Introduction: Swimming Hurts More Than You Think
When people think of swimming, they often imagine a graceful, low-impact sport that’s easy on the body. But behind the smooth strokes and quiet pool decks lies a brutal truth every competitive swimmer knows: swimming can be relentless. With thousands of yards a week, double practices, and constant pressure to perform, swimmers push their bodies to the edge, often without realizing the damage being done until pain forces them out of the water.
As a former Division I swimmer who chased Olympic dreams and battled injury after injury, I’ve lived this reality. I’ve felt the frustration of nagging pain that just wouldn’t go away and the confusion of treatments that never addressed the root cause. Now, as a sports performance physical therapist at The Charlotte Athlete, my mission is to help swimmers understand why their bodies hurt, and how to fix it for good.
This article dives into the biomechanics of swimming injuries, the movement flaws that cause them, and what it truly takes to stay healthy in the water. Whether you’re a swimmer, coach, or parent, the insights here could be the key to unlocking your full potential, without pain holding you back.
From Competitive Swimmer to Injury Specialist
I myself started swimming competitively since I was 7 years old and competed up until this past year at the age of 28. My love for the sport allowed me to compete Division I at Campbell University. After graduation I decided to continue training to pursue my dreams of getting an Olympic trial cut. During this journey I was able to swim at the US OPEN and compete against numerous Olympians who I had always looked up to. My career ended with just missing the 50 meter freestyle cut by .11 of a second. Along this journey I was also coaching athletes ages 5 to 18. This gave me first hand experience into the constant aches and pains that seemed to come with the sport. Along the way to my swimming journey I faced numerous injuries and pains. All of which I now realize was never being treated for the root cause of pain. I remember when I was a junior in college I began to have elbow pain. After numerous visits to the trainers and multiple strategies to help with the pain the symptoms always lingered. Once I started graduate school and now followed up with being a fellow in training I have grown to learn that the root cause was never the actual pain at my elbow, but stemming from nerves in my neck. The entire time my treatment was focused on masking the pain I felt, but never getting to the underlying problem which was poor head position in my butterfly stroke technique. Having been through this and going through the frustration of non-helpful treatments, it is a passion of mine now to help other athletes avoid this setback.
Coaching Reveals Common Gaps in Swimmer Development
My past as a swimmer has not only helped me but also as I coached athletes from fun summer league teams all the way to national qualifiers, I also quickly realized that there is a lot missing when dealing with swimmers. What is missing are key foundational movements and mobility that create a stable foundation. For example, when a young swimmer begins to learn how to swim the goal should be how to properly execute the strokes. Teaching them that efficiency is more important than just flailing through the water. As swimmers grow up they keep these poor movement patterns without proper strength and mobility which lead to many over use injuries. For example, head and body position is the most important thing in swimming. If a swimmer does not have proper thoracic mobility to rotate in the water or core strengthen to keep hips from sinking, then they will compensate and use their hyper mobile shoulders to compensate which can lead to shoulder impingements, tendinitis or labral tears. Also, if they do not have proper core strength then they will compensate with extra movement through their low back to stay on top of the water that can lead to hypermobility and instability and pain in the low back. If these weak points were addressed at a younger age then there would not be set backs or times for swimmers having to get out of the water and miss practice. Since swimming is a year round sport this is extremely important to keep a constant routine.
The Demands of the Sport: Swimming is No Joke
The athletic demands of swimming are extremely high. Swimmers on average achieve ~30,000 yards per week. Sometimes practices are twice a day for 2 hours each. This constant repetitive movements can lead to overuse injuries, especially if stroke technique is filled with errors. On top of these practices in the water, depending on the age, swimmers also do dry land or weights. These are out of the water exercises to aid with power and strength in the water. Due to the high volume of practices, and with younger swimmers not focused on recovery, this can increase the risk of injuries occurring. Taking off more than one day of practice can hinder an athletes flow as well. Since swimming is a fluid sport and feeling the water is crucial, athletes having to miss time in the water for injuries take away from their potential in the season.
Overuse Injuries
Since swimming is a “non contact” and non impact sport, the injuries seen are often due to overuse, as well as improper mechanics in the actual strokes. Swimmers on average swim ~30,000 yards a week. Practices last 2 hours and there is practice everyday of the week, sometimes even twice a day. With this extremely high physical demand on the athlete if proper stroke mechanics are being neglected this can easily lead to tendonopathies in the shoulder or knee. Body position plays an important role as well with fluidity in the water and some swimmers will compensate with their lower back which can lead to pain.
Acute Injuries in a non-contact sport? Yes, it Happens.
Acute injuries are possible with swimming although it is a non contact injury. This can be from trauma when finishing into a wall with a straight arm or hand which can lead to joint sprains of the elbow or wrist or even fingers. Each event in swimming also requires fast burst off the block or wall and when in the water. If an athlete does not properly warm up their muscles then this can lead to a strain
Acute injuries in swimming are typically found with impact with the wall. When swimmers are trying to hit the wall to finish a race their arms are stretched out as far as they can and then direct impact with the wall can lead to joint pain or sprains. Majority of the events and movements in swimming require quick bursts of movement/energy, if the swimmer does not properly warmup before hand, this can also lead to a variety of injuries such as muscle strains, or tendinitis.
The Biomechanics Behind Swimming Injuries
The most common movement patterns in swimming that result in injuries is a lack of thoracic rotation, external rotation of the shoulder and hip extension. Each of these movements corresponds with body position in the water for the swimmer. When swimming freestyle and backstroke, it is crucial for the swimmer to rotate through their thoracic spine which allows them to reach and rotate to increase the distance of their catch. When swimmers lack the rotation through their thoracic spine they typically compensate with over use of their shoulder to correct for this. When thoracic rotation is not achieved, the swimmer will only use their glenohumeral joint to swing their arm around and typically land in internal rotation of the shoulder. This leads to overuse of the Subscapularis muscle and can lead to impingement in the front of a swimmers shoulder. Pain may be felt in the anterior deltoid or middle deltoid. These patterns also lead to a decrease of external rotation that the swimmer can achieve which is important in the recovery portion of the stroke (bringing the arm out of the water).
