Swimmer’s Shoulder: Signs, Symptoms, Stretches, and Treatment

Pinching and sharp pain in the shoulder may limit your ability to swim efficiently and use your arm for normal functions. Schedule your appointment at Redefine Healthcare, New Jersey’s premier pain management practice, for a swimmer’s shoulder evaluation if you suspect soreness or tension in muscles that are affecting your range of motion. Dr. Eric Freeman is a pain and rehabilitation specialist and comes up with advanced, noninvasive treatment options to reduce your pain while addressing your condition successfully. He helps you understand what is causing this pain and recommends physical therapies and stretches that maximize your body’s potential and keep the pain away.

The shoulder is one of the most complex joints in the human body. It is designed to allow a wide variety of motions. However, due to this increased mobility, the shoulder is also inherently unstable. In addition to it, the structure of the shoulder lends itself to impingement syndrome as the muscles and tendons of the shoulder joints are surrounded by bones, versus most bones in the body, which are surrounded by muscles.

The sport of swimming is unique as the shoulders are responsible for propelling the weight of the body against the resistance of the water. A maximal range of motion and flexibility is required for efficient swimming, but sometimes it can result in shoulder laxity or instability, resulting in painful conditions.

What Is a Swimmer’s Shoulder?

Swimmers shoulder is a common orthopedic injury faced by people who swim frequently. It is caused by abnormal rubbing and pinching of the structures in the shoulder due to repetitive use, resulting in irritation, inflammation, tearing, and scarring.

Also known as shoulder impingement, it is a condition in which swimmers aggravate their shoulders when they swim due to the constant rotation of joints. Symptoms of swimmer’s shoulders include pain and limited range of motion. About 40 to 90% of swimmers experience this problem at one time or another.

It is also common in athletes who perform repetitive movements with their shoulders, such as in baseball, softball, and volleyball.

Factors That Increase the Risk of Swimmer’s Shoulder

The shoulder is an extremely mobile joint that is responsible for a lot of motion. Because of this, it needs to be well supported by the ligaments and muscles that help it function smoothly. Overworked muscles and ligaments can result in a variety of painful conditions, including the swimmer’s shoulder.

Some factors that can result in overworked ligaments and muscles include:

• Poor technique
• Over-training
• Fatigue
• Previous or unhealed shoulder injury
• Hypermobility

Use of large hand paddles can also result in certain injuries, including:

• Tears in rotator cuffs
• Ligament and capsule damage
• Tendonitis and rotator cuff impingement
• Bursitis
• Cartilage damage

The shoulder rotates countless times in just an hour when you are swimming freestyle. Repetitive movements for a long time can tire out your rotator cuff muscles, and improper positioning can cause the surrounding muscles and tissues to rub against each other. The resulting inflammation can cause pain if you continue swimming, and your shoulder will keep on feeling this way unless you take measures to reduce inflammation properly and retain and stretch the rotator muscles off.

What Causes a Swimmer’s Shoulder?

Repetitive strain or movements in the shoulder joint irritates the tendon and muscle tissues. It can lead to wear and tear on the shoulder, which causes inflammation and scarred tissue. This wear and tear and other problems can affect the smooth and normal movement of the joint.

These repetitive movements involving the same set of muscles can lead to muscle imbalance and joint restriction and result in the swimmer’s shoulder.

If left untreated, a swimmer’s shoulder can cause a labral tear or rotator cuff tear.

Signs of Swimmer’s Shoulder

A common sign of shoulder impingement is pain that radiates along the back of the shoulder and feels like it is deeply set in the muscles. Some people also experience pain along the front of their shoulders.

Motions like reaching out and overhead frequently, like swimming, can increase this pain. It is due to the position of your arms and upper extremities while swimming. The longer you swim at one time, the more pain you will feel. It can lead to shoulder tendonitis, which is tendon inflammation of the biceps and supraspinatus shoulder muscles.

It is essential to understand that different parts of the shoulder can suffer an injury during a swimming stroke. This may cause a range of pain, anywhere from local pain close to the shoulder joint, to pain that travels up the neck and shoulder or down the arm.

Symptoms of Swimmer’s Shoulder

The initial swimmer’s shoulder symptoms are often mistaken for soreness. However, there is a big difference between normal muscle soreness and fatigue and symptoms of an overuse injury.

The most common swimmer’s shoulder symptoms include:

• Reduced range of motion in the affected shudder as compared to the other shoulder
• Increased joint laxity than with the other shoulder
• Limited strength in comparison to the other shoulder
• Localized inflammation and pain in the shoulders
• Difficulty reaching the area behind your back
• Change in stroke pattern
• Worsening pain when lying on the affected shoulder

If you experience shoulder pain while swimming, do not take it lightly and consult your doctor to prevent the problem from developing further. Take a break from swimming to stop the condition from aggravating. Taking it lightly or ignoring it can result in more pain and inflammation in the joint.

