Back to school and back to swimming lessons. It reminded us that swimming is a popular and incredibly healthy year-round sport in Australia, with people of all ages participating for both recreation and competition. We recommend it for lots of people all the time. Swimming provides an all-body workout with lots of repetitive actions with resistence because water has greater resistance to movement than air. As a result of these forces, overuse injuries do occur from time to time. Incorrect technique can also lead to potential injury.
Here are a few of the more common swimming injuries that we see.
Swimmer’s shoulder is the most common injury seen – almost 90% of all swimming injuries!
Swimmers shoulder occurs when the rotator cuff muscles which hold your shoulder in its socket are overused repetitively which leads to inflammation. This inflammation decreases the space between the top of the shoulder blade and the top of the arm causing an impingement of the tendons. Overtraining may lead to shoulder pain due to fatigued muscles (muscles having to work harder in a weakened condition). Unilateral breathing may also contribute to pain in the opposite shoulder as it has to support the forward movement with the head turned away to the side. Poor technique may be a factor.
Initially pain is felt during or immediately after swimming, although as it worsens (athletes swimming through the pain), pain can be felt at rest or during the night. Pain may be poorly localised and deep within the shoulder. A reproducible click or painful catch may indicate a tear within the cartilage of the socket (glenoid labrum). Rest and an appropriate rehabilitation program is essential to ensure a safe and successful return to swimming.
Swimmers kness is usually a result of poor technique and is most often seen in breast stroke swimmers due to the wide kick and increased rotation of the knees. This places repetitive stress on the medial collateral ligament (inner aspect of the knee joint) resulting in inflammation and pain on the inner side of the knee. Pain increases as you continue with each whip kick and your knee is generally tender and sometimes swollen following swimming/exercise. This injury is able to be prevented with a proper warm-up and stretching program, as well as strengthening exercises for your thigh muscles (quadriceps and hamstrings). Rest is important if this injury has developed along with icing the inside of your knee for 15-20 minutes approximately 4 times throughout the day, especially after exercise. Speak with your physiotherapist regarding a rehabilitation program which is suitable for you.
Lower Back Pain
Poor technique may lead to lower back pain in swimmers. This is most often freestyle swimmers with a high head position or low hips and legs position in the water. Butterfly swimmers also often have lower back pain from lifting the upper body out of the water. Ensuring you have a correct and strong dolphin kick is important so it’s the body wave that lifts you out of the water rather than your back muscles alone. Symptoms generally include pain, stiffness and swelling in the lower back. Rest is often required along with alternating the amount of time training one specific stroke. Heat to the lower back will help to relax the muscles. Exercises which focus on strengthening and stretching the back muscles will take some pressure of the spine and need to be included in your rehabilitation program.
Neck pain in swimmers, is caused by the high head position in the water along with lifting your head out of the water or turning it sideways to take a breath. Neck and shoulder stretches are vital and need to be combined with strengthening exercises which your physiotherapist can assist with. It is also good for you to focus on:
- Your form during flip turns to avoid over-extension
- Keeping your head in line with the spine
- For freestyle, keep and your eyes looking straight down and avoid looking to the front, lifting or over-rotating the head to breathe. Rotate the body so the head does not need to rotate as much to clear the water
- For breaststroke or butterfly, look down rather than to the front when you breathe in so your head stays in a neutral position
- For backstroke, gradually increase your swim distances so that the neck muscles have time to adapt.
With any kind of injury, it is essential to address the issues at the first signs of the symptoms in order to prevent further damage. Initial treatment usually involves rest and ice followed by an early rehabilitation program provided by your physiotherapist before returning to competitive or recreational swimming.