Swimming is such a unique sport. There are not many sports that mix cardiovascular fitness in a non-weight bearing environment such as water. Combine that with the lack of oxygen and resistance the water produces which in turn requires both upper and lower body strength and endurance. No wonder it can be such a tough sport!

The main propulsive force for swimmers comes from the upper body – which again is uncommon as most sports come from the legs – with competitive swimmers completing between 5-20+hrs per week and in that time covering anywhere from 10km-100km. That equates to approximately 2500 or more shoulder rotations per day! That is a significant load going through the shoulder and thats before you add in any dry training or any other activities you may complete at school/work or in other sports. With this in mind its not a surprise to learn that the prevalence of shoulder injuries in swimmers ranges from 40-91% percent (5).

Let’s have a look at the shoulder. There are a variety of factors that are in play with shoulder injuries in swimmers. The factors that we consider are stroke technique/biomechanics, overuse and fatigue of the muscles and joint range of motion or laxity (4,5) 

  1. Swimming requires a lot of repetitive overhead movement. The position the shoulder goes into can put it at risk of impingement. Impingement is when the soft tissue structures around the shoulder become inflamed and can get impinged between the bony structures of the shoulder. It characteristically has that sharp, pinching feeling that you get in certain positions like when you lift your arm above your head and can also be very painful to sleep on(3). It commonly happens in the recovery phase of both freestyle and backstroke and causes the swimmer to jerk their shoulder away from that position. For swimm ers with a history of this there are technical things that can be worked on to minimise this. Like, when doing freestyle not crossing the midline as your hand enters the water. There are also some tell-tale signs for coaches that a swimmer may be in pain. During the recovery phase the swimmer may not be getting their elbow up as high as usual and instead have a really wide arm during the recovery and hand entry phase.
  2. The make up of the shoulder makes it an inherently unstable joint that requires the muscles to assist with its dynamic stability. During the course of swimming these muscles can become fatigued which can hinder their ability to help with providing stability. When this occurs it can leave the shoulder in a vulnerable position where it may be more likely to succumb to pain or an injury. Unfortunately female swimmers tend to be more prone to this type of injury as on average their arms are shorter requiring them to perform more strokes over a determined distance. Swimming can be particularly bias with the muscles it uses and places a high amount of demand on the muscles that internally rotate and adduct the shoulder, the muscles that predominantly perform these movements are the Latissimus Dorsi (Lats) and the Pectoralis muscles (Pecs). Due to this bias it can alter the shoulder position and the overall stability of the joint.
  3. Swimmers anecdotally have very mobile shoulder. This provides them with a significant advantage in that it allows them to position themselves to increase their stroke length as well as decreasing the amount of drag.The issue that can come from this is that swimmers have less stability through their shoulders and they compensate by using their muscles to supplement the stability. This in combination with a decrease capacity for the muscles to provide this stability due to them being fatigued and overused muscles can result in injuries.

There are multiple ways your Osteopath can help. Some of the ways in which we can help are:

  • Through a developed protocol screen your body, assessing things like your range of movement, your muscular strength and endurance and then devising a plan to exploit your strengths as well as working on any areas you’re not as strong in. 
  • Stroke analysis especially for swimmers with a history of injury can be extremely beneficial so we can determine if there is anything we can alter in your technique that decreases the risk of injury.
  • Tracking and management of the amount of load your putting your body through. This can be done through keeping a diary and logging the amount of kilometres and gym sessions you are performing. 

Prevention is the best cure and if we work collaboratively in a team it sets us up to get the best possible results. Some things that you can implement now are:

  • Incorporate dynamic stretches into the warm up along with swimming specific muscle activation exercises. The idea of a warm up, especially for explosive and fast events, is to excite the nervous system. These types of exercises facilitate that (1).
  • Save static stretches (the ones where you hold a position for a while) for after swimming or as part of a separate training program.
  • Introduce strengthening exercises to address all the shoulder muscles, not just the ones swimmers use most often.




Article by Lachlan Cossens, Osteopath at McKinnon Osteopathy. Lachlan swum competitively for 10 years competing at national age and open national championships across this time.

To book an appointment with Lachlan Click here or call on 9578 2436





  1. Behm, D. G., & Chaouachi, A. (2011). A review of the acute effects of static and dynamic stretching on performance. European journal of applied physiology, 111(11), 2633-2651.
  2. Hughes, J. (2015). Sub-Acromial Impingement. [image] Available at: http://www.opt.net.au/subacromial-impingement/ [Accessed 6 May 2018].
  3. Koester, M. C., George, M. S., & Kuhn, J. E. (2005). Shoulder impingement syndrome. The American journal of medicine, 118(5), 452-455.
  4. Walker, H., Gabbe, B., Wajswelner, H., Blanch, P., & Bennell, K. (2012). Shoulder pain in swimmers: A 12-month prospective cohort study of incidence and risk factors. Physical Therapy in Sport, 13(4), 243-249.
  5. Wanivenhaus, F., Fox, A. J., Chaudhury, S., & Rodeo, S. A. (2012). Epidemiology of injuries and prevention strategies in competitive swimmers. Sports health, 4(3), 246-251.