Some common characteristics of a swimmer’s shoulder include:

• Bicep and supraspinatus tendon inflammation within the subacromial muscles in the back that can lead to shoulder impingement syndrome
• Errors in training, like overloading, overtraining, and particularly, poor stroke technique
• Altered shoulder joint mobility, posture, muscle performance, or neuromuscular control that results in the onset of symptoms
• Innate ligamentous laxity along with multidirectional shoulder instability or more joint movement in many swimmers

All swimmers, at one time or another, can develop imbalances in the muscle where the internal rotators and adductors of the arm over-develop. This can result in the weakness of scapular stabilizers and external rotators as they are not used as much. Thus, poor technique or muscle imbalance, or both these factors lead to laxity in the anterior capsule. All these conditions make the humeral head move up and forward, which affects the subacromial area and causes irritation and impingement.

How a Swimmer’s Shoulder Is Treated?

Identifying the affected tendons or muscles, the severity or the level of the condition, and diagnosing the problem accurately is crucial for effective treatment.

Treatment for a swimmer’s shoulder, for the most part, is non-surgical and involves stretching and physical therapy to strengthen the shoulder and regain movement. In case of severe impingement, where there is a significant tear in the rotator cuff or nerve damage, surgical intervention becomes necessary.

The specialist will review the symptoms and perform a physical exam to press on different areas of the shoulder to check for pain, tenderness, and swelling. Mobility and range of motion are also assessed to confirm the diagnosis. The physician may also run imaging tests to detect more serious bone or soft tissue injuries. An x-ray checks for broken or dislocated bones, while a CT scan or MRI reveals tendon tears.

Swimmer’s shoulder treatment plans include:

• Icing – Applying an ice pack directly to the shoulder after training for about 20 minutes can reduce inflammation and pain.
• Anti-inflammatory medications – The use of anti-inflammatory medication for a few days after the injury can lessen the inflammation and keep the pain down too. It is essential to use them exactly as directed by the physician.
• Rest – Resting the shoulder and avoiding aggravating shoulder movements help to keep down the inflammation and prevent worsening of pain. Wait a few days before you resume training or decrease yardage and only kick with your arms at your side to avoid further discomfort.
• Steroid injections – Steroid medications are used for treating severe shoulder joint inflammation. The injections relieve pain temporarily while you rest and recover.
• Ergonomic adjustments – Reducing repetitive movements can prevent shoulder problems. Making changes to your work environment and home is significant in this regard. Shifting frequently used things into lower shelves will ensure you do not have to reach overhead.

Physical Therapy

Physical therapy is a significant part of the swimmer’s shoulder treatment plan. It is beneficial for recovering from a muscle injury, helps to release tension, and prevents further irritation. The therapist can stretch and massage the rotator cuff muscles manually, as they can be hard to reach, and manipulate them the right way to provide relief.

The therapist guides you regarding custom exercises if you have healed enough to target your rotator cuff muscles. Strengthening these muscles can provide support to the shoulder joint during activity and make them more resistant to injury in the future. Reconditioning the shoulder can also prevent it from becoming a weak spot in the long run.

Physical therapy is necessary if you want to continue swimming while rehabilitating. It implements different techniques that keep the pressure off the shoulder joints. You will also learn about warm-up and cool-down stretching for muscles before and after swimming for long-term well-being.

Swimmers Shoulder Stretches

The three most common areas that experience stiffness or tightening are posterior rotator cuff muscles, pectoral muscles, and thoracic spine. Most often, the stiffness and tightness do not go away on their own, and need stretching.

Discussed here are three stretches that will help you address these areas effectively. You must consult an experienced and trained physiotherapist to diagnose your injury accurately before performing these stretches to avoid any problems.

Shoulder external rotators / lats stretch

• Stand next to the frame of a door, elbows by your side, and bend them out 90 degrees.
• Begin rotating your body forward, keeping your elbows to your side. Continue rotating until you feel the stretch in your shoulder in the front.
• This stretch can also be performed lying on the floor. Lie on the floor on your back, with your elbows to your side, bending out 90 degrees. Wedging your hand under something, keep your shoulder flat on the floor.

Pec major stretch – stop sign

• For this stretch, you have to sit on the floor.
• Extend your legs out to the side, bending the knees and keeping the soles of your feet together.
• Place your elbows on your knees or thighs while keeping your back straight.
• Begin pushing towards the floor with your forearms.

Thoracic spine mobility

• This stretch is performed with a thoracic roller or wedge.
• Lie down on your back and bend your knees up, placing a wedge underneath your thoracic spine.
• Take some time to relax over this wedge. If it feels uncomfortable, place a towel over the wedge.
• Beginners will cross their arms over their chest, while advanced individuals will place their arms behind their heads.
• For the upper thoracic, lift your buttocks into the air while pushing your legs upwards to increase the force through the wedge. Keep your buttocks down for mid-lower thoracic.

The goal of physical therapy and stretches is to help your muscles heal and ensure you return to swimming as quickly as possible. The perfect outcome of swimmer’s shoulder treatment plans is for you to perform at full power, function, speed, and agility and minimize the risk of future injury.

A swimmer’s shoulder is a common joint injury that can occur in both recreational and competitive swimmers. If shoulder pain is affecting your quality of life or your ability to use your arm freely, it is time to seek medical attention. Dr. Eric Freeman is committed to helping you return to your active lifestyle and back in the water as soon as possible. He discusses the steps you need to take for quick and effective healing and normal shoulder mobility. At Redefine Healthcare, you can look forward to the highest quality pain rehabilitation treatments that focus on managing your condition safely and effectively, addressing the root cause for long-term pain relief.