Overuse Injuries in Swimming

Learn about common overuse injuries in swimming, including swimmer's knee, rotator cuff injuries, and shoulder impingement, along with their causes, symptoms, prevention, and treatment strategies.
Written by
Chris Temples
Published on
Jun 18, 2024

Understanding Swimmer's Knee, Rotator Cuff Injuries, and Shoulder Impingement

Swimming is a demanding activity, both for the recreational swimmer, or the athlete training for an event, often involving multiple hours of practice each week. While the benefits of swimming are numerous, including improved cardiovascular health, muscle tone, and mental well-being, the sport also carries the risk of overuse injuries. Today we are going to explore three common overuse injuries among swimmers: swimmer's knee, rotator cuff injuries, and shoulder impingement, delving into their causes, symptoms, prevention, and treatment.

Swimmer's Knee

Swimmer's knee, also known as breaststroker's knee, is a common overuse injury among swimmers, particularly those specializing in the breaststroke. This condition involves pain and inflammation around the knee joint, particularly affecting the medial collateral ligament (MCL).

Photo Source: Thermoskin

The repetitive motion of the breaststroke kick places significant stress on the knee's MCL. This ligament, which stabilizes the knee, can become strained and inflamed due to the forceful and repetitive lateral movements. Symptoms of swimmer's knee include pain on the inside of the knee, swelling, and tenderness. In severe cases, swimmers might experience a reduced range of motion and difficulty performing the breaststroke kick.

Preventing swimmer's knee involves incorporating strength training exercises to build the muscles around the knee, improving flexibility through stretching, and ensuring proper technique during the breaststroke kick. Swimmers should also incorporate cross-training activities to avoid overloading the knee joint.

While traditionally treatment for swimmer's knee typically involves rest, ice, compression, and elevation (RICE), the original physician that popularized the RICE method later came back out and recanted his statement as it directly inhibits the healing cycle. Instead, it is preferable to utilize the PEACE (protection, elevation, avoid antiinflammatories, compression, education) and LOVE (load, optimism, vascularization, exercise) method that is backed by modern research.

Rotator Cuff Injuries

Rotator cuff injuries are another prevalent overuse injury among swimmers. The rotator cuff is a group of four muscles and their tendons that stabilize the shoulder joint, allowing for a wide range of shoulder movements.

Image Source: Verywell Health

Swimming, especially freestyle, backstroke, and butterfly, involves repetitive overhead arm movements. These movements can lead to microtraumas in the rotator cuff muscles and tendons, particularly if the swimmer has poor technique or insufficient strength. Symptoms include shoulder pain, weakness, and a reduced range of motion. Swimmers might also experience a grinding sensation when moving the shoulder.

Preventing rotator cuff injuries involves strengthening the shoulder muscles, improving flexibility, and ensuring proper swimming technique. Swimmers should focus on exercises that target the rotator cuff, such as internal and external rotations with resistance bands. Proper warm-ups and cool-downs are also crucial.

Shoulder Impingement

Shoulder impingement is another common overuse injury among swimmers, often resulting from repetitive overhead movements and poor stroke technique.

Shoulder impingement occurs when the tendons of the rotator cuff become compressed or "impinged" between the shoulder bones during overhead arm movements. This compression can lead to inflammation and pain. Symptoms include sharp pain in the shoulder, particularly when lifting the arm, as well as weakness and reduced range of motion. Swimmers may also experience pain at night, which can disrupt sleep.

Image Source: Emerge Ortho

To prevent shoulder impingement, swimmers should focus on maintaining proper technique and incorporating exercises that strengthen the muscles around the shoulder joint. Stretching and flexibility exercises can help maintain a full range of motion and reduce the risk of impingement.

Treatment for shoulder impingement typically involves modifying activities and avoiding activities that excessively exacerbate the pain. Physical therapy is crucial for improving shoulder strength and flexibility. In some severe cases, corticosteroid injections or arthroscopic surgery to remove any impinging structures.


Swimmer's knee, rotator cuff injuries, and shoulder impingement are common overuse injuries that can significantly impact a swimmer's performance and overall health. Understanding the causes, symptoms, prevention strategies, and treatment options for these injuries is crucial for swimmers who train extensively. By focusing on proper technique, incorporating strength and flexibility exercises, and listening to their bodies, swimmers can minimize the risk of these overuse injuries and continue to enjoy the numerous benefits of their sport. Ultimately, a balanced approach to training and recovery is key to maintaining long-term health and success in swimming. Consider implementing cross training into your exercise regimen - alternating days of swimming with strength and/or flexibility sessions and adequate rest for your training load.

If you are in the Birmingham, Alabama area and are experiencing any of the injuries listed above, book a free injury screen with Vulcan Performance at one of our two locations (Mountain Brook or Inverness) by clicking here. We look forward to enhancing what moves you!

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