Knee pain in swimmers

Daniel Smit | APA Titled Paediatric Physiotherapist

A practical guide for swimmers, families and coaches

Knee pain can interrupt swimming, especially when breaststroke kicking is uncomfortable. “Swimmer’s knee” is a broad, informal label, not a diagnosis. Whether you swim for competition, recreation or fitness, the pattern of pain, training history and your wider health all matter. Early communication with your coach or a trusted support person can help you make sensible training changes while you work out what is contributing.

What people mean by swimmer’s knee

People often use “swimmer’s knee” to describe knee pain that appears during or after swimming. “Breaststroker’s knee” is a more specific descriptive term for pain associated with the breaststroke kick, often felt on the inner side of the knee. It still does not identify one particular injured structure. Older swimmer studies found that knee symptoms were reported more often in breaststroke swimmers, but knee pain can occur with other strokes too. The evidence is limited and largely based on older competitive-swimmer cohorts, so it cannot tell us how common the problem is among swimmers of all ages and levels today. [1,2]

A sore knee is not automatically caused by breaststroke. Front-of-knee pain can also show up with running, jumping, stairs or dryland training. In younger swimmers, growth-related conditions can cause pain around the bony attachment below the kneecap. A sudden injury or another health condition can also cause knee pain. An individual assessment helps distinguish these possibilities; the location of pain alone is not enough to diagnose it. [3,4]

What to notice

These observations can help you explain the pattern to a coach, family member or clinician. There is no need to test the knee or push into pain.

• Where is the pain: inner side, front of the knee, below the kneecap or somewhere else?
• Which activity brings it on: breaststroke kick, another stroke, turns, starts, running, jumping or stairs?
• When does it begin, how does it change during the session, and is it still sore later or the next morning?
• Has anything changed recently in breaststroke distance, kick sets, training frequency, dryland work, fins, competition or recovery?
• Is walking, work, school activity, sleep or normal knee movement affected? Is there swelling, limping, locking or a feeling that the knee gives way?

What to do when pain starts

• Tell someone you trust and, if you train with a coach, let them know. If you are a young swimmer, tell a parent or another trusted adult too. Early, calm adjustments are usually easier than waiting until pain affects your movement or makes you miss sessions.
• Temporarily reduce or change the activity that clearly provokes pain. This may include breaststroke kicking, hard kick sets or a dryland drill. Do not force yourself to “kick through it”.
• If other strokes or pull-buoy swimming feel comfortable, you can consider keeping those parts of training and discussing the plan with your coach if you have one. Younger swimmers should involve a parent or trusted adult. Stop or adjust if pain increases or changes your movement.
• Review the recent total load across pool training, dryland, other sports and competitions, as well as rest and recovery. There is no single workload number or percentage that fits every swimmer.
• Arrange an assessment if pain keeps returning, is worsening, limits training or everyday activity, causes a limp, or is not settling with sensible changes.

Training changes and a gradual return

A short-term change in training is not the same as giving up swimming. The aim is to find a level of activity you can do comfortably while an appropriate plan is made. A physiotherapist or doctor can assess the knee, consider your swimming and other activities, and guide rehabilitation if needed.

When symptoms are settling, build swimming back in steps. Start with the strokes and distances that feel comfortable, then add breaststroke kick or harder work gradually, ideally in discussion with your coach. Check how the knee feels during the session, later that day and the next morning. If pain starts to climb, affects technique, or lingers afterwards, reduce the most recent increase and get advice. Do not use a race date or a universal “10% rule” to decide readiness.

When to seek urgent medical care

Get prompt medical advice for a new, substantially swollen knee, a knee that locks or cannot straighten, a marked limp, or pain after a significant injury. Seek urgent care if you cannot bear weight, or have a hot, red, swollen knee with fever or feel unwell. [5]

How Strides Performance can help

A sports physiotherapy assessment can look at your pain pattern, knee movement and strength, training history, other activities and goals. For younger swimmers, growth and development can also be relevant. We can work with you and, where appropriate, your family and coach on practical training changes and a progressive return plan.

Download the knee pain in swimmers handout (PDF)

References and further reading

Related resources and physiotherapy support

Explore Strides Performance physiotherapy in Narre Warren. Selected appointments are available in Nunawading. View appointment and booking information or ask us about your needs.

• Return to sport after injury
• Athlete screening