SWIMMING INJURIES

 

This article is based on current research.  It is intended to inform parents and swimmers, but not to replace professional input or to self-diagnose a problem.

 

Swimming is a sport, and as in any sport, injuries can occur.  Most injuries associated with swimming are overuse injuries because the training involved requires repetitive motions of the arms and legs.  Some of the overuse injuries that can occur are described below.  Key points to remember are: always follow habits of injury prevention (sufficient warm-up and warm-down, stretching, keeping core muscles strong), communicate with your coach about any injury or suspected injury, seek help from a medical professional if pain is not eliminated with ordinary treatment, and follow prescribed regimens for rehabilitation.  Often, coaches can modify a swimmer’s training plan to allow for rehabilitation of the injury along with completion of a successful season.  The most important thing to remember is, pain is your body’s way of telling you something is wrong.  Don’t ignore it!  It is especially important for young swimmers to avoid any motion which causes pain.  For older swimmers, it is important to distinguish between  muscle soreness (which will naturally occur in athletes training intensely) and joint pain.  Joint pain generally indicates that there is an injury or impending injury.

 

 

Swimmer’s Shoulder

 

Shoulder pain is the most common complaint in competitive swimming.  While there may be a number of underlying causes for shoulder pain, the condition is generally termed, “swimmer’s shoulder”.  The shoulder is a unique joint, similar to a shallow ball and socket, but really more analogous to a golf ball on a golf tee.  The so-called ball, is the head of the arm, medically termed the humerus bone.  The so-called shallow socket (or tee) is called the glenoid fossa .  The cup of the socket is deepened by a ring of cartilaginous tissue called the glenoid labrum.  A few ligaments connect the top of the arm (humerus) to the glenoid labrum.  The design of the shoulder joint allows the least amount of restriction to movement, which enables us to use our arms with greater dexterity than our legs.  However, this also makes the shoulder relatively unstable and prone to injury.

 

A group of four muscles, called the rotator cuff muscles are involved in fine movements of the shoulder.  The tendons of these muscles come together around the top of the shoulder and are referred to as the “rotator cuff”.  During normal arm use, the rotator cuff muscles, together with the ligaments around the shoulder, keep the ball (arm) located centrally in its socket (glenoid fossa).  However, because of the amount of use and the relative over-development of chest muscles compared to back muscles in swimmers, the ball (arm) can easily move out of its optimal position.  This can allow overstretching of ligaments, tightness in parts of the joint capsule or impingement (squeezing) of some of the muscles and tendons (usually the biceps or the supraspinatus).  Any of these things can be extremely painful.  If these conditions are allowed to worsen, they can lead to more serious problems such as tendon tears, labrum tears, or, partial or full dislocation of the arm.  It is healthy for pre-pubescent swimmers to participate in other sports or dance because they will naturally develop some of the muscles not overused in swimming.  This will reduce their chances of muscle imbalances leading to shoulder injury.

 

The risk of swimmer’s shoulder can be reduced by proper training and by developing strength and endurance in the muscles surrounding the shoulder.  The most important way to reduce the risk of shoulder injury is core body strengthening.  Core body strengthening gives a swimmer more power to the stroke, greater endurance, and increased control of body position and alignment, all the while reducing the demand on the shoulder.  The core body muscles include the abdominals, back muscles and scapular stabilizers.  Exercise for these muscles can be done after swimming, in a separate session or just prior to swimming without any added risk of injury.

[FIGURE 1]

The primary stabilizers of the scapula are the trapezius, rhomboids, lattisimmus dorsi and serratus anterior.  These muscles are rarely involved in swimming injuries.  Exercises for the primary scapula stabilizers can be found in basic strength training books.  Common ones are lat pull downs, seated rows, tricep extensions and push-ups with a plus.  You should not do any weight training without consulting with your coach or physician.  Weight training can actually be harmful for children who have not gone through puberty.  At any age, correct performance of exercises is critical to developing proper muscle balance and preventing injury to the lower back.

 

Rotator Cuff MusclesOlder swimmers should also work on strengthening the rotator cuff muscles (subscapularis, supraspinatus, infraspinatus and terres minor).  There are special exercises for the rotator cuff muscles.  These muscles fatigue easily.  It is extremely important that rotator cuff exercises are properly executed with low weights (or no weights), or light- resistance bands.  Your coach will demonstrate rotator cuff exercises for you and make sure you are performing them correctly.  Exercises for the rotator cuff should never be done immediately preceding swim training.  They should be done in a separate session.  Doing them just before practice increases the risk of injury because the rotator cuff muscles will be too fatigued to hold the shoulder joint in the proper position during swim training.  If you have already been experiencing shoulder discomfort, consult with a doctor or physical therapist before doing any rotator cuff exercises, or continuing with swim training. 

Text Box: Watch for these symptoms of swimmer’s shoulder:

1. Pain during freestyle
    and butterfly strokes

2. Pain that is worse with
    backstroke and less 
    intense with breaststroke

3. Increased sensitivity 
    when sleeping on the
    aggravated side

4. Shoulder is tender to
    the touch

5. In advanced cases, pain
    that occurs when not
    swimming or using the
    shoulder

Staying flexible is another way to reduce the risk of injuries, however, it is important that you learn proper stretch technique.  Never risk over-stretching by doing partner-assisted stretches.  You should perform light stretches before practice and prolonged or static stretches after practice.  You should stretch the chest muscles (pectorals), latts, hamstrings, quads and hip flexors.

