According to the University of New South Wales, around 1% (~200,000) of the Australian population will experience shoulder pain.[1] Due to the physical demands of swimming, up to 35% of competitive swimmers will experience shoulder pain.[2]
While swimming is an excellent sport for health and fitness, competitive swimmers are vulnerable to shoulder injuries. The mobility and power needed to swim at an elite level can lead to enormous repetitive stress through the shoulder. The term ‘swimmer’s shoulder’ was created because of the many shoulder injuries seen in swimmers.
Read on to understand what you should know about swimmer’s shoulder; the risk factors, treatment options and expected recovery time.
What is Swimmer’s Shoulder?
Swimmer’s shoulder is a general term used to describe shoulder pain experienced by swimmers. The repeated extreme shoulder movements required from swimming can increase the risk of developing shoulder injuries. Examples of common injuries include rotator cuff tendonitis and impingement syndrome.
What are the symptoms of swimmer’s shoulder?
Swimmer’s shoulder presents with varying symptoms, depending on the structures affected within the shoulder joint.
Common symptoms of swimmer’s shoulder
What causes swimmer’s shoulder?
Swimmer's shoulder is caused by overuse of the shoulder joint, particularly with repetitive motions, like swimming. Additional causes include repetitive lifting and other sports like tennis, cricket, or any other throwing sports.
Common causes of swimmer’s shoulder
Sports that increase the risk of swimmer’s shoulder
Swimmer’s shoulder commonly affects athletes who rely on repeated high-intensity shoulder movements resulting in excessive stress on the shoulder joint, leading to different conditions such as a labral tear or rotator cuff tendonitis.
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Swimming
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Baseball
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Cricket
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Tennis
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Volleyball
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Javelin
How is swimmer’s shoulder diagnosed?
Swimmer’s shoulder usually becomes a problem over time, with constant repetition of movement. Pain and discomfort may come and go, but micro-tears and stress around the shoulder joint can accumulate and lead to instability and immobility of your shoulder.
It is vital to have your shoulder evaluated if you are experiencing pain and instability during your activities. One of the most preferred medical solutions is an assessment with a physiotherapist.
Through extensive clinical experience, physiotherapists are highly qualified experts that can effectively diagnose joint injuries such as swimmer’s shoulder and help you return to your pre-injured state.
A physiotherapy assessment will start with a mini-interview about your medical history and lifestyle to create a background of your condition. Use this time to discuss with your physiotherapist the relevant issues about your injury.
Your physiotherapist will then perform specific movement screens and physical tests to assess the integrity of the shoulder joint and identify the root cause of your symptoms.
After your evaluation, your physiotherapist will guide you through your treatment program.
This will include:
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Home exercise programs to maximise your recovery
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Number of treatment sessions
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Expert advice and education.
How is swimmer’s shoulder treated?
Swimmer’s shoulder is an overuse injury that can happen over time. Unless you address the root cause of your symptoms, overhead shoulder activities will only worsen your condition.
If you are experiencing symptoms of swimmer’s shoulder, it is important to have your condition assessed and treated as soon as possible to correct faulty shoulder mechanics.
There are several options when it comes to treating swimmer’s shoulder. One of the more common and the treatment option referred to by Australian GPs the most frequently is physiotherapy.
Physiotherapists regularly rehabilitate shoulder conditions such as swimmer’s shoulders, and it is one of the most common sporting injuries that physiotherapists encounter in the clinic. Thus, they are in the best position to provide treatment for this kind of condition.
Your treatment will focus on decreasing your pain, improving your shoulder mobility, and stabilising critical structures of your shoulder.
Depending on the severity of your swimmer’s shoulder, a physiotherapist may provide you with a combination of the following types of treatments:
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Strengthening Exercises - Exercise to strengthen your shoulder muscles to improve your control and decrease shoulder laxity.
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Stabilisation Exercises - Involves key exercises that will stabilise the shoulder joint and treat instability and prevent shoulder dislocations.
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Soft tissue Mobilisation - Manual muscle relaxation techniques used to reduce spasms and facilitate blood flow.
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Manual Therapy - Hands-on techniques used by your physio to improve your joint mobility and decrease your pain.
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Taping Techniques - Specialised tape to promote good movement and help stabilise the shoulder.
