Common injuries in

swimmers
Cause of injuries in swimmers
• Poor stroke mechanics
• Poor flexibility or range of motion of neck or lower back
• Hyper flexibility of joints with insufficient muscular stabilisation
• Decreased rotator cuff or scapular muscle strength
• Insufficient core strength/stability
• Decreased hip muscle strength
• Overtraining
• Insufficient rest periods
Common injuries in swimmers
I. Upper extremity injuries:
i. Swimmers Shoulder
ii. Shoulder instability
iii. Triceps tendinitis
III. Back injuries:
i. Cervical strain
ii. Low back strain and
Spondylolysis

II. Lower extremity injuries:

i. Breaststroker’s knee
ii. Patellofemoral pain
iii. Extensor tendinitis
 Swimmer’s Shoulder
• Shoulder pain is the most common complaint in
competitive Swimmers. Nearly 50% of collegiate
and masters swimmers report shoulder pain
lasting at least 3 weeks.
• Swimmer's shoulder is a condition with a
gradual onset due to repetitive activity and can
be classified as microtrauma.
• Swimmer's shoulder refers to shoulder
tendinopathy or impingement.
• Typically, the swimmer feels maximum pain at
the beginning of the pull-through phase. Often,
the swimmer will swim through this pain for
weeks until the pain is present throughout the
entire freestyle.
• It usually presents as subacromial impingement involving
the rotator cuff tendon, bicipital tendon, or subacromial bursa.
• Primary subacromial impingement involves compression of these
structures between the acromion and greater tuberosity (due to
usually a tight posterior capsule causing the humeral head to
migrate anteriorly) or abnormal acromial morphology. However,
primary impingement syndrome is less common in competitive
swimmers than secondary impingement.
• Secondary impingement occurs through a series of impairments,
usually in a swimmer with increased anterior glenohumeral laxity
( shoulder ROM in swimmers often exhibit excessive external
rotation and limited internal rotation). This shift in ROM towards
increased external rotation is an adjustment to the demands on
the glenohumeral joint allowing anterior laxity and greater
demand on the rotator cuff and the long head of the biceps to
reduce humeral head elevation and anterior translation.
Management:
• Ice, anti-inflammatory medication, and occasionally subacromial
corticosteroid injection.
• The serratus anterior, a scapular stabilizer, is one of the most
important muscles involved in the freestyle stroke, strengthening of
serratus anterior muscle should be done.
• Strengthening of external rotators
• To prevent future injury strengthening of rotator cuff and scapular
stabilizing muscles should be done.
SHOULDER INSTABILITY
• If the shoulder capsule is overstretched, the risk for
instability and injury is increased.
• Instability can be anterior, posterior, inferior or a
combination. The more unstable the glenohumeral joint,
the greater is the risk of developing a labral tear, a Hill-
Sachs lesion, or a Bankart lesion.
• In swimmers, excessive shoulder mobility can functionally
allow the athlete to have more powerful stroke, but this
excessive motion could lead to overstretching of the
supporting shoulder structures, ultimately resulting in pain
and decreased performance. A stretched shoulder capsule
can lead to subluxation.
• Treatment includes rotator cuff muscle strengthening and
scapular stabilization exercises
Triceps tendinitis
• Triceps tendinitis can develop as a result of
the full extension necessary in the
backstroke.
• The ulnar collateral ligament may get
stressed in the recovery phase of the
freestyle leading to sprain.
• Treatment consist of rest, nonsteroidal anti-
inflammatory drugs (NSAIDs), and ice.
 Breaststroker’s/ Swimmers Knee

• Knee pain is found in 34% to 86% of swimmers, being

highest in breaststrokers.
• Repetitive stress placed is placed on the medial knee
produces pain during the whip-like motion.
• The breaststroke kick is a high valgus load produced
during sudden flexion-extension, adduction and
external rotation of the knee against the hydrodynamic
environment, resulting in stress to the medial
compartment.
• Hence, strain occurs to the medial collateral ligament
and compression on the lateral knee.
• Treatment includes rest, ice, and anti inflammatory
medications.
Patellofemoral pain
• The typical symptoms of patellofemoral
symdrome also occur in swimmers usually due to
the flutter kick, dolphin kick used in the butterfly
stroke, and wall push off after flip turns.
• Treatment includes rest, ice, NSAIDs, and
quadriceps strengthening.
• Swimmers should be encouraged to train using a
foam buoy between the thighs in order to rest
the knees.
• Some swimmers may benefit from a neoprene
patella stabilizing brace/McConnel taping.
Extensor tendinitis
• Extensor tendinitis may occur from the
flutter kick or dolphin kick.
• Rest from the flutter kick is best achieved
using a foam buoy.
• Treatment includes rest, ice, and NSAIDS.
• A lower extremity stretching program
focusing on improved range of motion at
the ankle will help in the recovery and also
in prevention.
Cervical strain
• It occurs because of the contortion involved in keeping
the head above the water during the breaststroke, or
while rotating the neck to breathe during the freestyle
stroke.
• The head rotation during the breathing cycle should
only be enough to allow a breath, not bringing the face
fully out of the water.
• As the swimmer moves forward, the water edge next
to the mouth is cupped, allowing minimal rotation to
achieve a sufficient breath.
• The athlete should maintain head position along the
long axis without lifting the head or tucking the chin
down when taking a breath.
• During the breaststroke, the head and neck should
Low back strain and spondylolysis
• The buttertly and breaststroke require hyperextension
of the lower back to maintain body position and
complete the stroke.
• The body roll done by freestyle and backstroke
swimmers can also cause strain, especially when the
swimmer fatigues.
• The athlete will tend to roll less at the hip and more at
the shoulder, increasing the strain at the lumbar spine.
• Treatment includes core strengthening and return to
fundamental stroke techniques.
• The hyperextension of the back required specifically in
the butterfly and breaststroke can predispose a
swimmer to the development of a spondylolysis. The
 RECENT ADVANCES

