Can swimming cause Achilles tendonitis?

It's very unlikely that swimming will cause Achilles tendonitis, but there are some exceptional circumstances in which it may. In this article I'll explain why swimming isn't a common cause of Achilles pain, as well as when or in what circumstances it may cause it. Remember, if you need more help with your Achilles injury, you're welcome to consult one of our team via video call.

The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in our articles.

We've also made a video about this:

Why swimming usually doesn't cause Achilles tendonitis

Achilles tendonitis or tendinopathy is an overuse injury that develops when you work your tendon too hard (either during one session or over a period of time). Your Achilles tendon is loaded/works whenever you walk, run or jump - the more intense the activity, the higher the load.

The only time when you load or use the Achilles tendon when you swim is when you kick off the wall or perhaps if you were to jump into the pool at the shallow end (not really swimming). The loads that these activities in the pool place on your tendon are very small compared to when you walk, run or jump. That's why it's really not that common to cause Achilles tendonitis or tendinopathy through swimming.

But, as with most injuries, there are exceptions to the rule.

When can swimming cause Achilles tendonitis or pain in that area?

1. If you've taken antibiotics that belong to the fluoroquinolone family (Cipro is one brand, but there are several others) in the last six months, then even kicking off the wall in the swimming pool can potentially overload your tendon. Fluoroquinolone antibiotics (NOT all antibiotics) are known to have a very negative effect on tendons and should only ever be used as a last resort.

2. If you swim with fins that are too tight and strongly press on your Achilles tendon, it can cause either your tendon, your heel bursa or both to become irritated.

3. Pain in the back of the heel can also be caused by irritation of the back of your ankle joint (called posterior ankle impingement). The repetitive motion of kicking can sometimes irritate that part of the joint. The pain from this is also felt in and around the Achilles tendon and it is often misdiagnosed as Achilles tendinopathy or tendonitis. We can easily tell the difference from listening to how your pain behaves during the day and what specific movements are most problematic.

4. Achilles tendons don't always become painful immediately when you overwork them. So, it's also possible that you first felt the pain after you swam, but that it was actually something else you did in the day or even the previous day that was the real cause.

How we can help

Need more help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Master's Degree in Sports Injury Management. Follow her on LinkedIn or ResearchGate.

References:

1. Cook JL, Rio E, Purdam CR, et al. Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? British Journal of Sports Medicine 2016;50:1187-1191.

2. Cook, J. L. and C. Purdam (2012). "Is compressive load a factor in the development of tendinopathy?" Br J Sports Med 46(3): 163-168.

3. Lang TR, Cook J, Rio E, et al. What tendon pathology is seen on imaging in people who have taken fluoroquinolones? A systematic review. Fundamental & Clinical Pharmacology 2017;31(1):4-16. doi: 10.1111/fcp.12228

4. Lewis T, Cook J. Fluoroquinolones and Tendinopathy: A Guide for Athletes and Sports Clinicians and a Systematic Review of the Literature. Journal of Athletic Training 2014;49(3):422-27. doi: 10.4085/1062-6050-49.2.09