Can I Swim After a Reverse Shoulder Replacement?

Strong, flexible shoulders are the quintessential characteristic of a good swimmer. But the shoulder, a particularly agile joint that allows you to move your arm through several planes of motion, can be fragile. Many swimmers know all too well how easy it can be to injure a shoulder, especially with the repetitive movements required in our sport.

There are several areas where things can go wrong in the shoulder, but modern medicine has a few solutions for those whose shoulder joints can’t perform the way they should.

Anatomy of the Shoulder

The shoulder is a ball-and-socket joint. The ball sits on the head of the humerus, the long bone of the upper arm, and the socket faces outward from the side of the scapula, better known as the shoulder blade. The small gap where the ball and socket meet forms the glenohumeral joint.

Through a symphony of stretching and contracting, the muscles and tendons of the shoulder allow you to move your arm forward, backward, to the sides, and around in a circle.

Dr. Russell Petrie, an orthopedic surgeon with the Hoag Orthopedic Institute in Southern California and one of the Los Angeles Chargers’ football team physicians, explains that the four tendons and muscles of the rotator cuff and the deltoid muscle wrap the shoulder, creating “two layers of muscle that run over the shoulder. The rotator cuff helps position the shoulder. The deltoid provides the power of the shoulder.”

Given the number and complexity of elements that make up a human shoulder and the multitude of repetitive motions swimmers make during each workout and competition, it’s no wonder that injury occurs frequently.

According to a 2016 study published in the Journal of the American Academy of Orthopaedic Surgeons, the incidence of “swimmer’s shoulder,” – which includes several distinct diagnoses, including impingement syndrome, rotator cuff tendinitis, labral injuries, instability or laxity in the muscles and tendons due to imbalance or dysfunction, anatomic variations, or neuropathy from nerve entrapment – may impact anywhere from 3% to 70% of swimmers depending on the study. Shoulder pain that interferes with training or progress in training is estimated to affect about 35% of elite and senior level swimmers, the study noted.

For Masters swimmers, an additional wrinkle comes into play: age.

Over time, the cartilage within the joint that helps pad the bones and prevent damage wears down, a condition called osteoarthritis. This most common form of arthritis is a degenerative, “wear and tear” condition that can develop in any joint, but can be problematic for swimmers specifically because of the repetitive nature of swimming strokes and general overuse during the course of a lifetime.

That’s the case for Pam O’Neill, a 73-year-old Masters swimmer in Wayland, Massachusetts. An avid daily swimmer for virtually her whole life, O’Neill has happily covered thousands of miles in the pool and open water. However, last year, she developed swelling and pain in her left shoulder that made it painful and difficult to swim normally. She added fins to help take some of the pressure off the shoulder, but the swelling steadily increased.  

O’Neill’s doctor recommended a reverse shoulder replacement, a procedure that would remove her natural shoulder joint and replace it with a prosthetic device that changes the way the shoulder joint functions. But like most ardent swimmers, she was worried whether she’d be able to return to swimming after this procedure and how a reverse replacement differs from a traditional, anatomic shoulder replacement surgery.

Anatomic vs. Reverse Shoulder Replacements

Petrie explains that an anatomic shoulder arthroplasty, aka a traditional shoulder replacement, is quite different from a reverse shoulder replacement, and is related to where the ball and socket sit.

For an anatomic replacement to work, you need to have an intact rotator cuff, Petrie explains. “When you do a traditional shoulder replacement, typically the deltoid and the rotator cuff are intact.”

Working around those functional muscles, the surgeon replaces the original ball and socket joint with a prosthetic ball and socket that lines up more or less with where the biological ball and socket once sat.

However, if the rotator cuff is torn, the prosthetic joint won’t stay in place. Without a functional rotator cuff, “there’s nothing to hold the humeral head down,” Petrie explains.

This is where a reverse shoulder replacement comes in. “The reverse total shoulder takes away the need for the function of the rotator cuff,” because it reverses where the ball and socket goes, Petrie explains.

It’s difficult to fully describe how it works without a visual aid, but by switching the socket to the top of the humerus and the ball to the outside of the scapula, your shoulder can move through most of its range of motion without the assistance of the rotator cuff because “the geometry of the prostheses stops the humeral head from riding up.”

This is great for keeping the joint in place, but will fundamentally change the biomechanics of how the arm and shoulder move, he says. “When we use an anatomic replacement, the function is closer to normal function,” Petrie says.

But by recruiting the deltoid to help rotate the arm, most folks can reestablish adequate mobility in the shoulder after a reverse shoulder replacement.

Dr. Hafiz Kassam, an orthopedic surgeon also with the Hoag Orthopedic Institute and a ringside physician for USA Boxing, summarizes the approach as “turning the socket into a ball and the ball into a socket. You cut out the old ball and socket and put a metal and plastic one in.”

