3 Common Swimmers Presentations

Setting it apart from running and cycling, swimming uniquely combines both upper and lower limb strengthening exercises and cardiovascular training in a non-weight bearing environment (Heinlein, 2010). This in conjunction with the highly repetitive nature of swimming, individuals are commonly predisposed to ‘overuse’ type musculoskeletal injuries involving the shoulders, knees and spine (Wanivenhaus, 2012). Swimming injuries usually occur secondary to a combination of: 

• Poor stroke mechanics/ breathing technique
• Poor range of motion of the spinal segments
• Hyper flexibility of joints with insufficient muscular stabilisation/control
• Decreased rotator cuff or scapular muscle strength
• Insufficient core strength/stability
• Poor hip muscle strength
• Overtraining and or insufficient rest periods

 

Swimmer’s Shoulder 

The term ‘swimmers shoulder’ was first used in the 1970’s as a way to describe anterior/front of shoulder pain during and post training. Since then the term has evolved to describe a group of symptoms as opposed to one specific diagnosis. Underlying causes which may lead to painful symptoms include (Torvin, 2006), 

• delayed onset muscle soreness or ‘DOMS’
• Rotator cuff tendinopathy
• Labral injury
• Bursitis
• Instability

Freestylers will commonly complain of deep or front of shoulder pain, pinching sensation with overhead movements and pain that increases with activity. In the clinic upon assessment your physiotherapist may see reduced shoulder and thoracic range of motion, muscle tightness of the upper limbs and/or decreased strength in the external rotators of the shoulders (Torvin, 2006).

 

Breaststroker’s Knee

Similarly to ‘swimmer’s shoulder’ breaststrokers knee is an umbrella term to describe painful symptoms at the knee during breaststroke. During the breaststroke action the knee is repetitively ‘whipped’ into a valgus or ‘knock knee’ position which places high loads on the inside of the knee joint and medial collateral ligament (MCL)(Knobloch, 2008). If there is prolonged training without addressing strength and mobility deficits it may lead to more serious conditions such as, adductor tendinopathy, MCL strain and pes anserine bursitis .  It commonly presents with pain and tenderness over the medial (inside knee), swelling, pain that worsens with prolonged exercise and reduced knee joint mobility (Knobloch, 2008). 

 

Swimmer’s Spine

To be an effective and efficient swimmer, a horizontal and streamline position is required for all stroking patterns. The streamline position relies on the swimmer maintaining a degree of sustained spinal extension and therefore exposes them to increased forces on the discs, joints, ligaments and muscles. These forces may lead to pain in the short term in swimmers who are unable to create enough stability through their core and lower limbs. In the short term if left unchecked it may lead to pain and reduced function, and in the longer term more serious conditions such as bony stress reactions (Heinlein, 2010). Underlying causes which may lead to swimmers spine include

• Over-training 
• Poor kicking technique
• Age related changes of the discs in facet joints in older swimmers
• Reduced flexibility of the spine, lower back and hip flexors
• Insufficient core strength to maintain straight alignment of body in water
• Overuse of devices such as paddles and fins 

Despite painful presentations occurring in different regions of the body, they all commonly evolve secondary to a combination of muscle weakness (and or imbalance), reduced joint range of motion, reduced muscle length and training program errors (Heinlein, 2010). The team at Flex are skilled in the assessment of the presentations above and can assist in creating an individualised program to reduce pain, improve function and get you back on track to achieving your swimming goals. 

 

References

Tovin B. J. (2006). Prevention and Treatment of Swimmer’s Shoulder. North American journal of sports physical therapy : NAJSPT, 1(4), 166–175.

Heinlein, S. A., & Cosgarea, A. J. (2010). Biomechanical Considerations in the Competitive Swimmer’s Shoulder. Sports health, 2(6), 519–525. 

Knobloch, K., Yoon, U., Kraemer, R., & Vogt, P. M. (2008). 200 – 400 m breaststroke event dominate among knee overuse injuries in elite swimming athletes. Sportverletzung Sportschaden, 22(4), 213–219.