Whether from a repetitive movement, lack of stability in the upper body muscles or spending too long in the pool training, swimmer’s shoulder is common in many swimmers. With years of experience with collegiate swimmers and as an athletic trainer, Dennis Coonan, Director of the Sports Medicine Center, often helps swimmers thrive before, during and after a shoulder injury.

What is swimmer’s shoulder?

Swimmer's shoulder isn’t a specific diagnosis, but a broad, catch-all term for many injuries that can happen to swimmers in the shoulder region.

“It’s similar to the term shin splints,” Coonan says, “which identifies anything that’s painful in the lower leg. Swimming shoulder could be any sort of pain in the upper body due to swimming.”

The underlying causes of swimmer’s shoulder can vary and may include several different diagnoses depending on an athlete’s symptoms and evaluation.

Most common shoulder injuries in swimmers

While each athlete may receive a different diagnosis based on their symptoms, swimmers are commonly diagnosed with:

• Rotator cuff strain, inflammation or tear
• Subacromial impingement that occurs when the rotator cuff tendon goes under the collar bone (clavicle) and the inflammation causes pain
• Labral tears, which can sometimes occur when athletes push through symptoms leading to instability and over-reliance on other muscles

Why do swimmers get shoulder pain?

Any swimmer can get injured, but the most common factor is high training volumes and repetitive overhead motions. Competitive swimmers perform thousands of strokes each year and spend significant time doing the same motion can cause pain. Over time, these motions can also create muscle imbalances that overdevelop the front of the shoulder and chest, causing the muscles in the back to weaken. Without proper weight training, these imbalances contribute to pain and injury.

Early warning signs of swimmer's shoulder

With any injury, pain is the first and most important warning sign. Secondarily, athletes may feel fatigue, lose endurance or see a decrease in their speed. Coonan notes one important distinction: Soreness and stiffness are different from a shoulder injury.

“When an athlete starts complaining that their shoulder hurts and it’s more of a sharp pain, that’s when it’s important to listen more and see if something needs to be corrected,” Coonan says. “Soreness can be painful and tight, but if you can put two fingers right on it and identify the point of the pain, that’s usually linked more to a specific injury.”

While pain is a big red flag, any other discomfort during specific strokes, such as clicking, catching, popping or instability can be an early warning sign of a shoulder injury.

When should swimmers be evaluated by a healthcare professional

Any pain or new symptoms should be addressed, but athletes should seek a further evaluation from an athletic trainer, physical therapist or physician when:

• Pain occurs with every stroke
• Pain is constant
• Symptoms don’t improve with reduced training volume
• Symptoms don’t improve with added strength exercises, warmup or cooldown routines

Common treatments for swimmer’s shoulder

Many treatments for shoulder injuries require rest, modifications to movement and rehabilitation. To start, athletes should reduce training time and adjust the training or stroke type if necessary to avoid further injury. Athletes should also reduce inflammation, use ice for pain control as needed and have relative rest — slowing down daily activities just enough to let injuries heal without stopping movement altogether — to give shoulder pain time to calm down. Further, incorporating weight and strength training can improve areas like the rotator cuff, shoulder blade (scapular) muscles, and the front and back of the shoulder.

Athletes may need a personalized treatment plan that targets the exact injury, which can include specific physical therapy exercises, changes to swimming patterns or sometimes surgery if a doctor identifies a tear.

Importance of warmup and cooldown routines for swimmers

Every athlete should warm up before jumping straight into the lanes. For swimmers, Coonan suggests dynamic stretching instead of static stretching, meaning routines should take athletes through a full range of motion. That can include arm circles, arm swings and shoulder rotations to prepare the shoulders for repetitive swimming movements.

“Sometimes athletes show up late to practice and practice has already started,” Coonan says. “Instead of warming up, and coaches allowing them time to warm up, they immediately get in the pool. By doing that, you’re missing out on time to avoid injury.”

More warmup strategies can include:

• Resistance band exercises targeting the rotator cuff and scapular muscles
• Beginning with a few easy and relaxed laps
• Gradually increase intensity rather than jumping directly into longer or harder swims

Proper recovery is similar to warming up, but in the opposite order:

• Finish practice with relaxing laps to cool down muscles
• Use resistance bands for gentle stretching of the shoulders, upper back and chest muscles

Return to sport after a shoulder injury

Before returning to swimming after a shoulder injury, it’s important to restore strength, mobility and proper movement patterns. Clinicians like athletic trainers look for muscular balance, strong upper back and shoulder muscles, and proper posture to prevent excessive rounding forward in the shoulders. Swimmers should also have shoulder mobility, including full rotation and strength throughout the shoulder to support muscle use and specific movements.

Proper nutrition and fueling are also essential to support healing, muscle recovery and the physical demands of returning to swimming. Sports dietitians and nutritionists can help swimmers create more balanced meals and look for areas of improvement to compete their strongest.

Together, these factors help swimmers safely return to the pool and reduce their risk of reinjury.