Mike Allen PT, ATC, CSCS

Director of Rehabilitation Services

Steadman Hawkins Clinic – Denver

What is swimmer’s shoulder?

Swimming is a unique sport that primarily involves heavy repetitive use of the upper extremity.  It is reported that over 80% of elite level swimmers will have shoulder pain at some point in their career.  The shoulder is a complexed joint involving three bones (clavicle, scapula and humerus), three joints (gleno-humeral, scapular thoracic and acromio-clavicular) and well over 20 muscular attachments.  It’s felt that repetitive concentric loading through a large range of motion creates laxity (looseness) in the shoulder joint causing the ball (gleno-humeral head) to move excessively in the socket (glenoid).  In time, this can cause inflammation at the rotator cuff tendons as they contact boney shelf (acromion) above that ordinarily protects these tendons.

What are the common symptoms?

Pain in the shoulder area may extend up into the trapezius and neck.  Initially, the pain may be isolated during activity only; as the symptoms progress pain occurs during both activity and rest.

Is the pain getting worse?

There is a distinct progression of symptoms that can be followed.  Early intervention may prevent a minor condition for becoming significantly worse:

Stage I: Pain at the beginning of practice that resolves after warm-up

Stage II: Pain at the beginning of practice that increases during practice

Stage III: Pain during practice that last after practice and affects daily function

*Once an athlete begins to have increased pain during practice that affects daily function it is time to have a medical professional evaluate.

What are some of the causes?

May be one or a combination of the following:

• Sharp increase in training volume
• Increased volume with a  particular stroke
• Breakdown in stroke mechanics
• Addition of training implements (paddles/kick boards) with increase volume
• Breathing from one side only
• Inadequate strengthening program

What can we do for treatment?

Swimmer’s shoulder can be one of the more challenging diagnoses to treat due to the instability in the shoulder joint.  Treatment will vary depending on the severity of symptoms:

Class I

• Minor reduction in volume or adjustment of a particular stroke
• Adjustment of mechanics
• Icing after practice; anti-inflammatory medication as needed
• Pre/post practice CP rotator cuff and scapular strengthening program modified based on symptoms
• May take 1-2 weeks to completely resolve

Class II

• Medical consultation with physician, physical therapist or athletic trainer
• X-ray and MRI likely
• Significant reduction in volume or short period of complete rest
• Comprehensive CP rotator cuff and scapular strengthening program
• Ice and anti-inflammatory medication as needed
• May take 4-6 weeks to resolve

Class III

• Same treatment as class II
• X-ray and MRI likely
• May take 6-12 weeks to resolve
• Potentially a surgical candidate if no improvement with physical therapy after 3-6 months.

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