Swimmer’s shoulder: the signs you shouldn’t ignore

In swimming, the shoulder is one of the most heavily used joints in the entire body. Every training session involves hundreds, sometimes thousands of repetitive movements, during which muscles, tendons and joints have to work in perfect coordination. When this balance is disturbed, discomfort can appear that at first seems negligible, but that over time risks compromising the quality of training and performance in the water.

Many swimmers live for weeks with mild pain, thinking it is a normal consequence of how hard they are training. In reality, acting early can prevent a simple overload from developing into a more complex problem.

Understanding the causes of shoulder pain when swimming, recognising the most important signs and starting a targeted physiotherapy programme makes it possible to protect the joint and carry on with this sport more safely.

During a normal training session the shoulder repeats the same movement hundreds of times.

Whether it is freestyle, backstroke, butterfly or breaststroke, every stroke requires perfect collaboration between:

• rotator cuff
• shoulder blade muscles
• deltoid
• trunk
• core muscles

When this collaboration breaks down, the stress on the tissues increases and shoulder pain in swimming can appear.

In most cases the problem does not come from a single movement.

More often it is the result of small stresses building up over time.

Among the factors that can encourage shoulder pain in swimming are:

• a sudden increase in distance
• an increase in training intensity
• insufficient recovery
• less than optimal technique
• reduced ability to manage load

This is why it is important to watch how symptoms develop and not simply treat the pain once it becomes intense.

The body rarely goes from normal to significant pain within a few hours.

Very often it sends progressive signals.

Among the most common are:

• discomfort during the last lengths
• pain after training
• stiffness in the morning
• difficulty with overhead movements
• loss of strength during the stroke

These symptoms can be the beginning of a condition that, if neglected, tends to worsen as the activity continues.

In swimming the quality of the movement matters as much as physical conditioning.

Even a small change in technique can alter how load is distributed across the joint.

For example, the following can play a part:

• position of the shoulder blade
• hand entry into the water
• trunk rotation
• coordination between upper and lower limbs
• control of stroke rhythm

When technique becomes less efficient, the risk of developing shoulder pain while swimming increases.

When pain appears, many people immediately think of a rotator cuff tear.

In reality the possible causes are numerous.

The following may be involved:

• tendons
• subacromial bursa
• scapular muscles
• joint capsule
• acromioclavicular joint

This is why a thorough assessment is the starting point of any treatment programme.

The shoulder blade is the base on which the whole shoulder rests.

If its movement is not well coordinated, the entire joint complex can be exposed to less favourable loads.

Altered scapular control can contribute to shoulder pain in swimming, especially in athletes who train many hours every week.

Regaining proper control of the shoulder blade often means improving the quality of the stroke as well.

While swimming, power is not produced by the arms alone.

Much of the movement comes from the trunk, pelvis and upper limbs working together.

When the core works inefficiently, the shoulder may be forced to compensate.

Over time these compensations increase the risk of overload.

This is why, in treating shoulder pain while swimming, the work does not concern only the painful joint.

The answer depends on the situation.

During a particularly painful phase it may be necessary to reduce the load temporarily.

However, a prolonged break from activity is not always the ideal solution.

Very often it is more useful to adjust:

• training volume
• intensity
• type of exercises
• technical work
• recovery

This makes it possible to maintain good physical condition without making the symptoms worse.

The physiotherapy approach is not simply about reducing pain.

The aim is to identify the factors that encouraged the problem.

In the case of shoulder pain in swimming, the following may be assessed:

• joint mobility
• rotator cuff strength
• shoulder blade control
• trunk stability
• quality of movement

A personalised programme is built on the basis of this information.

Manual techniques can help reduce symptoms, but lasting recovery almost always requires active work.

Exercises are used progressively in order to:

• improve strength
• increase muscular endurance
• regain scapular control
• refine technique
• prepare the return to full training

The progression is adapted to each swimmer's characteristics.

One of the most overlooked aspects concerns how training is distributed.

Sudden increases in volume or intensity can exceed the tissues' capacity to adapt.

A more balanced plan, on the other hand, supports recovery and reduces the risk of relapse.

This applies both to competitive athletes and to those who swim recreationally.

At TI-FISIO in Lugano, every patient is assessed by looking not only at where the pain appears, but also at how the whole system produces movement.

The assessment may include:

• shoulder mobility
• shoulder blade control
• muscle strength
• trunk coordination
• functional analysis of the movement

On the basis of the results, a personalised programme is built that may combine manual therapy, therapeutic exercise and practical guidance for a gradual return to training.

The wish to resume training quickly is understandable.

However, rushing the process can encourage symptoms to return.

Before a full return it is important to check:

• no pain during the stroke
• strength recovered
• good muscular endurance
• control of movement
• tolerance to training loads

Respecting this progression makes the return safer.

Shoulder pain in swimming should not be considered a normal consequence of training.

It is often the signal that the body is struggling to handle the load, or that some aspects of the movement could be improved.

With prompt treatment and a personalised physiotherapy programme, it is possible to reduce pain, improve technique and return to swimming more efficiently, limiting the risk of further overload.

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