Dryland training for swimmers: shoulder care, strength and mobility

Shoulder pain is the commonest problem

91% of 80 young elite swimmers had had shoulder pain, and about 1 in 5 female club and masters swimmers in every age group had shoulder pain that limited them. It tracks how much you swim.

Sources 1, 2, 3

Mostly an overloaded tendon

69% of the elite swimmers scanned had an overloaded supraspinatus tendon of the rotator cuff (tendinopathy), linked with hours and distance swum. Loose shoulders, rotation range and past shoulder pain are risk factors.

Sources 1, 4

Prevention isn't proven in swimmers

No swimming trial has measured injuries. A 12-week routine kept rotator cuff strength through a season in competitive swimmers, and a warm-up programme cut shoulder problems in handball players in one trial, though pooled handball trials weren't significant.

Sources 5, 6, 7

Dryland strength makes you faster

Adding strength training to swimming improved performance by about 2 to 2.5%, and combined training took about 2 seconds off 100 m. Heavy pulling did best.

Sources 8, 9, 10

Starts and turns are leg power

Jump height tracked start performance almost perfectly, and jump and strength training improved starts and turns.

Sources 11, 12

Swimming doesn't load bone

Swimmers' bone density was similar to that of people who don't exercise. Add jumps and strength training on land.

Sources 13, 14

Aerobic and anaerobic

Pool races last from about 20 seconds to about 15 minutes, so both aerobic and anaerobic fitness count (our description), and elite swimmers may cover up to 9 miles a day in training.

Source 15

The arms do most of the work

Most of the propulsion comes from pulling the arm down and in and turning it inwards, driven mainly by the big chest and back muscles (pectoralis major and latissimus dorsi). That's why the muscles that turn the arm inwards get strong compared with those that turn it outwards.

Sources 15, 5

The back and the knees

Every stroke holds the lower back extended to keep you streamlined, more so in butterfly and breaststroke, which undulate. The breaststroke whip kick loads the inside of the knee.

Sources 15, 16, 17

Starts and turns

Pushing off the block or the wall is an explosive leg extension, and start performance tracked jump height almost perfectly.

Source 11

What isn't loaded: your bones

The water supports your weight, so swimming doesn't load bone.

Source 13

What to train (our reading)

Rotator cuff and shoulder-blade endurance, heavy pulling, jumps for starts and turns, a strong trunk, hip rotation range for breaststrokers, and impact work for your bones.

Swimmer's shoulder: how commonEmerging evidence

The share with shoulder pain and the rate of injuries are different measures, and the studies defined them differently:

• 80 young elite swimmers aged 13 to 25: 91% had had shoulder pain.
• 236 female competitive swimmers aged 8 to 77: shoulder pain that limited them in 19 to 23% of every age group, masters included.
• 12 studies of 1,460 competitive swimmers: shoulder pain in 19% to 91% by age group, highest in teenagers.
• 341 elite swimmers: 0.39 injuries per 1,000 hours overall, and 0.11 shoulder overuse injuries per 1,000 hours.
• The 2015 World Championships: 12.9 injuries and illnesses per 100 athletes; shoulder sprains and lower back muscle cramps were each 5.7% of injuries.

Sources 1, 2, 3, 18, 19

Mostly an overloaded tendonEmerging evidence

In the young elite swimmers, 84% had a positive impingement sign, and 69% of the 52 scanned had supraspinatus tendinopathy, which tracked the hours and distance they swam; joint looseness was only weakly linked. Our shoulder impingement (rotator cuff pain) and shoulder pain guides cover treatment.

Source 1

What raises the risk for shouldersEmerging evidence

Across 29 studies, the risk factors with moderate certainty were joint looseness and instability, shoulder rotation range, previous pain or injury, and competing at a higher level; the rest were low certainty. Athletes with hypermobile joints had about 3 times the odds of shoulder injury. Swimming volume was linked with shoulder pain in teenagers, and elite swimmers training more than 4 times a week had 4 times the risk of a shoulder overuse injury. Our hypermobility and shoulder dislocation guides cover loose shoulders.

