At Dunsborough Physio Centre we see a huge number of swimming-related injuries each summer. With great beaches and indoor / outdoor pools nearby, large numbers of Dunsborough community members get involved in swimming events such as the Busselton Jetty Swim each summer.
Swimming is enjoyed by both young athletes and older age groups. The more recent popularity of triathlons and adventure sports has encouraged the older athlete to extend their "career" in the discipline of swimming. Most swimming injuries are classed as overuse injuries and relate to faulty biomechanics. Swimming has a distinct profile of injuries. Common problems seen among swimmers include "swimmer's shoulder", an overuse injury that causes inflammation of the supraspinatus tendon, sub-acromial bursa, and/or the biceps tendon, overuse injuries of the elbow (golfer's / tennis elbow), knee injuries (including breastroker's knee), ankle injuries (often tenosynovitis / tendinitis), and back injuries (stress fracture / degenerative).
Common injuries in swimmers include:-
Neck pain: more commonly seen in the older athlete, neck pain is often due to facet joint arthritic change, and disc degeneration +/- nerve root irritation. Muscle innervation and sensation to the shoulder region is predominantly derived from the C5/C6 nerve roots. If these nerve root are irritated due to degenerative change in the neck, shoulder complaints can arise. Arthritic change may also limit neck rotation making correct breathing patterns difficult. Swimmers who do not bilateral breath are more prone to neck pain. Looking forward rather than directly downward, and lifting the head too high when taking a breath can increase load on the neck and create pain.
Swimmer's Shoulder: shoulder injuries are the most common injuries seen in swimmers. "Swimmer's shoulder" is a chronic condition involving repetitive impingement of soft tissue under the coraco-acromial arch. Poor technique plays a huge role in this condition which can lead to sub-acromial bursitis, rotator cuff pathology, and long head of biceps irritation. Other shoulder problems in swimmers often relate to instability of the shoulder due to joint capsule laxity and labral (gleno-humeral gasket) damage, caused by repetitive forces placed on the anterior structures of the shoulder joint.
Breastroker's knee: this overuse condition often seen in breastrokers, involves sprain to the medial collateral ligament (MCL) due to repetitive rotatory / valgus force applied to the knee during the breastroke kick action. Poor technique is implicated in this condition.
Low Back Pain: Hyperextension of the lumbar spine during freestyle and butterfly can create low back pain, as can poor kick technique. In the younger athlete stress fractures are more common, whereas in the older athlete discal degeneration and facet joint degeneration are more common.
Biomechanical flaws: Shoulder Injury Prevention
There are a number of biomechanical flaws in a swimming stroke action which can lead to shoulder pain. Below are some of the more common shoulder issues associated with poor technique, and ways to alter your technique to lessen your chance of injury.
If pain is felt at the beginning of the freestyle stroke or as the arm starts pulling through, this may be due to the upper-arm being positioned behind the back (from shoulder to shoulder): this can cause pain. Swimmers need to be aware their arm position at the start of the stroke: the upper-arm and back have to line up to lessen stress on the shoulder.
In freestyle, pain may be felt when the stroke starts because the shoulder is rotated inward when the arm starts pulling through the water. If you’re feeling pain, either decrease the rotation to that side or pull more in front of you (not as wide). This can be a common problem on a swimmer’s non-breathing side because many swimmers lean on that side when they breathe. Make sure not to take the arm across the midline at the start of the stroke as this also can create shoulder impingement issues. Lessening the force of pull at the very start of the freestyle stroke can also lessen the chance of shoulder impingement.
Another biomechanical flaw commonly seen in freestylers occurs at the start of the recovery phase. If pain is felt early in the recovery phase the swimmer might be exaggerating the finish motion too much, and the hand and arm are too high when the recovery starts. Keep the arm lower to the water to start the recovery.
In backstroke, many swimmers press down with their hand and arm to start the stroke. This can definitely make the arm cross behind the back. If you’re feeling pain, either rotate more to that side or aim for a shallower pull.
In butterfly pain may develop when the swimmer presses deep with their chest and the hands stay high at the surface. If you feel pain, press forward with the chest and aim for a flatter stroke.
General Injury Prevention Strategies: ensuring correct technique, core strengthening, mixing strokes during training, adequate rest, strengthening the rotator cuff muscle group, strengthening scapular stabiliser musculature, maintaining equivalent amounts of internal and external rotation around the shoulder, learning to bilateral breath, and carrying out neck and low back flexibility exercises can lessen injury rate in swimmers.