Swimming Injuries: Shoulder Pain and Beyond

Swimming is often praised as a low-impact exercise, but the repetitive nature of stroke mechanics can lead to significant overuse injuries, particularly in the shoulders. At M.O. Therapy in Markham, we treat swimmers of all levels, from recreational lap swimmers to competitive athletes. Understanding swimming injuries and implementing prevention strategies is essential for longevity in the sport.

Understanding Swimming Injury Patterns

Swimming places unique demands on the body compared to land-based sports:

• Elite swimmers perform 1-2 million shoulder rotations per year
• The shoulder is involved in 90% of propulsion during freestyle
• Overuse injuries account for the majority of swimming-related problems
• Shoulder pain affects 40-91% of competitive swimmers at some point
• Most swimming injuries develop gradually over time

These statistics highlight the importance of proper technique, training load management, and preventive care.

Swimmer's Shoulder: The Most Common Injury

Swimmer's shoulder is an umbrella term describing shoulder pain in swimmers, typically involving rotator cuff tendinopathy, subacromial impingement, or a combination of both.

What Causes Swimmer's Shoulder?

Repetitive Overhead Motion:

• Each stroke cycle involves significant shoulder rotation
• The catch and pull phases create high forces on the shoulder
• Thousands of repetitions lead to cumulative microtrauma
• The recovery phase can contribute to impingement

Muscle Imbalances:

• Swimmers often develop strong internal rotators
• External rotators and scapular stabilizers may lag behind
• This imbalance pulls the shoulder forward and up
• Creates impingement and rotator cuff compression

Shoulder Laxity:

• Many swimmers have naturally loose shoulders
• While helpful for range of motion, excess laxity reduces stability
• The rotator cuff works harder to stabilize the joint
• Leads to fatigue and eventual overload

Poor Technique:

• Hand entry crossing the midline
• Excessive internal rotation during pull
• Improper body roll
• Thumb-first entry patterns

Training Errors:

• Sudden increases in volume or intensity
• Excessive use of paddles or resistance equipment
• Insufficient recovery between sessions
• Year-round training without periodization

Stages of Swimmer's Shoulder

Stage 1: Mild

• Pain only during or after swimming
• No pain with daily activities
• Full range of motion maintained
• May respond quickly to rest and technique correction

Stage 2: Moderate

• Pain during swimming affecting performance
• Some pain with daily overhead activities
• Mild weakness may be present
• Requires more comprehensive treatment

Stage 3: Severe

• Constant pain affecting sleep
• Significant weakness and function loss
• Unable to swim without significant pain
• May require extended rest or intervention

Treatment for Swimmer's Shoulder

Initial Management:

• Relative rest (reduce swimming volume, avoid painful strokes)
• Ice application after activity
• Anti-inflammatory medication if appropriate
• Activity modification to allow healing

Physiotherapy Treatment:

• Manual therapy for shoulder mobility
• Soft tissue techniques for muscle tension
• Scapular stabilization exercises
• Rotator cuff strengthening program
• Postural correction exercises

Technique Modification: Work with a swim coach to address:

• Hand entry position and angle
• Body roll mechanics
• Catch and pull technique
• Stroke rate and rhythm

Progressive Return:

• Start with kicking drills only
• Add one stroke at a time
• Gradually increase volume
• Monitor symptoms closely

Swimmer's Shoulder Prevention

Strength Training Program:

Rotator Cuff Strengthening:

1. Side-lying external rotation (3x15)
2. Prone T's, Y's, and I's (3x12)
3. Standing external rotation with band (3x15)
4. Low rows with squeeze (3x12)

Scapular Stability:

1. Wall slides (3x15)
2. Prone scapular retraction (3x12)
3. Push-up plus (3x10)
4. Serratus anterior punches (3x12)

Core and Postural:

1. Dead bugs (3x10 each side)
2. Bird dogs (3x10 each side)
3. Plank variations (hold 30-60 seconds)
4. Thoracic rotation stretches

Training Modifications:

• Limit paddle use (increase shoulder stress)
• Ensure adequate rest between hard sessions
• Periodize training with recovery weeks
• Cross-train to reduce repetitive strain

Proper Technique Points:

• Enter water with fingertips first, not thumb
• Keep hand entry within shoulder width
• Rotate body as a unit (not just arms)
• Maintain high elbow during catch phase
• Complete the pull past the hip

Other Common Swimming Injuries

Breaststroker's Knee

What It Is:

• Medial collateral ligament (MCL) stress
• Caused by the whip kick motion
• Creates valgus stress at the knee

Symptoms:

• Pain on inside of knee
• Worse during and after breaststroke
• May have swelling
• Tenderness along MCL

Treatment:

• Reduce or eliminate breaststroke temporarily
• Ice after swimming
• Strengthen hip external rotators
• Work on kick technique
• Gradual return with modified kick width

