Yoga for swimmers: the shoulders, upper back and hips, and why loose shoulders need strength

Shoulder pain is the commonest problem

In 80 young elite swimmers, 91% reported shoulder pain, and about 1 in 5 female club and masters swimmers of every age had pain that got in the way. It tracks how much you swim, and sudden jumps in training.

Sources 1, 2, 3

Loose shoulders need strength, not more stretch

Loose, unstable shoulders are a risk factor, and athletes with very flexible (hypermobile) joints had about 3 times the odds of a shoulder injury. Stretching aggravated painful shoulders in a survey of 1,262 swimmers, and the NHS says not to overextend your joints just because you can.

Sources 4, 5, 6, 7

Stretch only a clear stiffness

The one shoulder stretch with trial support, the cross-body stretch, restored about 20 degrees of inward turning in people who had lost it on one side. Across 22 studies, shoulder range itself had moderate evidence against being a risk factor.

Sources 8, 9

Strength first; yoga adds control

Weaker endurance at the back of the shoulder predicted pain, five shoulder exercises twice a week held rotator cuff strength through a season, and dryland strength training improved swimming. Yoga adds shoulder-blade, back and trunk holds, not a replacement.

Sources 3, 9, 10, 11

Breathe slowly on land, never hold it in the water

In 27 young swimmers, a month of yogic breathing improved lung tests. But Swim England says never hyperventilate or practise prolonged breath-holding: it can cause a blackout underwater without warning.

Sources 12, 13, 14

No trial of yoga poses in swimmers

We found no trial of yoga poses in swimmers, so this page borrows from shoulder and dryland studies. Swimming doesn't build bone, and yoga doesn't either.

Sources 15, 16

The arms do most of the work

The arms produce most of the propulsion by pulling down and in, so the muscles that turn the arm inwards get strong compared with those that turn it out (our swimming page). Every stroke streamlines the body with the arms overhead, and front crawl and backstroke rotate the trunk with each breath and stroke.

Strokes load the back and knees differently

Butterfly and breaststroke arch the lower back, and the breaststroke kick loads the inside of the knee. Starts and turns are leg power (our swimming page).

Source 17

Swimmer's shoulder is a description, not a diagnosis

It's mostly an overloaded rotator cuff tendon (supraspinatus tendinopathy) that tracks how much you swim, with looseness, the shoulder blade, stroke technique, posture and sudden jumps in training playing parts. Our shoulder pain when swimming guide covers it in full.

Sources 1, 18, 19

Loose in one direction, stiff in another

Elite swimmers' shoulders are looser than recreational swimmers', partly inborn and partly from training. Yet some swimmers also lose inward turning at the back of the shoulder, or stiffen through the chest and upper back. So the shoulder can be too loose one way and stiff another, which is why blanket stretching doesn't suit it.

Sources 20, 21, 22

No trial of yoga poses in swimmersMixed evidence

A PubMed search for yoga or pranayama (yogic breathing) with swimming returned 46 records: one trial of yogic breathing, and none of yoga poses in swimmers. A Europe PMC title search found none either. What yoga does for swimmers is borrowed from shoulder, posture and dryland studies, below.

Sources 15, 23

Yogic breathing in young swimmersEmerging evidence

In one small randomised study, 27 national and international swimmers aged 13 to 20 did yogic breathing for 30 minutes, 5 days a week, for a month: sectional breathing, bellows breathing (bhastrika) and alternate nostril breathing with breath holds. Their maximal voluntary ventilation (how much air they could move in a minute of hard breathing), forced vital capacity (how much air they could blow out after a full breath in) and strokes per breath improved more than in swimmers who had no extra training. This page doesn't teach the fast breathing or the breath holds, for the safety reasons below.

Source 12

BonesEmerging evidence

Across 64 studies, swimmers' bone density was similar to that of people who didn't exercise, and lower than in high-impact sports. Yoga isn't the impact or heavy strength work that builds bone either; our swimming page has the jumps and strength training.

Source 16

How common it isEmerging evidence

Of 80 elite swimmers aged 13 to 25, 91% reported shoulder pain. Of 236 female competitive swimmers aged 8 to 77, about 1 in 5 in every age group, masters included, had shoulder pain with disability. Across 12 studies (1,460 swimmers), shoulder pain ranged from 19.4% to 91.3% by age group, highest in teenagers.

