Swimmer's Shoulder: Risks of Swimming Through Pain, Recovery, and Prevention

Can you swim through swimmers shoulder?

Swimming through "swimmer's shoulder" is generally not recommended and can exacerbate the injury, leading to chronic pain and prolonged recovery; proper diagnosis and a structured rehabilitation plan are crucial for effective healing and safe return to activity.

Understanding Swimmer's Shoulder

"Swimmer's shoulder" is a broad term encompassing a range of painful conditions affecting the shoulder joint, predominantly in swimmers. It's an overuse injury resulting from the repetitive, high-volume overhead movements inherent in swimming. The shoulder, being the most mobile joint in the body, is also highly susceptible to instability and injury under such demands.

Common Conditions Associated with Swimmer's Shoulder:

• Rotator Cuff Tendinopathy: Inflammation or degeneration of the tendons of the rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis). The supraspinatus tendon is most commonly affected due to its position under the acromion.
• Shoulder Impingement Syndrome: Compression of the rotator cuff tendons and/or the subacromial bursa between the humeral head and the acromion during overhead arm movements.
• Biceps Tendinopathy: Inflammation of the long head of the biceps tendon, often at its attachment in the shoulder joint.
• Subacromial Bursitis: Inflammation of the bursa, a fluid-filled sac that reduces friction between bones and tendons.

Contributing Factors:

• Overuse and Training Errors: Sudden increases in training volume, intensity, or frequency.
• Poor Stroke Mechanics: Inefficient technique, such as insufficient body roll, a dropped elbow during the pull phase, or improper hand entry, can place excessive stress on the shoulder.
• Muscle Imbalances: Weakness in the rotator cuff muscles, scapular stabilizers (e.g., serratus anterior, trapezius), or core muscles relative to the larger prime movers (latissimus dorsi, pectoralis major).
• Poor Flexibility and Mobility: Limited thoracic spine mobility or shoulder capsule tightness can alter shoulder mechanics.
• Joint Laxity: Hypermobility in the shoulder joint can predispose individuals to impingement.

The Risks of Swimming Through Pain

Attempting to "swim through" the pain of swimmer's shoulder is highly ill-advised and carries significant risks:

• Exacerbation of the Injury: Continued repetitive stress on an inflamed or damaged tendon/bursa will worsen the condition. Acute inflammation can progress to chronic tendinopathy, which is harder to treat, or even lead to partial or complete rotator cuff tears.
• Development of Compensatory Patterns: To avoid pain, the body will naturally alter movement patterns. This can lead to inefficient stroke mechanics, place undue stress on other joints (neck, opposite shoulder, lower back), and potentially cause secondary injuries.
• Prolonged Recovery Time: Pushing through pain delays the healing process, requiring longer periods of rest and more intensive rehabilitation in the long run.
• Psychological Impact: Persistent pain and the inability to perform can lead to frustration, anxiety, and a negative relationship with swimming.

When to Seek Professional Help

It is crucial to consult a healthcare professional at the first sign of persistent shoulder pain or discomfort that doesn't resolve with a few days of rest.

Indicators for Professional Consultation:

• Pain that worsens with activity or persists at rest.
• Pain that limits your daily activities or sleep.
• Weakness or inability to lift your arm.
• Clicking, popping, or grinding sensations in the shoulder.
• Any sudden, sharp pain during a swim.
• Loss of range of motion.

Who to See:

• Sports Medicine Physician: For diagnosis, medical management (e.g., anti-inflammatories, injections), and referral.
• Physical Therapist/Physiotherapist: For comprehensive assessment, development of a personalized rehabilitation program, and guidance on safe return to sport.
• Orthopedic Specialist: If surgical intervention is considered necessary (rare for initial swimmer's shoulder).
• Experienced Swim Coach: For stroke analysis and technique correction in conjunction with rehabilitation.

The Path to Recovery: A Structured Approach

Recovery from swimmer's shoulder is a multi-stage process that requires patience and adherence to a professional plan.