Another common movement pattern in swimming that can lead to injuries is a lack of hip extension. Under water kicking and kicking in general are what truly propels a swimmer forwards in the water. If the swimmers hips are sinking due to lack of extension then this creates drag in the water. If this happens then a swimmer will likely increase the extension in their low back in order to raise their legs to the top of the water. The compensation of over extension through the low back in combination with poor core control will lead to low back pain due to a hypermobility of the lumbar joint segments. Not only can this lead to pain and injury, but also a deficient stroke that will require more energy use leading to faster fatigue.
The most common root cause for injuries in swimming is the repetitive movements. As discussed earlier, swimmers can swim up to 40,000 or even 50,000 yards in one week. Typically, freestyle is the stroke most often done, but as athletes age they begin to specialize in other strokes which can again lead to overuse injuries with these repetitive movements. For freestyle, swimmers typically will experience anterior shoulder pain due to constant extension into flexion. The catch of the stroke underwater needs to have your elbow high and in line with your hand as you pull down towards your hips. A usual fault here is that swimmers elbows will drop which decreases the arm to be functioned as a “human paddle”. Over rotation of the shoulder when the arm enters in internal rotation is another way swimmers see injuries.
Stroke Specific Injuries
For backstroke, swimmers are constantly forcing their shoulder into internal rotation and then flexion. If swimmers overpronate their shoulders into internal rotation on the catch of the stroke then this is where labral tears or rotator cuff tendinopathies can occur.
In breastroke, there tends to be a lot of knee injuries. Swimmers are supposed to keep hips neutral as they go into knee flexion, from there the hip is internally rotated and then abducted to snap the legs around and back together. If proper hip mobility is not achieve then the swimmers will compensate with more lateral rotation of the tibia which can lead to knee pain.
Lastly, butterfly, there are usually low back or shoulder injuries. Butterfly requires you to have an undulation of your body, but typically swimmers will overcompensate and get hyper extension in their low back. This causes the swimmer to move “up and down” rather than forward through the water. When this happens the arms and shoulders must then work to bring the swimmer to the surface of the water leading to dropped elbows and a less efficient stroke as well.
How the Charlotte Athlete Treats Swimmers
If a swimmer came to the Charlotte Athlete, the focus would first be a full body movement analysis. As mentioned above, swimming requires multiple areas of mobility and stability. If a swimmers is compensating for one then this can lead to the root cause of why they are injured. After a full body movement analysis is completed then would come manual therapy. Based off of the joint mobility deficits by the swimmers, certain joint mobilizations would be used to increase the range of motion of a specific joint. For example, if a swimmer is lacking scapular movement when trying to reach forward and extend their catch then we would work to manually move the scapula and then immediately strengthen in order to keep this movement. Strengthening would consist of multiple mobility drills for the thoracic spine as well as the hips. Dry needling would also be used case by case. Due to the repetitive nature of swimming certain muscles like lats, multifidus, and upper trap would be constantly used. This can lead to tension in the muscles which can be aided by the use of dry needling. Cupping with movement would also be used. By cupping and putting the swimmer through their stroke movement patterns this can reduce the amount of muscle tension and restriction. Once mobility is restored and then proper strengthening has taken place, then comes the maintenance phase and progressive overload. Since swimming will constantly challenge the body it is important to keep strengthening in order to keep up with the physical demands.
Education for swimmers would be to stress the repetitive nature of the sport. Like discussed earlier, repetitive movements with either a lack of mobility, weakened muscles or poor stroke patterns are the root causes that lead to injuries in swimmers. Even if an injury is acquired and then properly treated, the odds of another injury occurring if constant maintenance is not utilized is extremely high. Stroke techniques and swimming overall is constantly being analyzed to determine how to make swimmers faster. If a swimmer does not keep up with this standard then they will begin to plateau and not drop times for potentially years. If a swimmer wants to keep dropping and ensure they do everything they can to prevent injuries then it is crucial to be in a gym to work on their weaknesses.
Sport specific warmups are going to focus on thoracic and hip mobility. Rotation through thoracic spine is going to be crucial as well. Shoulders should be properly warmed up, specifically muscles like the lower trap, serratus anterior and lats. Exercises for this can be the worlds greatest stretch, serratus punches with a band, wall slides, banded thoracic rotation and hip capsule mobility on a foam roller.
To bridge the gap between physical therapy and performance it is crucial to think of the athlete as a full person and not just their location of injury. Like this article discussed, one compensation or lack of mobility can lead to a laundry list of other compensations that can lead to injury. By thinking of the athlete as an entire unit you can then target specific weaknesses and mobility deficits to best prepare the swimmer for competition without constantly being out of the water.
Stop Masking Pain. Start Solving It!
If you’re a swimmer—or a parent or coach of one—you know how frustrating it is to push through pain, miss key practices, or stall in progress without ever getting clear answers. At The Charlotte Athlete, we go beyond cookie-cutter rehab plans. We assess the entire body, identify the root cause, and build customized treatment strategies that bridge the gap between physical therapy and performance.
You don’t need to accept pain as part of the sport. Whether you’re aiming for Olympic trials or just trying to make it through your next meet pain-free, we’re here to help you move better, swim stronger, and stay in the water where you belong.
Let’s get you back to doing what you love. Without the setbacks.
Thanks for reading,
Dr. Michelle