Sources 1, 2, 18

Mostly an overloaded tendonEmerging evidence

Of 52 elite swimmers scanned, 69% had supraspinatus tendinopathy, and it went with more hours (a correlation of 0.39) and more distance (0.34) swum, a modest link. Shoulder looseness was only weakly linked with pain and not with the tendon changes. In teenage swimmers, training volume was linked with pain, and reviewers advise avoiding sudden large increases.

Sources 1, 18

What predicted painEmerging evidence

In 201 youth swimmers followed for two seasons, a sudden jump in training load (about 4 times the odds), weaker endurance at the back of the shoulder and errors in how the hand entered the water predicted shoulder pain that got in the way. Across 29 studies, looseness and instability, shoulder rotation range, past pain or injury and competitive level were the risk factors with moderate certainty. A 22-study review named strength endurance at the back of the shoulder as possibly the most relevant risk factor you can change.

Sources 3, 4, 9

Looseness is a risk factorEmerging evidence

Loose, unstable shoulders were among the risk factors with moderate certainty across 29 studies. Athletes with hypermobile joints had 3.25 times the odds of a shoulder injury (8.23 times with a hypermobile shoulder), on low-quality evidence. The NHS says the main treatment for joint hypermobility syndrome is improving muscle strength and fitness, and "do not overextend your joints just because you can".

Sources 4, 5, 20, 7

Stretching a painful shoulder can aggravate itEmerging evidence

In a 1993 survey of 1,262 US competitive swimmers, current shoulder pain ranged from 10% in age-group swimmers to 26% on the national team, and those with painful shoulders found that weight training, hand paddles, kickboards, stretching and resistance work aggravated them.

Source 6

Some stiffness goes with pain tooMixed evidence

In small studies, less range taking the straight arm out and back at shoulder height (24 young swimmers), stiffer back-of-shoulder and small chest muscles (46 swimmers over 6 months), and less inward turning with a rounder upper back (64 men) went with pain, and in 1985 a lack of flexibility predicted swimmer's shoulder in 168 swimmers. But a 22-study review found moderate evidence against shoulder rotation range as a risk factor. A study of 236 swimmers suggested chest and back-of-shoulder stretching only as part of a programme with less swimming, cross-training and strengthening.

Sources 24, 22, 21, 25, 9, 2

The one stretch with trial supportEmerging evidence

In 54 adults (not swimmers) whose shoulder turned inwards at least 10 degrees less on one side, the cross-body stretch, 5 holds of 30 seconds once a day for 4 weeks, gained 20.0 degrees against 5.9 in the control group; the sleeper stretch's 12.4 degrees wasn't a significant gain. In 44 college swimmers, adding corner and sleeper stretches to band strengthening changed nothing measured.

Sources 8, 26

Short stretches before a swim are fineEmerging evidence

In 14 competitive swimmers, 2 holds of 30 seconds for the back and chest muscles after an aerobic warm-up gave small range gains and small power losses that weren't significant; adding band pull-overs gave the biggest range gain and better strength. Across sports, long holds of 60 seconds or more just before testing cost about 4.6%. So keep long holds for after training.

Sources 27, 28

What this means for yoga

Strength and control first; stretch only a clear stiffness, such as one shoulder turning inwards less than the other, with the cross-body stretch at chest height. With a loose shoulder: no binds, deep shoulder openers, hanging in downward dog or holds at the end of your range, and stop or shrink any move that feels as if the shoulder might slip (our shoulder pain when swimming and hypermobility guides).

Rotation and postureMixed evidence

In 34 college swimmers, upper-back rotation wasn't linked with shoulder pain or with how the shoulder blade moved. In 64 male swimmers, a bigger upper-back curve while lifting the arm went with pain. An 8-week posture exercise programme changed forward head and rounded shoulder posture in 28 college swimmers, while a consensus of stretching researchers agrees that stretching alone doesn't improve posture.

Sources 29, 21, 30, 31

What this means for yoga

Upper-back twists and gentle back bends feel good and let the shoulder blade move, but they haven't been shown to prevent shoulder pain. Pair them with the shoulder-blade holds below (our reading).

The back of the shoulderEmerging evidence

Weaker endurance at the back of the shoulder predicted pain in youth swimmers, and a 22-study review named it as possibly the most relevant risk factor you can change. In 30 competitive swimmers, five shoulder exercises twice a week for 12 weeks limited the fall in rotator cuff strength over a season. A review of 14 low-quality studies found 6 to 8 weeks of strengthening the muscles that turn the arm out and draw the shoulder blades back, with chest stretches, may reduce shoulder pain.

