Swimming

01 Overview

Swimming is a competitive sport and a popular recreational pastime for people of all ages. There are numerous swimming events in the Summer Olympics, including backstroke, butterfly, breaststroke, and freestyle. Overuse injuries are common in swimming, and the shoulder is a common area of injury.

(see Section 04 - Prevention)
Athlete silhouette
View Common Injuries by clicking the blue dots on the silhouette

The shoulder is the most common site of injury among swimmers. Competitive swimmers can get “swimmer’s shoulder,” or an overuse injury from repeated motions.

The knee is the second most common site of injury in swimmers. The medial (inside) part of the knee is a common area of injury among breaststroke swimmers.

Lower back pain is a commonly reported injury across all levels of swimming. Butterfly swimmers are at a higher risk of lower back pain compared to other strokes.

Concussions can occur if the swimmer misses the timing of a flip turn and hits the wall, or by colliding with another swimmer.

02 Injury Statistics

Injuries among swimmers occur most often to the shoulder, knee, and the lower back. Most of these injuries are overuse in nature rather than acute. Females report more knee injuries and more spinal injuries as compared to males.

Curious about the research on injuries?

It is estimated that...

View Summary of Incidence Rates

03 Risk Factors

Risk factors in swimming include previous injury, shoulder joint dynamics, type of stroke, and competition level.

  • History of Injury

    Previous injury increased the risk of injury in swimming, particularly injuries to the shoulder.

  • Type of Stroke

    Breaststroke swimmers have a five times higher risk of knee pain, and butterfly stroke swimmers have a higher risk of lower back pain as compared to other swimmers. Swimmers specializing in strokes other than freestyle have a 33% greater risk of any injury as compared to those specializing in freestyle.

  • Shoulder Joint

    Instability in the shoulder joint, or increased length and elasticity of the ligaments at the front of the shoulder can increase the risk of shoulder pain among swimmers. Having an imbalance in external and internal shoulder rotation (i.e., decreased internal range of motion and increased external range of motion) can increase the risk of shoulder pain.

  • Competition Level

    Freshman elite college/university swimmers have a higher risk of injury compared to senior elite swimmers. Elite swimmers have higher incidence of shoulder pain than recreational swimmers. Athletes at higher competition levels are at a higher risk of shoulder pain as compared to athletes at lower levels.

04 How can I prevent injury?

Some muscle soreness or joint pain is expected when increasing your level of physical activity. However, it is important to listen to your body for persistent or worsening pain, and to know when to rest. Learn more about how to prevent injuries in swimming.

  • Participant & Parent

    Talk to your coach or organization, if applicable, about the prevention strategies below and how they might be incorporated into training and policies.

    Strength Training and Neuromuscular Training Program

    Incorporate endurance, balance, and strength dry-land conditioning to reduce your risk of injury. Consider including strength and endurance exercises to strengthen your primary rotator cuff, scapular, and abdominal and lower back muscles. Wanivenhaus et al (2012) list some strength training exercises for the competitive swimmer.

    Get Set Neuromuscular Training
    The Get Set app contains exercises that can be done at home. Created by the Oslo Sports Trauma Center, Norwegian School of Sport Sciences, and Making Waves AS in 2014 for the International Olympic Committee, the app allows you to search by body part to view exercises that work to strengthen each area of the body, or search by sport to view a library of exercises that are specific to swimming.

    Download Get Set for Android.

    Download Get Set for iOS.

    Oslo Sport Trauma Research Centre Neuromuscular Training
    Adopt strength training exercises designed to prevent injuries to the shoulder and back. The Oslo Sport Trauma Research Centre has developed exercises that specifically help reduce the risk of shoulder and back injuries. This resource includes videos and PDFs for download.

    Learn more about exercises to help prevent shoulder injuries.

    Learn more about exercises to help prevent back injuries.

    For more exercises, visit http://fittoplay.org/.

    Managing Concussion

    It is important to be aware of concussion signs and symptoms and know what to do if concussion is suspected. The Concussion Awareness Training Tool (CATT) is an online resource for participants and parents to learn more about how to recognize, prevent, and manage a concussion. CATT also includes resources on how to respond to a potential concussion situation, as well as detailed Return to School and Return to Sport protocol.