Sources 4, 20, 3, 18

Breaststroker's kneeEmerging evidence

Pain on the inside of the knee from the whip kick. 86% of 36 competitive breaststrokers had had it and 47% had it weekly; in 391 competitive swimmers, 73% of breaststroke specialists and 48% of others had knee pain, and in a small film analysis injury rates were much higher when the hips were opened less than 37 or more than 42 degrees at the start of the kick. Among elite swimmers, 200 to 400 m breaststrokers had 5 times the risk of knee pain. These studies are old and small. We don't have a guide to it yet; our knee pain guide covers knee pain in general.

Sources 21, 16, 18, 17

The lower back and neckMixed evidence

Butterfly went with 2.5 times the risk of low back pain and 4 times the risk of neck injury in elite swimmers. Disc wear on scans was found in 68% of elite swimmers against 29% of recreational ones, but it wasn't linked with back pain. Swimmers with back pain arched the lower back more in the dolphin kick and had a tighter hip flexor (psoas), and in teenage breaststrokers and butterflyers a stress fracture in the spine (spondylolysis) can cause back pain. After the shoulder, the knee and spine are the commonest sites, and few of their risk factors are certain. Our back pain and neck pain guides cover these.

Sources 18, 22, 23, 24, 25

A 12-week routine kept rotator cuff strength through a seasonEmerging evidence

30 competitive swimmers aged 16 to 35, swimming at least 8 hours a week with no shoulder pain in the past 6 months, did five exercises twice a week for 12 weeks: turning the arm in and out with the elbow raised to shoulder height, scapular punches, and T and Y raises. They did 2 sets of 10 slow reps, 5 seconds up and 5 down, at about 75% of the most they could lift once, with weights of 1 to 5 kg or bands, checked and progressed by a physiotherapist.

Rotator cuff strength fell in 1 test in the exercise groups against 5 in the control group, who did mobility exercises, and the balance between the muscles stayed closer to normal. No one dropped out. It measured strength, not injuries. Our shoulder care routine for swimmers is built on it.

Source 5

Shorter programmes changed littleMixed evidence

44 college swimmers did band exercises for the shoulder blades and rotator cuff, rows, punches and throwing motions, plus corner and sleeper stretches, 3 times a week for 6 weeks; their strength and shoulder-blade movement didn't differ from controls. An 8-week elastic-band programme in 22 male swimmers and a single session in 23 young swimmers made no significant difference either.

Sources 26, 27, 28

The nearest tested programme is in handballEmerging evidence

In 660 elite handball players, a warm-up of 15 exercises in five groups (for the range of turning the arm in, the strength to turn it out, shoulder-blade strength, the kinetic chain and upper-back mobility), done 3 times a week through a 7-month season, cut shoulder problems by 28% (17% against 23% at any one time), but not significantly the more serious ones. Teams did it in about half their sessions. Pooled with two other handball trials, the effect wasn't significant. Our shoulder mobility and stability routine is built on its four parts; it's untested in swimmers.

Sources 6, 7

Manage your swimming volumeEmerging evidence

Volume tracked shoulder pain in teenagers and tendon changes in elite swimmers, so increase distance gradually and avoid sudden jumps, especially in young swimmers. With a painful shoulder, an expert review advises against hand paddles and pulling sets; a kickboard held with your elbows bent, or fins, can ease the load on the shoulder.

Sources 3, 1, 15

Breaststroke knee: cut the distance firstEmerging evidence

Knee pain was linked with breaststroke distance, years of training, age, kick technique and a shorter warm-up. Cut breaststroke distance first, build it back gradually early in the season, warm up properly, and ask a coach to check your kick (our reading of these associations).

Sources 21, 16

What isn't shownMixed evidence

That any programme prevents swimmer's shoulder in swimmers; that stretching prevents it, when loose shoulders are themselves a risk factor; or that core training speeds up turns, where the evidence is inconclusive.

Sources 4, 12, 29

Dryland strength makes swimmers fasterEmerging evidence

Across 27 studies of young and experienced competitive swimmers, adding strength training improved performance by about 2 to 2.5%, whether the strength work was in the water, swim-like on land or general gym training, and combined training beat swimming alone.