Sources 3, 9, 10, 32

Dryland trainingEmerging evidence

Across 27 studies, strength training plus swimming beat swimming alone, improving performance by about 2% to 2.5%. Across 36 trials (844 swimmers), combined water and dryland training took about 2 seconds off 100 metres.

Sources 11, 33

Where yoga fits

The shoulder care routine and dryland workout on our swimming page carry the strength. Yoga adds holds lying on your front for the shoulder blades and back (locust, prone Y-T-W raises), weight on the arms built up gradually, as our yoga for shoulder pain guide does, and trunk holds such as boat pose and side plank.

Breaststroke knee and butterfly backEmerging evidence

In 341 elite swimmers, the 200 to 400 metre breaststroke carried 5.1 times the risk of knee pain, and butterfly 2.5 times the risk of low back pain and 4 times the risk of neck injuries; more than 4 sessions a week raised the risk of knee and shoulder problems. Swimmers who stretched had about a fifth of the risk of overuse knee injuries, but that's an association in one German study, read as its English abstract, not proof that stretching prevents them.

Source 17

Hips for breaststrokers

Our knee pain when swimming guide reports that breaststrokers with frequent knee pain had less inward rotation at the hip in a small series, and uses 90/90 switches for hip rotation, skipped if they press on a sore inner knee. Leave out hero pose, lotus and deep kneeling while the inner knee is sore.

Backs that hurt arching

Keep back bends small and stop if arching hurts. A teenager whose low back pain lasts and is worse arching backwards, in butterfly, breaststroke or push-offs, may have a stress fracture of the spine and needs it checked, as our back pain when swimming guide explains.

Yogic breathingEmerging evidence

In 27 young competitive swimmers, a month of yogic breathing improved lung tests and strokes per breath against no extra training. It's one small study, and its practice included fast breathing and breath holds that this page doesn't teach.

Source 12

Slow breathingMixed evidence

In 13 teenage swimmers, 7 weeks of slow breathing at 6 breaths a minute improved how recovered and in control they felt and how they rated their training, but not heart rate or heart rate variability. Across 223 studies, slow breathing raised heart rate variability while people did it. It's a calm way to wind down, on land.

Sources 34, 35

Never in the waterStrong evidence

Swim England says "Do not practise prolonged breath-holding" and "Never hyperventilate": over-breathing lowers carbon dioxide, so the urge to breathe comes late and a swimmer can lose consciousness underwater. The Royal Life Saving Society UK says shallow water blackout can happen at any depth and "the swimmer may experience no warning symptoms prior to the blackout"; breathe normally before going under, don't resist the urge to breathe, and never swim alone.

Sources 13, 14

With a loose shoulder or a past dislocation

Leave out end-of-range shoulder stretches, binds (cow face arms, reverse prayer, eagle arms held long), hanging in downward dog, and wheel pose, whose page says to choose bridge pose instead after a shoulder dislocation (our shoulder and hypermobility guides).

Sources 4, 5, 7

The sleeper stretch

It did no better than the cross-body stretch in the trial, and lying on the shoulder squeezes it, so our swimming routines leave it out.

Source 8

If arching hurts

Leave out deep back bends (bow, camel, wheel and upward dog), and get a teenager's lasting low back pain checked (our back pain when swimming guide).

Source 17

A sore inner knee

Leave out hero pose, lotus, half lotus and deep kneeling (their cautions and our knee pain when swimming guide).

Breathing

No breath holds, no fast or forceful breathing such as bhastrika and kapalabhati, and never over-breathe before going underwater.

Sources 13, 14

Eyes, blood pressure and pregnancy

With glaucoma, skip headstands, shoulder stands and other full inversions, and keep other head-down poses brief or use a supported version. With high blood pressure that isn't controlled, skip headstands, shoulder stands and long head-down holds. In pregnancy, after the first trimester keep time flat on your back short. (Our glaucoma, high blood pressure and pregnancy guides.)

