Blog 1: Everything Swimming 🏊♂️
Part 1: Injury Risks in Swimming: What Every Athlete Should Know
Welcome to The Everything Swimming Blog Series!
Welcome to the first part of our 3-part swimming series where Dr. Keirstyn dives in deep on everything you need to know! Whether you're a competitive youth swimmer logging 20,000+ yards per week, a Masters swimmer keeping fit and racing on weekends, or a triathlete building your swim fitness, swimming creates unique stresses on your body that most swimmers don't fully understand.
Swimming looks smooth and low-impact from the outside. But the repetitive overhead motion, high training volumes, and specific stroke mechanics create injury patterns that can sideline even the most dedicated swimmers.
Over the next three parts, we'll break down:
Common swimming injuries and why they happen (this blog)
Building your swimming body through dryland training and recovery
Long-term swimming health and injury prevention
Let's start by understanding what breaks down and why.
The Unique Physical Demands of Swimming
What Makes Swimming Different:
Swimming is a repetitive overhead sport performed in an unstable, low-gravity environment:
High repetition: Competitive swimmers perform 2,000-4,000+ shoulder rotations per practice
Overhead reaching: Every stroke requires shoulder elevation and rotation
Full-body rotation: Core and hip rotation drive propulsion
Breathing mechanics: Neck rotation (freestyle, backstroke) creates asymmetry
Low impact but high volume: Joints aren't absorbing impact, but tissues face constant stress
The Volume Problem: Club swimmers train 6-10+ times per week. Masters swimmers train 3-5x weekly but often lack the conditioning foundation built in youth. Both create overuse injury risk.
Most Common Swimming Injuries
1. Swimmer's Shoulder (Rotator Cuff Impingement & Tendinopathy)
The #1 swimming injury, affecting 40-60% of competitive swimmers at some point.
What It Is: Irritation or damage to the rotator cuff tendons from repetitive overhead motion and impingement (pinching) in the shoulder.
What It Feels Like:
Pain in front or side of shoulder
Worse during or after swimming (especially freestyle, butterfly)
Weakness or fatigue during sets
Pain with overhead reaching outside the pool
May feel clicking or catching
Why It Happens:
Repetitive overhead stress: 2,000+ shoulder rotations per practice
Poor scapular control: Shoulder blade doesn't move properly during arm motion
Weak rotator cuff: Can't stabilize shoulder during high-repetition movements
Limited thoracic spine mobility: Stiff upper back forces shoulder to compensate
Stroke technique issues: Crossing midline, thumb-first entry, elbow dropping during pull
Who Gets It: Freestyle and butterfly swimmers (highest overhead volume), though all strokes can cause it
The Pattern: Often starts as mild fatigue or "tightness," progresses to pain during swimming, eventually hurts at rest.
2. Lower Back Pain
Common in swimmers, especially butterfly and breaststroke specialists.
What It Feels Like:
Aching or sharp pain in lower back
Worse during or after swimming
Stiffness in the morning or after sitting
May radiate to hips or glutes
Why It Happens:
Excessive lumbar extension: Butterfly and breaststroke create repeated arching
Core weakness: Can't stabilize spine during rotation and propulsion
Hip mobility limitations: Tight hip flexors or limited hip rotation forces lower back compensation
Breathing mechanics: Head lifting (breaststroke) or excessive body undulation creates spinal stress
Who Gets It: Butterfly and breaststroke swimmers primarily, but freestylers with poor body position too
3. Knee Pain (Breaststroker's Knee)
Specific to breaststroke swimmers from the unique kicking motion.
What It Is: Medial collateral ligament (MCL) stress or irritation from repetitive valgus force during the whip kick.
What It Feels Like:
Pain on inside of knee
Worse during or after breaststroke kick
May feel unstable or "loose"
Soreness after practice
Why It Happens:
Breaststroke kick mechanics: Knee rotates outward while flexed, then snaps inward forcefully
Valgus stress: Inward force on knee stresses MCL repeatedly
High repetition: Breaststrokers perform 1,000+ kicks per practice
Weak hip stabilizers: Glutes can't control leg position, increasing knee stress
Who Gets It: Almost exclusively breaststroke swimmers (and some IM swimmers during breast sets)
4. Neck Pain
Common from breathing mechanics and head position.
