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Monday, December 20, 2010 11:08 AM
Swimming is not usually the first sport that comes to mind during the cold months of winter. These months are actually important for competitive swimmers, as teams often travel to begin intense training programs. While swimming is not a contact or collision sport associated with traumatic injuries, it does have a high rate of injuries, especially in advanced-level swimmers.
Shoulder injuries are especially common, with one study showing that 73% of elite swimmers have had shoulder pain at some point in their careers.3 These swimmers often swim up to 10,000 meters per day. That distance correlates to roughly 30,000 shoulder rotations per week.1 Emphasis on increased strength and dry-land training throughout the year as well has been thought to contribute to the injuries seen. Here are some ideas to keep competitive swimmers in the pool and out of the training room and doctor’s office.
Shoulder Injuries
The shoulder is the most frequent location of pain in competitive swimmers, likely due to the high numbers of rotations the shoulder undergoes during the year. Swimmers and coaches should focus on efforts to prevent these injuries, if possible, or treat them early when symptoms develop. Adding strengthening and stabilization programs as part of routine shoulder maintenance, similar to baseball pitchers, might decrease shoulder injuries. When shoulder pain arises, modifying the swimmer’s training (decreasing distance, focusing on kicking, etc.) and concentrating on proper mechanics are essential. If needed, taking a few days off to rest the shoulder might prevent lingering problems.
Hip and Knee Injuries
The whip kick (or frog kick) during the breaststroke can lead to hip and knee pain in swimmers. The adductor muscles of the hip have to forcefully contract during the finish of the kick, sometimes resulting in overuse injuries. Proper mechanics of the whip kick, year-round strengthening of the hip adductors, and warm-up exercises for the adductors should be emphasized.
Likewise, patellofemoral pain and patellar tendinitis occur in all swimmers, related to flip turns, pushing off the wall, and the dolphin and flutter kicks. A program of quadriceps and hip strengthening and stretching to prevent these injuries might be appropriate.5
Injuries Out of the Pool
While practice is associated with the majority of swimming injuries, a study of collegiate swimmers showed that 38% of injuries resulted from activities out of the pool, including resistance training and other dry-land workouts.4 While these workouts are believed to help increase performance in the pool and possibly decrease swimming injuries, the specific workouts should be evaluated for safety and effectiveness. They should be designed with swimmers’ activities and body composition in mind. As with all strength and conditioning programs, proper supervision and spotters should always be available, and proper warm-up and cool-down routines should be performed.
Recent Increase in Injuries
The incidence of injuries seems to be increasing in recent years. In 1996, McFarland and Wasik noted a rate of 2.12 injuries per 1000 exposures (participation in one event, practice, strength training session, etc.) in female collegiate swimmers2, while Wolf et al. presented a rate of 3.78 per 1000 exposures in female collegiate swimmers in 2009.4 While it is difficult to point to any one risk factor for this increase, the emphasis on year-round training seems at least to be a possible culprit. Even competitive club and high school swim teams are training throughout the year. The repetitive nature of this training places tremendous stress on the shoulder with few chances to rest. As many groups have suggested for youth pitchers, it might be appropriate to advocate 1-3 month breaks from swimming. The athletes can still train or play sports during the break, but they should focus on activities that don’t stress the shoulder.
1. Heinlein SA, Cosgarea AJ. Biomechanical considerations in the competitive swimmer’s shoulder. Sports Health. 2010;2(6):519-525.
2. McFarland EG, Wasik M. Injuries in female collegiate swimmers due to swimming and cross training. Clin J Sport Med. 1996;6(3):178-182.
3. McMaster WC, Troop J. A survey of interfering shoulder pain in United States competitive swimmers. Am J Sports Med. 1993;21(1):67-70.
4. Wolf, BR, Ebinger AE, Lawler MP, Britton CL. Injury patterns in Division I collegiate swimming. Am J Sports Med. 2009;37(10):2037-2042.
5. Wolf BR. Injuries in Swimming. Sports Medicine Update. July/August 2009:2-5.
1 comment(s) so far...
Re: Keeping swimmers in the pool and out of the training room
Another great article, David! As someone who works with lots of swimmers, I can attest that the high training volumes associated with the sport definitely take a toll on the body.
I would like to expand a bit on the reference you made to dryland training, though. In relation to the injury rate due to activities outside the pool, I contend that much of the reason for such injuries stems from kids rushing into resistance training before they're ready, and/ or engaging in imbalanced workouts that often stress the same muscle groups they're already overusing in the pool (i.e. the pecs, lats hip flexors and quads etc.) A more balanced approach that stresses the importance of improving both dynamic and static flexibility of the muscles that surround the shoulders, hips, knees and ankles, combined with intensive core strengthening, as well as emphasis on the muscles that help stabilize the scapula can serve as an effective means of keeping injuries at bay. As you accurately point out, these programs have to be properly evaluated and supervised in order to produce the desired effect.
If you log on to the official USA Swimming website and click on strength and conditioning under the tips and training tab in the menu bar, you'll find a number of video presentations I've done on the type of dryland training swimmers should be doing to help stay injury free. I just want to make sure that swimmers, coaches and parents don't come away with the message that dryland training is somehow inherently dangerous. The truth is, it's one of the best things a swimmer can do to stay heathy and improve performance, it just has to be properly structured.
Thanks again for such a great article.
Best,
Mike Mejia
By Mike Mejia on
Tuesday, December 21, 2010 9:34 AM
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