The pain is real.

Swimmer’s shoulder can affect up to 70% of swimmers

Swimmer’s shoulder can be painful and limit training

The rotator cuff and biceps tendons are primarily affected and can become painful.

Improving thoracic spine mobility and scapular control can help improve biomechanics

Active Release Technique and chiropractic care combined with improving swim stroke is the way to go!


It’s almost spring in Colorado! That means a lot more people have begun training for longer events such as triathalons or have started swim season. I have recently had an influx in new people coming in with shoulder pain related to swimming. Let me tell you about Henry.

Henry is a recreational endurance athlete. He love running long distances, riding his bike for miles and miles, but struggles to swim. He has decided that he will take this year’s training season more seriously, training for the Boulder Sunrise Triathalon on June 21st. He has begun ramping up his volume and is now putting in more work in the pool - up to three hour-long swimming sessions per week. Awesome! Everything had been going great until he started feeling some pain in the right shoulder. At first his shoulder just felt stiff and took a little longer to warm up, but the stiffness soon turned into pain. The pain in the back of his shoulder became unbearable and now he can’t swim. His season started to look like it was over before it even began. That’s when he called my office…

What is swimmer’s shoulder?

rotator cuff.jpg

The suprasinatus, infraspinatus, and subscapularis muscles, which are all part of the rotator cuff, tend to be pretty inflamed or otherwise unhappy. Check out the diagram. You can see that both the infraspinatus (IS) and subscap (SS) muscles are rather large and they both live on the shoulder blade.

The supraspinatus is our main concern here. Check out how the muscle goes between the two large bony bridges of the scapula, the acromion and coracoid processes. Depending on anatomical varieties, there may be a pretty small amount of space in that area. Keep in mind that the diagram does not show a few important ligaments that further narrow the space for the supraspinatus tendon to run through. The small space is supported by a network of bursae, or small fluid-filled cushions, in the area to help the tendon run more smoothly.

Your body is an amazing robust machine! But after thousands and thousands of reps performed with errors, things can get broken down and upset. That’s what happens in Swimmer’s shoulder. After thousands of reps with less-than-perfect technique, these rotator cuff muscles become overused and their tendons get pretty pissed off. The burase that surround the area can also get inflamed and that can narrow the space for the supraspinatus tendon to pass through which further irritates the tendon. If left unchecked, the tendon my fray and possibly even tear over time. All this can make the shoulder feel stiff, weak, and painful. Up to 70% of recreational swimmers develop shoulder pain, so it’s worth taking a look into what to do about it.

Henry’s Evaluation

Henry came in and after a good conversation about not only his shoulder, but also his training, goals, and a bit about his personal life. We learned that his training volume had increased and he admitted that his swimming technique could “really use a lot of work. It probably sucks pretty bad.” Swimming is his weak point in tris so being a true athlete, he decided to tackle his weaknesses and really spend some time becoming a stronger swimmer. That’s great! If you have good technique, but proper swimming stroke is outside the scope of this article, so we’ll focus on his evaluation.



Henry’s posture was pretty poor. Other than being an aspiring triathlete, he also works as an insurance adjuster. He sits at a desk all day long. He showed the classic “upper crossed syndrome.” While upper crossed syndrome may not in itself cause pain, it can cause all kinds of mobility issues in the neck, mid back, and shoulders that can lead to pain down the road.


Try this test for yourself!

We ran Henry through a comprehensive movement analysis called the Selective Functional Movement Assessment (SFMA). Our results showed a severe restriction in mobility of his thoracic spine. Watch the video below to test yourself! I want to see about 70-90 degrees of rotation each way on the kneeling t-spine rotation test. Henry only was able to rotate about 30 degrees each way, which is less than half! We found some other issues that may also have an effect, such as limited shoulder rotation and some hip issues, but our primary focus will now be on restoring the t-spine.

Luckily all our orthopedic testing was relatively normal, so I know we weren’t dealing with any tears or other more serious injuries.

Why thoracic spine mobility matters

The thoracic spine is the part of your spine where your ribs are. We should be able to move that part of our spine under control to help position our shoulder to be where it needs to be to do all the fun stuff it can do. If the spine can rotate and extend, that can place the scapula in a better position for us to swim. Remember, swimming is a rotational sport, so the more rotation we can have in the mid back, the less our shoulders have to do to get that good reach and pull. Over the course of a training cycle, a swimmer could put in hundreds of thousands of repetitions. If their technique is poor or their thoracic spine isn’t extending and rotating, it means the smaller muscles of the shoulder (supraspinatus from above!) have to do more work with each stroke. Over time, the smaller muscles get pretty upset that they are doing so much extra work, so they start talking to you in the form of pain.

So not only is a restricted t-spine making us work harder, it could be causing pain too! Not fun.

Henry’s Treatment



We’ve been adjusting Henry’s neck and thoracic spine as indicated by my evaluation on each visit. The adjustments have been going smoother each time and I’m needing to adjust fewer and fewer segments, which is great! The adjustments have helped improve Henry’s mobility and posture (plus they feel great).


The true magic lives here. Active Release Techniques (ART) is considered the gold standard in soft tissue treatments. ART is useful for relieving pain and restoring range of motion, and with a protocol for every single muscle in the body, I can target and treat a specific muscle and even a specific spot in the muscle! You can think of ART as massage plus stretching combined into one awesome treatment.


This is where Henry did a great job! We assigned a handful of exercises for Henry to do at home and before he worked out. These focused mainly on improving his thoracic spine mobility, but there were a few great muscle activation exercises to help his shoulder blades and rotator cuff be better prepared for his workouts.


We had to take a step back in order to take two steps forward. I asked Henry to take two weeks off of swimming while we got his shoulder calmed down. During this time, he focused more on what he was able to do, like running, biking, and lifting weights.Henry also took this time to research proper swimming technique and some drills to do once I gave him the clear to get back in the pool.

Henry took those drills and with his newly-found mobility, he was able to improve his stroke. He reported back that he was even able to set some new personal records while swimming laps! We have been working together for a few weeks and he is able to swim without pain and he has chosen to continue getting adjusted regularly even though he is out of pain! I look forward to helping Henry reach his goal of completing a full triathlon this summer!

What can we help you with? What pain or limitation is holding you back from your goals? Let us know by scheduling a visit.

Dr. Andrew  Cuiffo

Dr. Andrew Cuiffo


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