Swimming Injuries

Mitch Jack physio

Article by A. Clarke, M. Jack

Common Swimming Injuries

swimming injuries

Swimming is a fantastic sport that combines all body strength, flexibility, and endurance. Swimmers are unfortunately prone to overuse injuries. The most common swimming injury regions are the shoulderlower back, and knee.

Shoulder Pain in Swimmers

Current data suggests that more than 30% of swimmers will miss competition or training due to injury. Of that population, over one-third of these injuries are in relation to shoulder pain [1]. Additionally, up to 91% of swimmers aged 13-25 years old experience shoulder pain on a frequent basis [2]. “Swimmer’s shoulder” is an umbrella term used to describe numerous injuries that relate both to the swimming population and shoulder injuries. Due to the structural and biomechanical complexity of the shoulder, many factors relating to the swimming stroke can contribute to the presence of pain. Specifically, pain can either be local to the injured shoulder or can refer to other areas of the body, namely the thoracic, cervical and upper arm regions. Elite swimmers are generally performing approximately 2500 shoulder revolutions per day and thus, most issues surrounding the shoulder are attributed to an overuse phenomenon [3].

Irrespective of competitive level, the most prevalent of injuries surrounding the swimming population is shoulder pain. Both intrinsic (tendon morphology, vascularity) and extrinsic (acromion formation, stroke biomechanics, muscular imbalances) can influence how and why a swimmer experiences shoulder pain. An example of an extrinsic factor is crossing the midline during hand entry – this leads to an increase in internal rotation and resultant mechanical rotator cuff related shoulder pain (RCRSP) [4]. However, the pain produced is known to be multifactorial as opposed to a singular cause and can be influenced by the following issues:

  • Stroke biomechanical abnormalities
  • Overuse, fatigue or improper control and utilisation of the muscles of the shoulder, scapula and upper back
  • Glenohumeral (shoulder) laxity

Shoulder pain is thought to be primarily due to the muscular imbalance between the dominant muscles (adductors, internal rotators) and stabilising muscles (rotator cuff). Consequently, this leads to muscle activation and control deficits, causing a superior and anterior translation of the humeral head generally accompanied by tightening of the posterior capsule of the shoulder. This superior translation and inadequate control results in the humeral head colliding with soft tissue structures (supraspinatus, subacromial bursa, biceps tendon) subsequently manifesting as RCSHP.

Pain and discomfort can be further exacerbated if the swimmer continues to train at the same level of intensity and frequency as pre-injury.

More Info: Swimmer’s Shoulder.

Knee Pain in Swimmers

Although less common, injury to the knee is prevalent in the swimming population and is almost exclusively reserved for the breaststroke population due to the nature of the kick [5]. Overuse is once more the primary culprit here, with repetitive stress placed on the medial knee and producing pain during the whip-like motion.

The breaststroke kick is a high valgus load produced during sudden flexion-extension, adduction and external rotation of the knee against the hydrodynamic environment, resulting in stress to the medial compartment. The result, therefore, is a strain to the medial collateral ligament and compression on the lateral knee. Consequently, it is not uncommon for swimmers to present with ligament sprains on the MCL, irritation of the medial plica and bursal irritation at the muscular insertions of the adductor and hamstring muscles. Furthermore, strain injuries can be present in the adductor muscles (adductor magnus and brevis, especially) [6].

Abnormalities in turning ability (quick knee flexion-extension during the somersault) can result in anterior knee pain such as patellofemoral pain syndrome. This condition arises as a result of patella mal-tracking or quadriceps strength and is consistently amenable to physiotherapy input and intervention.

More info: Breaststroker's Knee

Low Back Pain in Swimmers

Because of its prevalence within the general and sporting population, low back pain can be as a result of swimming. As swimming athletes are positioned horizontally in the water, gravity and buoyancy forces are traveling through the body with the potential to cause changes at the lumbar spine. Due to the undulating motion (lumbar extension) utilised in butterfly and breaststroke, there is potential for developing pain secondary to stress on the joints [7].

Moreover, tightness in the hip flexors or inadequate body roll during swimming may lead to compensation at the lumbar spine.

More info: Swimmer's Back Pain

Swimming Injury Treatment

Overall, your swimming physiotherapist will aim to treat your immediate pain and restore normative function during your first few sessions. Once this has been completed, further assessment will look to identify reasons exploring how and why the injury came on to help reduce recurrence in the future and keep you in the pool.

Treatment may involve manual therapy, massage and/or exercise prescription, but more importantly, finding the root cause of the injury and modifying stroke technique to prevent the issue from reoccurring. Any further questions about the above injuries or prevention, please consult your PhysioWorks swimming physiotherapist.