What It Feels Like:
Stiffness or pain in neck
Worse on one side (breathing side in freestyle)
Headaches
Pain with rotation or looking up
Why It Happens:
Breathing rotation (freestyle): Repetitive one-sided neck rotation creates asymmetry
Head position: Lifting head too high (freestyle, breaststroke) stresses neck extensors
Poor body position: Hips dropping forces head to lift higher to breathe
Muscle imbalance: Breathing side neck muscles overwork while opposite side weakens
Who Gets It: Freestyle swimmers (especially unilateral breathers), breaststrokers who lift head excessively
5. Hip and Groin Issues
Less common but increasingly recognized in high-level swimmers.
What It Feels Like:
Deep hip or groin pain
Worse with flutter kick (freestyle) or whip kick (breaststroke)
May feel like pinching or tightness
Often affects hip flexors
Why It Happens:
Hip flexor overuse: Repetitive kicking (especially flutter kick) overloads hip flexors
Limited hip mobility: Restricted hip rotation or extension creates compensation
Core weakness: Poor core control forces hips to work harder for propulsion
Breaststroke mechanics: Extreme hip rotation and abduction stresses hip joint
Who Gets It: High-volume swimmers, especially those with limited hip mobility or weak core
Stroke-Specific Injury Patterns
Freestyle:
Shoulder (rotator cuff impingement)
Neck (breathing side)
Lower back (if body position is poor)
Backstroke:
Shoulder (rotator cuff, different impingement pattern than freestyle)
Neck (from head position on wall during turns)
Breaststroke:
Knee (MCL stress from kick)
Lower back (from undulation and head lifting)
Hip/groin (from kick mechanics)
Butterfly:
Shoulder (highest overhead demand)
Lower back (from repeated extension)
Hip flexors (from undulation)
Individual Medley (IM):
Combination of all stroke-specific risks
Highest overall injury risk due to volume and variety
The Overuse Injury Cycle in Swimming
Stage 1: Tissue Irritation
Mild soreness during or after practice
Resolves with rest
Performance not affected
Stage 2: Tissue Inflammation
Pain during practice, especially during harder sets
Soreness persists between practices
Slight performance decline
Stage 3: Tissue Damage
Pain throughout practice and at rest
Compensation patterns develop (altered stroke mechanics)
Significant performance decline
Stage 4: Chronic Injury
Constant pain, even outside the pool
Unable to train normally
May require extended time off or medical intervention
The Key: Catch issues at Stage 1-2. Most swimmers push through to Stage 3-4 before seeking help.
Warning Signs Swimmers Ignore
Early Red Flags:
Shoulder "fatigue" that requires extra warmup
One-sided tightness that doesn't resolve with stretching
Decreased distance per stroke (stroke count increasing)
Avoiding certain strokes or sets
Compensatory movements (dropping elbow, crossing midline)
Don't Ignore:
Pain that changes your stroke mechanics
Weakness during sets you used to handle easily
Swelling or stiffness that persists overnight
Pain at rest or during daily activities
Asymmetries that feel "off"
How Chiropractic Care Helps Swimmers
At Endurance Therapeutics, Dr. Keirstyn works with swimmers at all levels — from youth club athletes to Masters competitors.
We Focus On:
Shoulder mechanics assessment: Identifying scapular control, rotator cuff strength, mobility restrictions
Stroke analysis: Understanding how your technique contributes to injury risk
Thoracic spine mobility: Optimizing upper back movement for better shoulder function
Core and hip stability: Building the foundation for efficient swimming
Injury prevention: Catching issues early before they sideline you
Preventative Care Matters: Most swimming injuries build over weeks to months from cumulative stress. Regular check-ins during high-volume training periods can identify problems before they become chronic.
If you're dealing with shoulder pain, lower back issues, or chronic soreness, don't wait until you can't train. Book an assessment with Dr. Keirstyn and let's identify what's breaking down before it costs you pool time.
What's Coming Next
In Part 2, we'll dive into building your swimming body — the dryland strength, mobility, and recovery work that keeps you healthy and swimming fast. We'll cover shoulder stability exercises, core work for swimmers, and what to do during high-volume training blocks.
📍 Endurance Therapeutics | Oakville, Ontario
📞 905-288-7161 | 🔗 https://endurance.janeapp.com/#staff_member/1