Source 8

About 2 seconds off 100 mEmerging evidence

Across 36 trials of 844 competitive swimmers, combining pool and dryland training took about 2 seconds off 100 m against the control groups. Water plus dryland resistance training ranked highest, and core and power training helped 25 m sprints and take-offs.

Source 9

Heavy, low-rep pulling did bestEmerging evidence

In 17 small controlled studies, dryland lifting of 6 reps or fewer for 3 sets, such as heavy pulldowns, had the largest effect on 50 m times. Another review found that low-volume training at high speed or high force carried over best.

Sources 10, 30

Jumps for starts and turnsEmerging evidence

Start performance correlated almost perfectly with vertical jump height, and jump training improved starts, though most studies used older starting blocks. Strength, ballistic and jump training improved turns; core training was inconclusive.

Sources 11, 12

Fitting it around the poolEmerging evidence

Two dryland sessions a week, after easier pool sessions or on separate days, with the jumps first while you're fresh (our suggestion). Swimming already loads your shoulders heavily, so pull heavy but keep extra overhead pressing to a minimum, and count the shoulder care routine as part of your dryland week: twice a week for 12 weeks kept rotator cuff strength through a season.

Sources 11, 15, 5

Young swimmers

One review of these trials left out groups with an average age under 16. Under-16s should have a coach teach and supervise their lifts, with moderate loads (our suggestion).

Source 30

The cross-body stretch for a stiff back of the shoulderEmerging evidence

In 54 adults without shoulder pain who could turn one arm inwards less than the other, the cross-body stretch, 5 × 30 seconds once a day for 4 weeks, restored about 20 degrees of inward turning, against 6 in the control group. It's a small trial, and not in swimmers.

Source 29

No sleeper stretch

In the same trial, the sleeper stretch's 12-degree gain wasn't significant, and lying on the shoulder squeezes it, as our shoulder guides note, so we've left it out.

Source 29

Don't stretch a loose shoulder furtherEmerging evidence

Loose joints are a risk factor for shoulder injury, so stretch only a clear stiffness. If your shoulder feels loose or has dislocated, put strength first and leave the stretches out (our reading, as in our shoulder dislocation guide).

Sources 4, 20

Upper back and hipsMixed evidence

Upper-back extension and rotation suit the streamlined position (our suggestion). Breaststrokers with frequent knee pain had less inward hip rotation, so hip rotation work may help them (an association). No trial shows that mobility work improves swim times.

Source 21

Swimming doesn't build boneEmerging evidence

Across 64 studies, swimmers' bone density was similar to that of people who don't exercise and lower than in impact sports. The UK consensus on exercise for osteoporosis doesn't count swimming as bone-loading.

Sources 13, 14

Load your bones on landStrong evidence

The consensus recommends at least 50 moderate impacts, such as 5 sets of 10 jumps, on most days, plus strength training 2 or 3 days a week. The jumps in the dryland workout count; with osteoporosis, start with heel drops and ask a physiotherapist.

Source 14

Cold water shockStrong evidence

In water at 15°C or colder, a sudden plunge makes you gasp and breathe up to 10 times faster, with a spike in heart rate and blood pressure that the Royal Society for the Prevention of Accidents (RoSPA) says can cause a heart attack, even in healthy people. If you fall in, tilt your head back with your ears under, relax and breathe, move your hands to stay afloat, and shout for help once it passes.

Source 31

Open waterStrong evidence

The Royal Life Saving Society UK warns that depth changes and is unpredictable, objects can be hidden under the surface, and currents can sweep you away, and it names jumping from height (tombstoning) as a hazard. Never jump or dive into water whose depth you haven't checked (our suggestion).

Source 32

EpilepsyStrong evidence

The UK National Health Service (NHS) advises thinking about safety when swimming. Hot or cold water is a common trigger for seizures, and in open water the Royal Life Saving Society UK advises supervision within arm's reach. Talk to your doctor or epilepsy nurse, and swim where there's a lifeguard, with someone who knows what to do (our suggestion).

Sources 33, 34

Ear infectionsStrong evidence

Don't swim with an ear infection. Earplugs, or a swimming hat over your ears, help prevent them.

