Swimmer's Shoulder: Why It Happens and How to Fix It

Swimmer's shoulder is a catch-all term for shoulder pain in swimmers, but it covers a range of underlying problems - rotator cuff tendinopathy, subacromial impingement, biceps tendon irritation, and glenohumeral instability. The common thread is high repetitive overhead loading through a fatigued, underprepared shoulder.

The volume problem

Elite swimmers may complete 10,000 to 14,000 strokes per shoulder per week in training. Even at recreational level, the volume is significant. At these numbers, small inefficiencies in technique or minor strength imbalances become major stressors. The shoulder was not designed to cope with this much overhead work without specific preparation.

The main contributing factors

The most common findings on assessment of a swimmer with shoulder pain are:

• Reduced internal rotation range of motion - related to posterior capsule tightness
• Weak external rotators relative to internal rotators (the catch and pull phase heavily favours the internal rotators)
• Poor scapular upward rotation - often related to tight pectoralis minor
• Restricted thoracic extension, which reduces overhead range
• Breathing pattern on freestyle affecting body roll and shoulder mechanics

What fixes it

Addressing swimmer's shoulder requires both load management and physical corrections. In the short term, reducing yardage, avoiding butterfly and freestyle pulling sets, and using a pull buoy to offload the shoulder are helpful.

Longer term, a targeted dry-land program addressing the specific deficits found on assessment is essential. This typically includes posterior capsule stretching, rotator cuff strengthening with an emphasis on external rotation, and scapular stabilisation work. Technique review - particularly hand entry position and catch mechanics - is also important.