Physical Therapy for Swimmer’s Shoulder

Swimming is a sport that primarily utilizes the upper body for propulsive force with 90% of the driving force provided by the torque generated from the shoulder. 

The shoulder muscles are the main part of the body that propel the swimmer through the water. The swim stroke requires the shoulder to move in range-of-motion extremes while tremendous muscular force is exerted on the shoulder joint structures.

Swimmer’s shoulder is the most common swimming-related shoulder injury, often caused by overuse due to the repetitive overhead motion of the swim stroke that irritates and inflames the rotator cuff muscles and tendons, leading to pain and limited shoulder mobility. 

Symptoms of swimmer’s shoulder include: 

• Pain when reaching arms overhead or behind the back

• Weakness in the shoulder

• Decreased range of motion in the shoulder

• Shoulder stiffness

• Swelling or tenderness in the shoulder

• Pain that radiates from shoulder to neck or down the arm

Physical therapy is one of the most effective treatments for swimmer’s shoulder, utilizing a targeted manual therapy, stretching, and strength and conditioning exercise program to restore shoulder function, mobility, and strength and a safe return to competitive swimming.

Physical therapy for swimmer’s shoulder can include: 

• Pain management using ice and heat as well as rest from aggravating activities to reduce inflammation in the shoulder.

• Manual therapy: soft tissue and joint mobilizations to improve range of motion in the shoulder and restore the shoulder joint’s full mobility. The therapist may specifically conduct posterior capsule mobilizations as tightness in this area often accompanies anterior shoulder laxity and contributes to swimmer’s shoulder. 

• Targeted stretching of tight muscles in the shoulder joint, upper chest, and upper back that may be restricting normal shoulder movement. 

• Targeted strengthening exercises:

  • Range of motion exercises involving gentle stretching and mobility exercises to improve flexibility and restore normal shoulder function. 

  • Rotator cuff strengthening involves external and internal rotation, abduction, and retraction exercises to help strengthen the rotator cuff muscles and restore muscular balance.

  • Scapular strengthening involves targeted exercises to strengthen the middle and lower trapezius, serratus anterior, and rhomboid muscles. 

  • Core strengthening to ensure a strong foundation for movement in the abdominal and lower back muscles, allowing for a fluid transfer of power from the lower body to the upper body and shoulder.

• Postural education to ensure proper posture to reduce stress on the shoulder and allow the shoulder to rest in proper position. 

• Sport-specific functional training focused on ensuring correct swim stroke technique to reduce excessive stress on the shoulder. A gradual return to sport program may be implemented with the swim coach, starting with low-intensity short-duration sessions, and gradually increasing in duration and intensity as the swimmer can tolerate.