Swimming injury prevention for girls.
Very high repetition volume in a non-impact sport — which creates its own bone and shoulder problems.
Non-impact
Swimming provides little osteogenic loading — dryland strength work supplies it.3
8 min
Pre-pool protocol targeting the scapula, cuff, and hips.
Competitive swimmers perform enormous stroke volumes — often tens of thousands of shoulder revolutions a week. Imaging work in elite swimmers linked shoulder pain primarily to swim-volume-induced supraspinatus tendinopathy, and epidemiological review identifies the shoulder as the dominant injury site in the sport, followed by the knee in breaststrokers and the low back in butterfly and turn-heavy training.
Swimming also has a bone problem that surprises people. Because it is non-impact, swimmers do not get the bone-loading stimulus that runners and jumpers do, and when high training volume is combined with inadequate fueling, bone density suffers. Dryland resistance training is not optional in this sport — it is the bone stimulus.
What actually injures swimming players
Shoulder pain / supraspinatus tendinopathy
The sport's defining injuryMechanism: Very high stroke volume with scapular fatigue, often worsened by paddles and heavy pulling sets.
Female-specific: Greater shoulder laxity in many female swimmers means scapular and cuff strength carries more of the stability burden; dryland strength is protective.1,2
Breaststroker's knee
Common in breaststroke specialistsMechanism: Repeated valgus load at the knee during the whip kick.
Female-specific: Hip strength and kick technique modification reduce symptoms; volume reduction on breaststroke kick sets is the first lever.2
Why the risk is different for girls
These factors change what prevention has to address — they are not reasons to train girls less.
No impact means bone needs a separate plan
Land-based resistance training and impact work — jumping, hopping, loaded carries — should be a scheduled part of a swimmer's week specifically for bone health, alongside adequate calcium, vitamin D, and total energy intake. This is especially important for adolescent girls building peak bone mass.3,4
Energy availability comes before every other adaptation
When an athlete does not eat enough to cover the energy her training burns, the body downregulates the systems it treats as optional first — menstrual function, bone remodeling, immune response, and tissue repair. The IOC calls this Relative Energy Deficiency in Sport (REDs), and it raises bone stress injury and soft-tissue injury risk independent of how good her mechanics are. Amenorrhea (no period for three or more months) in an athlete is a clinical finding, not a convenience.4,5,3
Puberty changes the machine mid-season
The adolescent growth spurt lengthens the levers (femur, tibia) faster than the neuromuscular system recalibrates, and in girls the strength gain that accompanies growth is smaller than in boys. The result is a two- to three-year window of reduced dynamic knee control, wider dynamic valgus on landing, and higher relative injury risk. Programming should get more — not less — landing and single-leg work through this window.9
Menstrual-cycle phase is a variable, not a taboo
Hormonal fluctuation across the cycle affects laxity, neuromuscular control, thermoregulation, and perceived exertion, and prospective data in international footballers found injury incidence differed by cycle phase. The practical action is not to restrict training but to track: a simple cycle log next to load data lets athletes and staff see patterns and adjust intensity, hydration, and fueling.10
The protocol, block by block
Run on deck before getting in, and complete two dryland strength sessions per week.
Block 1 of 5
General warm-up
Arm swings, trunk rotations, hip openers, and light aerobic movement on deck.
- Warm before the water
- Full range
- Unhurried
What to check, and when to escalate
Shoulder pain and range check
Monthly question set on pain during and after training, plus internal rotation range measurement.
Red flag: Pain persisting after practice, night pain, or progressive range loss.
Scapular control
Observe a wall slide and push-up plus from behind.
Red flag: Winging or early shrug — add scapular strength work before increasing yardage.
Energy and menstrual history
Confidential preseason and mid-season check on fueling around double sessions, cycle regularity, and prior fracture.
Red flag: Amenorrhea or under-fueling around morning practice — refer to a clinician.
Load rules that prevent overuse
- Increase weekly yardage gradually and log paddle and pull volume separately — those sets load the shoulder disproportionately.
- Do not stack maximal pull sets on consecutive days; rotate stroke emphasis across the week.
- Schedule two dryland strength sessions weekly, including impact work, for bone health and shoulder capacity.
- Fuel between double sessions; a morning practice on no breakfast is a REDs risk factor, not discipline.
Gear & equipment
- Hand paddles reintroduced last and used sparingly — they multiply shoulder load.
- Well-fitted goggles; a poor fit changes head position and, downstream, stroke mechanics.
- Snorkels and fins used deliberately, not defaulted to, since they change the loading pattern.
Stages, not dates
Progression is criteria-based and clinician-led. A calendar date is not a clearance.
Stage 1 of 5
1. Pain-free at rest
No night pain; full pain-free shoulder range.
Questions coaches and parents ask
In most cases it is cumulative stroke volume overwhelming the cuff and scapular muscles, producing supraspinatus tendinopathy — not a single technical fault. The fixes are yardage management, reduced paddle and pull volume, and structured dryland shoulder strength work.
Every claim, sourced
12 peer-reviewed sources. Each links to its PubMed record so you can read the original.
- 1
Sein ML, Walton J, Linklater J, et al. Shoulder pain in elite swimmers: primarily due to swim-volume-induced supraspinatus tendinopathy. Br J Sports Med. 2010;44(2):105-113.
PubMed 18463295 - 2
Wanivenhaus F, Fox AJS, Chaudhury S, Rodeo SA. Epidemiology of injuries and prevention strategies in competitive swimmers. Sports Health. 2012;4(3):246-251.
PubMed 23016094 - 3
Ackerman KE, Cano Sokoloff N, De Nardo Maffazioli G, Clarke HM, Lee H, Misra M. Fractures in relation to menstrual status and bone parameters in young athletes. Med Sci Sports Exerc. 2015;47(8):1577-1586.
PubMed 25397605 - 4
Mountjoy M, Ackerman KE, Bailey DM, et al. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023;57(17):1073-1097.
PubMed 37752011 - 5
De Souza MJ, Nattiv A, Joy E, et al. 2014 Female Athlete Triad Coalition consensus statement on treatment and return to play of the female athlete triad. Br J Sports Med. 2014;48(4):289.
PubMed 24463911 - 6
Kox LS, Kuijer PPFM, Kerkhoffs GMMJ, Maas M, Frings-Dresen MHW. Prevalence, incidence and risk factors for overuse injuries of the wrist in young athletes: a systematic review. Br J Sports Med. 2015;49(18):1189-1196.
PubMed 25872521 - 7
Gabbett TJ. The training—injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med. 2016;50(5):273-280.
PubMed 26758673 - 8
Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2014;48(11):871-877.
PubMed 24100287 - 9
Hewett TE, Myer GD, Ford KR, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33(4):492-501.
PubMed 15722287 - 10
Martin D, Timmins K, Cowie C, et al. Injury incidence across the menstrual cycle in international footballers. Front Sports Act Living. 2021;3:616999.
PubMed 33733235 - 11
Sugimoto D, Myer GD, Foss KDB, Hewett TE. Dosage effects of neuromuscular training intervention to reduce anterior cruciate ligament injuries in female athletes: meta- and sub-group analyses. Sports Med. 2014;44(4):551-562.
PubMed 24370992 - 12
Jayanthi N, Pinkham C, Dugas L, Patrick B, LaBella C. Sports specialization in young athletes: evidence-based recommendations. Sports Health. 2013;5(3):251-257.
PubMed 24427397
Go deeper