Swimming Performance and the Role of Physical Therapy: Move Better, Swim Stronger, Stay Pain-Free

By Kathy Ryan-Ceisel, PT MHS

Sports Physical Therapist and Overhead Throwing Specialist

Owner, Athletic Edge and Wellness

🏊‍♀️ Swimming is one of the most physically demanding sports — combining endurance, strength, flexibility, and precise technique. Whether you’re a competitive swimmer or just training for fitness, your body endures repetitive overhead movements, high shoulder rotation forces, and constant core engagement. Over time, even small imbalances can limit performance or lead to injury.

That’s where physical therapy comes in — not only to help swimmers recover from pain but to improve performance, efficiency, and longevity in the water.

💪 The Physical Demands of Swimming

Swimming uses nearly every major muscle group, but it’s particularly taxing on:

• Shoulders and upper back – Repetitive overhead strokes can cause fatigue, impingement, or rotator cuff irritation.

• Core and hips – Power and stability for every stroke come from the trunk and pelvis, driving rotation and maintaining body alignment.

• Knees and ankles – Flutter and dolphin kicks put stress on these joints, especially in breaststroke where “breaststroker’s knee” is common.

Research shows that swimmers perform thousands of shoulder revolutions per week. One study found that up to 91% of competitive swimmers experience shoulder pain — often referred to as “swimmer’s shoulder.”(Hibberd et al., 2016, Clinical Journal of Sports Medicine)

Common injuries include:

• Rotator cuff tendinopathy or impingement

• Shoulder instability

• Low back strain from repetitive extension and rotation

• Knee pain (breaststroke kick)

• Neck tightness from breathing mechanics, poor technique, and muscular imbalance in the shoulder

🔬 How Physical Therapy Enhances Swimming Performance

1. Movement Analysis & Biomechanical Screening

Physical therapists evaluate a swimmer’s movement patterns — both on land and in the pool — to identify inefficient mechanics, mobility restrictions, or muscular imbalances. Small deficits in shoulder rotation, hip extension, or core control can drastically affect stroke efficiency and drag.

Example: If a swimmer lacks shoulder external rotation, they might overreach during freestyle, placing excess strain on the rotator cuff and slowing stroke recovery.

2. Shoulder Stability and Strength Training

The shoulder joint sacrifices stability for mobility — which is why swimmers are prone to overuse injuries. PTs develop strengthening programs for the rotator cuff, scapular stabilizers, and posterior chain, which support efficient propulsion and joint protection.

Key exercises include:

• Scapular retraction drills

• External rotation-posterior rotator cuff work with resistance bands

• Closed-chain stability work (planks, wall slides)

• Land-based power work for the lats, traps, and serratus anterior

3. Core and Hip Control for Power and Efficiency

Strong core and hip control allow swimmers to transfer energy efficiently from the upper to lower body.  The latissimus dorsi (lats)  must work during the water entry, pull through, and recovery phase; it is most active to pull the arm down and back through the water. The lats also connect the lower back dynamically to the arm. The lats help to generate power the most with the freestyle and butterfly strokes.

Physical therapy builds endurance and stability through exercises like:

• Dead bugs, bird dogs, and Pallof press

• Shoulder extension, rowing, and superman’s

• Glute bridges and hip hinging

• Rotational control drills for butterfly and freestyle strokes

A well-trained core also helps prevent low back pain — a frequent issue in butterfly and breaststroke swimmers.

4. Mobility for Fluid Motion

Mobility in the thoracic spine, shoulders, and hips ensures optimal stroke mechanics. PT-guided mobility sessions use manual therapy, stretching, and activation techniques to enhance range of motion without compromising stability.

This helps swimmers:

• Achieve longer stroke length

• Reduce drag

• Improve breathing rotation

5. Injury Recovery and Prevention

If pain develops, physical therapists guide swimmers through individualized rehab that restores strength, mobility, and endurance while maintaining water feel and conditioning.

A PT’s goal is always a safe and complete return to performance, not just a return to the pool. Often swimmers need a guided return to swimming protocol with modifications in distance, intensity, and stroke selection.

6. Graded return to pool training after injury

When injuries occur and training is halted, it is imperative a structured plan is in place for returning to swimming. Water has 12x the resistance than air; safely reintroducing swimming activities while gradually restoring endurance, technique, and load tolerance in the shoulder and upper body is paramount to long term performance and success. It is easy to overload healing tissues with the added resistance from the medium of water. The goal is progressive exposure — not conditioning — during early phases. Land based exercises are performed to compliment swimming goals.

Phase 1: Reintroduction / Technique Emphasis

Goals: Restore tolerance to water mechanics, focus on body position, streamline, and low-resistance arm motion. Use of kickboards and fins is encouraged to maintain cardiovascular load while reducing arm stress.

Phase 2: Controlled Load & Volume Progression

Goals: Gradual reloading of shoulder through increased volume and controlled intensity.

Phase 3: Power Endurance & Stroke Integration

Goals: Restore higher-intensity training, incorporate all strokes as tolerated, and mimic competitive demands.

Phase 4: Full Return to Training

Goals: Resume regular practice volume and competition-level intensity.

🏊‍♀️Workload & Intensity Considerations (Research-Based)

• Load should increase progressively: <15% weekly volume increase (Mann et al., J Sci Med Sport, 2020).

• Monitor shoulder load: Use the Acute: Chronic Workload Ratio (ACWR) — aim for 0.8–1.3.

• Stroke-specific demands:

  • Freestyle: Moderate load; continuous propulsion.

  • Backstroke: Lower anterior shoulder stress; good for early reintroduction.

  • Breaststroke: High medial knee stress due to whip kick — add later.

  • Butterfly: Highest shoulder torque — reintroduce last and minimally.

🧠 The Science of Prevention

Studies show that swimmers with poor scapular control, weak external rotators, or limited thoracic mobility are significantly more likely to develop shoulder pain.(McMaster & Troup, 1993; Tate et al., 2012)

Regular movement screenings, dryland training, and early PT intervention can reduce injury rates by addressing these issues before they become performance-limiting. Dr-land training program prove to be effective in reducing muscle imbalance and muscular fatigue in swimming.

🏁 Takeaways

Physical therapy plays a vital role in both the performance and longevity of swimmers. Through movement analysis, strength optimization, mobility work, and recovery strategies, PT helps athletes move efficiently, avoid injury, and reach peak performance in the water.

If you’re feeling shoulder fatigue, hip tightness, or stiffness after swimming — or just want to improve your form — working with a sports physical therapist can keep you at your best, one stroke at a time.

At Athletic Edge and Wellness, we specialize in helping swimmers recover from injury, improve technique, & enhance performance through personalized physical therapy and movement training. Whether you’re returning from shoulder pain, building endurance, or working on stroke mechanics, our team will help you move efficiently and confidently in and out of the pool.

💧 Contact us today to schedule your swimming assessment or learn more about our performance and recovery programs.📞 Call us at 224-505-3343 or visit us at ww.edge360wellness.com to get started!