If SS is ultimately an impingement problem related to overuse, and there are ways to decrease the probability of that impingement occurring, then it logically follows that SS could be made less probable to occur (Bak & Fauno, 1997; Baum, 1994; Johnson, Gauvin, & Fredericson, 2003; mayo Clinic, 2000; Newton, Jones, Kraemer, & Wardle, 2002; Pink & Jobe, 1996; Pollard & Croker, 1999; Reuter & Wright, 1996; Tuffey, 2000; Weisenthal, 2001).  If certain methods are employed in a swimmer's training program, it might be possible to make recovery from SS episodes easier or quicker (Bak & Fauno, 1997; Baum, 1994; Johnson, Gauvin, & Fredericson, 2003; mayo Clinic, 2000; Newton, Jones, Kraemer, & Wardle, 2002; Pink & Jobe, 1996; Pollard & Croker, 1999; Reuter & Wright, 1996; Tuffey, 2000; Weisenthal, 2001).  These prevention methods can be divided into (Bak, 1997; Bak & Fauno, 1997; Baum, 1994; Johnson, Gauvin, & Fredericson, 2003; Koehler & Thorson, 1996; Maglischo, 2003; mayo Clinic, 2000; Newton, Jones, Kraemer, & Wardle, 2002; Pink & Jobe, 1996; Pollard & Croker, 1999; Reuter & Wright, 1996; Tuffey, 2000; Weisenthal, 2000):

• technique modifications
• training program design
• flexibility development
• strength development

A swimmer’s stroke technique may be altered to reduce the likelihood or severity of a potential impingement between the rotator cuff and the coracoacromial arch and an episode of SS (Bak & Fauno, 1997; Baum, 1994; Chang, 2002; Costill, Maglischo, & Richardson, 1992; Johnson, Gauvin, & Fredericson, 2003; Koehler & Thorson, 1996; Loosli & Quick, 1996; Maglischo, 2003; Mayo Clinic, 2000; Pollard & Croker, 1999; Reuter & Wright, 1996; Tuffey, 2000; Weisenthal, 2001). These changes could include several elements, from head position through hand-pull pattern.  Specific modifications or technique methods that can reduce the chance of impingement include:

• Encourage adequate body-roll of the trunk, shoulder through hip (45° to 100° from the long axis in both directions), while swimming (Costill, Maglischo, & Richardson, 1992; Johnson, Gauvin, & Fredericson, 2003; Mayo Clinic, 2000; Tuffey, 2000).
• Ensure that swimmers are breathing to both sides in order to facilitate a greater degree of body-roll to both sides (Bak & Fauno, 1997; Costill, Maglischo, & Richardson, 1992; Johnson, Gauvin, & Fredericson, 2003; Mayo Clinic, 2000; Tuffey, 2000).
• Rotate the hips and shoulders as with the arm pull to allow a freer range of shoulder motion, allowing the elbow to stay lower or closer to the water during the recovery phase but still keeping the hand lower than the elbow (Baum, 1994; Koehler & Thorson, 1996; Mayo Clinic, 2000).
• Teach a hand entry and pull pattern that stays outside the midline of the long axis (Johnson, Gauvin, & Fredericson, 2003; Koehler & Thorson, 1996; Mayo Clinic, 2000; Weisenthal, 2001).
• Teach a fingertip or little-finger-first hand entry, as opposed to a thumb first entry (Johnson, Gauvin, & Fredericson, 2003; Weisenthal, 2001).
• Encourage a technique of eyes-down swimming or a neutral head-position, looking at the bottom of the pool instead of the wall ahead of the swimmer (Johnson, Gauvin, & Fredericson, 2003; Tuffey, 2000).
• Encourage a hand-exit at or slightly behind the beltline (Johnson, Gauvin, & Fredericson, 2003; Pollard & Croker, 1999; Weisenthal, 2001).
• Promote establishing a finger-tip down, high-elbow hand position before rearward force is applied to the water; move to a catch position first, then perform the push (Maglischo, 2003; Mayo Clinic, 2000; Weisenthal, 2001).

To decrease the affect overuse could have on SS episodes, appropriate levels of training must be introduced, as the swimmer is able to handle them – too much work too soon, before the body has been prepared for that level of work, can result in SS (Baum, 1994; Koehler & Thorson, 1996; Tuffey, 2000).  Training load problems could be exacerbated through the overuse of equipment such as hand paddles and kickboards (Baum, 1994; Costill, Maglischo, & Richardson, 1992).  Training considerations to decrease SS problems include:

• Limit hand-paddle use early in the training season (Baum, 1994; Costill, Maglischo, & Richardson, 1992; Loosli & Quick, 1996; Pollard, 2001).
• Limit the use of a kickboard (Costill, Maglischo, & Richardson, 1992; Pollard, 2001).
• Avoid sudden increase in workout intensity or mileage (Costill, Maglischo, & Richardson, 1992; Koehler & Thorson, 1996; Mayo Clinic, 2000; Tuffey, 2000).
• Match water and dry-land work in terms of progression, intensity, and load (Baum, 1994).
• Utilize swim-fins to reduce shoulder stress (Counsilman & McAllister, 1986; Loosli & Quick, 1996).
• Mix in other swimming strokes more frequently during a workout and throughout the season (Pollard, 2001).

