What kinds of injuries can occur?
Although injuries are few, they do happen. Most athletic injuries can be divide into two main groups - acute and chronic (overuse).
Acute injuries come from sudden traumas such as a fall, a strike with an object, or cuts and bruises. They are not common in swimming but can occur from collisions with other swim-mers, improper use of equipment or contact with the edge of the pool. For the most part, they can be prevented.
Supervised swimming will help keep acute inju-ries to a minimum.
Horseplay or dangerous activities in and around the water should be discouraged. The risk of acute injury (and the ultimate risk -drowning) goes up sharply at lakes, beaches and backyard pools where swimming is not supervised. The use of alcohol also increases the chance of acute water-related injuries.
The most common injuries seen in swimmers are caused by overuse. In these, irritation develops from repetitive movement at a specific part of the body. Too little recovery time between swim sessions leads to more irritation and pain.
There are four competitive swimming strokes: freestyle (front crawl), backstroke, breast-stroke, and butterfly. Seventy-five per cent of the forward movement comes from the arms in freestyle, backstroke and butterfly. In the breaststroke the arms and legs work equally. In these strokes, shoulder pain is the most common chronic complaint - with the knees, feet and back affected as well.
Because of the repeated rotation of the arms, particularly in freestyle and butterfly, the shoul-der is very prone to overuse problems. The tendon that runs from the muscles in the shoul-der blade across the outside of the shoulder becomes irritated. Each time that the arm swings overhead, the tendon can get pinched between the bones and ligaments. Swelling and pain known as "swimmer's shoulder" result. It may occur in anyone who swims, and becomes more common with more frequent and intense swimming.
Young competitive swimmers may swim up to 7,000 meters a day. This means about 750,000 shoulder rotations a year. A seven or eight year old who competes for five years will have made about 4 million shoulder rotations. It is not dif-ficult to see why many of these young athletes develop shoulder pain at some point in their careers.
In the early stages of swimmer's shoulder, the athlete may feel pain at a certain point of the arm stroke, or only after a long, hard workout. If untreated, the pain will occur earlier in the practice session and will begin to affect performance. At some point, swimming may no longer be possible due to constant pain.
In an older swimmer, the same type of overuse can lead to thinning and fraying of the tendon, or an actual muscle tear.
Some swimmers may have a mobile shoulder joint that puts them at greater risk of a painful overuse syndrome.
In most cases, a doctor must identify the exact source of pain in the shoulder. Based on this, treatment can be started – often involving a physiotherapist.
The main aim of treatment is prevention of further problems. After enough rest time to allow the inflammation to settle, an exercise program is begun. This strengthens the shoulder muscles and corrects any imbalance.
Stretching should be done before all swim sessions. Incorrect stretching methods can increase irritation of the shoulder tendons, so instruction in proper technique should be given by a qualified person. Swimmers under age 15 should be taught to stretch on an individual basis. Older swimmers may stretch with partners but this must be done carefully to avoid overstretching the soft tissues.
Correction of the stroke technique can help prevent swimmer's shoulder. Under the guidance of a qualified coach, a swimmer can alter the body roll, reach, and hand position to decrease the force on the shoulder during the arm pull. Hand paddles can put extra stress on the shoulder muscles and should be discouraged. Also, weight training with the arm above the level of the shoulder should be avoided.
Training programs should be planned to avoid overwork – or "too much too soon." Excessive fatigue should be avoided as tired muscles are more prone to injury.
Unlike sports where the legs are planted firmly on the ground, swimming results in very few cartilage or ligament tears. Instead, symptoms come from tendon and ligament irritation, again from overuse.
The thick tendon just below the kneecap may become inflamed from repeated straightening of the knee during kicking, usually during freestyle or butterfly. The pain often comes on gradually, but like the shoulder, increases with more activity.
As in treatment of the shoulder, the swimmer should avoid activities that cause pain, even if it interrupts training. Swimming may be con-tinued using arms only to maintain fitness. Ice may be useful in relieving minor discomfort. An exercise program by a physiotherapist, including stretching and muscle strengthening, may be used for a gradual return to full activity.
As the name implies, "breastroker's knee" is common in those swimmers who do a lot of breastroke. Pain develops on the inside aspect of the knee because of the extra stress placed on the structures there during the whip kick. Repeated motion leads to irritation of the liga-ment and pain. The mainstay of treatment is rest, ice, and a change in the way the kick is done. This should allow a gradual return to swimming.
The most common foot and ankle complaints in swimmers are sprains from slipping on a wet pool deck. These are treated like those incurred in any other sport.
An injury specific to swimming is inflammation of the tendons on the back of the foot from repeated motion during the flutter kick. This is common to both freestyle and backstroke and is made worse by the use of flippers. Treatment consists of rest, ice and stretching of the tendons before each practice session.
With breastroke and butterfly, over-arching of the lower back may lead to back pain during or after swimming. This is more common in an aggressive training program or in older swimmers who already have back problems. The joints at the back of the spine become inflamed. When pain occurs, breastroke and butterfly swimming should be stopped. freestyle and backstroke can be continued if these do not cause pain. If pain persists, a doctor should be consulted.
Swimming can be a source of fun and fitness for both young and old - and injuries can be prevented. Proper attention to safety, pre-season conditioning, adequate warmup, and early treatment of problems are important. Common sense and moderation reduce time off from sports and increase enjoyment and performance.