulder. This is often due to inflammation of the rotator cuff tendons or the surrounding bursa. Tenderness is usually noticeable on the shoulder, particularly in the front or side of the joint.
Clicking, Popping, Or Grinding Sensations
In more severe cases, swimmers may notice clicking, popping, or grinding sensations when moving the shoulder. These sounds can occur when tendons rub against the bones or other tissues in the shoulder. While swimmer’s sensations are not always painful, they are a sign of damage or irritation within the joint.
Impact On Swimming Performance
As swimmer’s shoulder progresses, it can significantly impact swimming performance. The pain and stiffness may prevent swimmers from maintaining their usual speed or form.
Athletes may find it difficult to complete long training sessions or swim at high intensities, which can affect their overall performance and competitiveness.
Swimmer’s Shoulder Treatment Options
Treating swimmer’s shoulder depends on the severity of the condition. For most people, a combination of conservative and advanced treatments can effectively manage pain, restore shoulder function, and prevent recurrence. Early intervention is key to preventing long-term damage.
Conservative Treatments And Home Remedies
Rest And Activity Modification
The first line of treatment for swimmer’s shoulder is rest and activity modification. Reducing or stopping swimming and other activities that exacerbate shoulder pain is essential to allow the tendons and muscles to recover. Completely avoiding painful movements helps prevent further irritation and damage.
During this period, it’s important to focus on gradually restoring normal shoulder function. While rest is crucial, it’s equally important to avoid complete inactivity, as maintaining some level of movement helps preserve shoulder flexibility and strength.
Ice Therapy For Inflammation And Swelling
Ice therapy is another effective conservative treatment for reducing inflammation and managing pain. Using an ice pack for 15 to 20 minutes several times a day can help bring down swelling in the shoulder. Ice should be applied, especially after physical activity or when experiencing acute pain.
Anti-Inflammatory Medications
Over-the-counter anti-inflammatory medications such as ibuprofen or naproxen can help reduce pain and swelling associated with swimmer’s shoulder.
These medications work by decreasing inflammation in the affected tendons and tissues. However, these medications should be used under the guidance of a healthcare professional, especially for long-term use.
Physical Therapy and Stretching Exercises
Physical therapy plays a vital role in treating swimmer’s shoulder. A physical therapist will guide you through a series of exercises designed to improve shoulder mobility, reduce pain, and strengthen the muscles around the shoulder joint.
Regular physical therapy helps restore proper movement patterns, improves posture, and corrects any biomechanical issues that may have caused the injury.
Strengthening Exercises (Focusing On Rotator Cuff And Scapular Muscles)
Once the initial pain and inflammation have subsided, strengthening exercises become essential to recovery. These exercises focus on building strength in the rotator cuff and scapular muscles, which are key for stabilising the shoulder during overhead movements like swimming.
Typical exercises might include:
- External and internal rotations using resistance bands.
- Scapular retractions to improve shoulder blade control.
- Shoulder raises and presses to build overall shoulder strength.
Advanced Treatments
In cases where conservative treatments do not provide sufficient relief, more advanced medical interventions may be necessary.
Corticosteroid Injections
For individuals with severe pain and inflammation, corticosteroid injections may be recommended. These injections deliver a powerful anti-inflammatory agent directly into the affected area, reducing swelling and pain.
Shockwave Therapy
Shockwave therapy is a noninvasive treatment that uses high-energy sound waves to stimulate healing in the affected shoulder tissues. It is often recommended for chronic cases of swimmer’s shoulder that do not respond well to other treatments.
Platelet-Rich Plasma (PRP) Injections
Another advanced treatment option is Platelet-Rich Plasma (PRP) injections. In this procedure, a concentrated solution of the patient’s own blood platelets is injected into the injured shoulder to promote healing.
Surgical Intervention (In Severe Cases)
For the most severe cases of swimmer’s shoulder, where there is significant damage to the tendons or the shoulder joint, surgical intervention may be necessary. Surgery typically involves removing any bone spurs or repairing torn tendons that are contributing to the impingement.
While surgery is usually the last resort, it can be effective in restoring full function to the shoulder for athletes who have not found relief with conservative treatments.
