Slide show: Swimming for fitness? Avoid rotator cuff injuries

Searching for a low-impact workout to add to your aerobic fitness routine? Swimming is an excellent option.

But if you plan to take the plunge, don't overdo it your first time in the water. Swimming places repeated demands on the shoulder joint, and you might develop swimmer's shoulder — another name for rotator cuff tendinitis. This painful condition can affect people who swim as part of their aerobic workout or just for fun.

Your rotator cuff is a crossroad of four different muscles — all connected by tendons to your arm and shoulder bones. Together these muscles form a cuff that makes your shoulder the most flexible joint in your body. But your shoulder's strength is also its weakness. Its wide range of motion makes it injury prone.

Repetitive overhead arm motion can inflame rotator cuff tendons — a condition known as overuse tendinitis. Or a tear can develop in one of the tendons. Both may cause pain and decreased range of motion. You may feel pain only when you take a swimming stroke. Or your shoulder may hurt when you lift your arm to comb your hair or put a shirt on.

Swimming is a superb, low-impact aerobic exercise. Follow these tips to prevent swimmer's shoulder:

• Stretch properly before each swim.
• Take a few slow overhead strokes as you start out.
• If you swim hard, incorporate a generous warm-up and cool-down period.
• Gradually increase distance and intensity.
• Use proper stroke technique.

To prevent injury:

• Keep your elbow well above your hand during the out-of-water recovery phase and catch phase of your next stroke.
• Enter your hand into the water pinky first during the catch phase, with your palm facing in. Don't let your arm cross the midline of your body. Turning your hand out, pointing your thumb downward, and crossing your body's midline with your arm all place a greater load on your shoulder when your arm is lengthened during the pull phase.
• Breathe from both sides. Turning your head to only one side places strain on your opposite shoulder.
• Kick strongly enough to maintain buoyancy and reduce shoulder stress.
• Take lessons if you're unsure of your stroke technique.

To stretch your shoulders before swimming:

• Grasp your arm above or below your elbow. Don't hold directly at your elbow to avoid excess stress on your joint.
• Gently pull your arm across your body so that you feel the back of your shoulder stretch.
• Hold for 30 seconds.
• Repeat two to three times.
• Switch arms and repeat.

Keep your rotator cuff in tiptop shape and the muscles in balance with this exercise to strengthen the muscles in the back of your shoulder:

• With arms in front bent at the elbows, pull your elbows back to squeeze your shoulder blades closer together.
• Hold for 10 seconds.
• Repeat three to five times.

Feel pain in your shoulder? Take a break from the pool.

• Rest.
• Apply ice.
• Take aspirin, ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others).

Complete rest is the shortest road to recovery, so stop swimming until the pain goes away.

But if the pain persists, see your doctor or a sports medicine specialist. He or she may recommend that you see a physical therapist to learn about exercises to provide balanced shoulder strength and to improve shoulder flexibility.