 

A critical factor in preventing shoulder injury is proper swim technique.  Speed is not the only reason DST coaches place a great deal of emphasis on proper stroke mechanics.

In freestyle swimming, for example, coaches will emphasize good body roll, bilateral breathing, and proper hand placement and elbow position, among other things.  It is important that swimmers pay close attention during practices and perform all stroke drills as instructed.

 

If you feel pain in your shoulder during swim practice, it is imperative that you notify your coach immediately!  Your coach will recommend an initial treatment of rest, ice and ibuprofen.  If the pain persists through several practices, or at times during the day or night when not swimming, referral to an orthopedist or sports medicine specialist will be necessary.  If you have a history of a shoulder problem, a daily habit of icing the area for 10-15 minutes after practices is recommended to reduce any possible inflammation. 

 

Knee joint anatomy diagram (Image credit: Seif Medical Graphics)

Knee Injuries

 

Knee problems in swimmers are much less common than shoulder problems.  When they do occur, they are more frequently seen in breaststroker’s.  “Breaststroker’s Knee” usually results from a chronic strain of the ligaments that stabilize the knee from side to side.  Large forces are produced in the medial collateral ligaments during the specific movements involved in the breaststroke whip-kick. 

 

Breaststroker’s knee can develop from too much, too fast kicking without proper strengthening of the muscles that move and support the knee, imbalances in strength and flexibility, insufficient warm-up and faulty breaststroke kick mechanics.   Knee problems are especially common in female teenagers, even if they are not breaststrokers, because they tend to be hyperflexible.  Doctors will frequently

diagnose the injury as patellofemoral pain syndrome, or,

 medial collateral ligament stress syndrome.

 

The main muscles that move the knee joint are the quadricep and hamstring muscles of the thigh. Therefore, thigh- strengthening exercises will help prevent injuries to the knee.  Maintaining flexibility in the medial hamstring, quads and hip flexors is also important. 

 

If you experience pain in your knee, tell your coach right away.  Your coach will probably recommend resting the knee by not performing breaststroke kick, or the use of a pull-buoy to avoid kicking altogether.  This will allow you to stay involved in swim practice.  Ice packs will also be recommended early on.  Ice massage is sometimes helpful. (Fill a paper cup with water and freeze it.  Rub it around your knees until numb – about 5 minutes - after practice). Your practices can be adjusted to include longer warm-ups and stretching, and avoid intense work that brings on pain.  In more severe cases, your coach will recommend you visit a doctor or physical therapist.

 

 

Overtraining

 

Success in swimming at elite levels generally often includes a desire to push one’s body to the limits in both training and competition.  A “tired” athlete is not uncommon. In the correct circumstance, all coaches like seeing their swimmers tired.  “Overtraining Syndrome” is a term used when tiredness or fatigue seems excessive and prolonged, and leads to a period of poor performance.  Overtraining can be thought of as a breakdown in the balance between the demands place on the body and it’s ability to cope with them.  It is essentially an overuse injury of the whole body.

 

It is unknown what exactly causes overtraining syndrome and there are few reliable warning signs.  However, there is a correlation with this syndrome and high intensity endurance sports such as running and swimming.  Symptoms are often vague but may include fatigue, aching heavy muscles, restless sleep, increased resting heart rate, weight loss, loss of “feel” in the water and depression.

 

DST coaches design their practices to include both high intensity interval training and low-intensity training or stroke work that is appropriate for the swimmer’s physiological age, strength and swimming experience.  Weekly plans include alternate days of high volume and “recovery” practices to avoid overtraining.  In other words, DST’s program includes built in rest periods, both daily and weekly.   It is the responsibility of the swimmer to practice appropriate and sufficient cool down, good nutrition, adequate hydration and stretching after swimming.  A sufficient amount of sleep is also of critical importance.  Swimmers should realize that workouts stimulate processes leading to gains in muscle strength and capacity, but it is during the rest periods that the majority of the desired metabolic changes actually occur.   All athletes should have at least one full day of rest per week.

 

Despite all precautions, there may be instances where overtraining is suspected.  Swimmers’ tolerance to training varies.  A workout that increases performance in some swimmers may cause others to become over trained.  Other differences between swimmers include, diet, level of fitness, hours of rest and sleep, lifestyle stresses and recent illnesses.  Often, a combination of factors leads to overtraining syndrome.  Is the swimmer maintaining sufficient carbohydrate and calorie intake?  Are they dehydrated?  Have they had a recent viral-type illness?  Are they playing other sports?  Are they pressured by school exams?

 

The risk of developing overtraining syndrome can be reduced if swimmers incorporate rest, recovery and good nutrition into their training plans.  Parents should be mindful of their children’s activities and not have them doing too much. 

 

Swimmer’s Ear

Otitis externa, or swimmer's ear, is usually caused by Pseudomonas aeruginosa or, occasionally, Aspergillus organisms.   Symptoms are pain and/or itching.   Treatment of swimmer’s ear usually involves physician-prescribed eardrops containing a suspension of antibiotics.  If pain has resolved, swimmers may return to practice within 2-3 days.  If you are prone to swimmer’s ear infections, you should routinely use ear drops of equal parts isopropanol and vinegar solution for prevention after swimming and showering.

Swimming in an "away" pool often triggers swimmer's ear.  When doing so, swimmers should be especially scrupulous about preventive measures.  A tight-fitting swim cap is the best method of keeping water out of the ear.   (Another reason to wear your team cap at meets!)