Shoulder health for swimmers

Daniel Smit | APA Titled Paediatric Physiotherapist

A practical guide for swimmers, families and coaches

Swimming repeats the arm-overhead movement many times, especially during training. Shoulder pain is reported by competitive swimmers, but it is not just a young-swimmer issue or something to hide and push through. A calm plan to understand symptoms and adjust training can help a swimmer stay as active as possible.

What people mean by swimmer’s shoulder

“Swimmer’s shoulder” is an informal umbrella term for shoulder pain linked with swimming. It is not one specific diagnosis. Pain can arise from several structures and may be influenced by the amount and type of swimming, recent changes in training, recovery, previous shoulder problems, strength and swimming mechanics. A physiotherapist or doctor can assess what is contributing for an individual swimmer.

Shoulder pain across ages and levels

Studies report shoulder symptoms in swimmers from youth through adult and masters competition, but estimates vary because studies look at different age groups, training levels and time periods. A U.S. survey of 671 competitive swimmers aged 9–17 found that 49% reported symptoms; this describes that sample and does not estimate pain in recreational or all-age swimmers. [1,2]

Why shoulders can become sore

Swimming involves repeated arm movements. Shoulder symptoms can reflect several factors, including recent changes in training volume or intensity, previous pain, recovery and strength. A systematic review found swim-training volume was associated with shoulder pain in adolescent competitive swimmers, but it did not establish a universal safe distance or a single cause that applies to every swimmer. [2,3] Consider changes in paddles, sessions, competition, gym or other upper-body work alongside sleep, recovery and other life demands. The right training adjustment depends on the individual.

Growth and development in younger swimmers

For children and teenagers, growth and development can change body size and how training feels. Growth itself is not an injury, and technique is not automatically the cause. Adjust training and strength work to the swimmer in front of you.

What to do when pain starts

• Tell someone you trust and, if you train with a coach, let them know early. A young swimmer should also tell a parent or trusted adult. Pain that changes a stroke, worsens during a session, returns repeatedly, or lingers after training deserves attention.
• Avoid repeatedly testing the painful stroke or trying to “swim it off”. Temporarily reduce or modify the parts of training that provoke symptoms while keeping comfortable activity where appropriate.
• Make a short note of when it hurts: which stroke, drill, distance or intensity; when it starts; what makes it better or worse; and how it feels later that day and the next morning.
• Review recent training and other demands: changes in pool volume, intensity, equipment, gym work, other sports, work or school, sleep and recovery. There is no single workload formula that can diagnose or prevent an individual swimmer’s shoulder pain.
• Arrange an assessment if symptoms persist, recur, limit training or everyday tasks, affect stroke technique, or are getting worse. A physiotherapist or doctor can assess the shoulder and help plan training modifications and rehabilitation.

Building shoulder capacity

Progressive strength training can be part of preparation for swimmers of different ages and levels. Programs often target the shoulder external rotators and scapular muscles; mobility work may be included when it is relevant. A scoping review found exercise therapy has been studied in competitive swimmers, but the evidence does not support one universal program or guarantee that injury will be prevented. [4]

A physiotherapist, coach or appropriately qualified strength and conditioning professional can help choose exercises that fit the swimmer’s age, training experience and needs, teach technique and progress resistance gradually. The goal is comfortable, controlled work that fits around swimming, not extra fatigue layered onto an already demanding week.

Returning to full swimming

Return should be guided by symptoms, shoulder function and the swimmer’s sport demands. In general, the swimmer should be able to move the arm comfortably, manage daily activities, and complete a gradual progression of swimming without pain escalating or lingering afterwards. Increase one training demand at a time where possible, and coordinate the plan with a coach and treating clinician if involved. A race date alone is not a reason to rush.

When to seek urgent medical care

Call 000 if shoulder pain occurs with chest tightness or difficulty breathing. After a shoulder injury, seek immediate medical care if the joint looks deformed, the arm cannot be used, the pain is intense or there is sudden swelling. Arrange medical assessment for persistent or worsening pain, pain at rest, fever, night sweats, unexplained weight loss, or new weakness or numbness. [5]

How Strides Performance can help

A sports physiotherapy assessment can consider symptoms, shoulder and upper-limb capacity, training history, age and development, recovery, stroke demands and goals. We can work with the swimmer and, where appropriate, their family and coach to agree on practical training modifications and a progressive rehabilitation plan.

Download the shoulder health for swimmers handout (PDF)

References and further reading

Related resources and physiotherapy support

Explore Strides Performance physiotherapy in Narre Warren. Selected appointments are available in Nunawading. View appointment and booking information or ask us about your needs.

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