Physiotherapy for Swimmers

Swimming is a popular non-impact sport with a relatively low risk of injury. Traumatic causes of injury are rare (except from the odd case of a broken toe after walking into a starting block!). The most common swimming injury, by far, that we see in elite swimmers is an overuse injury of the shoulder (swimmers shoulder). We also, however, see overuse injuries of the knee (known as breaststrokers knee). Other problems that may occur are pains in the elbow, foot & ankle and the back. In the leisure swimmer, neck strain can occur due to holding the head out of the water in forced extension for a long period.

The main causes of an overuse injury are:

- Sudden increase in training distance or intensity
- Swimming technique that requires you to reach too far and over-rotate the body
- The over use of pull buoys and hand paddles
- Swimming only freestyle at every training session
- Over developing certain muscle groups whilst neglecting others e.g. imbalances between the front shoulder muscles compared to the muscles of back of the shoulders

Your Physiotherapist at will work with you to achieve the following:

· To manage the acute injury. Reducing pain and inflammation

· To advise you on exercises to do at home to encourage quicker recovery. You will also be advised on what to avoid during training and when is the best time for you to return to competition

· To give you a detailed postural assessment. This will include analysis of any muscle imbalances that you may be presenting with – i.e. tight / shortened muscles compared to stretched weak ones!

· To advise you of a land based training programme that you will need to take back to your club to continue with after discharge. This will correct any imbalances of the muscles and will help you to achieve a better posture

Common Swimming Injuries

Shoulder Injuries

With a swimmer the propulsive force comes from the upper body, with the legs acting as stabilisers. The shoulder joint therefore is subject to repetitive microtrauma and this may lead to overuse symptoms.

Shoulder Instability

Instability of the shoulder is common in swimmers mainly due to the sport-specific demands that require:
1. Increased shoulder movement
2. Increased internal rotation and adduction strength (rotating and pulling in of the arm)
3. Prolonged shoulder–intensive training

Shoulder Tendonitis – Impingement

The shoulder joint has a fair amount of movement for a ball and socket joint but in achieving this, it loses stability. The stability of the joint rather than being provided by a deep socket, comes from a group of four tendons (tendons join a muscle to a bone) collectively known as the rotator cuff. It is with the repetitive overhead movements of the shoulders that the rotator cuff becomes tired, and inflammed. Signs of an inflammed tendon are often pain with movements that require rotation of the shoulder, including reaching back to put on a coat, and also taking the arm out to the side.

Knee Injuries

The inside of the knee in breaststrokers is the main site of pain due to the forces placed through the joint with because the ‘whip kick’ action of breaststroke. This kick motion puts the joint into rotation which stresses the joint. It is important with breaststrokers to have the biomechanical alignment of the lower limbs assessed. It is imprtant, especially for breast-stroke swimmers, to strengthen the muscles of the hips and knees, including the quadriceps, the abductor and adductor muscles, and to work with a good stretching regime.

Foot & Ankle Injuries

With competitive swimming full range of the ankle is necessary in order to achieve some propulsion from the feet to assist the power generated from the upper body. Repetitive foot motion through this exaggerated range can inflame the tendons of the foot and cause pain.

Preventing Swimming Injuries

If you do have an injury then we will help you to overcome that injury. However, we acknowledge that it is far better to prevent an injury from occurring in the first place. Below are some helpful hints to prevent swimming injuries:

- With your freestyle technique it is important to bend your elbow as you pull in towards you under the water. This saves the shoulder taking excess strain, which can lead to a rotator cuff injury

- Build training intensity gradually, especially after a break

- Avoid the use of pull bouys and hand paddles as both put extra stress through the shoulder joints

- Vary your strokes during training. Avoid freestyle intensive sessions

- Breathe bilaterally with freestyle training to avoid over rotation to one side

- Address poor swimming technique, as this leads to excessive stress on the muscles, tendons and joints leading to pain

- If you are returning from an injury then it can be wise to use fins initially. This takes some of the emphasis from the shoulder joints and prevents a recurrence in the early stages whilst you are still undertaking your rehabilitation programme

- If you are recovering from a shoulder injury then on returning to training keep your pace slow and use it as an opportunity to work on technique and drills