Prevention is Key!

Evidence suggests that injury management should focus on prevention and early treatment intervention. Addressing your specific impairments associated with the condition, and analysing training methods and stroke mechanics all assist in quickly returning you to your pain-free best in the pool [8].

A large part of managing an injury involves communication between parents, coaches and your physiotherapist to not only to enhance recovery but prevent injury.

Swimming Injury Risk Screening

PhysioWorks has a swimmer screening service that is available both in the clinic and at your pool for the whole squad. Please contact us for more information about our swimmer screening and injury prevention program.

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Common Swimming Injuries

Shoulder Pain

Knee Pain


Foot and Ankle:


Wrist and Hand:

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Common Treatments for Swimming Injuries

swimming physio brisbane

  • Early Injury Treatment
  • Avoid the HARM Factors
  • Soft Tissue Injury? What are the Healing Phases?
  • What to do after a Muscle Strain or Ligament Sprain?
  • Acupuncture and Dry Needling
  • Sub-Acute Soft Tissue Injury Treatment
  • Core Exercises
  • Scapular Stabilisation Exercises
  • Rotator Cuff Exercises
  • Closed Kinetic Chain Exercises
  • Biomechanical Analysis
  • Balance Enhancement Exercises
  • Proprioception & Balance Exercises
  • Agility & Sport-Specific Exercises
  • Medications?
  • Real Time Ultrasound Physiotherapy
  • Soft Tissue Massage
  • Brace or Support
  • Dry Needling
  • Electrotherapy & Local Modalities
  • Heat Packs
  • Joint Mobilisation Techniques
  • Kinesiology Tape
  • Neurodynamics
  • Prehabilitation
  • Scapulohumeral Rhythm Exercises
  • Strength Exercises
  • Stretching Exercises
  • Supportive Taping & Strapping
  • TENS Machine
  • Video Analysis
  • Yoga
  • FAQs Swimming Injuries

  • Common Physiotherapy Treatment Techniques
  • What is Pain?
  • Physiotherapy & Exercise
  • What Causes Post-Exercise Muscular Pain?
  • What are the Best Core Exercises?
  • Can Kinesiology Taping Reduce Your Swelling and Bruising?
  • Heat Packs. Why Does Heat Feel So Good?
  • How Does an Exercise Ball Help Back Pain?
  • Rotator Cuff: What is it?
  • Sports Injury? What to do? When?
  • What are Common Adolescent / Children Leg Injuries?
  • What are Growing Pains?
  • What are the Early Warning Signs of an Injury?
  • What is a TENS Machine?
  • What is Chronic Pain?
  • What is Nerve Pain?
  • What is Sports Physiotherapy?
  • What is the Shoulder Impingement Zone?
  • What's the Benefit of Stretching Exercises?
  • When is the Best Time for a Pre-Event Massage?
  • Why Kinesiology Tape Helps Reduce Swelling and Bruising Quicker
  • Helpful Products for Swimmers

    Swimming Injuries

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    1.Sein, M., Walton, J., Linklater, J., et al. (2010). Shoulder pain in elite athletes: primarily due to swim-volume-induced supraspinatus tendinopathy. British Journal of Sports Medicine. 44(); 105-13.

    2.Pink, M. & Tibone J. (2000). The painful shoulder in the swimming athlete. The Orthopaedic Clinics of North America. 31(2); 247-61.

    3.Wolf, B., Ebinger, A., Lawler, M. & Britton, C. (2009). Injury patterns in Division 1 collegiate swimming. American Journal of Sports Medicine. 37(); 2037-42.

    4.Johnson, J., Gauvin, J. & Fredericson, M. (2003). Swimming biomechanics and injury prevention. The Physician and Sports Medicine. 31(1); 41-6.

    5.Kennedy, J., Hawkins, R. & Krissoff, W. (1978) Orthopaedic manifestations of swimming. American Journal of Sports Medicine. 6(6); 309-22.

    6.Rodeo, S. (1999). Knee pain in competitive swimming. Clinical Sports Medicine. 18(2); 379-87.

    7.Wanivenhaus, F., Fox, A., Chaudhury, S. & Rodeo, S. (2012). Epidemiology of injuries and prevention strategies in competitive swimmers. 4(3); 246-51.

    8.Tovin BJ. (2006) Prevention and Treatment of Swimmer's Shoulder.  N Am J Sports Phys Ther. 1(4):166-75.

    More info: Swimming

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    Last updated 21-Jul-2019 02:28 PM

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