The Swimmer’s Trio: Shoulder pain, Low back pain and Knee pain
Swimmers are among the most injury-prone athletes due to the repetitive nature of their sport and high training loads. The 3 most commonly reported complaints among swimmers are (in order) shoulder pain, low back pain, and knee pain. These injuries are often linked to the demands of different strokes, poor technique, and overtraining.
Shoulder Pain
Shoulder pain, or "swimmer's shoulder," is perhaps the most infamous injury among competitive swimmers. According to a study published in the British Journal of Sports Medicine, shoulder injuries account for about 40% of all injuries in swimmers, primarily caused by the overhead motions of the sport, especially the freestyle and butterfly strokes (Bruckner & Kipp, 2009). The rotator cuff muscles and the long head of the biceps tendon are commonly involved in these injuries. Overuse, combined with the high range of motion required in swimming, can lead to muscle imbalances, inflammation, and degenerative conditions such as tendinopathy, as well as tearing. It is commonly accepted that shoulder pain can often be exacerbated by poor technique, such as improper arm entry or excessive internal rotation during strokes. To manage swimmer’s shoulder, maintaining shoulder strength and flexibility is essential. Research suggests that a tailored strengthening program that targets the rotator cuff and scapular stabilizers can significantly reduce the risk of injury. A study by Kibler et al. (2015) found that swimmers who underwent a specific shoulder rehabilitation program had a marked reduction in shoulder pain and dysfunction.
Low Back Pain
Low back pain is another frequent complaint among swimmers. While it’s often associated with land-based athletes, swimmers aren’t immune. According to a 2014 study in BJSM, approximately 20-25% of competitive swimmers report experiencing low back pain, with those in the breaststroke and butterfly disciplines being the most affected (Jørgensen et al., 2014). The repetitive hyperextension of the spine, especially during the undulating motions of the butterfly stroke and the "frog kick" in breaststroke, can place excessive stress on the lumbar spine and surrounding muscles. Insufficient core stability, lack of pelvic control and/or awareness, and overtraining can also increase the risk of low back pain and discomfort. It follows that a core strengthening program is key to managing low back pain in swimmers; a randomized controlled trial (RCT) by Panjabi et al. (2018) demonstrated that core stability exercises significantly reduced the incidence of low back pain in swimmers.
Knee Pain
While knee injuries are less common in swimming compared to running or cycling, they do occur, particularly in breaststrokers. The distinctive “frog-kick”, or more correctly, “whip-kick” in breaststroke requires a forceful whipping motion, which can put particular strain on the knee joint, especially the medial collateral ligament (MCL) and patellofemoral joint. It has been reported that knee injuries, though less frequent, still account for 12-27% of swimming-related injuries (Chase, et al. 2013; Kennedy & Hawkins, 1974). One of the key risk factors for knee pain in swimmers is improper kick technique, as well as training volume and frequency. Poor flexibility or strength in the hip and thigh muscles can also contribute to improper movement patterns that place stress on the knees. Improving strength and mobility of the lower body can help offset knee pain in swimmers. A study by D’Souza et al. (2017) found that swimmers who included strength training for the lower body experienced fewer knee-related injuries. Furthermore, proper technique in the breaststroke kick is essential to minimize knee strain.
Conclusion
Shoulder, low back, and knee pain are common issues for swimmers, often resulting from overuse, poor technique, and inadequate muscle strength or flexibility. However, with targeted exercises and proper technique, these injuries can often be prevented or managed effectively. Incorporating strength training, core stability work, and regular flexibility sessions into a swimmer’s routine can go a long way in keeping them pain-free and performing at their best. By understanding the root causes and addressing them proactively, swimmers can ensure they stay in the pool, rather than on the sidelines recovering from injury.
If you’re experiencing pain whilst swimming, need some guidance with a pre-session mobility routine, or would benefit from a targeted strengthening program, you can book a Physiotherapy Consultation or Swimming Mobility Screen here.
References:
Bruckner, J. A., & Kipp, K. (2009). Shoulder injuries in swimmers. British Journal of Sports Medicine, 43(2), 122-130.
Jørgensen, U., et al. (2014). Prevalence of low back pain in competitive swimmers: A systematic review. British Journal of Sports Medicine, 48(2), 101-107.
Kibler, W. B., et al. (2015). Shoulder rehabilitation and injury prevention in swimming. Sports Medicine, 45(4), 521-533.
Panjabi, M. M., et al. (2018). Effect of core stability exercises on low back pain in swimmers. Journal of Athletic Training, 53(5), 453-460.
D’Souza, M., et al. (2017). The role of strength training in knee injury prevention in swimmers. International Journal of Sports Medicine, 38(8), 625-632.
Chase KI, Caine DJ, Goodwin BJ, Whitehead JR, Romanick MA. A prospective study of injury affecting competitive collegiate swimmers. Res Sports Med 2013; 21:111-123.
Kennedy JC, Hakwins RJ. Breast stroker’s knee. The Physician and Sportsmedicine 1974; 2:33-38.