Wednesday, November 26, 2014
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Common swimming injuries and effective treatment

Poor swimming mechanics may be a contributing factor in many swimming injuries. But assessing these mechanics is beyond the expertise of most sports medicine.

Common swimming injuries and effective treatment

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My last blog was about basketball injuries. Now, let’s dive into the pool and talk about common swimming injuries.

Swimming Mechanics

Poor swimming mechanics may be a contributing factor in many swimming injuries. But assessing these mechanics is beyond the expertise of most sports medicine. Your swimming stroke should be assessed by your coach, taking into account your specific injury, in order to eliminate an underlying biomechanical cause. A team approach should be taken with swimming injuries incorporating these stroke changes along with a specific rehabilitation program from your athletic trainer or sports medicine provider.

Shoulder/Upper Arm

Shoulder/upper arm injuries are the most common body area injured in swimming. These injuries can generally be categorized into two causes: flexibility and strength issues.

From a flexibility stand point, shoulder injuries are usually from being too loose (hypermobile) or too tight (hypomobile). Hypermobility allows the shoulder ball to subtly move around in socket where hypomobility stresses shoulder structures due to lack of flexibility.

Strength issues are usually seen as problems with scapular (shoulder blade) positioning and stability. Shoulder injuries should be thoroughly evaluated by your team’s athletic trainer or a sports medicine specialist to assess the underlying cause of the problem and develop an appropriate treatment plan which may include time out of the pool, rehabilitation, medications, injection, and even surgery when indicated. Common diagnoses include rotator cuff tendonitis/impingement, biceps tendonitis, rotator cuff tear, and labral tear.

Spine

Neck and back injuries are the second most common behind the shoulder. Swimming puts significant stress on the spine, specifically rotational stress on the cervical and thoracic spine. Common diagnoses include sprain/strain, spondylolysis, and disc derangement (bulge, herniation, etc).  

As with the shoulder, these injuries should be evaluated thoroughly by your team’s athletic trainer or a sports medicine specialist to assess the problem and develop an appropriate treatment plan which usually includes time out of the pool, rehabilitation, and medication.

Lower Extremity

Hip pain is an uncommon problem in swimming and is more frequently associated with the breast stroke due to the rotational motion of the kick. Some common diagnoses for hip pain in swimmers include sprain/strain, femoral acetabular impingement, and labral injuries. As with the shoulder, these injuries can generally be categorized into two causes: flexibility (hyper or hypomobility) and strength issues. Your team’s athletic trainer should assess the injury and either provide an appropriate rehabilitation program or refer the athlete to a sports medicine physician for further evaluation and treatment options.

Patellofemoral pain is another uncommon problem in swimming. It is also known as anterior knee pain or chondromalacia and its main symptom is pain behind the knee cap. More common in females than males, patellofemoral pain is usually the result of overuse from the kicking motion involved in swimming.

The first line of treatment is an evaluation by your team’s athletic trainer to put together an appropriate rehabilitation program including lower extremity stretching and strengthening. It may also require some time out of the water to allow the symptoms to subside. Patellofemoral pain from swimming is of a different etiology than weight-bearing sports where the underlying problem is a biomechanical/kinetic chain dysfunction.

Elbow/Wrist/Hand

Hand and wrist injuries are relatively uncommon in swimming. They include finger sprains/fractures from contact with the wall and overuse injuries of the elbow and wrist such as sprains/strains and tendonitis. Finger injuries should be evaluated by your athletic trainer and referred to a sports medicine physician if a fracture is suspected. Overuse injuries are usually the result of overtraining or poor swimming mechanics. These injuries should also be evaluated by your athletic trainer. Treatment may include time out of the pool, rehabilitation, and referral to a sports medicine specialist if indicated.

As you can see, upper extremity injuries account for the majority of swimming injuries. Many of these are minor and can be managed conservatively with a quick return to sports. The above treatment recommendations are just a guideline and any injury should be evaluated by your team’s athletic trainer or a sports medicine physician to accurately diagnose the injury and provide appropriate care.

Swimming injury prevention brochure from the STOP (Sports Trauma and Overuse Prevention) Sports Injuries program: http://www.stopsportsinjuries.org/files/pdf/AOSSM_Swimming.pdf


Read more Sports Doc for Sports Medicine and Fitness.

Justin Shaginaw, MPT, ATC Athletic Trainer for US Soccer Federation; Aria 3B Orthopaedic Institute
About this blog

Whether you are a weekend warrior, an aging baby boomer, a student athlete or just someone who wants to stay active, this blog is for you. Read about our growing list of expert contributors here.

Brian Cammarota, MEd, ATC, CSCS, CES Partner at Symetrix Sports Performance
Ellen Casey, MD Physician with Drexel University Sports Medicine
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Head Team Physician for Phillies & St. Joe's; Rothman Institute
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Peter F. DeLuca, M.D. Head Team Physician for Eagles, Head Orthopedic Surgeon for Flyers; Rothman Institute
Joel H. Fish, Ph.D. Director of The Center For Sport Psychology; Sports Psychology Consultant for 76ers & Flyers
R. Robert Franks, D.O. Team Physician for USA Wrestling, Consultant for Phillies; Rothman Institute
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer, The Sporting Club at The Bellevue
Eugene Hong, MD, CAQSM, FAAFP Team Physician for Drexel, Philadelphia Univ., Saint Joe’s, & U.S. National Women’s Lacrosse
Martin J. Kelley, PT, DPT, OCS Advanced Clinician at Penn Therapy and Fitness, Good Shepherd Penn Partners
Julia Mayberry, M.D. Attending Hand & Upper Extremity Surgeon, Main Line Hand Surgery P.C.
Jim McCrossin, ATC Strength and Conditioning Coach, Flyers and Phantoms
Kevin Miller Fitness Coach, Philadelphia Union
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales and Hatfield, PA
Kelly O'Shea Senior Health Producer, Philly.com
Tracey Romero Sports Medicine Editor, Philly.com
David Rubenstein, M.D. Team Orthopedist for 76ers; Main Line Health Lankenau Medical Center
Robert Senior Event coverage, Sports Doc contributor
Justin Shaginaw, MPT, ATC Athletic Trainer for US Soccer Federation; Aria 3B Orthopaedic Institute
Thomas Trojian MD, CAQSM, FACSM Associate Chief of the Division of Sports Medicine at Drexel University
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