Swimming has a reputation as one of the gentlest forms of exercise — low-impact, joint-friendly, and easy on the body compared to running or team sports. That reputation is well earned, but it isn’t the whole story. The same repetitive strokes that make swimming such an effective, full-body workout can also wear down the shoulders, knees, back, and neck over time. Common swimming injuries are rarely the result of a single bad moment in the pool; they tend to build gradually from technique flaws, overtraining, or muscle imbalances, which is exactly why they’re so easy to ignore until they start limiting how much you can swim.
Below, we break down the injuries we see most often in swimmers at our Vancouver clinic, what physiotherapy treatment typically involves, and the habits that help prevent these injuries from coming back.
Why Swimmers Get Injured
Unlike sports with sudden collisions or changes of direction, most swimming injuries are overuse injuries. A handful of factors tend to show up again and again:
- Repetitive motion — the same shoulder rotation or kick pattern repeated thousands of times per workout
- Technique flaws — small errors in stroke mechanics that place uneven load on joints and soft tissue
- Rapid increases in training volume or intensity, especially after time away from the pool
- Muscle imbalances between the front and back of the shoulder, or tight hip flexors that change how the low back moves
- Insufficient rest between sessions, which doesn’t allow tendons and muscles to recover
Swimmer’s Shoulder
Swimmer’s shoulder is by far the most frequently reported swimming injury. One widely cited study of competitive swimmers found that the shoulder accounts for the large majority of all swimming-related injuries — a reflection of just how much load repeated overhead strokes like freestyle, butterfly, and backstroke place on the joint (Wanivenhaus et al., Sports Health).
“Swimmer’s shoulder” is really an umbrella term that can include:
- Rotator cuff tendinopathy or tears
- Shoulder impingement syndrome
- Labral injuries, including SLAP tears
- Bicep tendinitis
Symptoms usually start as a dull ache during or after swimming and can progress to pain during everyday overhead movements, along with weakness or a noticeable loss of range of motion. Left untreated, it tends to get worse rather than better, since the swimmer often keeps swimming through it.
Physiotherapy treatment for swimmer’s shoulder
Treatment generally focuses on calming down the irritated tissue first, then rebuilding the strength and control that protect the joint going forward — rotator cuff and scapular strengthening, stretching of the tight anterior chest muscles that pull the shoulder forward, manual therapy to restore normal joint mechanics, and stroke technique correction where needed. Our physiotherapy team builds this around your specific stroke mix and training load rather than a generic protocol.
Swimmer’s Knee (Breaststroker’s Knee)
The whip-kick used in breaststroke places significant sideways stress on the knee, particularly on the medial collateral ligament (MCL). Over time, this repetitive stress can lead to what’s commonly called breaststroker’s knee, along with patellofemoral pain syndrome (sometimes called “runner’s knee,” though it shows up in swimmers too) caused by stress on the tendon connecting the kneecap to the thigh bone.
Typical symptoms include pain along the inside of the knee or around the kneecap, swelling, and discomfort that’s most noticeable during or right after kicking sets.
Physiotherapy for swimmer’s knee typically includes strengthening for the quadriceps and hip muscles that control knee alignment, flexibility work, and — often the most useful piece — modifying kick technique or temporarily substituting freestyle or backstroke kick sets while the knee settles down.
Neck and Lower Back Pain in Swimmers
Neck pain
Repeated head rotation to breathe, especially with an inconsistent or one-sided breathing pattern, can strain the muscles and joints of the neck over a long swim season. Bilateral breathing and attention to head position can reduce this load, and physiotherapy can help resolve pain that’s already set in through manual therapy, postural correction, and targeted strengthening.
Lower back pain
Butterfly and breaststroke both involve repeated hyperextension of the lower back, and tight hip flexors or limited hip rotation can force the lumbar spine to compensate during freestyle as well. This can range from general muscle strain to more specific issues like facet joint irritation. A physiotherapy assessment can identify which movement pattern is driving the pain and build a plan — often combining core strengthening, hip mobility work, and manual therapy — to address it directly.
Other Swimming-Related Injuries
Swimmer’s ear
Not every swimming injury is musculoskeletal. Swimmer’s ear is an infection of the outer ear canal caused by water remaining in the ear after swimming, and it’s one of the most common non-injury complaints among frequent swimmers (Mayo Clinic). Drying the ears thoroughly after swimming and using earplugs can go a long way toward preventing it; persistent cases should be seen by a physician, since antibiotic treatment is often required.
Wrist, elbow, and ankle tendonitis
Less common but still worth watching for: the repetitive hand and wrist motion of each stroke can lead to tendon irritation in the wrist and elbow, while a consistently pointed-toe kicking position can strain the ankle.
How Physiotherapy Can Help
Whichever area is affected, physiotherapy treatment for swimmers tends to follow the same general approach:
- A thorough assessment of stroke technique, joint mobility, strength, and movement patterns to identify the root cause — not just the painful area
- Manual therapy to relieve pain, reduce inflammation, and restore normal joint and soft tissue movement
- A targeted strengthening and flexibility program built around the muscles most stressed by your strokes
- Guidance on modifying training volume, stroke selection, or technique while you recover
- A gradual return-to-swimming plan so the injury doesn’t simply resurface once you’re back in full training
Preventing Swimming Injuries
- Warm up properly and stretch the shoulders, hips, and ankles before getting in the pool
- Work with a coach on technique — small mechanical fixes often do more for injury prevention than any single exercise
- Increase training volume and intensity gradually rather than jumping back in at full effort
- Cross-train to balance out the muscles that swimming overdevelops and underdevelops
- Build in rest days, and pay attention early to pain that doesn’t resolve within a day or two
Frequently Asked Questions
What is the most common swimming injury?
Swimmer’s shoulder is by far the most common swimming injury, accounting for the large majority of injuries reported by competitive and recreational swimmers. It’s typically caused by the repetitive overhead motion used in freestyle, backstroke, and butterfly.
How do I know if my shoulder pain from swimming is serious?
Pain that persists after you get out of the pool, worsens over several sessions, or is accompanied by weakness or a noticeable loss of range of motion is worth having assessed by a physiotherapist rather than swimming through it.
Can physiotherapy help with swimmer’s knee?
Yes. Physiotherapy for swimmer’s knee usually combines strengthening for the muscles that support the knee, flexibility work, and adjustments to kick technique or kick volume while the knee recovers.
Should I stop swimming completely if I have a swimming injury?
Not always — a physiotherapist can often help you modify your stroke mix, volume, or technique so you can keep training in some capacity while the injured area heals, rather than stopping altogether.
How long does it take to recover from a swimming injury?
It depends on the injury and how early it’s addressed. Mild cases of swimmer’s shoulder or swimmer’s knee caught early can improve within a few weeks of targeted physiotherapy, while more established overuse injuries can take longer.
Get Help With a Swimming Injury in Vancouver
If you’re dealing with shoulder, knee, back, or neck pain from swimming, our team at Oakridge Physiotherapy on Cambie Street can assess what’s driving it and build a treatment plan around your training goals. If shoulder pain is your main concern, our guide on relieving shoulder pain covers additional treatment options.
Don’t just put up with it — book an appointment and let’s get you back in the water pain-free.