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Swimming
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Swimming
g is regarded as the
ideal form of exercise
because it is so
injury-free. Physical
problems only really
emerge as a result of
competitive training,
combined with heavy land
training. The result?
Over-use or repetitive
microtrauma injuries
such as swimmer's
shoulder and
breast-stroke knee .
These two terms are just
generalised names for a
variety of injuries that
can occur at the
shoulder or knee joint
because of the heavily
repetitive nature of
competitive swimming.
This stress can be
appreciated if you
imagine a swimmer
training 200-300 lengths
per session, x 8+
sessions per week for
eight months of the year
- those arms certainly
circle a lot of times!
This is why efficient
technique (with regular
assessment) and even
diet are vital to ensure
a swimmer's competitive
career is as injury-free
as possible.
Swimmer's
shoulder is more
properly known as
painful arc/ rotator
cuff tendinitis, or
shoulder impingement. In
swimmers, painful
arc/rotator cuff pain in
the shoulder can occur
in any of the following
movements:
1 Adduction of the arm
at the shoulder (when
the extended arm is
lifted sideways to
vertical, away from the
mid-line of the body)
2 When this movement is
blocked
3 Flexion of the arm at
the shoulder (when the
extended arm is lifted
out in front)
4 When this movement to
left or right is
blocked.
Pain occurs in the arc
between 80-110 degrees.
If little strength can
be put against blocked
movement, there could be
a tear in the rotator
cuff. Cause: over-use of
any of the four shoulder
muscles, poor blood
supply or poor swimming
efficiency and
technique. This form of
trauma often accompanies
shoulder impingement.
Treatment involves rest
and assessment of the
swimmer's bio-mechanics
in order to identify any
faults that may
contribute to the
injury. It is also
important to look at the
land conditioning or
weight traning the
swimmer is undertaking,
again to identify
possible injury factors.
The acromioclavicular
joint (where the
clavicle and scapula
meet) may develop
degenerative arthritic
changes, particularly
from damage in
resistance weight
traning. The repetitive
motions of swimming may
also stress this joint.
The problem is usually
treated conservatively
with rest; however, if
there is no satisfactory
response, non-steroidal
anti-inflammatory drugs,
local heat and ice
contrast and
occasionally a cortisone
injection may be needed.
Arthritis of the
glenohumeral joint
(where the head of the
humerus meets the
glenoid cavity) may be
seen in the masters age
group, though it is rare
in the young.
Inflammatory arthritis
(rheumatoid) may,
however, affect the
young athlete; it
destroys the surface of
the joints. Massive
arthritic destruction of
the glenohumeral joint
may require prosthetic
joint replacement or
joint fusion. Obviously
neither would allow an
athlete to effectively
take part in competitive
swimming.
Where the force comes
from
The propulsive force of
a swimmer comes from the
upper body, with the
legs acting as
stabilisers and
providing little
propulsion. The shoulder
joint must withstand
repetitive microtrauma
and is subject to
overuse syndromes.
However, not all
swimmers who train under
similar conditions
develop significant
interfering shoulder
problems - most will
escape any ill effects.
The most powerful
swimming muscles are the
adductors and internal
rotators (subscaplaris,
supraspinatus and teres
major). In an unstable
shoulder, the external
rotators will be
required to do extra
work to restrain the
humeral head from
anterior translation
during the press and
in-sweep phases of the
freestyle stroke. This
can lead to overload,
fatigue and secondary
inflammation, and may
account for the common
complaint of posterior
pain in an individual
with anterior shoulder
subluxation or
dislocation.
Strengthening of the
rotator-cuff muscles
provides the best
stability to the joint
and decreases the chance
of hypermobility.
Military press (shoulder
press), side raise with
dumbbells (with external
rotation), medicine ball
exercises, lateral
pull-downs and seated
rows are examples of a
few.
Dealing with
breast-stroke knee
While the alignment of
the knee centre relative
to the hip centre during
the start of the
breast-stroke kick
affects the development
in the medial collateral
ligament (which
stabilises the knee on
the inside of the leg)
and capsule. The optimum
initiating position from
the breast-stroke kick
is with the hip and knee
centres aligned. When
the knee centre is
narrow or wide of the
hip centre, it causes
increased stress on the
medial collateral joint
structures. Exceeding
the elastic limits of
the ligament will cause
damage and injury. In
young swimmers, this
form of stress could
open growth plates of
the femur and tibia and
cause micro-injury which
will result in
inflammation and thus
seriously impair
training. If you're a
coach, what's the
breast-stroke kick like
in your younger
swimmers?
