Swimming Injuries

Swimming Injuries

Article by J. Miller, A.Clarke

Common 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 shoulder,  lower 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 concerning shoulder pain. Additionally, up to 91% of swimmers aged 13-25 years old experience shoulder pain frequently. “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 pain. Specifically, pain can either be local to the injured shoulder or refer to other body areas, 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.

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). 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 the shoulder’s posterior capsule. 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.

You can further exacerbate pain and discomfort 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. 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).

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 from 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 result from swimming. As swimming athletes are positioned horizontally in the water, gravity and buoyancy forces are travelling through the body with the potential to cause changes in 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.

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 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.

A large part of managing an injury involves communication between parents, coaches, and your physiotherapist to enhance recovery and prevent injury.

Swimming Injury Risk Screening

PhysioWorks has a swimmer screening service available both in the clinic and at your pool for the whole squad. Don’t hesitate to contact us for more information about our swimmer screening and injury prevention program.

Common Swimming Injuries

Shoulder Pain

Knee Pain


Foot and Ankle:


Wrist and Hand:

Arm Pain Causes

Arm pain and injuries are widespread. Arm pain can occur as a result of either sudden, traumatic or repetitive overuse. The causes can be related to sports injuries, work injuries or simply everyday arm use.

Arm pain can be a local injury, musculoskeletal injury or could even be referred from nerves in your neck (cervical radiculopathy). This can result in neck-arm pain.

Causes of Arm Pain by Region

Causes of Arm Pain by Structure

Neck-Related Arm Pain

Shoulder-Related Arm Pain

Elbow-Related Arm Pain

Wrist-Related Arm Pain

Hand-Related Arm Pain

Muscle-Related Arm Pain

Other Sources of Arm Pain

Common Causes of Arm Pain

The most common sources of arm pain include shoulder painwrist pain and elbow pain.

Referred Arm Pain

As mentioned earlier, arm pain can be referred to from another source. Cervical radiculopathy is a common source of referred arm pain. Cervical radiculopathy will not respond to treatment where you feel the arm pain. However, it will respond positively to treatment at the source of the injury (e.g. your neck joints).

Professional assessment from a health practitioner skilled in diagnosing both spinal-origin and local-origin (muscle and joint) injuries (e.g. your physiotherapist) is recommended to ensure an accurate diagnosis and prompt treatment directed at the arm pain source.

Arm Pain has Diverse Causes.

The causes of your arm pain can be extensive and varied. Due to this diversity, your arm pain should be assessed by a suitably qualified health practitioner to attain an accurate diagnosis, treatment plan and implementation specific to your arm pain.

What Arm Pain is Associated with a Heart Attack?

Left-arm pain can be an early sign of a life-threatening cardiac issue. Based on this, a professional medical assessment that involves an accurate history, symptom analysis, physical examination and diagnostic tests to exclude a potential heart attack is important to exclude this potentially life-threatening source of arm pain.

For more information, please consult with your health practitioner, call an ambulance on 000, or visit a hospital emergency department to put your mind at ease.

Good News. Most Arm Pain is NOT Life-Threatening.

Luckily, life-threatening arm pain is far less likely than a local musculoskeletal injury. Arm pain caused by a localised arm muscle, tendon or joint injury should be assessed and confirmed by your health practitioner before commencing treatment.

Arm Pain Prognosis

The good news is that arm pain, and injury will normally respond very favourably to medical or physiotherapy intervention when early professional assessment and treatment is sought. Please do not delay in consulting your healthcare practitioner if you experience arm pain.

Common Arm Pain Treatments

With accurate assessment and early treatment, most arm injuries respond extremely quickly to physiotherapy or medical care, allowing you to resume pain-free and normal activities of daily living quickly.

Please ask your physiotherapist for their professional treatment advice.