Returning to Swimming After Shoulder Injury

Shoulder injuries can be a frustrating setback for triathletes, especially those who are in swim training mode. 

Whether it's a rotator cuff tear, dislocated shoulder, or other injury, recovery can be a long and challenging process. However, with the right approach and mindset, and a little patience, it's possible to recover from a shoulder injury and get back in the lap swimming pool or out doing open water swims.

Triathletes get shoulder injuries in a number of ways. Many obviously get shoulder overuse injuries from swimming, but a surprising number of triathletes hurt their shoulders in bike accidents or falls. And for some people, their shoulders are just not built well and they are more prone to shoulder slips and even early arthritis, which is more common than you might think.

Perhaps the most common triathlete shoulder injuries are from swim training, especially overuse injuries or injuries related to poor swim technique. The common swim-related injuries tend to be rotator cuff tendinitis, bursitis, and impingement syndrome.

Rotator cuff tendinitis is an inflammation of the tendons that connect the shoulder muscles to the bone. This is often caused by overuse of the shoulder joint, and can lead to pain and weakness in the shoulder.

Bursitis is an inflammation of the bursa, which is a small fluid-filled sac that cushions the joint. This can also be caused by overuse of the shoulder joint, and can lead to pain and swelling in the shoulder.

Impingement syndrome occurs when the tendons and bursa in the shoulder become compressed by the bones in the joint. This can cause pain and weakness in the shoulder, and can also lead to rotator cuff tears if left untreated.

The other common cause of shoulder injury in triathletes tends to be from bike accidents. Any fall on a bike often leads to stress on the shoulder whether the arm is outstretched or not. This can create some serious trauma-caused injuries, such as a rotator cuff injury or torn labrum. Also common is a subluxation, where the shoulder very slightly slips around the joint, almost to the point of a dislocation but not quite. These injuries require more time to heal, and often physical therapy to give the shoulder strength and range-of-motion again.

While most triathlete shoulder injuries are caused by swimming or cycling accidents, the fact is that many will experience a shoulder problem from nothing having to do with triathlon. You could tweak your shoulder by doing yardwork, playing with your kids, or sleeping wrong! Shoulders are delicate joints.

The big question on shoulder injuries - or any injury - is when to self-diagnose and when to see a medical professional.

Unless you are an old pro at dealing with a shoulder injury, you are probably smart to start with a physical therapist. They will have seen many shoulder injuries like yours, and will give you an idea of how to rehab it and what kind of pain is OK to tolerate. They will probably tell you if you should see a doctor as well.

If needed, a trip to an orthopedist who specializes in shoulders is the next step. They will do a series of tests, and their main focus will be on if you need surgery or not. Contrary to popular belief, most shoulder surgeons will not advise surgery unless you absolutely need it.

It is likely that an orthopedist will order an MRI so they can see what’s going on inside your shoulder. If they suggest an MRI, definitely do it if it is not cost-prohibitive. An MRI will give you some answers and a clearer path to recovery. An MRI provides a lot more information than just doing an exam does.

Whether you are taking care of yourself or under the care of a PT or doctor, your shoulder will benefit from rest, ice, compression, and elevation (RICE) to reduce pain and swelling. That should be the goal until you feel like you can start doing some lite, basic range-of-motion exercises again.

Anyone who has had a shoulder injury knows that one of the more frustrating things during this phase is the inability to sleep well. Injured shoulders keep you up at night! Find some extra pillows to prop your affected arm and shoulder in a more comfortable position, and if possible try sleeping on your back.

Once the initial pain and swelling have subsided, rehabilitation exercises can help to strengthen the shoulder and improve range of motion. 

These exercises may include shoulder shrugs, wall push-ups, and arm circles. Doing shoulder stretching (door frames are great for this) will help, and focus on anything that will work your shoulder’s range-of-motion. 

Start slow, and be gradual. You don’t want to re-injure.

That first short swim after a shoulder injury can be nerve-inducing, but when the shoulder has regained strength and range of motion, it's time to begin a gradual reintroduction to swimming. 

Start slow, take lots of breaks, and focus on a full and smooth range of motion. Pay attention to if your body is trying to protect the injured shoulder. If so, you might be creating other problems through poor technique. It really helps to have someone watch you, it is hard to self-assess your swim stroke.

Be gradual and give your shoulder rest.  One swim per week is about right for someone who is rehabbing a shoulder, but at the point of re-entering the pool. Don’t get bothered by your lap times, this is for rehab.

If your shoulder has acute pain during the swim, or if your post-swim shoulder feels reinjured, then lay off and keep seeing your PT. However, it is common to push through a little stiffness when returning to the pool.

Von Collins is an avid triathlete, endurance cyclist, coach, and the author of four endurance and fitness guides, including Your First Triathlon Guide: 100 Days to Your First Triathlon. He is part of the editing team at Complete Tri.