The surgery usually takes about an hour, and you’ll likely be in a sling for about four weeks afterward. Full recovery takes about three to four months, Kassam says.

When Can I Go Back to Swimming?

Either kind of shoulder replacement procedure is a big surgery, and it will take a while for most people to resume their normal level of activities. For swimmers who rely heavily on the shoulder joint, the outlook isn’t always great for getting back to swimming quickly.

“There’s probably no consensus about exercise after shoulder replacement,” Petrie says. For swimmers looking to return to the sport, you’ll likely need between two and six months recovery time before you can even think about swimming. Starting with a gentle breaststroke is usually the best option, and it’s critical to give yourself time to ramp up slowly so you don’t reinjure the repaired shoulder.

Unfortunately, some people never manage to get back to swimming while others do return, but in a limited capacity. Your surgeon may place some limitations on your swimming after a reverse shoulder replacement as a means of preserving the new joint for as long as possible.

Some limitations might make themselves known if you do try to get back to your previous activity levels. For example, Petrie says swimming breaststroke is possible for some patients, but “I don’t think anyone’s done butterfly after a reverse replacement because butterfly requires a tremendous amount of strength,” that can be very difficult to regain after a big surgery like this.

It’s also worth noting that reverse shoulder replacements can dislocate and folks who’ve had a reverse shoulder replacement may be more likely to come back for corrective care.

However, it’s important to note that your outcome could be different; Petrie says there’s not a lot of data about the long-term durability of reverse shoulder replacements, the first of which was first performed in the United States in 2004.

There’s also not a lot of data about how likely athletes are to return to this chosen sport after a surgery. However, one study conducted at the Mayo Clinic in 2021 found that four years after a reverse shoulder replacement, 73% of the 30 participants who had been swimmers before the surgery had returned to swimming.

That rate is lower than the 86% who returned to elliptical and treadmill training or the 91% who were able to return to fishing. The study authors noted that participants whose sports required overhead arm movements, such as swimming and climbing, were more likely to struggle in returning to sport.

Nevertheless, the 73% who did come back to swimming offer plenty of reason to hope you’ll be able to get back to swimming if you’re facing the prospect of a reverse shoulder replacement.

Medicine’s Constant March Forward

Medical innovation isn’t always linear in its forward motion, but over time, improvements do occur, and reverse shoulder replacements are just one of many medical procedures that have improved in recent years. 

Kassam says the implants used in reverse shoulder arthroplasty have changed over time, as has the approach. “I think that we’re learning a little bit more about how to get people back to ‘normal,’ after the surgery,” he says.

Kassam describes the procedure as “essentially making the shoulder not a shoulder and then asking it to work,” in that the biomechanics are significantly altered. But as the implant designs have advanced, outcomes are improving for patients.

“It’s certainly much better with modern designs today than it was even five to seven years ago,” he says.

When he performs a reverse shoulder replacement on a patient, Kassam says he doesn’t place restrictions on people. “I think they can go back to whatever they want to do.”

However, if something goes wrong with a reverse shoulder replacement, it can be more difficult to fix than an anatomic replacement. “But again, that’s changing as well,” he adds.

The more people who’ve had these surgeries, the more practice surgeons have gotten and that along with improved materials and design all means better results; Kassam says he’s had patients who’ve gone back to sports that require a lot of shoulder function such as swimming and golf. Some folks with labor-intensive jobs that require heavy lifting, such as firefighters, have also been able to return to work after a reverse shoulder replacement.

Selecting the right design and style for the prothesis and determining the correct amount of offset (that’s the horizontal width between the two pieces which allows the deltoid to drive motion) is an art that your surgeon can talk you through. But Petrie say the more reverse shoulder replacements are done, the more surgeons’ understanding of best practices advance.

Still, it’s important to talk with your surgeon about your plans for after the surgery and to understand the potential risks of returning to sport.

“Every artificial joint is a mechanical device, and eventually it’s going to wear. They are intended to last a person their whole life but might wear out and need to be redone,” Petrie says. “It’s just like your car; the more you use it, the more we worry that people are going to wear them out.”

That said, shoulder replacements can be expected to last 15 to 20 years these days, and most people can get back to doing what they want, Kassam says.

That’s good news for waylaid Wayland swimmer O’Neill, who’s been eager to quell the pain, swelling, and stiffness in her shoulder but doesn’t want to give up her daily swimming habit.

Kassam offers additional hope for swimmers like O’Neill. “If you’ve heard horror stories about shoulder surgery, I would say that’s no longer the case. What people have gone through with replacements 10 years ago versus today is a night and day difference. It has evolved tremendously,” and that includes not just the surgery itself, but also rehabilitation and improvement to the implants themselves.