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Advice and Education - Appropriate advice on how you can gradually return to your activities and prevent re-injury.
A typical physiotherapy session with your local physiotherapist will last anywhere between 30-60 minutes. It is not uncommon for patients to feel the benefits in just one session.
Next step - Creating a treatment plan made for you
After your initial evaluation, your physiotherapist will create a specific plan of care to get the most out of your recovery and help you get back to your pre-injury state.
Self-care for swimmer’s shoulder
If you think you have swimmer’s shoulder, here are the best things you can do and avoid.
Things to do:
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Rest
Resting is always a part of your recovery. Take a break from high-intensity shoulder activities for a couple of weeks to heal affected shoulder structures properly.
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Use Cold Compress
Apply cold compress on the shoulder area for 15 minutes to reduce swelling and inflammation.
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Gentle Stretching
Stretching the shoulder muscles can improve range of motion and minimise tension on the shoulder joint resulting in decreased pain.
Things to avoid:
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Avoid high-intensity shoulder activities.
Avoid repetitive overhead movements or throwing motions for a few weeks to help your shoulder recover.
Do I need a specialist or surgery?
Diagnostic imaging can identify shoulder pathology that may be causing your symptoms. X-ray scans can check for bone and arthritic lesions within the shoulder joint. MRI scans will look for ligamentous injuries and muscle tears within the shoulder area.
Severe cases of swimmer’s shoulder may need surgical intervention, especially if there’s a problem with the shoulder labrum or complete tear of the ligaments and tendon.
Your GP may refer you to a physiotherapist to get the appropriate treatment and rehabilitation of your shoulder.
What is the recovery time / prognosis for swimmer’s shoulder?
Recovery time is largely dependent on being proactive and seeking professional treatment along with the severity of your shoulder pain and injury.
With treatment and proper guidance, you can return to normal activities within two to four weeks. More severe cases can take several months if not managed appropriately.
Physiotherapy can improve the overall outcome of patients with swimmer’s shoulder. Consistency with your treatment program can go a long way and will help you sustain your sporting career.
Important factors in recovery include:
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Focusing on your rehabilitation program daily
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Resuming your sports activity gradually
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Paying attention to pain, and resting as necessary.
Can swimmer’s shoulder be prevented?
These tips can help you prevent swimmer’s shoulder or maximise your recovery if you’re already in pain.
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Strengthen your shoulder muscles - Strengthening your rotator cuff muscles can help you prevent shoulder injuries and impingement syndromes.
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Do stretching exercises – Stretching exercises can help relieve the tension on your shoulder muscles and elongate tight structures that can contribute to your pain.
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Proper warm-up and cool-down – Warming up can help you properly activate your shoulder muscles before engaging in high-intensity activity. Cool-downs and adequate rest periods can help your body recover.
Outlook and the main takeaways
Swimmer’s shoulder is a painful condition that affects the shoulder joint. It is a result of excessive stress and cumulative trauma on the shoulder.
It is crucial to recognise your pain patterns and know that pain is your body’s signal that something is incorrect. If you have pain and discomfort in your shoulder, book a consultation with a physiotherapist to start your recovery immediately.
Anatomy of the shoulder joint
The shoulder complex is designed to have a great range of motion with varying degrees of freedom for movement. It is composed of several functional joints that work together to achieve smooth and stable shoulder movements.
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Glenohumeral: Ball and socket joint, which provide dynamic articulation between the glenoid of the scapula and the upper part of the humerus.
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Scapulothoracic: Articulation formed between the thoracic rib cage and anterior surface of the scapula
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Sternoclavicular: Articulation between the sternum and clavicle, which allows movement of the clavicle in three planes.
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Acromioclavicular: Articulation formed between the clavicle and scapula.
The large amount of mobility of the glenohumeral and scapulothoracic is balanced by the stability of the acromioclavicular and sternoclavicular joints.
Ligaments and muscle tendons of the rotator cuff around the glenohumeral joint provide stability to the shoulder joint, allowing the shoulder to withstand large external forces while providing enough mobility to accomplish complex movements.
Swimmer’s shoulder usually presents as subacromial impingement with potential damage to the rotator cuff, bicipital tendon or bursa.
