Common Swimming Injuries: Prevention and Treatment

Competitive swimming can place swimmers at a higher risk of shoulder pain due to the repetitive overhead motion required. Swimming requires intense, repetitive upper-body muscle use, which can lead to overuse injuries that occur gradually over time. The majority of swimming injuries are related to the shoulder, although injuries to the neck, back, and knee are also common. Physical therapy addresses these injuries through sport-specific training and a comprehensive rehabilitation program to improve strength, endurance, mobility, and stability.

Swimming-Related Injuries

 Swimming is a full-body workout that strengthens multiple regions of the body and builds flexibility and endurance in the swimmer, particularly in the upper body. In fact, elite swimmers swim up to 9 miles a day, which is 2,500 shoulder revolutions. The repetitive nature of strokes in swimming increases the risk of overuse injuries to the shoulder, knee, spine, and back.  

Shoulder Injuries: Shoulder injuries are the most common injury among swimmers. One study of 80 elite swimmers age 13 to 25 showed that 91% have had an episode of shoulder pain. Overuse of the shoulder through repetitive strokes leads to muscle fatigue in the rotator cuff, upper back, and anterior shoulder muscles. This decreases the shoulder’s stability throughout the stroke and can lead to injury. A shoulder injury can also result from upper body strength imbalances.

• Swimmer’s Shoulder: The most common shoulder injury, swimmer’s shoulder involves pain in the front of the shoulder that worsens with repetitive overhead motion. The swimmer usually experiences decreased range of motion and strength. Swimmer’s shoulder is often associated with other shoulder issues such as rotator cuff tendinitis and shoulder impingement. It is caused by poor stroke mechanics, muscle fatigue of the shoulder and upper back, and instability and laxity of the shoulder joint.

• Rotator Cuff Tendinitis: In swimmers, it is generally caused by untreated swimmer’s shoulder and results from poor technique, overuse, and overtraining. Rotator cuff tendinitis is the overuse of the rotator cuff muscles and tendons that surround and stabilize the shoulder, which become inflamed.

• Biceps Tendinitis: develops due to repetitive, overhead movements that irritate and inflame the biceps tendon in the shoulder joint. It is associated with a sharp pain in the front of the shoulder.

• Shoulder Impingement: is caused by pinched tendons or bursa in the shoulder. It is often associated with altered movement of the shoulder joint and poor stroke mechanics.  

Neck Pain: can result from a shoulder injury as the neck muscles compensate for the weakened shoulder. The repetitive motion of turning the head or lifting it above water during strokes can strain and stress the small muscles of the neck as well.

Knee Pain: is more common in those that specialize in the breaststroke due to overuse. Knee injuries include MCL sprains (pain on the inside of the knee) and bursitis/tendonitis of the knee (pain and tenderness in kneecap or inside of knee, swelling, and pain when squat/ kick).

Back Pain: All swim strokes involve a streamlined position that requires hyperextension of the lower back. Certain strokes, like the butterfly and breaststroke, place more stress on the lower back and the repetitive nature of the strokes place repeated stress on the joints of the spine. Tight hip flexors, poor core strength, and weak hip muscles can contribute to a higher incidence of back pain in swimmers as well.

Common causes of swimming injuries include:

• Overtraining

• Insufficient rest between training or competitions

• Poor stroke mechanics

• Poor breathing technique

• Limited flexibility or range-of-motion

• Decreased rotator cuff or shoulder blade (scapular muscle) strength

• Poor core strength or stability

• Decreased hip muscle strength

Physical Therapy Treatment

Physical therapy can help swimmers prevent and address injuries through sport-specific training and a comprehensive rehabilitation program to improve strength, endurance, mobility, and shoulder stability. A physical therapist designs an upper body, hips, quadriceps, back, and core strengthening program to address muscular weakness and imbalances that contribute to pain and injury. Stretching and manual therapy are also used to address tight soft tissue to decrease pain. The therapist also engages in targeted strengthening exercises of the rotator cuff and scapular muscles to improve shoulder stability and strength.

A preseason evaluation is recommended to screen for any musculoskeletal impairments or improper training methods to prevent injury during the season and address those impairments and methods before an injury occurs.