Prevention:

• Limit breaststroke volume
• Strengthen hip and thigh muscles
• Maintain flexibility in hips
• Use proper kick technique

Lower Back Pain

Causes in Swimmers:

• Hyperextension during butterfly and breaststroke
• Poor core stability
• Tight hip flexors
• Excessive rotation or arching

Common Conditions:

• Muscle strain
• Facet joint irritation
• Disc problems (in severe cases)
• Spondylolysis (stress fracture)

Treatment:

• Core strengthening program
• Hip flexor stretching
• Technique modification
• Manual therapy as needed

Prevention:

• Strong core muscles
• Flexible hip flexors
• Proper body position in water
• Avoid excessive hyperextension

Neck Pain

Causes:

• Breathing technique in freestyle
• Hyperextension in breaststroke
• Poor body roll
• Starting position (backstroke)

Treatment:

• Address breathing mechanics
• Strengthen neck stabilizers
• Improve body roll
• Manual therapy for muscle tension

Foot and Ankle Issues

Plantar Fasciitis:

• Pushing off wall during turns
• Kicking technique stress
• Walking on pool deck

Ankle Impingement:

• Repetitive pointing of foot
• Especially in flutter and dolphin kicks
• Can develop bone spurs over time

Dry Land Training for Swimmers

Proper dry land training prevents injuries and improves performance:

Essential Exercises

Upper Body:

• Pull-ups and chin-ups
• Rows (various angles)
• Push-ups and variations
• Shoulder stability exercises

Core:

• Plank variations
• Anti-rotation exercises
• Leg raises
• Medicine ball work

Lower Body:

• Squats
• Single-leg exercises
• Jump training (controlled)
• Hip mobility work

Flexibility:

• Shoulder stretches
• Hip flexor stretches
• Ankle mobility
• Thoracic spine rotation

Sample Weekly Program

Monday: Upper Body Strength

• Pull-ups 3x8-10
• Dumbbell rows 3x12
• Push-up variations 3x15
• Rotator cuff work 3x15

Wednesday: Core and Stability

• Plank series (front, side, rotating)
• Dead bugs 3x10 each
• Pallof press 3x10 each
• Medicine ball throws 3x10

Friday: Lower Body and Power

• Goblet squats 3x12
• Single-leg deadlifts 3x10 each
• Jump squats 3x8
• Calf raises 3x15

Return to Swimming Protocol

Phase 1: Pool Re-Introduction

• Kicking only with kickboard
• 20-30 minutes maximum
• Focus on body position
• No pain allowed

Phase 2: Stroke Introduction

• Add pull buoy work
• One stroke at a time
• 50% normal volume
• Monitor symptoms

Phase 3: Progressive Training

• Gradually increase volume
• Add additional strokes
• Introduce intervals
• Continue monitoring

Phase 4: Full Training

• Return to normal training
• Maintain strength program
• Continue technique focus
• Ongoing prevention strategies

When to Seek Professional Help

Contact M.O. Therapy if you experience:

• Shoulder pain that persists beyond a few days of rest
• Pain that wakes you at night
• Weakness in the shoulder or arm
• Clicking, catching, or locking sensations
• Symptoms that don't improve with basic self-care
• Any sudden, severe pain

Treatment at M.O. Therapy

Physiotherapy

• Comprehensive shoulder assessment
• Manual therapy techniques
• Customized exercise program
• Return-to-swim planning
• Technique recommendations

Massage Therapy

• Sports massage for muscle tension
• Deep tissue work for chronic tightness
• Pre and post-competition massage
• Recovery enhancement

Chiropractic Care

• Spinal and shoulder joint assessment
• Joint mobilization
• Soft tissue techniques
• Movement optimization

Frequently Asked Questions

How long does swimmer's shoulder take to heal? Recovery time varies based on severity. Mild cases may resolve in 2-4 weeks with proper rest and treatment, while more severe cases can take 2-3 months or longer. Chronic cases require longer rehabilitation programs.

Can I swim with shoulder pain? Swimming through significant pain is not recommended as it often worsens the condition. However, modified swimming with pain-free strokes or using only legs may be possible while the shoulder heals.

How can I prevent shoulder problems in swimming? Prevention includes proper technique, balanced strength training (especially rotator cuff and scapular muscles), adequate rest between sessions, and avoiding sudden increases in training volume.

Should I use paddles if I have shoulder pain? No, paddles increase the load on the shoulder and should be avoided when experiencing shoulder pain. Even after recovery, paddle use should be limited and carefully monitored.

Book Your Assessment

Don't let swimming injuries keep you out of the water. At M.O. Therapy in Markham, our team specializes in treating swimmers and helping them return to training pain-free.

Call (905) 201-5827 or book online for your assessment. We offer direct billing to most insurance providers and same-day appointments for acute injuries.