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 start intense training programs. While swimming is not a contact or collision sport associated with traumatic injuries, there is a high rate of swimming injuries, especially in high-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.These swimmers often swim up to 10,000 meters per day. That distance correlates to roughly 30,000 shoulder rotations per week. The 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.
The shoulder is the most frequent location of pain in competitive swimmers, likely due to the large numbers of rotations the shoulder undergoes during the course of the year. Swimmers and coaches should focus on efforts to prevent these injuries, if possible, or treat them early when symptoms develop. Adding periscapular and rotator cuff strengthening and dynamic shoulder stabilization programs as routine shoulder maintenance, similar to what baseball pitchers do, 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 a lingering problem later on.
Hip and knee injuries
The whip kick (or frog kick) during the breaststroke can lead to hip and knee pain in these swimmers. The adductor muscles of the hip have to forcefully contract during the finish of the kick, so overuse injuries to these muscles can occur. 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 throughout the year 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 specifically for swimmers with their 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.
Swimming injuries from increased competition
Wolf et al. showed a higher number of injuries in college freshmen (1.21 injuries per female swimmer and 1.19 per male swimmer) compared to later years of collegiate swimmers.4 It is likely that the increased rate of injuries in freshmen results from significantly increased training, both in and out of the pool. Swimmers preparing to jump to a higher level of competition should prepare ahead of time and gradually increase their training and dry-land workouts.
Recent increase in swimming injuries
The incidence of injuries seems to be increasing in recent years. In 1996, McFarland and Wasik noted an injury 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 stresses on the shoulder with few breaks 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.