Appropriate levels of flexibility in the rotator cuff and general shoulder region will promote a proper range of motion in all planes of movement to help decrease the likelihood of SS developing (Chang, 2002; Costill, Maglischo, & Richardson, 1992; Johnson, Gauvin, & Fredericson, 2003; Loosli & Quick, 1996; Newton, Jones, Kraemer, & Wardle, 2002; Pink & Jobe, 1996; Pollard & Croker, 1999; Reuter & Wright, 1996; Otis & Goldingay, 2000; Weldon & Richardson, 2001).  This could include steps to enhance flexibility, as well as steps to stop or limit some types of stretches to eliminate or decrease laxity (Baum, 1994). Flexibility work should include and consider:

• Complete a proper warm-up of muscles before any flexibility work is started (Baum, 1994; Loosli & Quick, 1996).
• Avoiding ballistic stretches (Baum, 1994; Costill, Maglischo, & Richardson, 1992; Pink & Jobe, 1996).
• Perform stretches in planes and positions of use, not in random directions (Baum, 1994; Costill, Maglischo, & Richardson, 1992; Johnson, Gauvin, & Fredericson, 2003; Mayo Clinic, 2000).
• Do not overstretch, as often happens when partner-type techniques are used (Baum, 1994; Costill, Maglischo, & Richardson, 1992; Johnson, Gauvin, & Fredericson, 2003; Mayo Clinic, 2000; Pink & Jobe, 1996).
• Hold stretches at a point of mild tension for 12-20 s, release and repeat two additional times (Baum, 1994).
• Utilize strain-counter-strain or muscle shortening to loosen a tight band of muscle, relieving pain and increasing range of motion (Baum, 1994; Counsilman & McAllister, 1986).
• Use range of motion, dynamic stretches, such as pendulum swings (Chang, 2002; Pink & Jobe, 1996).
• Use isolated stretches of the pectoralis, posterior capsule, and latissimus dorsi (Johnson, Gauvin, & Fredericson, 2003; Pink & Jobe, 1996; Weldon & Richardson, 2001).

To decrease instability issues and increase strength and muscle endurance that can result in impingement and SS, specific exercises can be performed to develop balanced-strength in the scapula’s stabilizers and the shoulder’s rotator cuff (Bak, 1997; Bak & Fauno, 1997; Baum, 1994; Chang, 2002; Costill, Maglischo, & Richardson, 1992; Johnson, Gauvin, & Fredericson, 2003; Koehler & Thorson, 1996; Loosli & Quick, 1996; Mayo Clinic, 2000; Newton, Jones, Kraemer, & Wardle, 2002; Pink & Jobe, 1996; Pollard & Croker, 1999; Reuter & Wright, 1996; Tuffey, 2000; Otis & Goldingay, 2000; Weisenthal, 2001; Weldon & Richardson, 2001).  Many methods could be used to develop balanced strength.  Exercises to consider for specific strengthening in these areas include:

• Use elastic band, elastic tubing exercises, or dumbbell exercises, focused on the rotator cuff and scapular stabilizers, to include internal and external rotation; shoulder flexion, abduction, extension, and retraction (Bak & Fauno, 1997; Baum, 1994; Chang, 2002; Costill, Maglischo, & Richardson, 1992; Johnson, Gauvin, & Fredericson, 2003; Koehler & Thorson, 1996; Loosli & Quick, 1996; Newton, Jones, Kraemer, & Wardle, 2002; Pink & Jobe, 1996; Pollard & Croker, 1999; Reuter & Wright, 1996; Tuffey, 2000; Otis & Goldingay, 2000; Weisenthal, 2001; Weldon & Richardson, 2001).
• Use push-ups with a plus progressed to three sets done to fatigue (Johnson, Gauvin, & Fredericson, 2003; Pink & Jobe, 1996).
• Perform strengthening exercises after a swimming workout to avoid fatiguing the rotator cuff which could lead to injury (Johnson, Gauvin, & Fredericson, 2003).
• Include body-core strengthening work to help build balanced strength through the entire kinetic chain (Johnson, Gauvin, & Fredericson, 2003; Newton, Jones, Kraemer, & Wardle, 2002).

It is possible to use certain methods in training to decrease the potential for SS developing in athletes.  Using these methods should also allow an athlete to recover more quickly from an episode of SS as they would be generally hardened against the injury, and the physical structures in place should be more resistant to advancement of the problem.

There are varieties of coaching tools and methods that could be employed to limit or prevent SS.  These methods probably work best when considered as a whole, or when all of them are used in concert.

Specific freestyle technique elements should be used to minimize shoulder strain. These include promoting good body-roll to both sides, a pull pattern that does not cross the midline, a pinky-first entry, a belt-line exit, and a hand deep-elbow high catch prior to force being applied.

When designing and implementing a training plan, several inclusions or exclusions could be considered. Some of these are building intensity or mileage over time in a progressive manner, ensuring athletes do not over-use kickboards or hand-paddles, and mix in various other strokes within individual workouts and throughout the season.

Flexibility elements should be examined to promote sound shoulder architecture.  Including appropriate range of motion stretches in functional patterns, avoiding over-stretching, and using specific stretches for the shoulder should be effective.

Building or keeping the shoulder region strong, as well as the whole kinetic chain, and taking steps to make that strength balanced through all planes, is the final piece.  Exercises should include those that help the rotator cuff and scapular stabilizers, should be preformed after, not prior to - swimming workouts, and should also include back and abdominal or body core work.

Through the utilization of these items when training swimmers, SS can be reduced to a minor nuisance or potentially eliminated.  This should allow athletes more opportunity to train pain and injury free, helping to maximize their abilities and achievement potential.