Olympics Swim Competition: 3 Common Injury Risks and Preventative Approaches

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July 29, 2016

By Tim Koba, MS, ATC

As the Summer Olympics approach, athletes and fans prepare for the athletic contests. One of the most popular sports in the summer games is swimming. With that in mind, we will take a look at 3 common injury risks and preventative approaches.

1. Shoulder

When we think swimming injuries, the shoulder comes to mind as the most commonly involved joint. In fact, the term swimmer’s shoulder was coined to discuss the unique anterior shoulder pain that swimmers experience as a result of their sport. This results from the triad of swimming biomechanics, muscular overuse and fatigue and glenohumeral laxity and instability. The typical swim stroke of shoulder adduction and internal rotation leads to hypertrophy of the pectoralis major and latissimus dorsi, as well as the under recruitment or over exertion of the teres minor, pectoralis minor and serratus anterior. As the arm is in constant overhead motion, the inability of those muscles to provide adequate stability can lead to increased pain and pathology.

2. Knee

Symptoms involving knee pain would not necessarily be thought to occur in swimming, but it is the second most common complaint amongst swimmers. The breaststroke is the most likely to result in pain, and the usual area of concern is the medial knee compartment with some anterior pain. The unique whip-like kicking motion of that stroke in conjunction with water resistance can lead to a variety of medial knee pathology including MCL tenderness, pes anserinus or hip flexor and adductor strains. The patella may also be overloaded if swimmers are constantly kicking and maintaining tension on their patella tendon.

3. Back

As swimmers propel themselves underwater they rely on hyperextension of their spine in order to streamline their bodies. Constant hyperextension can lead to developing extension based low back disorders, spondylolysis and degeneration over time. The breaststroke and butterfly tend to place the most strain on the low back.


The common denominator in developing an injury as a swimmer is stroke mechanics. If the stroke movement deteriorates due to fatigue, muscle imbalance or stress, pain will ensue.

As Athletic Trainers, our job is not to change their stroke mechanics, but rather, to work with the coach and athlete to identify overload leading to pain. Once identified, the coach can correct the movement and reinforce proper stroke mechanics. To help swimmers increase their strength, endurance and shoulder stability, simple exercises can be performed as a prehab strategy. Exercises that address the external rotators, rhomboids, lower trapezius and serratus muscles can effectively stabilize the head of the humerus and decrease strain as a result of their sport. Incorporating a core stability training program can help avoid low back pain and degeneration.

When athletes improve their underwater form, strengthen their shoulders and stabilize their core, they can better handle the high training loads that lead to success. Working with swimmers to address these areas can also keep them under the water and out of the athletic training facility.


Wanivenhaus, F., et al. (2012). Epidemiology of injuries and prevention strategies in competitive swimmers. Sportshealth.


About the Author

Koba 1

Tim Koba is an Athletic Trainer, strength coach and sport business professional based in Ithaca, New York. He is passionate about helping others reach their personal and professional potential by researching topics of interest and sharing it with others. He contributes articles on injury prevention, management, rehabilitation, athletic development and leadership.

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