Shoulder pain in swimmers

What it is

Competitive swimmers perform a very large number of overhead arm cycles per session - often several thousand. No other sport produces that repetition count at that range, and shoulder pain is reported by a large proportion of swimmers at some point.

The stroke itself creates the imbalance. Propulsion comes from the internal rotators and the lats, which become strong and tight, while the external rotators and the scapular retractors get little work. Add scapular muscle fatigue late in a session and the shoulder blade stops positioning the socket properly at exactly the point the volume is highest.

What it feels like

• Pain in the front or outside of the shoulder during and after swimming
• Worse in the pull-through phase and on the recovery over the water
• Building through a session and worse in the harder sets
• Aching at night and lying on that side
• Reduced stroke rate or a changed stroke to avoid it

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Enormous overhead repetition volume

Several thousand arm cycles per session, several sessions a week. It is the highest overhead repetition count in any sport and volume is the dominant risk factor.

Internal rotator dominance

Propulsion comes from the internal rotators and lats. They become strong and tight while the external rotators, which decelerate and centre the joint, get almost no work.

Scapular muscle fatigue

The scapular muscles position the socket for each stroke. They fatigue through a session, and once they do the shoulder blade stops rotating properly and the subacromial space narrows at exactly the wrong time.

A tight posterior capsule and short pecs and lats

The swimming position and the muscular pattern both shorten the front and tighten the back of the joint, reducing the range available and altering how the head sits in the socket.

Poor stroke technique

A crossover entry, dropped elbow in the pull, or insufficient body roll all increase the load on the shoulder for the same distance covered.

Hand paddles and heavy pulling sets

Both substantially increase the load per stroke. Rapid increases in paddle use are a common precipitant.

Rapid increases in training volume

The start of a season or a training camp. As with any overuse problem, tissue tolerance has not moved with the demand.

Breathing to one side only

Unilateral breathing produces an asymmetric stroke and asymmetric loading. Bilateral breathing is one of the simplest technique changes available.

Generalised hypermobility

Swimmers are often selected for shoulder flexibility, and hypermobile shoulders rely more on muscle for stability - which fails first under fatigue.

Little or no land-based strength training

Many swimmers do very little external rotator or scapular work. The imbalance that the stroke creates is never counterbalanced.

Who tends to get it

• Competitive swimmers at high training volumes
• Anyone who has recently increased volume or paddle use
• Swimmers with hypermobile shoulders, which is a large proportion
• Those who breathe to one side only
• Swimmers who do no land-based shoulder strengthening

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineShoulder Relief & Overhead Range

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Night pain, weakness, or instability episodes need assessment

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Land-based strengthening plus technique and volume management improves most cases over six to twelve weeks without stopping swimming altogether. The imbalance the stroke creates is permanent as long as the swimming continues, which makes the land-based work a season-long habit rather than a course of treatment. Pain that persists despite that, or that comes with instability or a sense of the shoulder slipping, deserves a proper shoulder assessment.

Prevalence basis: Aquatic sports medicine surveys

Others the same routine covers

These share the Shoulder Relief & Overhead Range routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.