    Other Considerations (about this section)

    Training
    Learn proper swimming stroke techniques and safety protocols. Having a coach monitor training volume, intensity, and duration can identify and minimize your risk of overuse injury.

    Additional Resources
    Swimming Canada has resources on concussion management and other resources on injury prevention.

    Drowning Prevention
    Any water-based activity comes with the risk of drowning. Find out more about drowning prevention from:

    Education
    Parachute Canada has two diving injury prevention programs: “Dive Smart” and “Sudden Impact.” These programs provide education on the importance of spinal cord injury prevention in and around water, and have been shown to change students’ opinions about checking the depth of swimming pools before diving. These resources include a Leader’s Guide and can be purchased on DVD or viewed on the Parachute Canada website.

    • “Dive Smart” is targeted at an elementary school students age 6 to 12 years and in Grades 1 to 6.
    • “Sudden Impact” is designed for high school 12 years of age and older, and in Grades 7 to 12.

    Sport-related Physicals
    Competitive swimming is physically demanding and some pre-existing conditions may increase the risk of injury. An annual sport-related physical evaluation ensuring fitness to participate can help to reduce risk of injury. KidsHealth provides information about what sports physicals are, why they may be appropriate and where you may go to get them.

    Learn more about Kids Health Sports Physicals.

  • Coach & Teacher

    Talk to your organization or school, if applicable, about the prevention strategies below and how they might be incorporated into training and policies.

    Strength Training and Neuromuscular Training Program

    Incorporate endurance, balance, and strength dry-land conditioning into your training programs to reduce your swimmers’ risk of injury. Consider including strength and endurance exercises to strengthen the primary rotator cuff, scapular, and abdominal and lower back muscles. Wanivenhaus et al (2012) list some strength training exercises for the competitive swimmer.

    Swimming-Specific Exercises for the Shoulder
    Encourage endurance and strength training in the following areas:

    • Increase body roll and scapula retraction during the forward crawl, and aim for normal strength and endurance of the cuff and scapular stabilizers
    • Improve flexibility of the anterior capsule
    • Avoid extreme anterior pelvic tilt and lumbar lordosis, allowing for increased control of the pelvis
    • Emphasize the serratus anterior, rhomboids, lower trapezius, and subscapularis muscles
    • Stretch and strengthen the quadriceps (vastus medialis obliquus) and hamstring to help prevent knee pain

    Get Set Neuromuscular Training
    The Get Set app contains exercises that can be done at home. Created by the Oslo Sports Trauma Center, Norwegian School of Sport Sciences, and Making Waves AS in 2014 for the International Olympic Committee, the app allows you to search by body part to view exercises that work to strengthen each area of the body, or search by sport to view a library of exercises that are specific to swimming.

    Download Get Set for Android.

    Download Get Set for iOS.

    Oslo Sport Trauma Research Centre Neuromuscular Training
    Adopt strength training exercises designed to prevent injuries to the shoulder and back. The Oslo Sport Trauma Research Centre has developed exercises that specifically help reduce the risk of shoulder and back injuries. This resource includes videos and PDFs for download.

    Learn more about exercises to help prevent shoulder injuries.

    Learn more about exercises to help prevent back injuries.

    For more exercises, visit http://fittoplay.org/.

    Managing Concussion

    It is important to be aware of concussion signs and symptoms and know what to do if concussion is suspected. The Concussion Awareness Training Tool (CATT) is an online resource for coaches and teachers to learn more about how to recognize, prevent, and manage a concussion. CATT also includes resources on how to respond to a potential concussion situation, as well as detailed Return to School and Return to Sport protocol.

    Other Considerations (about this section)

    Training
    Train swimmers on proper swimming stroke techniques and safety protocols. Monitor their training volume, intensity, and duration in order to help identify and minimize the risk of overuse injury.

    Additional Resources
    Swimming Canada has resources on concussion management and other resources on injury prevention.