Source 35

Asthma

Chlorine can trigger asthma in some people. Our asthma guide covers swimming and warming up.

Check the readiness questions first

Check with your GP or a qualified exercise professional before hard training if you answer yes to any question on the Physical Activity Readiness Questionnaire (PAR-Q+): a heart condition or high blood pressure, chest pain, dizziness or fainting, another long-term condition or its medicines, a bone or joint problem, or being told to exercise only under medical supervision.

Source 36

Epilepsy

Talk to your doctor or epilepsy nurse first, and follow the water safety advice above.

Sources 33, 34

A heart condition, before cold or open water

Cold water shock sends heart rate and blood pressure up sharply. Ask your GP or heart team before swimming in cold or open water (our suggestion).

Source 31

A shoulder that has dislocated or feels loose

Loose shoulders are a risk factor for injury. Put strength before stretching, and see our shoulder dislocation guide.

Sources 4, 20

An ear infection now

Wait until it has cleared before you swim.

Source 35

Pregnant

The NHS says swimming can be good exercise in pregnancy, and advises against scuba diving.

Source 37

Call 999: chest pain

Get out of the water and call 999 for sudden chest pain or discomfort that doesn't go away (it can feel like squeezing, pressure or burning), pain that spreads to your arms, neck, jaw, stomach or back, or chest pain with sweating, feeling sick, light-headedness or breathlessness.

Source 38

Shoulder

Ask for an urgent GP appointment or contact NHS 111 for sudden or very bad shoulder pain, an arm you can't move, a shoulder that has changed shape or is badly swollen, pins and needles that don't go away, no feeling in the arm, an arm that's hot or cold to touch, pain after a fall or injury, severe pain in both shoulders, or if you feel feverish or unwell. See a GP if shoulder pain is getting worse or isn't better after 2 weeks.

Source 39

A blow to the head

Hitting your head on the wall, the floor or another swimmer can cause a concussion. Under the UK concussion guidelines for grassroots sport, if in doubt, stop for the day and get assessed by NHS 111 or a healthcare professional within 24 hours. Call 999 if someone was knocked out and hasn't woken up, can't stay awake, has a fit, or has new numbness or weakness, or problems walking, speaking or understanding.

Sources 40, 41

Back pain with numbness

Call 999 or go to A&E if back pain comes with numbness or loss of feeling around your genitals or bottom, changes in bladder or bowel control, or pain or numbness in both legs.

Source 42

Knees

Contact NHS 111 if your knee is very painful, you can't move it or put any weight on it, it's badly swollen or has changed shape, it locks or gives way, or it's hot and red and you have a high temperature.

Source 43

"Shoulder pain is just part of swimming"Emerging evidence

It's common, but it tracks how much you swim and is mostly an overloaded tendon, which responds to managing the load and strengthening.

Sources 1, 3

"Stretch your shoulders to prevent swimmer's shoulder"Mixed evidence

No trial shows it, and loose shoulders are a risk factor, so strength comes first and stretching is for a clear stiffness, such as less inward turning on one side.

Sources 4, 20, 29

"Swimmers don't need dryland strength"Emerging evidence

Swimming combined with strength training beat swimming alone in pooled trials.

Sources 8, 9

"Swimming builds strong bones"Emerging evidence

Swimmers' bone density is similar to that of people who don't exercise, and the UK osteoporosis consensus doesn't count swimming as bone-loading. It's still good for your heart and lungs.

Sources 13, 14

"Breaststroke is bad for your knees"Emerging evidence

Knee pain is common in competitive breaststrokers and linked with breaststroke distance, years of training and kick technique. It says little about occasional swimmers (our reading).

Sources 21, 16, 18

"Swimming is always good for a bad back"Mixed evidence

The NHS lists swimming among the activities that may help back pain, but butterfly went with 2.5 times the risk of low back pain in elite swimmers. Favour freestyle or backstroke while your back settles (our suggestion).

Sources 42, 18

"Core work speeds up your turns"Mixed evidence

The evidence for core training on turns is inconclusive; leg power training has better support.

Source 12