By Kari Martin, PT, DPT, Mercy Clinic East Sports Medicine and Rehabilitation Center
Recent trends have shown a sharp increase in youth sports participation and athletic activities, including swimming. With the increase in participation, there has been a concomitant rise in the number of sports-related injuries. A majority of these injuries are due to overuse as athletes are frequently competing in multiple sports or in year-round competition and training. Additionally, increasingly higher demands are put upon these young athletes, increasing their likelihood of sustaining a season-compromising and possibly career-ending injury.1
With overuse comes fatigue and lapses in appropriate swimming technique. Often swimmers demonstrate tremendous flexibility or joint laxity, which can be normal, but when swimmers repetitively move through an inappropriate range of motion due to poor technique, slight injuries and micro-trauma can cause shoulders, low backs and knees to become painful. 2
The shoulder is the joint most commonly affected by swimming injuries or overuse. Shoulder injuries may include rotator cuff impingement (pressure on the rotator cuff as the hand is ‘catching’ water at the beginning of the pull), biceps tendinitis (painful inflammation of the bicep tendon) and shoulder instability (in which structures that surround the shoulder joint do not work to maintain the ball within its socket). Each of these conditions can result from fatigue and weakness of the rotator cuff and muscles surrounding the shoulder blade.2
Low back pain
Due to the increased amount of time that swimmers spend with their backs in a hyper-extended position, as well as their tendency to have higher than average flexibility in their joints and decreased core strength, it is common for elite level swimmers to complain of low back pain resulting from lumbar disc disease or spondylosis.3
Knee injuries that involve the tendons and ligaments along the inside of the knee (breaststrokers’ knee) are common.2 These kinds of injuries, as well as other knee and hip pain in swimmers, are often caused by core weakness, hyper-mobility and other muscle imbalances.
Treatment of common swimming injuries
Common treatment protocols for shoulder, low back and knee pain often include components of stretching and strengthening the shoulder complex, core stabilization, and correcting muscle imbalances.4, 5 The exercises depicted here are some examples of exercises that can be done to prevent excess laxity in the shoulder complex, as well as to improve core and shoulder stability.
Additionally, should the athlete experience pain with swimming that persists, they should see a doctor, physical therapist, or athletic trainer for a full diagnostic work-up and care plan.
Lay on your side with your head supported, your bottom arm perpendicular to your body, and your elbow bent to 90 degrees. With your top hand, gently push your forearm toward the table until you feel a slight stretch or resistance by your shoulder blade. Hold 30 seconds. Repeat 3 times.
Lay on your side with your head supported. Place a towel roll under your elbow. Start with your hand near your belly button and raise until your forearm is parallel with the ground (as pictured). Start without weight and complete 20 repetitions 2 times.
Start on your elbows and toes. Keep your back flat by pulling your belly button toward your spine and pushing your tailbone towards your heels. Keep your shoulder blades rounded, without pinching them together. Hold 30 seconds. Repeat 3 times.
Double knee-to-chest stretch
Lie on the floor with your back relaxed and straight. Pull both knees toward your chest until you feel a stretch in your lower back. Do not bounce. Hold 5 seconds. Repeat 5 times.
Keep your chest up and maintain a curvature in your lower back as you lean forward. Do not allow the knee on the leg being stretched to bend up. Hold 30 seconds. Repeat 3 times. Seated hamstring stretch can be done on the floor. Sit with one knee bent and the bottom of your foot against the inside of the opposite thigh.
Start with both feet on a stability ball, with hips lifted. Keeping your core and abs tight, draw your heels toward you, keeping your hips elevated (as pictured). Complete 20 repetitions 2 times.
- Mariscalco MW, Saluan P. Upper Extremity Injuries in the Adolescent Athlete. Sports Medicine and Arthroscopy Review. 2011; 19(1): 17-26.
- Preventing Swimming Injuries. Stop Sports Injuries: Keeping Kids in the Game for Life.
- Kaneoka MD K, Marks MD S. Low Back Pain in Elite Competitive Swimmers. 17th FINA World Sport Medicine Congress: ‘Enhancing Performance: The Health Aquatic Athlete.’ 2010 April 1.
- Reeser JC, Verhagen E, Briner WW, Askeland TI, Bahr R. Strategies for the prevention of volleyball related injuries, Br J Sports Med. 2006; 40: 594-600.
- Edwards SL, Lee JA, Bell JE, Packer JD, Ahmad CS, Levine WN, Bigliani LU, Blaine TA. Nonoperative treatment of superior labrum anterior posterior tears; improvements in pain, function and quality of life. Am J Sports Med. 2010 July; 38(7): 1456-1461.