    Education
    Parachute Canada has two diving injury prevention programs: “Dive Smart” and “Sudden Impact.” These programs provide education on the importance of spinal cord injury prevention in and around water, and have been shown to change students’ opinions about checking the depth of swimming pools before diving. These resources include a Leader’s Guide and can be purchased on DVD or viewed on the Parachute Canada website.

    • “Dive Smart” is targeted at an elementary school students age 6 to 12 years and in Grades 1 to 6.
    • “Sudden Impact” is designed for high school 12 years of age and older, and in Grades 7 to 12.

    Facilities
    The Ontario Physical Education Association (OPHEA) provides recommendations for implementing swimming programs in secondary schools.

    Learn more about adding swimming to your school program.

    Sport-related Physicals
    Competitive swimming is physically demanding and some pre-existing conditions may increase the risk of injury. An annual sport-related physical evaluation ensuring fitness to participate can help to reduce risk of injury. KidsHealth provides information about what sports physicals are, why they may be appropriate and where you may go to get them.

    Learn more about Kids Health Sports Physicals.

  • Official & Administrator

    Talk to your coaches, teachers, organization, or school about the prevention strategies below and how they might be incorporated into training and policies.

    Managing Concussion

    It is important to be aware of concussion signs and symptoms and know what to do if concussion is suspected. The Concussion Awareness Training Tool (CATT) is an online resource to learn more about how to recognize, prevent, and manage a concussion. CATT also includes resources on how to respond to a potential concussion situation, as well as detailed Return to School and Return to Sport protocol.

    Strength Training and Neuromuscular Training Program

    Encourage coaches and teachers to incorporate endurance, balance, and strength dry-land conditioning into their training programs to reduce swimmers’ risk of injury. Have them consider including strength and endurance exercises to strengthen the primary rotator cuff, scapular, and abdominal and lower back muscles. Wanivenhaus et al (2012) list some strength training exercises for the competitive swimmer.

    Swimming-Specific Exercises for the Shoulder
    Encourage endurance and strength training in the following areas:

    • Increase body roll and scapula retraction during the forward crawl, and aim for normal strength and endurance of the cuff and scapular stabilizers
    • Improve flexibility of the anterior capsule
    • Avoid extreme anterior pelvic tilt and lumbar lordosis, allowing for increased control of the pelvis
    • Emphasize the serratus anterior, rhomboids, lower trapezius, and subscapularis muscles
    • Stretch and strengthen the quadriceps (vastus medialis obliquus) and hamstring to help prevent knee pain

    Get Set Neuromuscular Training
    The Get Set app contains exercises that can be done at home. Created by the Oslo Sports Trauma Center, Norwegian School of Sport Sciences, and Making Waves AS in 2014 for the International Olympic Committee, the app allows you to search by body part to view exercises that work to strengthen each area of the body, or search by sport to view a library of exercises that are specific to swimming.

    Download Get Set for Android.

    Download Get Set for iOS.

    Oslo Sport Trauma Research Centre Neuromuscular Training
    Adopt strength training exercises designed to prevent injuries to the shoulder and back. The Oslo Sport Trauma Research Centre has developed exercises that specifically help reduce the risk of shoulder and back injuries. This resource includes videos and PDFs for download.

    Learn more about exercises to help prevent shoulder injuries.

    Learn more about exercises to help prevent back injuries.

    For more exercises, visit http://fittoplay.org/.

    Other Considerations (about this section)

    Facilities
    The Ontario Physical Education Association (OPHEA) provides recommendations for implementing swimming programs in secondary schools.

    Learn more about adding swimming to your school program.

    Training
    Encourage coaches to train swimmers on proper swimming stroke techniques and safety protocols, and have them monitor their training volume, intensity, and duration in order to help identify and minimize the risk of overuse injury.

    Additional Resources
    Swimming Canada has resources on concussion management and other resources on injury prevention.

    Education
    Parachute Canada has two diving injury prevention programs: “Dive Smart” and “Sudden Impact.” These programs provide education on the importance of spinal cord injury prevention in and around water, and have been shown to change students’ opinions about checking the depth of swimming pools before diving. These resources include a Leader’s Guide and can be purchased on DVD or viewed on the Parachute Canada website.

