Swimming is one of the best forms of exercise going. It builds strength, flexibility and endurance, and it’s easy on the joints, which is exactly why so many people stick with it year-round. But low-impact doesn’t mean no-impact. The repetition adds up, and the same stroke that keeps you fit can start to cause pain when technique slips or your training load climbs too fast.
Most swimming injuries are overuse injuries. They build gradually rather than happening in one moment, which is why they’re easy to swim through until they aren’t. At NDPSC, we see a range of swimming-related injuries at our West Ryde clinic. Below are the ones we see most often at our West Ryde clinic, why they happen, and what actually helps.
What Causes Most Swimming Injuries
Three things drive the majority of them. Overuse and a sudden jump in training volume, so the tissue never gets a chance to adapt. Stroke technique, where small faults in hand entry, catch or body position load a joint in a way it isn’t built for. And mobility or strength gaps outside the pool, like a stiff upper back or a weak rotator cuff, which quietly change how you move in the water. Get on top of those three and you prevent most of what follows.
Swimmer’s shoulder
The shoulder is by far the most commonly injured area in swimmers. It makes sense when you count the rotations. A single training session involves thousands of overhead strokes, and the shoulder is a mobile, relatively unstable joint that relies on the rotator cuff and the muscles around the shoulder blade to keep it controlled.
“Swimmer’s shoulder” is really an umbrella term. It can involve rotator cuff impingement or tendinopathy, biceps tendinitis, or bursitis, and in swimmers with naturally loose, flexible joints it can be linked to a degree of instability. A classic sign is pain through the middle of the arc as you lift your arm out to the side, often felt as you reach forward in the recovery phase of the stroke.
It’s usually driven by a mix of tight and weak muscles around the shoulder blade, a stiff upper back, and stroke faults that force the shoulder to work harder than it should. For persistent shoulder pain, it’s worth getting assessed rather than pushing through.
Breaststroker’s knee
Knee pain shows up mostly in breaststrokers, because the whip kick loads the inside of the knee in a way the other strokes don’t. The repeated forceful rotation and the outward snap of the lower leg stress the medial (inner) structures, particularly the MCL, and it can also present as patellofemoral knee pain around the kneecap.
Kick technique and kick volume are the usual culprits. Strengthening the quads and hips, working on flexibility, and adjusting the kick under guidance tend to settle it.
Lower back pain
The lower back takes load from the arched, extended body position swimmers hold in the water, especially in freestyle and butterfly, and from the dolphin kick. Tight hip flexors add to it by pulling the pelvis into more extension, so the lumbar spine ends up compensating.
Most swimmers’ back pain is muscular and settles with load management and core work. One thing worth flagging though: new lower back pain that persists in a swimmer with no prior history, particularly in a teenager, should be assessed properly rather than trained through. Occasionally it points to a stress-related bony problem in the spine that needs a longer period of modified activity, so it’s not one to ignore. See our lower back pain page for more.
Neck, hip and groin
A couple of others round out the list. Neck strain often comes down to head position and breathing technique, where lifting or turning the head repeatedly loads the neck. Hip and groin pain, including adductor strain and hip tendon irritation, tends to come from the breaststroke kick as well.
Which Swimming Stroke Causes Which Injury
A quick guide, since most swimmers favour one or two strokes:
- Freestyle and backstroke: mostly the shoulder, from the repeated overhead rotation.
- Breaststroke: the knee, hip and groin, from the whip kick.
- Butterfly and freestyle: the lower back, from the extension and the dolphin kick.
If you know where you hurt and which stroke you do most, you can usually narrow down what’s going on, and a physio can confirm it quickly.
How To Prevent Swimming Injuries
Prevention comes back to the same few things. Build training volume up gradually instead of in big jumps. Work on stroke technique with a coach so you’re not loading a joint through a fault every lap. And do the dry-land work that supports your swimming: rotator cuff and shoulder-blade strengthening, upper-back mobility, core and hip strength, and a proper warm-up before you get in. Cross-training helps balance out the muscles that swimming alone tends to under-work.
How Can Physiotherapy Help For My Swimming Injury
When you come in, the first thing we do is a full assessment to find the cause rather than just chase the sore spot. From there, treatment usually combines hands-on work to settle pain and restore movement, a targeted strengthening and mobility program, and where it helps, tools like dry needling or taping.
For competitive swimmers we’ll also look at your stroke and load to work out what’s driving the problem, then build a graded plan to get you back in the water without the injury returning. Our sports physiotherapy team does this regularly.
When Should I See a Physiotherapist?
Don’t wait for pain to become your normal. If discomfort lasts beyond a session or two, keeps coming back, or is changing your stroke, get it looked at early, while it’s still a small problem. Book an appointment online or call us on (02) 9874 8410. For related overuse problems, our sports injuries page covers more.
Frequently Asked Questions
What is the most common swimming injury?
Shoulder injuries are the most common by a wide margin, since the shoulder does the bulk of the work and takes thousands of overhead rotations per session. Knee and lower back problems come next.
Can I keep swimming with a swimming injury?
Often you can keep training in a modified way rather than stopping altogether, for example switching strokes or cutting volume for a while.
The right adjustment depends on the injury, which is what an assessment sorts out. Swimming through pain and ignoring it is what tends to make things worse.
Do I need a scan for a swimming injury?
Usually not. A qualified physiotherapist can diagnose most swimming injuries hands-on and will only refer for imaging if something doesn’t fit the typical overuse pattern.