1. Initial Management (Acute Phase):

• Relative Rest: Temporarily cease or significantly reduce aggravating activities, especially swimming. This doesn't necessarily mean complete immobilization but avoiding movements that cause pain.
• Pain and Inflammation Control:
  • Ice: Apply to the affected area for 15-20 minutes several times a day.
  • NSAIDs: Over-the-counter non-steroidal anti-inflammatory drugs (e.g., ibuprofen) can help manage pain and inflammation, under medical guidance.

2. Rehabilitation (Guided by a Physical Therapist):

This phase is critical and should be personalized.

• Phase 1: Pain and Inflammation Reduction & Gentle Mobility:
  • Passive or active-assisted range of motion exercises.
  • Gentle isometric exercises for the rotator cuff.
• Phase 2: Restoring Full Range of Motion & Building Strength:
  • Scapular Stability Exercises: Focus on strengthening the muscles that control the shoulder blade (e.g., serratus anterior, rhomboids, trapezius). Examples include 'Y', 'T', 'W' exercises, prone rows, and push-up plus.
  • Rotator Cuff Strengthening: Targeted exercises for internal and external rotation, abduction, and extension, often using resistance bands or light weights.
  • Core Strength: A strong core is fundamental for efficient body rotation and transferring power in swimming, reducing stress on the shoulders.
  • Thoracic Spine Mobility: Exercises to improve rotation and extension of the upper back, which directly influences shoulder mechanics.
• Phase 3: Functional and Sport-Specific Training:
  • Gradual Return to Swimming: This should be carefully monitored and progressive, starting with short distances, reduced intensity, and focusing on pain-free movement.
  • Stroke Technique Analysis and Correction: Working with a swim coach to identify and rectify biomechanical flaws is paramount to prevent recurrence. This includes optimizing hand entry, body roll, catch, and pull phases.
  • Progressive Loading: Slowly increasing the volume, intensity, and frequency of swimming as tolerated.

Modifying Your Training During Recovery

While recovering, it's essential to maintain cardiovascular fitness and strength in other areas without aggravating the shoulder.

• Cross-Training:
  • Lower Body Workouts: Cycling, running (if pain-free), elliptical trainer.
  • Core Training: Planks, bird-dog, anti-rotation exercises.
  • Single-Arm Drills: If one shoulder is affected, you might be able to perform drills with the unaffected arm, but only under professional guidance to ensure no compensatory strain.
• Water-Based Alternatives (with caution):
  • Kicking Drills: Using a kickboard (held with the unaffected arm or under the chest to avoid shoulder stress) or fin swimming can maintain leg strength and cardiovascular fitness.
  • Deep Water Running: A non-impact option that can maintain cardiovascular fitness.

Prevention Strategies for Swimmer's Shoulder

Once recovered, implementing robust prevention strategies is key to avoiding future issues.

• Prioritize Proper Technique: Regular coaching and video analysis to ensure efficient and biomechanically sound stroke mechanics across all strokes.
• Progressive Overload: Avoid sudden spikes in training volume, intensity, or frequency. Gradual increases allow the body to adapt.
• Balanced Strength and Conditioning Program:
  • Rotator Cuff and Scapular Stabilizer Strengthening: Incorporate exercises like external/internal rotations, band pull-aparts, face pulls, and 'Y', 'T', 'W' raises into your routine 2-3 times per week.
  • Core Strength: Maintain a strong core to support efficient movement and reduce shoulder strain.
  • Latissimus Dorsi and Pectoralis Strengthening: Ensure these larger muscles are balanced with the smaller stabilizing muscles.
• Flexibility and Mobility: Regularly perform stretches for the shoulder capsule, pectorals, and lats, and mobility drills for the thoracic spine.
• Effective Warm-up and Cool-down: A dynamic warm-up before swimming prepares the shoulder for activity, and a static stretching cool-down helps maintain flexibility.
• Listen to Your Body: Pay attention to early warning signs of fatigue or discomfort. Early intervention is always easier than treating a full-blown injury.

In conclusion, attempting to swim through swimmer's shoulder is a gamble with your long-term shoulder health. Prioritizing rest, professional diagnosis, and a structured rehabilitation program is the most effective and safest path to recovery and a sustained return to the water.