Shoulder: urgent

• Call 999 or go to A&E: after a fall or injury, your shoulder looks out of place or has changed shape, you cannot move your arm, or your shoulder is painful, bruised or swollen. Do not drive yourself, and do not try to put it back in yourself.
• Call 999: shoulder or arm pain with chest pain that feels tight or squeezing, or chest pain that spreads to your arms, neck or jaw, especially with shortness of breath, sweating or feeling sick. It could be a heart attack.
• Same day (GP or NHS 111): sudden or very bad shoulder pain; you cannot move your arm; the arm or shoulder is badly swollen or has changed shape; pins and needles that do not go away; no feeling in the arm; the arm is hot or cold to the touch; pain that started after an injury such as a fall; or severe pain in both shoulders.
• Same day (urgent GP appointment or NHS 111): throbbing or cramping pain, swelling, redness and warmth in one arm. These can be signs of a blood clot caused by thoracic outlet syndrome, which can be life-threatening if not treated quickly.
• Call 999: sudden breathlessness, sharp chest pain (it may be worse when you breathe in) and a cough or coughing up blood. It can be a blood clot that has reached the lungs. Do not drive yourself to A&E.

Sources 36, 37

Shoulder: see a GP or physiotherapist soon

• Pain that is getting worse or has not improved after 2 weeks of looking after it yourself, or it is very hard to move your arm. In many areas you can refer yourself to physiotherapy.
• Your shoulder has partly or fully come out of joint, or you worry it might.
• Pins and needles or a cold arm alongside neck pain, or a new loss of strength or feeling in the arm that you cannot explain (a possible nerve problem).
• Not improving after a good 3 months of exercise, or the arm is clearly weak: ask for a specialist opinion.
• A child or teenager who swims with shoulder pain that lasts more than 2 weeks, keeps coming back or stops them training: get it checked by a GP or sports physiotherapist (our suggestion).

Source 36

Back

• Call 999 or go to A&E: loss of feeling or numbness around the genitals or bottom, new trouble peeing or controlling your bladder or bowels, changes in genital sensation during sex or problems with erections or orgasm, or pain, tingling, weakness or numbness in both legs. These are signs of cauda equina syndrome, which needs treating in hospital urgently. Don't drive yourself.
• A teenager in a sport that arches or twists the back, such as gymnastics, dance, diving, butterfly or breaststroke swimming, volleyball, cricket fast bowling, baseball pitching, weightlifting, football or rugby, with back pain that lasts more than a couple of weeks, is worse arching back or stops them training: get it checked by a GP or sports physiotherapist. It can be a stress fracture in the spine.

Source 38

After breath-holding in the water

Swim England says anyone rescued after losing consciousness underwater should go to hospital straight away, and anyone who feels ill after prolonged underwater breath-holding should "seek medical advice urgently". Practise breathing on land, and never hold your breath or over-breathe in the water.

Sources 13, 14

During yoga

With a loose shoulder, stop an exercise or shrink its range if you feel the shoulder is about to slip, as our shoulder dislocation guide advises. Mild shoulder discomfort, up to about 5 out of 10 and settled by the next session, is fine; stop for sharp, pinching or worsening pain (our shoulder care routine for swimmers). Stop for chest pain, dizziness or unusual breathlessness.

Source 39

"Swimmers should stretch their shoulders as far as they go"Emerging evidence

Loose, unstable shoulders are a risk factor, elite swimmers' shoulders are already looser than most, and stretching aggravated painful shoulders in a survey of 1,262 swimmers. Stretch only a clear stiffness, such as one shoulder turning inwards less than the other.

Sources 4, 5, 20, 6, 8

"Swimmer's shoulder is just tight muscles"Emerging evidence

It's mostly an overloaded rotator cuff tendon that tracks how much you swim, with looseness only weakly linked, and weaker endurance at the back of the shoulder predicted pain.

Sources 1, 18, 3

"Yoga breathing will let you hold your breath longer underwater, so practise in the pool"Strong evidence

Breath-holding after over-breathing can cause a blackout underwater without warning. Swim England says never hyperventilate and don't practise prolonged breath-holding.

Sources 13, 14

"Yoga can replace dryland training"Emerging evidence

Strength training plus swimming improved performance by about 2% to 2.5%, and combined water and dryland training took about 2 seconds off 100 metres, while no trial has tested yoga poses in swimmers.

Sources 11, 33, 15

"The more flexible the better, for every stroke"Emerging evidence

Some flexibility helps the stroke, but athletes with hypermobile joints had about 3 times the odds of a shoulder injury, and the NHS says not to overextend your joints just because you can.

Sources 5, 7