The sun is shining, it's getting warmer outside and people are starting to emerge from hibernation.
While it's still a little too cold in the midwest, we're starting to think about opening up our pools and returning to lakes and beaches for the spring and summer months. Now is the perfect time to focus on perfecting your swimming technique as you prepare your return (or initial dive in) to the water.
By far and away, the most common reported injury in swimmers is shoulder pain - according to a survey completed by the NCAA over 5 years, there is between a 40 and 91% prevalence of shoulder pain in elite level swimmers (Wanivenhaus et al. Sports Health. 2012 May; 4(3): 246–251).
Potential causes of shoulder pain in swimmers include rotator cuff tendinopathy, biceps tendinopathy (both rotator cuff and biceps tendinopathy are due to inflammation of tendons due to shearing of the respective tendons at certain parts of the stroke) and shoulder instability (structures that surround the shoulder joint do not work to maintain the ball within its socket). Each of these conditions can result from fatigue and weakness of the rotator cuff and muscles surrounding the shoulder blade which is related to the repetitive nature of the sport.
Low Back Pain
Due to the increased amount of time that swimmers spend with their backs in a hyper-extended position, as well as their tendency to have higher than average flexibility in their joints and decreased core strength, it is common for elite level swimmers to complain of low back pain resulting from lumbar disc disease or spondylosis.
Though less thought of with swimming, knee injuries that involve the tendons and ligaments along the inside of the knee (breaststrokers’ knee) are common as well. These kinds of injuries, as well as other knee and hip pain in swimmers, are often caused by core weakness, hyper-mobility and other muscle imbalances.
Neck pain in swimmers typically occurs on the athletes' preferred breathing side in freestyle, but can also be related to inappropriate positioning in the water. Swimmers will often times hold their heads high in the water as they're learning to swim this can cause muscle strain which can lead to a whole host of other issues that may implicated the neurovascular system in addition to the muscle soreness.
As with any workout, it's important to be sure that your body is ready for whatever activity you're about to throw at it before jumping right in. A good dynamic warm up is essential to preparing for swimming. That said, many swimmers use easy swimming as a warm up prior to their swimming work out - you see the problem.
For starters swimmers, like athletes in any other sport, should be doing warm ups and training that are appropriate for their specific bodies as well as what they're training for. Just like a quarterback will work on different drills than an offensive linemen, sprint specialists should be working on things that are different than milers.
In addition, while swimmers are typically hypermobile and very flexible, there are those that are very stiff and muscle bound. In prepping their bodies to swim, the hypermobile athletes should work on some stability work to prep their joints, while the stiffer athletes should work mobility and stretching.
In either all situations, swimmers need to work on core strength and body control. When you put an athlete in the water, being able to hold a body line will make every swimmer more efficient.
Treatment of common swimming injuries
If you happen to experience these or any other type of pain associated with swimming don't hesitate to reach out to your physical therapist for a work up and personalized care plan. The swimming athlete is a unique athlete, and swimming rehab should also be unique to each athlete. Common treatment protocols for shoulder, low back, neck and knee pain often include components of stretching and strengthening the shoulder complex, core stabilization, and correcting muscle imbalances.
Get strong to swim strong, and enjoy your time in the water!