Factors leading to rotator cuff tendinopathy in the competitive swimmer include overwork, shoulder joint laxity or instability, impingement, and stroke mechanics. Balanced muscle strengthening, flexibility training, avoidance of overwork when fatigued, and technique modification when necessary are fundamental to a preventative program. As well, the importance of an informed coach cannot be overstated. Treatment ranges from conservative measures such as stretching, strengthening, icing, and physiotherapy modalities, to surgical intervention in those athletes with severe tendinopathies.