Injury Prevention for Swimmers!
Swimming is one of the best cardiovascular endurance exercises out there that strengthens the whole body! A lot of land based sport athletes resort to swimming and aquatic exercises even when they are injured or for cross training because it is a low impact sport that can in times of injury for a land based athlete provide a pain-free method for exercise. Because of it’s low impact nature, many people also enjoy swimming as a lifelong sport. Now even though swimming is an amazing sport, it has its own host of common injuries seen in competitive athletes and recreational athletes.
The most common injuries we see in swimming are shoulder, low back, neck and knee. A fun fact--the average high school swimmer performs about 1-2 million strokes a year with EACH arm. That is a lot of repetitions of one specific motion! If you haven’t guessed it yet, the most common causes of injuries in swimming are due to overtraining, poor stroke mechanics, and a sudden increase in workload.
Swimmer’s Shoulder, also known as, shoulder impingement is by far the most common swimming injury we see. Impingement syndrome occurs when the supraspinatus and biceps tendons get inflamed and repetitively aggravated or pinched between the acromion and humeral head during active motion. Often times, impingement is associated with poor posture, increased mobility of the shoulder joint capsule, poor motor control and strength imbalances from a structural standpoint. When imbalances in the body then mix with training errors such as overtraining, overloading, or poor technique, then we tend to see these injuries occur! Swimmer’s shoulder tends to affect freestyle, butterfly, and backstrokers the most. The good news is, these injuries respond very well to scapular stabilization programs and improvement of stroke form and efficient technique.
Lower back pain in swimmers is also quite common. Younger athletes are prone to back pain caused by repetitive stress in the lower back from hyperextension, stress from diving, or underwater kicking. These athletes need a strong focus on core stabilization exercises and core strengthening to help maintain their posture during hours of swimming.
Neck pain in swimmers is common since a HUGE part of the sport involves when and how you breathe. Just like how the shoulders undergo repetitive stress, we have to make sure we have proper positioning and alignment of the head and neck during all strokes too. Ideal positioning with all strokes during swimming reflects our ideal regular standing position on land. During freestyle breathing for instance, we often see people over-rotating or over-extending the neck to breathe which disturbs that proper alignment position. Instead, breathing during freestyle should involve a whole body rotation, and a smaller neck movement to place less stress through both neck shoulder joints. Bilateral breathing is also important to help aid in reducing imbalances through the right and left sides.
(Katie Ledecky showing off great breathing mechanics in Rio!)
Knee injuries are more common in breastrokers since the breaststroke kick mechanics places stress along the medial knee structures such as the MCL, the medial retinaculum and patella. Often times, swimmer’s that experience knee pain with breaststroke commonly have reduced internal rotation and extension mobility of their hips which translates to more stress along the medial knee. A second mechanism can be aberrant patellar tracking which can irritate soft tissue structures and cartilage under the kneecap.
(a good view of how much hip internal rotation is needed in efficient breaststroke kick)
(here is also a good view of proper neutral neck alignment during breaststroke)
As with any types of sports injuries, injury prevention is key! Here are some key methods that can help!
Proper Dynamic warm-up: joints and tissues function better when they are properly prepped for the 2 hour practice you have coming up! (Here is Michael Phelp’s doing his signature arm flap warmup pre-race! See? Olympians have to warm up too!!)
2. Dry Land and Strength training: dry land strengthening not only improves your power in the pool, but it helps to stabilize the joints that you repetitively use during practice, promotes good postural awareness and strength so that you don’t end up with repetitive stress injuries!
(Missy Franklin rocking some side planks during dry land practice!)
3. Flexibility and stretching: swimmers tend to have too much mobility in certain joints like the shoulders, and too little mobility in places like the hips and thoracic spine!
4. Stroke technique and mechanics: efficient technique leads to less injury and quicker speed!
If you or your swim team would like some help with swimming injuries, injury prevention, injury screens, or a strength and flexibility workshop, please reach out so we can help (617.618.9290 or firstname.lastname@example.org)!
Violet Chang, PT, DPT, OMT
Graston Technique Certified
Girl Fit Physical Therapy