So often we react passively to those quiet pains taking a backseat in our lives. Minor aches and niggles, these can all easily be brushed aside for having little to no impact on us. These can, however, sometimes be the signs of something chronic with potentially life-altering consequences if left untreated. In this blog, MSK physiotherapist Hardik Nimla explores why it is so important to assess the origins of pain to help isolate the imbalances that one’s daily routine (or poor exercise form) might be causing in the body.
Listening to Your Body Before Pain Becomes Injury
A swimming pool can often be used as a helpful tool to locate injury. It is something you learn after years of quiet early morning laps and feeling how your body performs against the resistance of water. This helps isolate strains in the body’s physical mechanics that might otherwise stay hidden.
It happened a few months ago that, during a routine swim, I felt an awkward stutter in my body’s usual rhythm. Midway through my third set, I caught a sudden sharp twinge in my right shoulder. It wasn’t too dramatic, yet it was enough for me to feel something worthy of concern. I stopped swimming and did a quick check at the wall: shoulder rolls, overhead reaches and a short stretch. I tried swimming again – only to feel the same pinpoint irritation. I judged I should not continue and left the pool early to assess my injury more thoroughly. I was not injured, but neither was I intact.
In this moment, my focus was less about pain and more about the disruption it was causing me. As a physiotherapist, I can immediately list the usual suspects causing aggravation in a situation like this, such as rotator cuff overloads, scapular dyskinesis, early-stage impingement or even biceps tendon involvement. Diagnosis, however, was not my priority. Pattern breakdown was, and back home, I assessed myself clinically using passive range, resisted strength, scapular rhythm, thoracic extension, trunk rotation and posterior cuff function. The result of this breakdown was that these were the same familiar pains I have been enduring for years. This wasn’t a new injury – but it was unveiling an old, insidious pain that had developed because of my previous lifestyle. Weak posterior cuff, compensatory upper trapezius dominance, stiff thoracic spine and sluggish scapular control. My years performing mostly aerobic training and sitting at a desk for work had finally caught up with me. The pool hadn’t caused the problem. It had simply revealed it.
So, I stayed away from the pool. No laps. No drills. For six weeks I committed to an entirely land-based rebuild. It wasn’t rehab in the traditional sense, but it was a consciously driven effort to correct the movement foundations I’d been neglecting.
“For six weeks I committed to an entirely land-based rebuild.”
The work started with scapular control. I began with simple exercises: wall slides (sliding my arms up and down against a wall like making snow angels) to reinforce overhead patterning, serratus punches (lying on my back and punching toward the ceiling) to engage the often-silent stabilizer beneath the scapula, and Y/W/T holds (lying face-down and lifting my arms into the shapes of the letters Y, W, and T) to re-educate mid-back endurance. For rotator cuff strength, I did side-lying arm rotations against a resistance band (like slowly opening a heavy door). Finally, I used basic twisting movements with a foam roller and threading exercises (twisting my torso and threading one arm under the other while lying on my side) to get my stiff middle back moving again. Simple, but specific. Together, they retrained all the parts that had forgotten how to work as a team.
It was, however, still not enough to just address the shoulder in isolation. Swimming is a rotational sport, and if rotation isn’t coming from the thorax and hips then, then it’s coming from somewhere less suited to that movement such as the glenohumeral joint. I therefore added foundational core work to my routine: long-lever planks, dead bugs, bird dogs and anti-rotation presses. This would help stabilise the pelvis and torso as a unit.
I wasn’t looking to build abs but to re-establish sequencing control and load transfer. Each week I tracked not just my shoulder symptoms but the better quality of all my movement: smoother transitions, more control through end ranges and improved kinetic coordination. The pain began to recede around week three. I did not thank rest because it was down to my body’s system stabilising and finding balance once again.
“That was my lesson: the body doesn’t demand more effort: it demands better input.”
I finally returned to the pool six weeks on from the incident, starting with recovery strokes and avoiding any propulsion-heavy work. After a few sessions I felt comfortable enough to resume full movements. I did swim a little differently – more efficiently and attentively – as I was no longer fighting in pain against the water. My stroke had less drag, more control and above all, more resilience. What stood out most to me was not how hard I was working but how little effort it took to swim well again. That was my lesson: the body doesn’t demand more effort: it demands better input. What got me back to my best wasn’t ice, rest or some novel protocol. It was consistent, unremarkable and targeted work. The twinge wasn’t a warning to stop; it was merely a reminder to recalibrate.
Written by Hardik Nimla, MSK Physiotherapist
The research behind these insights
Batalha, N., Dias, S., Marinho, D. A., & Parraca, J. A. (2018). The Effectiveness of Land and Water Based Resistance Training on Shoulder Rotator Cuff Strength and Balance of Youth Swimmers. Journal of Human Kinetics, 62(1), 91–102. https://doi.org/10.1515/hukin-2017-0161
Davis, D. D., Nickerson, M., & Varacallo, M. (2020). Swimmer’s Shoulder. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470589/
Karpiński, J., Rejdych, W., Brzozowska, D., Gołaś, A., Sadowski, W., Swinarew, A. S., Stachura, A., Gupta, S., & Stanula, A. (2020). The effects of a 6-week core exercises on swimming performance of national level swimmers. PloS One, 15(8), e0227394. https://doi.org/10.1371/journal.pone.0227394
Tommasina, I. D., Trinidad-Morales, A., Martínez-Lozano, P., Ángel González-de-la-Flor, & José Ángel Del-Blanco-Muñiz. (2023). Effects of a dry-land strengthening exercise program with elastic bands following the Kabat D2 diagonal flexion pattern for the prevention of shoulder injuries in swimmers. Frontiers in Physiology, 14. https://doi.org/10.3389/fphys.2023.1275285
Tovin, B. J. (2006). Prevention and Treatment of Swimmer’s Shoulder. North American Journal of Sports Physical Therapy : NAJSPT, 1(4), 166. https://pmc.ncbi.nlm.nih.gov/articles/PMC2953356/
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