Injury Prevention Strategies for Open Water Swimmers: A Guide for Coaches and Physiotherapists

Open water swimming is a demanding sport that places unique loads on the body. Unlike pool swimming, open water environments bring unpredictable variables including chop, currents, cold water exposure, and prolonged time in horizontal positions. These factors increase the risk of overuse injuries, acute strain, and performance-limiting niggles.

For strength and conditioning coaches and sports physiotherapists working with elite or developing athletes, targeted injury prevention strategies are essential to sustain high training volumes and reduce time lost to injury. This article outlines evidence-informed approaches to protect open water swimmers and optimise long-term performance.

Common Injury Profiles in Open Water Swimmers

Understanding the primary injury risks in open water swimmers guides prevention. The most frequent presentations include:

• Shoulder overload syndromes: Rotator cuff tendinopathy, posterior cuff strain, and labral irritation from repetitive overhead stroke mechanics.

• Lumbar and thoracic issues: Hyperextension-related low back pain and stiffness from prolonged prone positioning.

• Cervical pain: Neck strain from repeated sighting in choppy conditions.

• Knee and hip pain: Particularly in athletes transitioning from pool to open water, where stabilising demands and prolonged kick efficiency differ.

• Cold-induced cramping: Muscular fatigue and altered neuromuscular control when swimming in cold water environments.

Biomechanical Considerations

Stroke mechanics in open water are subtly different from pool technique. Coaches and physiotherapists should account for:

• High stroke volumes: Elite open water swimmers often exceed 60,000–80,000 strokes per week, amplifying cumulative loading.

• Asymmetric loading: Breathing to one side or sighting increases unilateral stress on cervical and thoracic regions.

• Propulsion vs. positioning: The requirement to navigate and maintain positioning within packs changes shoulder rotation forces and kick strategy.

These biomechanical demands highlight the importance of robust tissue tolerance, efficient load distribution, and technical refinement.

Injury Prevention Strategies

1. Strength and Conditioning for Shoulder Resilience

• Rotator cuff strengthening: Prioritise endurance-focused external rotation, prone horizontal abduction, and scapular stabilisation drills.

• Closed-chain stability: Incorporate serratus anterior activation (e.g. push-up plus, landmine press) to enhance scapular control.

• Eccentric loading: Implement eccentric rotator cuff work to build tissue tolerance against repetitive traction forces.

2. Trunk and Spinal Conditioning

• Anti-extension core training: Exercises such as dead bugs, pallof presses, and rollouts offset prolonged spinal extension.

• Thoracic mobility: Encourage rotation and extension drills to maintain range for efficient stroke mechanics.

• Neck strength: Controlled isometric and eccentric loading prepares cervical structures for sighting demands.

3. Hip and Lower Limb Support

• Hip stability: Emphasise glute medius and deep rotator strength to support efficient kicking and streamline.

• Hamstring endurance: Address repetitive flutter kick loads with eccentric hamstring and posterior chain conditioning.

4. Technical Monitoring

• Stroke symmetry: Encourage bilateral breathing patterns to reduce unilateral stress.

• High elbow recovery: Protects glenohumeral joint loading.

• Video analysis: Identifies inefficient or asymmetrical mechanics contributing to overload.

5. Recovery and Load Management

• Periodisation: Ensure micro and meso cycles include deload phases to balance volume and intensity.

• Recovery protocols: Prioritise mobility, soft tissue treatment, and hydrotherapy post high-volume sessions.

• Monitoring tools: Use RPE, wellness questionnaires, and wearable data to track cumulative stress.

6. Environment-Specific Strategies

• Cold water preparation: Gradual acclimatisation and strength training in thermally stressed conditions can reduce neuromuscular fatigue.

• Pack positioning: Educate athletes on drafting strategies to reduce unnecessary mechanical strain.

• Sight training: Incorporate sighting practice in controlled training to adapt cervical mechanics.

Collaboration Between Coaches and Physiotherapists

Injury prevention for open water swimmers relies on close collaboration between S&C coaches, swim coaches, and physiotherapists. Key strategies include:

• Integrated screening: Annual musculoskeletal screenings to flag deficits in shoulder stability, spinal mobility, or hip function.

• Shared data: Regular updates between physiotherapists and S&C staff on injury trends, recovery metrics, and training loads.

• Progressive rehab-to-performance: Streamlining the transition from injury rehab back into full-volume training.

Key Takeaways

• Open water swimmers are at high risk of shoulder, spinal, and neck-related injuries due to unique biomechanical and environmental stresses.

• Injury prevention requires structured S&C, technical monitoring, and recovery management.

• Coaches and physiotherapists should collaborate to identify risk factors early, apply targeted training, and ensure long-term athlete resilience.

By addressing these areas systematically, coaches and physiotherapists can support open water swimmers to train consistently, compete effectively, and remain injury-free across demanding seasons.