29 November 2021

Swimmer’s Shoulder and how to avoid it

May 23, 2008

In a three kilometre swim session an average swimmer will take over 2400 strokes. If you are swimming regularly this has the potential to place considerable pressure on the shoulder and its associated structures. ‘Swimmer’s Shoulder’ refers to a number of different conditions, but is most commonly related to impingement syndrome. This feature not only explains the syndrome, but also how to avoid it or treat it.

swimmers-shoulder-1.pngThe shoulder has four muscles which stabilise and control the movement of the joint; together these muscles are called the rotator cuff. The tendon of one rotator cuff muscle along with a bursa – a fluid filled sack aiding movement of the tendon – can pinch or impinge between the top of the arm bone and the shoulder blade during movement, particularly overhead, causing inflammation in the region.

Shoulder impingement for swimmers presents as either a dull ache or sharp pinching pain in the front of the shoulder, often referring to the side of the upper arm. It is exacerbated by overhead movements, including swimming, most commonly with front crawl and butterfly.

Factors influencing shoulder impingement include the natural size and shape of the acromion (part of the shoulder blade forming the roof of the joint), the formation of bony spurs on the under-surface of the acromion in older individuals, and poor muscular control of the shoulder blade.

Individuals with a stiff upper back or slouched posture, place the shoulder in a position where impingement is more likely during overhead movement. Muscle imbalance of the rotator cuff and larger muscles around the joint influence the way the shoulder blade and arm move and may also increase the likelihood of the condition.

Swimming technique

For the regular swimmer an efficient and correct technique is vital for avoiding shoulder impingement problems.

Outlining the components of the front crawl:

  1. Glide – from when the hand first enters the water
  2. Catch – end of the glide when the first movement should be internal rotation of the arm
  3. Pull – main pull through the water propelling you forwards
  4. Recovery – when your arm is out of the water


How to avoid it

To avoid suffering Swimmer’s Shoulder, try following these recommendations when training:

Recovery Phase

  • As the arm exits the water at the end of the pull, if it is excessively internally rotated so the palm of the hand is facing away from the body, a wringing effect occurs and the bursa and tendon will impinge.
  • To minimise pressure on the shoulder, the arm should externally rotate early during the recovery phase, so as a breath is taken the eyes see the thumb and not the back of the hand.
  • Effective reach during the glide phase on the contralateral arm encourages rotation or ‘body roll’ along the axis of the body, opening the chest and placing the shoulder in a better position during early recovery.

Breathing Bilaterally

  • When breathing only to one side, there is a tendency for the shoulder blade to elevate slightly on that side, increasing the risk of impingement. Breathing bilaterally minimises pressure on just one shoulder.

Depth of the hand on Glide

  • If the hand and arm are close to the surface of the water at the end of the glide, there is more pressure on the shoulder than taking the hand deeper on entry. Ideally, fingers should always be deeper than the wrist which should in turn be deeper than the elbow. The elbow remains close to the surface of the water.


  • The first movement at the end of the glide should be internal rotation of the arm from the shoulder, as the elbow bends to 90º and remains near the surface of the water. This is preferred to lowering the arm straight towards the pool floor and dropping the elbow as it bends, which again closes down the shoulder joint increasing the risk of injury, while also losing power through stroke.

How to treat it

Primary treatment of shoulder impingement includes applying ice the point of the shoulder for twenty minutes every two hours and avoiding the aggravating activity. As the rotator cuff muscles tend to tighten when the condition is apparent, it is beneficial to release them through massage. It is recommended this be done by a qualified professional; alternatively self massage is an option by lying on a golf ball or tennis ball placed under the shoulder blade, although care should be taken.

If the pain continues, anti-inflammatory medications are often useful. Once a recurrent shoulder impingement has presented, it is essential to address muscle imbalances and rotator cuff muscle control through rehabilitative exercises from a Physiotherapist. If conservative management fails, further options including injection or surgery still remain.

Andrew Griffin, Sportsister
The Women’s Sports Magazine

Andrew is an Australian Physiotherapist currently working with the English Institute of Sport, primarily associated with the British Synchronised Swimming team.

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