Finally, there is a high
risk of the patella
(knee-cap) riding
laterally during the
breast-stroke kick. This
is magnified when the
patella tendon
attachment site at the
tibial tubercle is
placed in an extremely
rotated position. This
is measured clinically
as the Q angle. Weakness
of the vastus medialis
(the inner thigh muscle
which is part of the
quadriceps) can decrease
effectiveness in
ensuring central
tracking of the patella.
If dislocation occurs,
surgery is almost
certain. Other minor
causes include weak
abductors and decreased
flexibility of the
hamstrings, adductor
muscles and the
iliotibial band. The
patella in particular
will be tender if
palpated. Treatment can
be confirmed by x-rays
(to determine the lining
of the patella and
tendons) and focus on
reducing the
inflammation. When
planning land
conditioning for
swimmers, I strongly
recommend, especially
for breast-stroke
swimmers, including a
range of quadriceps
exercises such as
squats, leg press,
cycling, lunges and leg
extensions, and also leg
raises for the abductor
and adductor muscles,
followed by quality
stretches.
The fibrocartilagenous
meniscus (pad-like
structures protecting
bone ends) of the knee
may be injured during
combined bending and
twisting movements. As
the knee flexes under a
load, the meniscus can
become trapped between
the joint surfaces,
causing a shearing force
that produces a tear.
The signs of such an
injury include a popping
and sapping noise, and
buckling and possible
locking of the knee.
Unfortunately, meniscus
tears do not heal at all
well and may need
arthroscopic surgery. In
masters swimmers,
generative arthritis or
wearing of the knee
surface may also result
in tearing of the
meniscus and is not
uncommon.
Tips
To Prevent Swimming
Injuries
Each
yearlarge amount of
swimming-related
injuries are treated in
hospitals, doctors'
offices, clinics,
ambulatory surgery
centers, and hospital
emergency rooms.
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Always take time to
warm up and stretch.
Research studies
have shown that cold
muscles are more
prone to injury.
Warm up with jumping
jacks, stationary
cycling or running
or walking in place
for 3 to 5 minutes.
Then slowly and
gently stretch,
holding each stretch
for 30 seconds.
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Learn
how to swim and do
not swim alone. Swim
in supervised areas
where lifeguards are
present.
Inexperienced
swimmers should wear
lifejackets in the
water.
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Do
not attempt to swim
if you are too
tired, too cold, or
overheated.
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Avoid
diving into shallow
water. Each year
approximately 1,000
disabling neck and
back injuries occur
after people went
headfirst into water
which was shallow or
too murky to see
objects.
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Swim
in a pool only if
you can see the
bottom at the
deepest point; check
the shape of the
full diving area to
make sure it is deep
enough.
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Dive
only off the end of
a diving board. Do
not run on the
board, try to dive
far out, or bounce
more than once. Swim
away from the board
immediately after
the dive, to allow
room for the next
diver. Make sure
there is only one
person on the board
at a time.
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When
swimming in open
water, never run and
enter waves
headfirst. Make sure
the water is free of
undercurrents and
other hazards.
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Do
not swim in a lake
or river after a
storm if the water
seems to be rising
or if there is
flooding because
currents may become
strong. The clarity
and depth of the
water may have
changed, and new
hazards may be
present.
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Check
weather reports
before going
swimming to avoid
being in the water
during storms, fog,
or high winds.
Because water
conducts
electricity, being
in the water during
an electrical storm
is dangerous.
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Remember that
alcohol and water
don't mix. Alcohol
affects not only
judgment, but it
slows movement and
impairs vision. It
can reduce swimming
skills and make it
harder to stay warm.
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Be
knowledgeable about
first aid and be
able to administer
it for minor
injuries, such as
facial cuts,
bruises, or minor
tendonitis, strains,
or sprains.
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Be
prepared for
emergency situations
and have a plan to
reach medical
personnel to treat
injuries such as
concussions,
dislocations, elbow
contusions, wrist or
finger sprains, and
fractures.
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Swimming 