Preventing Injury in Competitive Swimming
Swimming is a dynamic sport that requires full body movement, coordination, power, and endurance, placing significant stress on the shoulder joint. Competitive swimmers train at high volume and intensity, often swimming up to 9 miles per day, which requires more than 2,500 shoulder revolutions during each training session. The intensity of competitive swimming training can increase the risk of common overuse injuries like swimmer’s shoulder, knee injury, or low back pain. Physical therapy can help swimmers prevent and address injuries through sport-specific training and a comprehensive rehabilitation program to improve strength, endurance, mobility, and shoulder stability. Check out our 5 tips to prevent injury in competitive swimming!
Physical Demands of Swimming
Swimming is a non-weightbearing sport that requires full body movement and coordination and a significant amount of power and endurance. Swimming is an upper-extremity and spine-intensive sport that places large rotational forces on the shoulder and trunk. Up to 90% of the driving propulsive force of a swim stroke is generated by the torque of the shoulder. Competitive swimming requires the shoulder to move in the extremes of its range of motion, while tremendous muscular force is exerted on the shoulder joint.
Competitive swimmers usually specialize in one of four competitive strokes: the butterfly, the backstroke, the breaststroke, and the freestyle stroke. Each of these strokes can place unique demands on the swimmer’s body and contribute to stroke-specific injuries.
Elite swimmers engage in consistently high training volumes and intensities, often swimming up to 9 miles per day during training, which requires more than 2,500 shoulder revolutions during each training session. In one-week, elite swimmers swim between 35-45 miles, which is equivalent to 30,000 strokes per arm per week.
Common Competitive Swimming Injuries
Competitive swimming is a demanding sport that can place significant stress on the musculoskeletal system, particularly the shoulders, knees, and low back. Most swimming injuries are overuse injuries, developing due to the repetitive movements that swimming requires. The majority of competitive swimming injuries are shoulder injuries; in fact, research has shown that 91% of elite swimmers ages 13-25 have reported at least one episode of shoulder pain.
Knee injuries are the second most common source of pain in elite swimmers and is most often seen in breaststroke swimmers. One study found that 86% of competitive breaststroke swimmers have had an episode of knee pain related to swimming the breaststroke. Breaststroke swimmers have a five-fold increased risk of knee pain compared to other stroke swimmers. Low back pain can also develop with statistics showing that as high as 50% of butterfly stroke swimmers and 46% of breaststroke swimmers experience low back pain.
Common competitive swimming injuries include:
Shoulder Injuries: Swimmer’s shoulder is the most common shoulder injury and is caused by the repetitive overhead motion required for almost every type of swim stroke, which places intense stress on the tissues around the shoulder, such as the rotator cuff and scapular muscles. The rotator cuff muscles and tendons that allow swimmers to raise and rotate the arm can become inflamed and tender, leading to rotator cuff tendinitis, shoulder impingement, pain at the front of the arm, and decreased mobility and strength in the shoulder.
Knee Injuries: Swimmer’s knee is common among breaststroke swimmers. The breaststroke requires the swimmer to turn the feet out, while extending and kicking the legs, causing the knees to externally rotate, which is contrary to the leg’s natural movement pattern.
Low back pain: Low back pain is most common among those who do the butterfly and breaststroke. Both these strokes require the swimmer to lift the head while the hips and legs sink, often causing swimmers to overarch the low back to compensate, which places stress on the back muscles and ligaments.
Competitive swimming injuries can be caused by overtraining and overuse, insufficient rest and recovery between sessions, poor stroke mechanics, improper breathing technique, poor flexibility or range of motion, excessive fatigue during training that causes the swimmer to compensate and use poor swim mechanics, decreased rotator cuff and scapular muscle strength, poor core strength and stability, and decreased hip muscle strength.
5 Tips to Prevent Injury in Competitive Swimming
It’s essential to properly stretch and engage in a dynamic warm up before a swim training session to reduce the risk of injury and warm up muscles. Exercising “cold” muscles that have not been prepared for intensive training are at a higher risk of injury. Swimmers often lack range of motion in internal rotation and horizontal adduction, so targeting the pectoralis major and minor muscles, posterior capsule, and latissimus dorsi is important prior to training. Post-workout static stretches can help swimmers stay loose and limber and keep muscles healthy for your next swim session.
To minimize the risk of an overuse injury, it’s essential to gradually increase mileage, duration, and intensity of swim training sessions. Overuse injuries like swimmer’s shoulder can develop when swimmers do too much intensive exercise for too long without sufficient rest and recovery time.
Use proper stroke technique. The swimmer’s arm should enter the water with the pinky finger first or the hand flat, avoiding rotating the arm. Entering the water with the thumb side of the hand down can increase the risk of shoulder pain. Be careful not to cross the midline of the body when the hand enters the water and keep hips turned toward the surface of the water to reduce drag. Move the body as one unit with the head in line with the trunk, breathing on both sides to distribute the load on the shoulders evenly. Roll the entire body to the side when you breathe to avoid excessive neck rotation and keep the arm and leg movements smooth and clean, avoiding excessively wide or deep kicks.
Address muscular imbalances with targeted strengthening and functional exercises. It’s critical to specifically target the scapular and rotator cuff muscles (which stabilize the shoulder joint) to strengthen the shoulder complex, since swim strokes and training tend to place excessive stress on the shoulder.
Building core strength and stability is also important to provide a strong foundation for upper body stroke movement and lower body kicks. A strong core can also prevent low back pain and improve overall swim performance. Engaging in plyometric training can also improve a swimmer’s explosive power and agility, while doing aerobic training can help overall fitness and reduce fatigue-related injuries. Cross training such as running or cycling can be very beneficial for swimmers to reduce overuse injuries while building cardiovascular endurance.
Work with a physical therapist to rehabilitate after injury or address any muscular weaknesses or imbalances. Physical therapy can help swimmers prevent and address injuries through sport-specific training and a comprehensive rehabilitation program to improve strength, endurance, mobility, and shoulder stability. A physical therapist designs an upper body, hips, quadriceps, back, and core strengthening program to address muscular weakness and imbalances that contribute to pain and injury. Physical therapists can also improve swim technique and performance, helping swimmers make small adjustments to their stroke, body position, and breathing patterns that can have a significant impact on a swimmer’s efficiency in the water.
Are you a competitive swimmer? Check out our tips to prevent injury this swim season and work with a physical therapist to prepare for a successful swim season through a targeted strengthening program to improve your strength, endurance, and mobility!
