The 4 Most Common Swimming Injuries — and How to Prevent Them
Swimming is brilliant — and not as injury-free as people assume
Swimming is one of the most physio-recommended forms of exercise. It's low-impact, it builds cardiovascular fitness, it's joint-friendly, and it's accessible at every age. We routinely tell patients with knee or hip arthritis to add it to their week. But "low-impact" doesn't mean "injury-free." Competitive and recreational swimmers alike develop very specific overuse injuries from the repetitive demands of the four strokes.
At Evolve Physio & Mastery in Cabramatta, we see swimmers from Cabramatta, Fairfield, Liverpool, and surrounding areas — masters athletes, age-group competitors, triathletes, and lap swimmers — and the same handful of injuries come up again and again. Here are the four most common, and what you can do about them.
1. Swimmer's shoulder
By far the most common swimming injury. Often called swimmer's shoulder, it's typically a rotator cuff or biceps tendinopathy aggravated by the high-repetition demands of freestyle and butterfly. Some studies estimate up to two-thirds of competitive swimmers experience shoulder pain at some point in their career.
Why it happens: a combination of high training volume, poor stroke mechanics (dropped elbow, crossing the midline, breathing only to one side), tight pectorals, weak scapular stabilisers, and overuse of paddles.
What helps: a structured rotator cuff and scapular stability program (the cornerstone of recovery), thoracic mobility work, training-load management, and stroke correction with a coach. Most cases respond well within 8–12 weeks of consistent rehab.
2. Breaststroker's knee
Pain on the inside of the knee, typically aggravated by the whip-kick of breaststroke. Caused by the repetitive valgus (knee-in) and rotational stress at the medial collateral ligament and surrounding structures.
Why it happens: high breaststroke volume, weak hips and glutes letting the knee drift inward, poor kick technique (knees too wide), and previous knee injuries.
What helps: reducing breaststroke volume in the short term, hip and glute strengthening, technique coaching to narrow the kick, and graded loading of the knee. We also assess the foot and ankle — restrictions there can change the stress on the knee.
3. Low back pain in swimmers
Common in butterfly and breaststroke swimmers, but also in freestylers who arch the back to breathe. Usually presents as a deep ache after sets, occasionally with morning stiffness.
Why it happens: poor core control, excessive lumbar extension during stroke phases, weak glutes, and tight hip flexors. Long stretches without dryland strength work make it more likely.
What helps: core and glute strengthening (the kind that translates to swimming, not just gym aesthetics), hip flexor mobility work, dryland posterior-chain work, and stroke and kick adjustments. Pilates can be a great adjunct for swimmers prone to back pain.
4. Neck pain (the breathing-side neck)
Most freestylers favour breathing to one side. Over months and years, that one-sided rotation can produce stiffness, muscular asymmetry, and persistent neck soreness — particularly on the dominant breathing side.
Why it happens: single-side breathing, poor head position (lifting the head rather than rolling), tight upper trapezius and levator scapulae, and limited thoracic rotation.
What helps: learning to bilateral-breathe, hands-on physio to restore neck and thoracic mobility, deep neck flexor strengthening, and stretching the chronically tight muscles. Sleeping position and pillow choice often play a role too.
Five simple ways swimmers can prevent injuries
- Add dryland strength work — twice a week, focused on shoulders, scapular stabilisers, glutes, and core
- Manage your load — sudden jumps in volume or intensity are the strongest predictor of overuse injury
- Bilateral-breathe in freestyle — even if it feels awkward at first, your neck and shoulders will thank you
- Use paddles sparingly — they're a tool, not a default. Excessive paddle work loads the shoulder dramatically
- Get coached — small technique tweaks prevent enormous amounts of injury
If something hurts, don't push through it
The biggest mistake we see in swimmers is grinding through small niggles until they become big problems. A two-week niggle caught early is often a 4-session physio fix. The same niggle ignored for three months becomes a 12-week rehab job. If you've had pain for more than a week or two, get it looked at.
Get back to clean, pain-free laps
Whether you're chasing a masters PB, training for a triathlon, or just doing your morning laps at Cabramatta Aquatic Centre, our physios will help you keep swimming. We combine hands-on treatment with stroke-aware rehab and load management — and we're happy to liaise with your coach.
Book a swimming injury assessment at Evolve Physio & Mastery in Cabramatta and let's get you back in the water properly.
Frequently Asked Questions
Should I swim through shoulder pain?
No. Swimming through shoulder pain almost always makes the underlying problem worse — small bouts of irritation become full-blown rotator cuff tendinopathies. Reduce volume, see a physio early, and you'll be back faster.
How much rest do swimmers actually need?
Most age-group and adult swimmers benefit from 1–2 full rest days per week, plus dedicated dryland strength training. Year-round high volume with no rest is one of the biggest contributors to overuse injury.
Do paddles and pull buoys cause injuries?
They can — particularly hand paddles, which dramatically increase shoulder load. They're useful tools used appropriately but become a clear injury risk when overused. A physio or coach should help you decide how often is sensible for your shoulder.
Can poor technique cause injuries?
Absolutely. Crossing the midline on entry, dropping the elbow on the catch, and breathing only to one side are classic technique faults strongly associated with swimmer's shoulder. A coaching session combined with physio rehab is usually the fastest fix.
Should I see a physio or a swim coach first?
If you have pain, see a physio first to settle symptoms and identify drivers. Once you're recovering, a stroke-correction session with a coach is invaluable for preventing recurrence. We often refer back and forth.
