Physical Therapy Can Get You Back in the Pool If Swimmer's Shoulder is Slowing You Down

Imagine gliding through the water, your arms slicing effortlessly as you chase the perfect stroke. For some, swimming can be seen as poetry in motion, since it combines strength, endurance, and grace. But what happens when something gets in the way of this aquatic symphony?

Enter swimmer's shoulder, one of the more frustrating obstacles for any athlete who spends much of their time in the pool.

Swimmer's shoulder is more than just an ache. It's a wake–up call from your body caused by the toll of repetitive overhead motions that demands your attention. This umbrella term encompasses a range of injuries–including tendinitis and impingement–that can turn fluid swimming strokes into painful struggles. These painful symptoms can sideline swimmers for an extended period, especially competitive swimmers, who are most vulnerable to swimmer's shoulder. Yet, there's hope: physical therapy can offer a lifeline by empowering swimmers to recover, prevent recurrence, and return to the water stronger than ever.

Investigating why swimmer's shoulder develops in the first place

Recognizing the impact of swimmer's shoulder on athletes, a key study set out to explore the most effective ways to treat and prevent this condition. Researchers wanted to determine the best approach to managing shoulder pain in swimmers while also identifying causes and risk factors that contribute to the problem.

To accomplish this, a group of swimmers–some with shoulder pain, some without–were examined, including how their shoulders moved and functioned, and any related muscle imbalances. Researchers also examined the various treatments that each participant underwent, which included rest, medication, and structured physical therapy, to determine which were most effective.

Results showed that up to 90% of competitive swimmers experience shoulder pain at some point in their careers. According to the study, the rotator cuff tendons, biceps tendon, and surrounding soft tissues are most frequently involved in these injuries, and the high volume of arm movements involved in swimming–especially during strokes like the freestyle and butterfly–puts excessive strain on these structures. Other key findings included the following:

• Shoulder mechanics can contribute to injury: swimmers with poor stroke mechanics had a higher rate of shoulder pain and dysfunction than those with proper form; in particular, overreaching, dropping the elbow, and excessive internal rotation were all found to place excess strain on the shoulder


• Muscle imbalances increase injury risk: swimmers with weak external rotator muscles and overly strong internal rotator muscles were more likely to develop shoulder pain than others


• Overtraining can be dangerous: excessive training volume and not taking enough time to recover contributed to the development of swimmer's shoulder; in particular, swimmers who trained for more than 15 hours per week were at a significantly higher risk of shoulder pain


• Good shoulder stability is crucial: many swimmers had unstable shoulders, which was associated with a higher risk for injury; therefore, researchers recommended that swimmers should aim to achieve a balance between mobility and stability

Physical therapy found to be a solution for preventing and treating swimmer's shoulder

The other primary finding was that physical therapy is the most effective treatment option for both treating and preventing swimmer's shoulder. Research showed that a structured physical therapy program focusing on strength, flexibility, and technique correction can significantly reduce pain and improve shoulder function over time. For swimmers who are dealing with shoulder pain, the study found that the most beneficial interventions were:

• Manual (hands–on) therapy and soft tissue mobilization to reduce pain


• Progressive strengthening programs focused on endurance


• Postural correction exercises to address compensatory movements

Additional details from these findings are provided below:

• Strengthening exercises for the rotator cuff and scapular stabilizers are best for preventing and rehabilitating swimmer's shoulder, especially:
  
  
  
  • External rotation exercises with resistance bands
  
  
  • Scapular retraction exercises to improve shoulder blade stability
  
  
  • Core strengthening workouts
  
  
  
  


• Proper stroke mechanics are crucial in reducing shoulder strain, as swimmers who received stroke technique coaching had lower injury rates; therefore, coaches and therapists should focus on ensuring that swimmers:
  
  
  
  • Maintain a high elbow position during freestyle
  
  
  • Avoid excessive internal rotation during the pull phase
  
  
  • Engage the core and lower body to distribute workload
  
  
  
  


• Swimmers should modify their training volume to allow adequate recovery; alternating between high–intensity and recovery sessions can help reduce overuse stress on the shoulder, while engaging in cross–training activities like cycling or yoga can also give the shoulders a break