Swimmers Shoulder: Symptoms, Types, Causes and Treatment

Swimmer’s shoulder is a term that resonates with both competitive and recreational swimmers alike. This common yet sometimes confusing condition can derail training and competition, causing pain and frustration. To help athletes, coaches, and healthcare professionals better understand and tackle swimmer’s shoulder, this article explores its symptoms, types, causes, and evidence-based treatments, drawing on the latest research.

Symptoms of Swimmers Shoulder

Shoulder pain is a frequent complaint among swimmers, often signaling the onset of swimmer’s shoulder. Recognizing the symptoms early is crucial for effective management and the prevention of more severe injury.

Pain	Weakness	Instability	Source(s)
Aching or sharp pain, often anterior or lateral shoulder	Decreased strength, especially with rotation or overhead movements	Sensation of looseness, "slipping," or apprehension	1, 2, 3, 5, 6, 7, 15

Table 1: Key Symptoms

Pain: The Hallmark Symptom

Most swimmers with shoulder problems report pain. This may be a dull ache or sharp discomfort, usually localized at the front (anterior) or side (lateral) of the shoulder, sometimes radiating down the arm. Pain is often aggravated by swimming, especially during certain strokes and overhead activities, and may worsen with increased training volume or intensity 1, 2, 3, 7, 15.

Weakness and Fatigue

A noticeable decrease in shoulder strength—especially when rotating the arm inward (internal rotation) or outward (external rotation)—is common. Swimmers may feel their shoulder tires more quickly than usual, or that they can’t generate the same power, particularly late in a workout or race 6, 8.

Instability and “Slipping” Sensations

Some swimmers experience a sensation of instability, as if the shoulder might “slip out,” particularly during certain movements or at the end of the stroke. This can be accompanied by an apprehension or reluctance to move the arm through its full range of motion 3, 5, 7.

Additional Signs

Other symptoms can include:

• Clicking or popping sensations
• Decreased range of motion, particularly in internal rotation
• Tenderness around the rotator cuff or biceps tendon
• Swelling or inflammation in severe cases

Symptom Progression

Symptoms often start subtly, perhaps as mild discomfort after a long or intense session, and can progress to persistent pain that interferes with training, daily activities, or even sleep if not addressed 3, 5, 13.

Types of Swimmers Shoulder

The term “swimmer’s shoulder” actually covers several specific injuries and dysfunctions. Understanding these types helps tailor treatment and prevention strategies.

Type	Description	Key Feature	Source(s)
Impingement	Tendons rub under acromion	Pain with abduction	1, 2, 3, 7, 9, 10
Tendinopathy	Overuse injury of rotator cuff/biceps	Tendon thickening	1, 7, 10
Instability	Excessive joint laxity/translation	Apprehension, “slip”	3, 8, 9, 11
Scapular Dyskinesis	Abnormal shoulder blade movement	Poor motion control	4, 12, 16

Table 2: Major Types

Shoulder Impingement Syndrome

This is the most recognized type, where the rotator cuff tendons (especially the supraspinatus) or the bursa are pinched (“impinged”) under the acromion during overhead motion. It manifests as pain during arm abduction, especially in the catch and recovery phases of the stroke 2, 3, 7, 9.

Rotator Cuff and Biceps Tendinopathy

Chronic overuse can lead to tendon injuries, most often affecting the supraspinatus, infraspinatus, or the long head of the biceps. These changes are evident on imaging as tendon thickening or degeneration (tendinosis), and are highly prevalent among competitive swimmers 1, 7, 10.

Glenohumeral Instability

Swimmers often develop increased laxity (looseness) in the shoulder joint, which may lead to subluxation (partial dislocation) or a feeling of instability. This non-traumatic instability results from repetitive microtrauma and can coexist with impingement 3, 8, 9, 11.

Scapular Dyskinesis

Abnormal movement or positioning of the scapula (shoulder blade) disrupts the normal mechanics of the shoulder, contributing to pain and dysfunction. This is increasingly recognized as a key factor in swimmer’s shoulder 4, 12, 16.

Other Types

Less commonly, swimmers may experience:

• Labral tears (cartilage damage inside the joint) 9
• Suprascapular nerve entrapment
• Os acromiale (unfused bone at the top of the shoulder) 9
• Arthritis or metabolic diseases (especially in older swimmers) 14

Causes of Swimmers Shoulder

Swimmer’s shoulder is a multifactorial condition, with causes ranging from training errors to anatomical predispositions.

Cause	Mechanism/Trigger	Impact	Source(s)
Overuse	Repetitive overhead strokes	Tendon degeneration	1, 2, 4, 5, 10, 11
Biomechanical faults	Poor technique, scapular dyskinesis	Impingement/instability	12, 16
Muscle imbalance	Weakness/fatigue of stabilizers	Altered joint kinematics	6, 8, 12, 16
Joint laxity	Hypermobile joints, especially in youth	Instability	3, 7, 8, 11
Prior injury	Previous pain increases risk	Recurrence	5, 11

Table 3: Main Causes

Training Volume and Overuse

The most consistent and powerful risk factor is simply the enormous training load: elite swimmers may log up to 80,000 meters per week, with each shoulder performing tens of thousands of rotations 1, 2, 10. This sheer repetition leads to microtrauma and gradual tendon degeneration, especially when compounded by inadequate rest or sudden increases in training 1, 5.

