07/28/2025
Are You a Swimmer Experiencing Pain? Let's Dive into Swimming-Related Orthopedic Injuries! Swimming is a fantastic, low-impact exercise, but the repetitive nature of its movements can sometimes lead to orthopedic injuries. At Prescription Fitness Physical Therapy and Sports Care, we focus on helping swimmers get back in the water, pain-free!
Let's break down some common swimming injuries:
Understanding the Problem: Pathophysiology & Etiology
Most swimming injuries are overuse injuries, meaning they develop over time due to repetitive stress on specific joints and muscles. This often stems from:
Poor Stroke Mechanics: Incorrect technique can place excessive strain on joints. For example, improper hand entry or body rotation in freestyle can lead to shoulder issues.
Muscle Imbalances & Weakness: If certain muscle groups (like the rotator cuff or scapular stabilizers in the shoulder, or hip and core muscles) are weak or imbalanced, other areas compensate, leading to overload and injury.
Overtraining: Rapid increases in training volume or intensity without adequate rest can overwhelm the body's ability to recover.
Hypermobility with Insufficient Stability: Swimmers often have naturally flexible joints, but without strong surrounding muscles, this can lead to instability and injury.
Common examples of swimming-related orthopedic injuries include:
Swimmer's Shoulder (Shoulder Impingement/Rotator Cuff Tendinopathy): The most prevalent swimming injury. Repetitive overhead arm movements can cause inflammation and compression of the rotator cuff tendons and bursa in the shoulder. Elite swimmers can take over a million strokes per year, making this area highly susceptible.
Biceps Tendinopathy: Often associated with shoulder issues, this involves irritation or inflammation of the biceps tendon, which runs through the shoulder joint. Repetitive pulling and reaching motions common in swimming, especially with poor mechanics or overuse of paddles, can lead to pain in the front of the shoulder.
Swimmer's Elbow (Medial Epicondylitis / Golfer's Elbow): While less common than shoulder issues, the forceful "pull" phase of the swimming stroke can stress the flexor tendons on the inside of the elbow, leading to inflammation and pain.
Ulnar Nerve Entrapment (Cubital Tunnel Syndrome): Repetitive elbow flexion and extension can irritate or compress the ulnar nerve at the inner side of the elbow, potentially causing numbness, tingling, or weakness in the ring and pinky fingers.
Wrist Tendinopathy/Strains: Improper hand positioning or excessive wrist flexion/extension during the "catch" and "pull" phases can strain the tendons around the wrist, leading to pain.
Breaststroker's Knee: The unique "whip kick" motion of the breaststroke places significant valgus (outward) stress on the knee, particularly impacting the medial collateral ligament (MCL) and surrounding soft tissues.
Lower Back Pain: Repetitive hyperextension, especially in butterfly and breaststroke, or insufficient core strength, can lead to stress on the lumbar spine.
How Common Are These Injuries? (Rate of Occurrence)
Shoulder pain is by far the most frequent orthopedic complaint among swimmers, with reported prevalence rates ranging from 40% to as high as 91% in competitive swimmers! While lower back, knee, elbow, and wrist pain are less common, they still affect a significant number of swimmers, particularly those who primarily swim breaststroke or butterfly. Overall injury rates for collegiate swimmers can be around 1.56 injuries per 1000 athlete-exposures.
Getting You Back in the Water: Physical Therapy Treatments
At Prescription Fitness Physical Therapy and Sports Care, our expert physical therapists will conduct a thorough assessment to understand the root cause of your pain. Treatment may include:
Pain Management: Modalities like ice, manual therapy (soft tissue mobilization, joint mobilizations), and sometimes dry needling to reduce pain and inflammation.
Therapeutic Exercises:
Strengthening: Targeting weak muscles such as the rotator cuff, scapular stabilizers, core, glutes, quadriceps, hamstrings, and forearm muscles to improve stability and support.
Flexibility & Mobility: Addressing tight muscles (e.g., chest, hip flexors) and improving joint range of motion.
Neuromuscular Re-education: Improving muscle control and coordination.
Stroke Technique Correction: Working with you and potentially your coach to identify and correct faulty swimming mechanics that contribute to your injury.
Graded Return to Activity: Developing a safe and progressive plan to increase your swimming volume and intensity.
Stay Strong in the Water: At-Home Prophylactic Treatments
Prevention is key! Here are some at-home strategies to help prevent swimming injuries:
Proper Warm-up & Cool-down: Always dedicate 5-10 minutes to dynamic stretching before swimming and gentle static stretches afterwards.
Focus on Technique: Pay close attention to your stroke mechanics. Consider working with a swim coach to refine your form, especially bilateral breathing for freestyle and ensuring your kick originates from your hips.
Cross-Training & Dry-Land Strengthening: Incorporate exercises that strengthen your core, shoulders (rotator cuff, scapular stabilizers), hips, glutes, and forearms. This builds a strong foundation for swimming.
Vary Your Strokes: If you primarily swim one stroke, try incorporating others to balance muscle development and reduce repetitive stress on specific areas.
Listen to Your Body: Don't push through pain. If you feel discomfort, reduce your intensity or take a break.
Gradual Progression: Avoid sudden increases in swimming volume or intensity. Gradually build up your yardage to allow your body to adapt.
Don't let pain keep you out of the pool! Contact us today at [Your Phone Number] or visit our website at [Your Website] to schedule an appointment. We're here to help you swim stronger and healthier!
Bibliography
Children's Hospital Boston. (n.d.). Sports Injury Prevention | Swimming. Retrieved from https://www.childrenshospital.org/sports-injury-prevention/swimming
ChoosePT. (n.d.). 5 Tips to Improve Your Swimming Stroke and Avoid Injury. Retrieved from https://www.choosept.com/health-tips/5-tips-improve-your-swimming-stroke-avoid-injury
Mangiarelli Rehabilitation. (n.d.). Physical Therapy for Swimmer's Knee. Retrieved from https://www.mangiarellirehabilitation.com/blog/physical-therapy-for-swimmers-knee
Penn Medicine. (n.d.). Swimmer's Shoulder – Symptoms and Causes. Retrieved from https://www.pennmedicine.org/conditions/swimmers-shoulder
Physiopedia. (n.d.). Swimming Overuse Injuries. Retrieved from https://www.physio-pedia.com/Swimming_Overuse_Injuries
Salerno, J., Tow, S., Regan, E. A., Bendziewicz, S., McMillan, M., & Harrington, S. (2022). Injury and Injury Prevention in United States Para Swimming: A Mixed-Methods Approach. International Journal of Sports Physical Therapy, 17(2), 293–306.
Shapiro, C., & Shamus, E. (2017). Swimming. In E. Shamus & J. Shamus (Eds.), Sports Injury Prevention & Rehabilitation, 2e. McGraw-Hill Education.
White House Clinic. (n.d.). Common Swimming Injuries and How to Avoid Them. Retrieved from https://www.whitehouse-clinic.co.uk/articles-and-advice/common-swimming-injuries-and-how-to-avoid-them
Yanai, T., & Hay, J. G. (2000). Biomechanics of the butterfly stroke. Medicine and Science in Sports and Exercise, 32(4), 856-865. (Cited in ResearchGate article for "Injuries in swimming sports: prevention and treatment methods")
