Swimmer's shoulder: the source is often not the shoulder

Swimming exposes the shoulder to one of the most repetitive loads the human body takes on. A seriously training swimmer performs hundreds of thousands of strokes per shoulder across a season. At that volume, even a small mechanical problem accumulates into symptoms.

"Swimmer's shoulder" is not one diagnosis; it is a shared name for pain that can involve several structures. In practice, the pattern I see usually falls under the same three headings.

1. Scapular control

The shoulder joint works on top of the shoulder blade. If the scapula doesn't get to the right place at the right time, the subacromial space narrows with every elevation of the arm and the tendons are compressed.

The typical picture in swimmers: weak serratus anterior and lower trapezius, short and dominant upper trapezius and pectorals. The result is insufficient upward rotation of the scapula. It is described as "impingement" in the shoulder — but the problem lies in the platform carrying it, not the joint itself.

2. Thoracic mobility

For the arm to reach fully overhead during the stroke, the mid-back has to extend and rotate. If the thoracic spine is stiff, the missing movement is borrowed from the shoulder joint and the lower back.

So one of the first places I look in a swimmer with shoulder pain is the thoracic spine. Improving mid-back mobility can reduce shoulder pain without touching the shoulder at all.

3. Loss of internal rotation, and training load

In overhead and stroke athletes, internal rotation range in the dominant shoulder decreases over time. Losses beyond a certain threshold have been associated with shoulder problems.

Add load and the picture is complete: entering a training camp, increasing distance, moving to paddle work, a dryland programme that suddenly gets heavier. Pain usually begins not because of "one wrong movement" but because of load that rose too fast.

What we do

Assessment covers the shoulder, the scapula, the thoracic spine and the training history together. A typical programme includes:

• Scapular control — serratus and lower trapezius focused, at controlled tempo
• Thoracic mobility — rotation and extension; brief but daily
• Rotator cuff endurance — based on repetition rather than heavy load; swimming is an endurance sport
• Soft tissue and manual therapy — to reduce symptoms, not as the solution on its own
• Load management — replanning volume and intensity with the coach

Without the last item the rest is temporary. Tolerance built through exercise can be lost in the same week by an unplanned increase in volume.

Does she have to stop swimming?

Usually not. Complete rest is rarely necessary and often makes things harder — loss of conditioning, technical regression, and a drop in the athlete's morale. Instead:

• Temporarily reduce the strokes and distances that provoke pain
• Review paddle and fin use
• Maintain total volume by keeping kick sets
• Balance the breathing side

The aim is not to leave the water, but to redistribute the load while staying in it.

When to get it assessed

• Pain lasting more than two weeks
• Pain that starts during training rather than after it
• Night pain, or clear difficulty raising the arm overhead
• Numbness, tingling or weakness in the hand

This article is for information only and does not replace individual assessment. For ongoing shoulder pain, see a doctor and a physiotherapist.