Summer is in full swing and thanks to the current restrictions and gym closures due to the global health crisis, more and more people are taking to pools, lakes and rivers to cool off and log some serious solo lap time.

In addition to being a safe way to exercise while maintaining social distance, swimming is a great full-body workout that builds endurance, strength and cardiovascular fitness. And while one of swimming’s greatest benefits is its low-impact on most joints, there is one common joint injury that plagues both recreational and competitive swimmers alike: swimmer’s shoulder.

Per the study Epidemiology of Injuries and Prevention Strategies in Competitive Swimmers in the US National Library of Medicine at the NIH:

“Shoulder pain is the most frequent orthopaedic injury in swimmers, with a reported prevalence between 40% and 91%… Swimmers at the elite level may swim up to 9 miles per day (more than 2,500 shoulder revolutions). Muscle fatigue of the rotator cuff, upper back, and pectoral muscles caused by repetitive movement may result in microtrauma due to the decrease of dynamic stabilization of the humeral head.”

These microtraumas, in turn, can lead to swimmer’s shoulder symptoms.

What is “swimmer’s shoulder?”

Also known as shoulder impingement or impingement syndrome, swimmer’s shoulder is common in athletes who perform repetitive movements with their shoulders, such as baseball, softball and volleyball players – and, of course, swimmers.

The shoulder is the most mobile joint in the body, allowing for an extensive range of motion. Unfortunately, the shoulder is also inherently unstable due to this mobility. Additionally, the structure of the shoulder lends itself to impingement syndrome, as the muscles and tendons of the shoulder joint are surrounded by bone (versus most bones in the body, which are surrounded by muscles).

The rotator cuff, which is a group of muscles and tendons that help lift the arm overhead, sits between the humerus (arm bone) and the acromion (top of the shoulder). Repetitive overhead activities (i.e. swimming strokes, throwing a softball, spiking a volleyball, etc.) can cause inflammation of the rotator cuff. As the muscles and tendons of the rotator cuff are surrounded by bone, this inflammation compresses the tendons and reduces blood flow. If left untreated, swimmer’s shoulder can cause the rotator cuff to fray and lead to more serious conditions, such as a full rotator cuff tear.

Swimmer’s Shoulder Symptoms: Where does swimmer’s shoulder hurt?

The initial swimmer’s shoulder symptoms are often mistaken for soreness; however, it’s important to know the difference between normal muscle soreness and fatigue and the symptoms of an overuse injury.

Swimmer’s Shoulder Symptoms:

• Difficulty reaching behind the back
• Pain when the arm is extended overhead
• Localized pain and inflammation in the shoulder
• Pain that extends from the shoulder to the neck or down the arm
• Pain that worsens when resting/lying on the shoulder
• Tenderness
• Decreased range of motion, joint control or muscle performance
• Change in stroke pattern and/or “lazy elbow”

As for the location of the pain from swimmer’s shoulder, Team USA Triathlon explains it best:

“The pain from swimmer’s shoulder can be vague or more specific in the front or the back of the shoulder. It can be localized or radiate, and it can be exacerbated with the underwater pull or the recovery phase of the stroke. Sometimes the pain is minimal and the biggest problem is just a loss of speed, power, or pace! The cause of swimmer’s shoulder is usually not from one thing alone but from multiple factors, involving stroke mechanics, overuse, and generalized laxity of the joint.”

How is swimmer’s shoulder diagnosed?

To properly diagnose any type of shoulder pain that does not resolve on its own or is negatively affecting your performance, sleep or everyday activities, you should see an orthopedic shoulder specialist in your area.

During your visit, your doctor will conduct a physical exam to understand the location, radiation and timing of your pain, test joint mobility and muscle strength and discuss any changes in your training or activities that could have caused shoulder impingement.

Depending on the results of this exam, your doctor may order further imaging – such as an X-ray to rule out anatomical causes and/or an MRI to see your shoulder’s muscles, tendons, ligaments and rotator cuff.

Swimmer’s Shoulder Treatment

More often than not, the treatment for impingement syndrome is nonsurgical and involves both swimmer’s shoulder stretching and physical therapy to strengthen the shoulder and regain mobility. If the impingement is severe, there are significant tears in your rotator cuff or your orthopedic shoulder specialist discovers nerve damage, surgical options may be warranted.

If you have any questions about swimmer’s shoulder or any other orthopedic injury and would like to talk to one of our orthopedic surgeons, please don’t hesitate to contact us.