Swimmer’s Shoulder: How to Treat Common Shoulder Injuries

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Swimmer's shoulder is a common condition seen in swimmers and other athletes. It can also be found in people with jobs that require overhead activities. It's a broad term that covers certain shoulder injuries that cause pain, weakness, and stiffness.

Swimming has many benefits, but it requires repetitive movements through the shoulders. It can also cause an imbalance in the shoulder muscles, since it usually works the front body muscles more than the back muscles. For these reasons, swimming can cause an overuse injury in your shoulder.

Swimmer's shoulder is especially common for competitive swimmers. Studies report up to 91% of competitive swimmers will have this condition at some point. But it's not limited to swimmers. Other athletes - like baseball and tennis players - as well as musicians and those who do overhead work (like painters) can be affected.

What are the symptoms of swimmer's shoulder?

The most common symptom of swimmer's shoulder is shoulder pain that worsens with activities. In fact, many athletes feel the need to take a break from their sport because this pain limits them.

You might also feel weaker than normal in one or both of your shoulders. Or you might feel stiffness. It's common to notice changes in your posture. This includes shoulders rounding forward and tightness in your chest muscles.

What are the different types of swimmer's shoulder?

For years, swimmer's shoulder was commonly blamed on shoulder impingement. But experts now think it can be related to several different conditions that cause pain. In other words, there are probably a few different things happening in your body, and "swimmer's shoulder" is an umbrella term. This term can encompass the following conditions.

Shoulder impingement

Shoulder impingement occurs when the rotator cuff tendons are compressed in the small space around your shoulder. It's also called subacromial impingement. This occurs when you frequently lift and move your arm overhead. Your bursa (a fluid-filled sack in your shoulder) can also get irritated, which causes pain.

Rotator cuff tendonitis

The rotator cuff tendons help stabilize your ball and socket shoulder joint. But overuse can cause these tendons to get out of balance. This can lead to inflammation (tendinitis) and strain (tendinopathy) over time. The result is shoulder pain. This is especially common in competitive swimmers who train and swim at a high intensity.

Instability or shoulder laxity

Your shoulder joint is also stabilized by the joint capsule, ligaments, and cartilage called the labrum. But, with overuse and time, these structures don't stabilize as well. So, swimmers can develop shoulder instability from the repetition of swimming strokes. This can worsen muscle imbalances and lead to other issues, such as impingement and tendon problems.

Scapular dyskinesis

With this condition, your scapula (shoulder blade) doesn't move normally during arm movements. It may also protrude or stick out. This can be caused by muscle weakness or muscle imbalances. This can affect the shoulder joint, leading to pain and impingement.

What causes swimmer's shoulder?

Swimmer's shoulder is caused by repetitive overhead activities, which stress the structures that stabilize your shoulder joint. Swimming is a common cause of swimmer's shoulder. However, any sport or activity that involves repetitive overhead activity can be a culprit.

Using certain muscles more than others in a repetitive fashion can lead to muscle imbalance over time. This causes certain muscles to become overworked, inflamed, and irritated.

Who is more at risk for swimmer's shoulder?

As mentioned, people who perform overhead activities are at higher risk. Other risk factors include:

• An increase in training

• Weakness in the posterior (back) shoulder muscles

• Joint looseness (or laxity)

• Scapular dyskinesis (issues moving the shoulder blade)

And some people (roughly 8%) have a bone variant called os acromiale (OA). This can happen as your bones develop early in life. This increases the risk of shoulder impingement and, in turn, swimmer's shoulder.

How do you treat swimmer's shoulder?

Most cases of swimmer's shoulder get better with nonsurgical treatment. Athletes can usually return to their sport after a few months of treatment.

The first steps in treatment are to stop the aggravating activity and address the inflammation. This will help make sure your condition doesn't get worse. Then, you can proceed with fixing your muscle imbalances and strengthening.

These are common ways to treat swimmer's shoulder:

• Rest: For at least a week, avoid any sports or activities that involve overhead motions or that increase pain.

• Ice: Appy an ice pack two or three times a day for 20 minutes. This will help decrease pain and inflammation.

• Anti-inflammatory medications: A short course (7 to 10 days) of nonsteroidal anti-inflammatory drugs (NSAIDs) can help with pain and inflammation. Examples include aspirin, ibuprofen, and naproxen.

• Corticosteroid injections: If you seek care from a healthcare professional, they might offer an injection of a powerful anti-inflammatory medication into the bursa (a fluid-filled sack in your shoulder). This helps reduce pain and inflammation.

• Home exercises: Studies have found that exercise helps treat and prevent swimmer's shoulder. Exercises may include strengthening of the rotator cuff and scapular muscles. Exercises for posture and stretching the posterior capsule (back of the shoulder joint) are also helpful.

• Physical therapy: If this is a new issue for you, consider getting help from a physical therapist. They can evaluate your shoulders and arm movements to determine which exercises will be best for you. They can also show you how to do the moves properly without reinjuring yourself.

• Gradual return to the sport or activity: After a period of rest and rehab, you can slowly return to your sport or activity. Keep your repetitions low at first. Stop or slow down if you feel pain.

If your pain persists after conservative treatment or pain returns when you resume activity, it's time to get medical attention. A musculoskeletal specialist - like an orthopedic surgeon or sports medicine physician - can help. They'll determine if something else may be going on, or if surgery is an option.

How do you prevent swimmer's shoulder?

You can prevent swimmer's shoulder in several ways. Here are some specific tips to prevent this condition:

• Don't train or exercise through pain. Stop or reduce the intensity or frequency to allow your shoulder to heal.

• Plan for rest days in your training program.

• Keep your shoulder muscles strong by strengthening your rotator cuff and scapular muscles.

• Maintain a good posture with overhead activities.

• Perform a warmup and a cool-down before and after an activity.

• If you're a swimmer, alternate swimming strokes to avoid overuse.

• Use swim fins on your legs to put less stress on your shoulder as your shoulder heals.

• Avoid using hand paddles or kickboards, since these put too much stress on your shoulder.

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