Biomechanical and Technical Errors

Faulty technique—such as crossing the midline during the pull, “dropping” the elbow, or poor body roll—can increase impingement risk. Scapular dyskinesis, where the shoulder blade moves abnormally, disrupts the normal “shoulder rhythm” and places undue stress on tendons and ligaments 12, 16.

Muscle Imbalance and Fatigue

Swimmers often develop strong internal rotators but relatively weaker external rotators and scapular stabilizers. These imbalances, especially when coupled with fatigue, impair the shoulder’s ability to maintain optimal alignment and function during vigorous activity 6, 8, 12.

Joint Laxity and Instability

Some swimmers, particularly those with generalized joint hypermobility (common in youth), are predisposed to excessive shoulder laxity. While some degree of laxity can enhance performance, too much creates instability, increasing the risk of impingement and other injuries 3, 7, 8, 11.

History of Prior Injury

A previous episode of shoulder pain or injury is a strong predictor for future problems. This may relate to residual weakness, incomplete rehabilitation, or altered movement patterns 5, 11.

Other Contributing Factors

• Inadequate cross-training or participation in other sports 4
• Use of hand paddles or sprint training 2
• Core weakness and poor posture 4, 12, 16
• Shortened or tight pectoralis minor and latissimus dorsi muscles 4

Treatment of Swimmers Shoulder

Effective treatment addresses both the symptoms and underlying causes. Most cases respond well to conservative management, but persistent or severe cases may require more intensive interventions.

Approach	Focus	Example Interventions	Source(s)
Rest/Activity Mod	Reduce aggravation	Modify or stop training	2, 13, 15
Physical Therapy	Restore balance	Strength, stretch, retrain	4, 6, 8, 12, 13, 15, 16
Medication	Control pain/inflammation	NSAIDs, ice	2, 13, 15
Technical Correction	Improve mechanics	Stroke analysis, correction	12, 15, 16
Surgery	Last resort	Debridement, repair, stabilization	2, 12, 13

Table 4: Main Treatments

Rest and Activity Modification

• Immediate reduction of painful activities is recommended to prevent further tissue damage 2, 13, 15.
• Swimmers may need to limit or temporarily stop overhead strokes, decrease yardage, or avoid hand paddles.
• Early recognition and action can prevent chronic problems.

Physical Therapy and Rehabilitation

Physical therapy is central, focusing on:

• Strengthening the rotator cuff and scapular stabilizers (especially the external rotators and lower trapezius) 4, 6, 8, 12, 13, 15, 16
• Stretching tight muscles such as the posterior capsule, pectoralis minor, and latissimus dorsi 4, 13, 15
• Correcting muscle imbalances by addressing both internal and external rotation strength deficits 6, 8
• Improving core stability and posture to optimize shoulder mechanics 4, 12, 16
• Neuromuscular retraining to address scapular dyskinesis and restore proper movement patterns 12, 16

Medications and Modalities

• Short-term use of NSAIDs (nonsteroidal anti-inflammatory drugs) and ice therapy can help manage pain and inflammation 2, 13, 15.
• Chronic use of NSAIDs or ice is discouraged due to potential side effects 13.

Technique and Training Adjustments

• Stroke analysis by coaches or therapists can identify and correct faulty mechanics, helping prevent recurrence 12, 15, 16.
• Gradual progression of training volume/intensity, and ensuring adequate recovery, are essential 1, 4, 5.

Surgical Intervention

• Surgery is reserved for swimmers who do not respond to conservative management.
• Procedures may include arthroscopic debridement, tendon repair, or stabilization for significant instability 2, 12, 13.
• Return to prior performance levels after surgery is variable and often suboptimal, except in select cases 12.

Prevention Strategies

• Early recognition and intervention at the first sign of pain 13, 15
• Balanced stretching and strengthening programs targeting both the anterior and posterior shoulder structures 13, 15
• Avoiding overuse and technical errors through coach education and athlete awareness 1, 2, 4, 12, 15, 16
• Cross-training and participation in other sports to reduce repetitive stress 4

Conclusion

Swimmer’s shoulder is a prevalent and often complex condition that can affect swimmers of all ages and abilities. Understanding its symptoms, types, causes, and evidence-based treatments empowers athletes and support teams to take proactive steps toward prevention and recovery.

Key Takeaways:

• Symptoms include shoulder pain, weakness, and instability, often progressing with continued swimming 1, 2, 3, 5, 7.
• Types encompass impingement, tendinopathy, instability, and scapular dyskinesis, each with specific features 1, 2, 3, 7, 9, 10, 12, 16.
• Causes are multifactorial: overuse, poor technique, muscle imbalance, joint laxity, and prior injury all contribute 1, 2, 3, 4, 5, 6, 8, 10, 11, 12, 16.
• Treatment focuses on early rest, physical therapy, technical correction, and, rarely, surgery 2, 4, 6, 8, 12, 13, 15, 16.
• Prevention hinges on balanced training, early intervention, core and scapular strengthening, and correction of technical errors 4, 12, 13, 15, 16.

By staying informed and attentive to the demands on their shoulders, swimmers can reduce their risk of injury and enjoy a long, healthy career in the water.