Effectiveness of Core Stability Exercises on Swimmer's Knee

in Breaststroke Swimmers-A Randomized Controlled Trial –
March 2019
( Indian Journal of Physiotherapy and Occupational Therapy)
 Aim and Methodology Outcome Results and
objectives measure Conclusion

To find the Inclusion Criteria: 1. Breaststroke swimmers with the age between 8 Visual Analogue This study concluded that
Effectiveness of to 18 years. 2. Knee pain occurred at least once a week and medial Scale (VAS), both conventional exercises
Core Stability aspect during breaststroke kick Functional Index and core stability exercises
Exercises on Group A: Warm up for 20 minutes and start with given conventional Questionnaire significantly execute a
Swimmer's Knee exercises. This exercises protocol consists of 5 sets of exercises, those (FIQ), Strength reduction in swimmer's knee
in Breaststroke are x-crunch up , flutter kicks, towel slides , superman plank and using pressure in breaststroke swimmers
Swimmers-A reverse wood chop with stretch. After the exercises. cool down was Biofeedback. under the prescribed time
Randomized followed for 10 minutes. This protocol was porformed for 3 times a frame, but amongst the two,
Controlled Trial week for 3 consecutive weeks. core stability exercises show
Group B: Warm up for 20 minutes and start with core stability a more significant reduction
exercises. Core stability exercises consists of knee bent bunkie with in swimmer's knee than
adduction and hip internal rotation, swiss ball , pall of press with hip conventional exercises.
internal rotation and ab wheel with ball squeeze and hip internal Hence core stability
rotation. This session was followed by 10 minutes cool down. This exercises for swimmer's knee
protocol was performed for 3 times a week for 3 consecutive weeks. can be used to effectively
reduce swimmer's knee.
Core stability in adolescent swimmers with
swimmer’s shoulder syndrome-2021
 Aim and Methodology
Objectives
the purpose of this Thirty adolescent competitive swimmers of
study was to both sexes (16 males and 14 females)
investigate the volunteered to participate in this study. They
effect of trunk were college students at the preparatory stage
muscle weakness of learning. They had 2–5 years of swimming
on shoulder practice and showed a good swimming style,
stability passing the 3rd Star test of the Egyptian
Swimming Federation. They swam 3000–7000
m per day and performed 8–14 hours/week of
swimming sessions and 3–6 hours/week of
dryland sessions. They were assigned into 2
equal groups of 15. The experimental group (A)
were referred by a physician and had a
diagnosis of SSS. However, at the time of
testing, they were pain-free to avoid muscle
inhibition due to pain. The control group (B)
were healthy swimmers with no history of
shoulder pain or instability
Outcome measure
1) trunk muscle strength was
measured via a Biodex System 3
Pro isokinetic dynamometer.
2) Core endurance functional
tests: Four tests (in non-weight-
bearing positions) [22] were
performed in a similar order to
ensure the same successive
loading. The tests were: (1) side
bridge endurance test
(quadratus lumborum
endurance stretch), (2) static
back endurance test or prone
extension endurance test
(paraspinal endurance
strength), (3) ball bridge test,
and (4) unilateral bridge test
Results and
Conclusion
The development of core
muscle strength and durability
decreases the reaction time at
which these muscles are
activated as a preparation for
making corset-like posture
before distal movement and
this, in turn, minimizes shoulder
injuries. Thus, it is very
important to incorporate a core
stability training program into
the rehabilitation plan to
provide proximal stability for
obtaining safe and proper distal
mobility across the shoulder
joint.
A Novel Rehabilitation Program Using
Neuromuscular Electrical Stimulation
(NMES) and Taping for Shoulder Pain
in Swimmers
Aim and Objectives Methodology Outcome measure Results and
Conclusion
Morphology and swimming
performance
Aim and Objectives Methodology Outcome measure Results and
Conclusion
The Impact of Eight Weeks Closed and Open
Kinetic Chain Exercise on Ratio of the
External to Internal Shoulder Rotator
Muscles’ Strength in Top Swimmers
Aim and Objectives Methodology Outcome measure Results and
Conclusion