Shoulder Pain with Swimming: What Triathletes Need to Know
- Apr 6
- 5 min read
Updated: Apr 14
Shoulder pain with swimming, often called swimmer’s shoulder, refers to a group of conditions caused by repetitive overhead motion and poor load tolerance. It commonly includes issues like tendon irritation, impingement, or rotator cuff strain.
This article explains the most common causes, how technique and training habits contribute, and what treatment options are available. It also outlines how physical therapy can help you return to swimming safely and with better shoulder function.
Common Causes of Shoulder Pain with Swimming
There are multiple reasons why you might have shoulder pain with swimming, which is also commonly called “Swimmer’s Shoulder”.
Common diagnoses associated with this include:
Shoulder impingement
Rotator cuff strain or tear
Labral tear of the shoulder
Swimmer’s Shoulder is generally caused by the repetitive motion of reaching overhead while swimming. While these diagnoses might sound scary, they can all be managed with conservative care, such as physical therapy.
Treatment Options for Shoulder Pain with Swimming
Your treatment options depend on factors such as how severe your pain is, whether it affects daily activities, if you have any nerve symptoms, and any changes in strength or range of motion.
Based on these factors, treatment options can include physical therapy, cortisone shots, or surgery.
Physical Therapy
Physical therapy is considered a first-line treatment for most cases of shoulder pain with swimming. The goal with physical therapy is to improve how your shoulder functions to resolve your pain and not temporarily reduce it.
That typically includes:
Restoring shoulder range of motion if it’s limited
Building strength in the muscles that support the shoulder
Improving your shoulder’s coordination and control
Gradually increasing your tolerance to the demands of swimming
A good rehab program should also fit into your training, not replace it. The goal isn’t to stop swimming completely, but to modify and rebuild so you can return to full training without setbacks.
If you’re trying to avoid surgery, a physical therapy assessment can help determine how serious your shoulder pain is and whether a referral to an orthopedic surgeon is actually needed.
Even if surgery ends up being necessary, physical therapy is still part of the healing process. Prehab can help improve outcomes, and post-operative rehab is what restores your strength, mobility, and confidence in your shoulder.
Cortisone Shots
Cortisone shots can be helpful if your shoulder pain is severe enough that day-to-day movements are also painful or if you’re unable to tolerate any exercise.
In these situations, the goal is to reduce pain enough to start moving again and begin a rehab program.
However, it’s important to understand that cortisone injections are not a standalone solution.
While they can reduce pain in the short-term, they don’t improve strength, mobility, or control of the shoulder. This is also why some people feel like cortisone injections “stop working” after a while. If the underlying issues of strength, mobility, or how the shoulder is handling load aren’t addressed, the pain can return after a while.
It’s also worth noting that repeated cortisone shots can weaken tendon tissue over time. This makes the tendon more susceptible to rupture in the future.
For that reason, cortisone injections are best used sparingly as a tool to calm symptoms enough to allow for effective rehab, not as a replacement for it.
Surgery
Surgery is typically not a first-line treatment for shoulder pain with swimming, but it can be necessary in certain cases.
There are some situations where it’s more obvious that surgery may be needed. For example, if you can’t lift your arm overhead on your own, but someone else can move it there for you, that can be a sign of a more significant tear. However, this is not common, especially if you’re still able to swim.
Surgery is more often considered if symptoms don’t improve with appropriate conservative care, such as physical therapy.
This means actually following a structured and progressive rehab program and not just going to one or two visits. If you’ve been consistent with a progressive program for about 6–8 weeks and aren’t seeing meaningful improvement, it may be time to consider a surgical consult.
Surgery can address structural issues in the shoulder, but it doesn’t improve strength, mobility, or control on its own.
This is why physical therapy is still a key part of the process after surgery. Rehab is what helps you rebuild strength, restore mobility, and return to swimming safely.
How Swimming Technique Impacts Shoulder Health
Swimming involves a lot of repetitive overhead reaching, so poor technique can increase the strain on your shoulder over time. Working with a swim coach to improve your technique can help with decreasing your shoulder pain.
Some common faults that contribute to shoulder pain include:
Crossing your midline during the stroke
Overreaching on entry
High elbow catch and/or recovery
Under or overrotation of the body
Additionally, using paddles can magnify any technique faults you have. So if you only have shoulder pain when swimming with paddles, improving your swim technique instead of avoiding the paddles would solve the root cause of your pain.
Improving your technique can reduce strain on your shoulder, but you still need the strength and mobility to support those positions.
How to Prevent Shoulder Pain With Swimming
Unfortunately, there is no way to 100% prevent shoulder pain with swimming. But there are ways to reduce your risk of pain and injury through smart training and building a resilient shoulder.
Load management
Most injuries occur when trying to do “too much, too soon”. This commonly occurs with sudden spikes in training volume. A smart training plan will build gradually to allow your shoulder to adapt and keep up with the training load.
Injuries also occur if you don’t allow yourself to recover enough between training sessions. Taking adequate rest days and focusing on quality sleep and good nutrition are an important part of reducing injury risk.
Exercises to Support the Shoulder
Building resilient shoulders can go a long way towards reducing future shoulder pain and injury. This is done by adding supplemental “dry land” training sessions.
Some key areas to focus on are general flexibility and strengthening. Flexibility exercises should include the lats and the shoulders. Strengthening exercises should include the rotator cuff, the shoulders (i.e. deltoids), and the back muscles.
The best strength program is the one you’ll actually do. Bodyweight and banded exercises work just as well using dumbbells and barbells, if that’s what you prefer. Just remember to progress the exercises as they get easier.
When to Rest and When to Seek Help
Seeing a swimming or triathlete physical therapist as soon as you start noticing shoulder pain will help you return to pain-free swimming faster. But it’s understandable if you’d rather try to rehab yourself or wait and see if it goes away on its own first.
If it’s only been a couple days or weeks since you started experiencing shoulder pain with swimming, it’s worth looking at your current training volume and pulling back a bit to see if that helps. This might look like decreasing the amount of swim sessions or the total yardage/meters each session for at least a week.
But you should probably seek professional help if you start noticing the following:
Shoulder pain affecting your daily life (not just swimming)
Loss of shoulder and/or grip strength
Loss of shoulder range of motion
Numbness and tingling down your arm
These are signs that your shoulder pain won’t just go away on its own without help.
Triathlete Physical Therapy in Nevada
If you're located in Nevada, and are hesitant to start physical therapy because you don’t have the time to drive to appointments, I offer remote physical therapy for triathletes who want structured rehab without weekly clinic visits.
Resolve your shoulder pain without wasting precious time driving to a clinic. Schedule an assessment today to return to swimming pain-free sooner!
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Resources
YANAI, TOSHIMASA; HAY, JAMES G.. Shoulder impingement in front-crawl swimming: II. analysis of stroking technique. Medicine & Science in Sports & Exercise 32(1):p 30, January 2000.
