More than a million competitive and recreational swimmers have made swimming one of the most popular fitness activities in the United States. It is a low-impact exercise and is less likely to cause injury than many other activities, making it ideal for seniors, pregnant women and those recovering from injury. More than one-third of swimmers practice and compete year-round and elite swimmers may train more than five miles a day, putting joints through extreme repetitive motion. That kind of regimen increases the risk of injury: With overuse comes fatigue and failure to adhere to proper stroke techniques, which in turn can lead to injuries. Most swimming injuries are to the shoulder, followed by the knee and neck. By following straightforward tips, most of these injuries can be avoided.
Swimmer’s shoulder is the most common injury among swimmers. It is an injury of the shoulder’s muscles and tendons due to overuse or poor swimming technique. It manifests itself as pain and inflammation. Swimmers, like athletes who throw a lot, put a great deal of stress on their shoulders, sometimes logging thousands of yards in the pool each day and using the shoulder as many as 2,000 times in a single five- to eight-mile workout. In fact, more shoulder injuries are reported among swimmers than pitchers in baseball.
Swimmer’s shoulder is most often associated with the freestyle stroke and also with the butterfly and backstroke. Specific injuries may include rotator cuff impingement – pressure on the rotator cuff from part of the shoulder blade or scapula as the arm is lifted; biceps tendinitis – painful inflammation of the bicep tendon; and shoulder instability, in which structures that surround the shoulder joint do not work to maintain the ball within its socket.
The most important factor in avoiding shoulder injury is to swim with correct technique. A qualified swimming professional or experienced swimmer can assess your stroke and highlight mistakes. And you should never over-train or train with tired muscles, as this means that the stabilizing muscles of the shoulder won’t work correctly and the shoulder is more likely to be injured. Also, avoid sudden increases in the number or intensity of workouts. Additional precautions include avoiding overuse of swim paddles, which put additional strain on the shoulders, and not over-using a kick-board with outstretched arms, as it puts the shoulders in a weak position.
Swimmer’s knee is an injury generated by the stroke mechanics of the breaststroke kick. When the legs extend, then are brought back together during the propulsive phase of the kick, the knee is subject to abnormal external rotation, which puts stress on the inner ligament of the knee, called the medial collateral ligament, and the hip. To avoid ‘breaststroke knee,’ alternate swimming strokes and have rest periods during the year when you don’t swim the breaststroke. Warming up and stretching before a swim session is important and exercises for the hamstrings and quadriceps will strengthen the legs.
Swimming-related neck injuries are usually caused by incorrect technique. The neck is very mobile and precautions must be taken to avoid muscle strain from overuse. When swimming the freestyle stroke, avoid over-rotation when lifting the head to inhale. Rotate the body more so the head remains aligned with the body when clearing the water. When swimming the breast or butterfly stroke, keep the head aligned with the spine at all times. In the backstroke, increase swim times gradually so the anterior muscles have time to adapt.
Following are additional common-sense tips to ensure safety in the water:
· Do not swim alone.
· Do not swim when tired.
· Perform core strengthening and cross-training exercises before the season.
· Warm up and stretch before a swim session; cool down and stretch after a session.
· When swimming in open water, make sure the water is free of undercurrents and other hazards.
· Do not run in the pool area.
· Do not dive in shallow water.
Swimming is a healthful activity that works most of the muscles in the body, especially if you do a variety of strokes. It can develop general strength, cardiovascular fitness and endurance. If you avoid over-training and use proper technique in the water, you can enjoy swimming for a lifetime.
Stuart J. Elkowitz, M.D., F.A.A.O.S., C.A.Q.H.S. is in practice with Somers Orthopaedic Surgery & Sports Medicine Group. He is board certified in orthopaedic surgery and received a Certificate of Added Qualification in Hand Surgery (C.A.Q.H.S.). He is a member of the American Society for Surgery of the Hand and the American Academy of Orthopaedic Surgeons. www.somersortho.com.