Rehabilitation And Recovery Process
Rehabilitation is critical to recovering from a swimmer’s shoulder. It ensures a full return to activity while preventing future injuries.
Swimmer’s Shoulder Recovery Time
The recovery time for a swimmer’s shoulder varies depending on the severity of the injury. Mild cases may recover in a few weeks, while more serious injuries can take several months.
Most recoveries follow a phased approach, starting with rest to reduce inflammation and gradually reintroducing swimming once the pain subsides. It’s crucial to avoid rushing back to full activity too soon, as this could cause setbacks.
Importance Of Adherence To Physical Therapy
Consistent physical therapy is essential during recovery. Exercises focus on maintaining flexibility and strengthening weak muscles, especially those in the rotator cuff and scapula.
Correcting posture and swimming technique during therapy is vital for preventing re-injury. Following the therapist’s plan ensures steady progress and reduces the risk of relapse. Once back in the pool, swimmers must pay attention to proper form and training techniques to avoid future shoulder issues.
Prevention Of Swimmer’s Shoulder
Preventing swimmer’s shoulder involves improving technique, preparing the body for swimming, and reducing overuse.
- Proper Swimming Technique: Focusing on correct body rotation and hand entry reduces unnecessary strain on the shoulder. Professional coaching can help refine strokes to minimise repetitive stress.
- Warm-up and Stretching: A good warm-up before swimming, including dynamic stretches for the shoulders and arms, helps loosen muscles and prevent injury.
- Cross-training: Incorporating activities like cycling or running helps avoid overuse of the shoulder muscles. Regular cross-training prevents fatigue and muscle imbalances.
- Strengthening Key Muscles: Strengthen the rotator cuff, back, and core muscles through targeted exercises to build support for the shoulder joint.
- Rest and Recovery: Ensure regular rest periods in training schedules. Overtraining without sufficient recovery leads to fatigue, making injuries more likely.
Conclusion On Swimmer’s Shoulder
Swimmer’s shoulder is a common but preventable condition, especially for those involved in repetitive overhead movements like swimming.
Early diagnosis and treatment are essential in preventing further damage to the shoulder and ensuring a quicker recovery. Recognising the symptoms early, such as persistent pain or weakness, allows for timely intervention through physical therapy, rest, and, if necessary, more advanced treatments.
If you wish to improve your swimming technique, enrol in a Swimwerks swimming lesson taught by NROC-certified coaches, you can avoid injury by perfecting your technique.
Frequently Asked Questions About Swimmer’s Shoulder
Can I Continue Swimming While Recovering From Swimmer’s Shoulder?
In most cases, it’s recommended to pause swimming during the initial phase of recovery to allow the shoulder to heal. Once pain decreases and strength improves, you can gradually reintroduce swimming, but only under the guidance of a healthcare professional or physical therapist.
What Are The Main Symptoms Of Swimmer’s Shoulder?
Common symptoms include shoulder pain during or after swimming, limited range of motion, muscle weakness, and sensations of clicking or popping in the shoulder joint. Without proper treatment, these symptoms can progressively worsen.
How Can I Prevent Swimmer’s Shoulder?
Prevent swimmer’s shoulder by maintaining proper swimming technique, doing adequate warm-ups and stretching, and incorporating strengthening exercises for the shoulder and back. Rest and recovery are also essential to avoid overuse injuries.
What Are The Best Treatments For Swimmer’s Shoulder?
Conservative treatments include rest, physical therapy, ice application, and anti-inflammatory medications. More severe cases may require advanced treatments like corticosteroid injections, shockwave therapy, or surgery.
How Does Cross-Training Help Prevent Swimmer’s Shoulder?
Cross-training involves engaging in other forms of exercise like cycling or running, which allows the shoulder to rest while maintaining overall fitness. It reduces the risk of overuse injuries by varying the muscles worked during training.
Can Swimmer’s Shoulder Lead To Permanent Damage?
If left untreated, swimmer’s shoulder can lead to chronic pain or more severe issues like rotator cuff tears. Early diagnosis and appropriate treatment can prevent permanent damage and allow a full return to swimming.