Ask Dr. Beacom: Know the Signs of Swimmer’s Shoulder

With early diagnosis and treatment, swimmer’s shoulder won’t keep your athlete out of the water.

swimmer's shoulder

The North American Journal of Sports Physical Therapy reports that competitive swimmers regularly exceed 4000 strokes for one shoulder in a single workout. As a result, it’s no surprise that many swimmers experience discomfort around their shoulder joint generally referred to as swimmer’s shoulder. Summit sports medicine specialist Dr. Amy Beacom is no stranger to swimmer’s shoulder. As a former collegiate swimmer and Team USA physician treating Olympic, Open Water World Championship, and Pan Am swimmers, she brings a depth of experience to her treatment of Twin Cities swimmers.

Swimmer’s shoulder is common, but very treatable

“Swimmer’s shoulder is common,” says Dr. Beacom. “But it’s pretty easy to predict which swimmers are going to get shoulder pain—and, with the right tools and expertise, it’s very easy to treat and correct this condition. In fact, Summit is adapting the Team USA swimmer’s shoulder protocol for the swimmers we treat. Of course, the first step in preventing swimmer’s shoulder is educating parents about when swimmers are most vulnerable and helping them to spot the red flags that signal a problem.”

The trifecta of risk factors for teenage swimmers

“It’s not difficult to anticipate who’s going to get shoulder pain and swimmers shoulder,” explains Dr. Beacom. “Teenage swimmers between the ages of 13 and 16 are particularly vulnerable to developing shoulder pain—due to a trifecta of developmental and training factors.

  • Rapid growth. Young teens are developing rapidly as their bones and muscles grow. Female swimmers are particularly susceptible because they tend to stand hunched with their shoulder blades forward; they aren’t using their shoulder muscles for stability and strength. Additionally, growth spurts affect coordination as teens adjust to their changing bodies, making them more vulnerable to joint injury.
  • Advancing from junior to senior-level swim competition. “The change in levels means more practices a week and more intense workouts,” explains Dr. Beacom. “It also means that coaches will start to focus 14- or 15-year-old swimmers in a specialization. If swimmers like distance, they are going to swim distance. If they have a specialty stroke like backstroke or breaststroke, their coach focuses their training in these specialties. This is part of the natural progression in the sport, but specialization can also lead to overuse injury.”
  • Moving from yard to meter pools. During the winter in Minnesota, swimmers train indoors in 25-yard pools. But in the summer, their training moves outdoors in 50-meter outdoor pools. “The move to a 50-meter pool means swimmers are suddenly swimming much farther,” notes Dr. Beacom. “This extra distance exposes swimmer weaknesses. I’ll see a lot of swimmers come in midsummer with shoulder pain. That’s because they’ve moved to longer outdoor Olympic pool. They have to swim farther, they get tired, and their form falls apart.”

Symptoms of swimmer’s shoulder

“I always encourage parents to bring their young swimmers in if they are concerned,” says Dr. Beacom. “It’s normal for young athletes to experience fatigue. But if shoulder pain doesn’t get better with rest or is worsening, that’s a red flag. Frequently, there is a progressive pattern with the shoulder pain. At first, it may bother the swimmer every once in a while. They may be able to do their warm-up, but experience pain afterward in the water. If a child is complaining about repeated pain that persists outside the water, making it hurt to sleep or use a hair brush, I definitely want to see them.”

Medical evaluation of swimmer’s shoulder

“When young swimmers see me for sudden shoulder pain, I begin by asking them about what’s different in their life,” Dr. Beacom explains. “I ask a couple of questions: Have you grown? Did you go up a level in swimming? Did the pain occur when you started swimming outside? That’s the trifecta. In the vulnerable teenage age range, swimmers don’t put on muscle mass before their bodies start to grow. As a result, they have really sloppy shoulder blades and their form is not great. Younger, shorter swimmers can get by with poor form if they are training in a yard pool with easier workouts. But when that swimmer starts to grow into longer arms and legs with the same poor stroke mechanics, the equation changes. Now they are in a longer pool doing even more swimming with more intensity. That’s when the wheels come off the bus.”

Dr. Beacom also asks swimmers about their kicking. “If you aren’t a good kicker, that also adds to the likelihood of shoulder issue because you can’t keep your body position up in the water,” she explains. “The good news is that every swimmer can learn to be a better kicker.

A strong swimmer IQ is key to recovery

“I also evaluate my patient’s swimmer’s IQ,” she says. “I ask them if they understand body roll, high elbow, dropped elbow, shoulder roll, and body position in the water. Often, parents don’t understand what I’m talking about, but almost all of these young swimmers get it—they have a really high swimmer IQ and they own this sport that they love. I know these kids and I love connecting with them. When a child has a good swimmer IQ, I know we’ll be able to teach them to change their mechanics in the water by working with their coach and focusing on muscle development in physical therapy with the swimmer’s shoulder protocol we use. They don’t have to get out of the water or stop swimming. If they love to swim and they want to swim, our swimmer’s program will get them better.”

Summit Orthopedics offers comprehensive sports medicine expertise

From Olympians to pro athletes to kids in youth sports and those who just want to be more active—Summit Orthopedics delivers expert care by fellowship-trained sports medicine physicians. If you are recently injured or concerned about ongoing pain, Summit Orthopedics sports medicine specialists have the expertise to evaluate your discomfort and develop a plan to quickly and safely help you get back to being active. 

Start your journey to stronger, healthier athletic condition. Find your sports medicine expert, request an appointment online, or call us at (651) 968–5201 to schedule a sports medicine consultation.

Summit has convenient locations across the Minneapolis-St. Paul metro area, serving Minnesota and western Wisconsin. We have state-of-the-art centers for comprehensive orthopedic care in Eagan, MNPlymouth, MN, Vadnais Heights, MN, and Woodbury, MN, as well as additional community clinics throughout the metro and southern Minnesota.

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  • Amy Beacom, M.D.

    “Staying active has always been important to me — in and out of the water. That’s why I’ve dedicated my practice to treating running and swimming orthopedic injuries. So my patients are able to stay active too.”

    More about this expert

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