The open water season has ended, and for many of us, that means heading indoors. The pool becomes our new training ground for building strength and endurance. We’re logging laps, focusing on speed work, and using paddles and pull buoys to get stronger for next year. But with all that intense training comes a common, nagging problem: shoulder pain.
That familiar ache in the front or side of your shoulder can quickly turn a great workout into a painful chore. It’s often called “swimmer’s shoulder,” a broad term for shoulder injuries common in the sport. More often than not, the root cause is a rotator cuff issue.
If you’re dealing with this, you’re not alone. Swimming requires thousands of repetitive overhead motions, putting incredible strain on the shoulder joint. To understand how to manage and prevent this, we’ll look at insights from Dr. Sabrina Strickland, a renowned orthopedic surgeon at the Hospital for Special Surgery who specializes in sports medicine.
Understanding the Rotator Cuff
What is the Rotator Cuff and Why is it Prone to Injury?
The rotator cuff isn’t a single thing; it’s a group of four muscles and their tendons that surround the shoulder joint. Their job is to keep the head of your upper arm bone (the humerus) securely within the shallow socket of the shoulder. They are essential for lifting and rotating your arm—basically, every part of your swim stroke.
According to experts like Dr. Strickland, the repetitive nature of swimming is a primary cause of rotator cuff issues. Each stroke places stress on these tendons. Over time, without proper strength, form, or rest, this can lead to inflammation (tendinitis) or even small tears in the tendons.
Common Causes of Rotator Cuff Injuries in Swimmers
- Overuse: Simply swimming too much, too soon, or without adequate rest. This is common when transitioning to focused indoor training, as intensity and volume often increase.
- Improper Technique: Flaws in your stroke mechanics can place uneven stress on the shoulder.
- Muscle Imbalance: Many swimmers develop strong pectoral and latissimus dorsi muscles (the big “pulling” muscles) but neglect the smaller stabilizing muscles of the rotator cuff and upper back. This imbalance can lead to poor shoulder mechanics.
Perfecting Your Form to Prevent Shoulder Pain
Dr. Strickland emphasizes that proper technique is crucial for preventing shoulder injuries. Small adjustments to your form can make a huge difference in reducing stress on the rotator cuff.
Avoid Crossing the Midline
A very common mistake in freestyle is letting your hand cross the centerline of your body as it enters the water. This “crossover” causes the shoulder to rotate internally under stress, which can pinch the rotator cuff tendons. Focus on entering the water with your hand directly in front of your shoulder.
Enter the Water Correctly
How your hand enters the water matters. Dr. Strickland advises against a thumb-first entry. This position forces the shoulder into excessive internal rotation, increasing the risk of impingement. Instead, aim for a flat-hand or pinky-first entry, which keeps the shoulder in a more neutral and protected position.
Roll Your Body
Efficient swimming involves rolling your entire body from side to side, not just twisting your neck to breathe. This body roll helps engage your core and larger back muscles, taking significant pressure off your shoulders. When you reach forward for your catch, the rotation should come from your hips and torso.
Strengthening for Injury Prevention
You can’t just swim to get stronger at swimming; you need to do targeted “dry-land” exercises to build the supporting muscles around the shoulder joint. A strong rotator cuff and upper back provide the stability your shoulder needs to handle thousands of strokes.
Key Strengthening Exercises
- External and Internal Rotations: Using a resistance band, keep your elbow tucked at your side and rotate your forearm outward (external rotation) and inward (internal rotation). These exercises directly target the rotator cuff muscles.
- Scapular Squeezes (Rows): Use a resistance band or cable machine to perform rowing motions. As you pull back, focus on squeezing your shoulder blades together. This strengthens the muscles in your upper back that help stabilize the scapula.
- Core Work: A strong core is the foundation of a powerful, efficient swim stroke. Incorporate planks, side planks, and other core exercises into your routine. A stable core reduces the strain on your shoulders by helping you maintain proper body alignment in the water.
What to Do When Shoulder Pain Strikes
Even with perfect form and consistent strengthening, you might still experience shoulder pain. The key is to address it immediately before it becomes a chronic problem.
Listen to Your Body and Rest
Pushing through sharp pain is a recipe for a more serious injury. If you feel pain while swimming, it’s time to stop. Take a few days off from swimming or modify your workouts to avoid aggravating the shoulder. You can still work your lower body with a kickboard.
Apply Ice
For acute pain and inflammation, applying an ice pack for 15-20 minutes after a swim can help reduce swelling and provide relief. This is especially helpful after an intense session where you felt some discomfort.
Work with a Coach or Physical Therapist
If the pain persists, consider seeking a professional opinion. A swim coach can analyze your stroke and identify technical flaws you might be missing. A physical therapist can provide a personalized rehabilitation plan with specific exercises to correct muscle imbalances and reduce pain.
When to See a Specialist
If your shoulder pain doesn’t improve with rest, icing, and stretching, or if it significantly impacts your daily activities, it’s time to consult a specialist. An orthopedic surgeon like Dr. Sabrina Strickland can properly diagnose the issue, which may involve imaging, such as an MRI, to assess the condition of the rotator cuff tendons.
A specialist can guide you on the next steps, whether it’s a more intensive physical therapy regimen, injections to reduce inflammation, or, in more serious cases, surgical intervention.
Keep Your Shoulders Healthy All Season
Don’t let shoulder pain sideline you from the sport you love. By focusing on smart training, proper technique, and proactive strengthening, you can keep your shoulders healthy and strong for many seasons to come. Swim smarter, not just harder.