    • “Dive Smart” is targeted at an elementary school students age 6 to 12 years and in Grades 1 to 6.
    • “Sudden Impact” is designed for high school 12 years of age and older, and in Grades 7 to 12.

    Sport-related Physicals
    Competitive swimming is physically demanding and some pre-existing conditions may increase the risk of injury. An annual sport-related physical evaluation ensuring fitness to participate can help to reduce risk of injury. KidsHealth provides information about what sports physicals are, why they may be appropriate and where you may go to get them.

    Learn more about Kids Health Sports Physicals.

  • Health Professional

    The role of health professionals in preventing swimming injuries has two main components:

    1. Providing ongoing education to swimmers, parents, and coaches on effective injury prevention programs such as balance and resistance training; and
    2. Ensuring that injured swimmers are completely healed and fit-to-perform before returning to activity to prevent re-injury or chronic injury.

    Managing Concussion

    It is important to be aware of concussion signs and symptoms and know what to do if concussion is suspected. The Concussion Awareness Training Tool (CATT) is an online resource to learn more about how to diagnose and manage a concussion. CATT also includes resources on how to assess a potential concussion, as well as detailed Return to School and Return to Sport protocol.

    Strength Training and Neuromuscular Training Program

    Encourage swimmers, coaches and teachers to incorporate endurance, balance, and strength dry-land conditioning into their training programs to reduce swimmers’ risk of injury. Have them consider including strength and endurance exercises to strengthen the primary rotator cuff, scapular, and abdominal and lower back muscles. Wanivenhaus et al (2012) list some strength training exercises for the competitive swimmer.

    Swimming-Specific Exercises for the Shoulder
    Encourage endurance and strength training in the following areas:

    • Increase body roll and scapula retraction during the forward crawl, and aim for normal strength and endurance of the cuff and scapular stabilizers
    • Improve flexibility of the anterior capsule
    • Avoid extreme anterior pelvic tilt and lumbar lordosis, allowing for increased control of the pelvis
    • Emphasize the serratus anterior, rhomboids, lower trapezius, and subscapularis muscles
    • Stretch and strengthen the quadriceps (vastus medialis obliquus) and hamstring to help prevent knee pain

    Get Set Neuromuscular Training
    The Get Set app contains exercises that can be done at home. Created by the Oslo Sports Trauma Center, Norwegian School of Sport Sciences, and Making Waves AS in 2014 for the International Olympic Committee, the app allows you to search by body part to view exercises that work to strengthen each area of the body, or search by sport to view a library of exercises that are specific to swimming.

    Download Get Set for Android.

    Download Get Set for iOS.

    Oslo Sport Trauma Research Centre Neuromuscular Training
    Adopt strength training exercises designed to prevent injuries to the shoulder and back. The Oslo Sport Trauma Research Centre has developed exercises that specifically help reduce the risk of shoulder and back injuries. This resource includes videos and PDFs for download.

    Learn more about exercises to help prevent shoulder injuries.

    Learn more about exercises to help prevent back injuries.

    For more exercises, visit http://fittoplay.org/.

    Other Considerations (about this section)

    Sport-related Physicals
    Competitive swimming is physically demanding and some pre-existing conditions may increase the risk of injury. An annual sport-related physical evaluation ensuring fitness to participate can help to reduce risk of injury. The American Academy of Pediatrics provides information about preparticipation physical evaluation.

    Learn more about Preparticipation Physical Evaluation.

    Training
    Encourage coaches to train swimmers on proper swimming stroke techniques and safety protocols, and have them monitor their training volume, intensity, and duration in order to help identify and minimize the risk of overuse injury.

    Education
    Parachute Canada has two diving injury prevention programs: “Dive Smart” and “Sudden Impact.” These programs provide education on the importance of spinal cord injury prevention in and around water, and have been shown to change students’ opinions about checking the depth of swimming pools before diving. These resources include a Leader’s Guide and can be purchased on DVD or viewed on the Parachute Canada website.

    • “Dive Smart” is targeted at an elementary school students age 6 to 12 years and in Grades 1 to 6.
    • “Sudden Impact” is designed for high school 12 years of age and older, and in Grades 7 to 12.