Disclaimer: This article is for general educational purposes only and does not constitute medical advice. Always consult a qualified health professional for advice specific to your condition. © 2026 Better Physiotherapy Bundoora.
Swimming is often prescribed as a low-impact rehabilitation exercise — and for most people it is. But competitive and masters swimmers accumulate enormous repetition-based loads, making overuse injuries of the shoulder, knee, and neck extremely common. Physiotherapy helps swimmers recover quickly and stay in the water.
Swimmer's Shoulder: The Most Common Swimming Injury
Swimmer's shoulder encompasses subacromial impingement, rotator cuff tendinopathy, and labral irritation. With freestyle and butterfly training volumes of 20,000+ metres per week, even small biomechanical inefficiencies are amplified. Physiotherapy treatment addresses:
- Rotator cuff strengthening — particularly external rotation and scapular retractors
- Scapular control — correcting winging and upward rotation deficit
- Posterior shoulder capsule tightness — sleeper stretch and cross-body stretch
- Stroke analysis — catch position, high elbow pull-through, breathing mechanics
- Training load management — reducing volume, avoiding butterfly and pulling if irritating
Knee and Ankle Injuries in Swimming
Breaststroke swimmers are at highest risk of medial knee pain. The whip kick subjects the medial knee to repeated valgus loading. Management includes: medial knee strengthening, hip abductor training to control knee alignment, modification of kick mechanics, and progressive return to full breaststroke volume. Ankle pain can arise from the hyperdorsiflexion demands of flutter kick in some swimmers.
Low Back Pain in Swimmers
Butterfly and backstroke place the lumbar spine in sustained hyperextension. Combined with the trunk rotation demands of competitive swimming, this can produce facet joint pain and paraspinal muscle overuse. Core stability training specific to the swimming environment — rotational control and breath-to-kick coordination — is an important component of management.
Swimming Injury Treatment at Better Physiotherapy Bundoora
We treat swimmers of all levels. Our physiotherapists understand the demands of competitive swimming and design programs that keep you in the water during rehabilitation wherever possible. Call (03) 9467 6900 or book online.
Frequently Asked Questions
What causes swimmer's shoulder?
The freestyle pull-through phase involves internal rotation and adduction of the shoulder at high speed, repeated thousands of times per training session. This overloads the supraspinatus tendon and the biceps long head tendon in the subacromial space. Contributing factors include: poor scapular control (winging), tight posterior shoulder capsule, excessive shoulder internal rotation range, and excessive training volume or intensity increases.
What is breaststroker's knee?
Breaststroker's knee (medial knee pain in breaststroke swimmers) is caused by the whip kick action of breaststroke, which places high valgus (inward) stress on the medial knee structures — specifically the medial collateral ligament and pes anserine tendons. It is managed with load modification (reducing breaststroke distance), medial knee strengthening, and technique coaching.
Why do swimmers get neck pain?
Freestyle breathing requires sustained neck rotation and extension — which, over thousands of repetitions per session, loads the cervical facet joints, upper trapezius, and deep neck flexors. Bilateral breathing (alternating sides) distributes this load more evenly. Physiotherapy for swimming-related neck pain includes cervical mobilisation, deep neck flexor strengthening, and technique review.
How is swimming injury physiotherapy different from other sports physio?
Swimming injuries require specific assessment of shoulder flexibility patterns (typical for swimmers is excessive anterior shoulder laxity with posterior tightness), stroke-specific biomechanics assessment, and a rehabilitation plan that accounts for the high training volumes common in competitive swimmers. Understanding stroke technique — and when to modify it — is essential for effective swimming physio.
Ashley Haleel
Physiotherapist & Owner — Better Physiotherapy Bundoora