swimming

Injury Prevention in Swimming

February 18, 2015

Michael RosenblatPT, CEP, NCCP(Triathlon), Dip(FLM), BASc(KIN),

MSc(PT)

Epidemiology and Risk Factors Pathomechanics Assessment Injury Prevention

Contents

Study Design Prospective cohort 34 swimmers (16 men, 18 women) Competing at NCAA Division I level

Results Injury incidence

20 of 34 swimmers sustained 34 injuries Injuries were more common in women

Injury location and type Shoulder (38.7%), back (16.1%), knee (12.9%)

Injury onset Overuse injuries (58.1%)

Epidemiology and Risk Factors

Chase et al. Res Sports Med 2013;21:111-123

Sex Differences in Shoulder Injuries Women reported incidences of shoulder pain

three times more than men Women demonstrate more generalized

glenohumeral joint hypermobility Participation in collegiate swimming among

women has increased


Harrington et al. J Sports Rehab 2014;23:65-75

Shoulder Injuries Swimmers shoulder Original definition

Impingement of the rotator cuff tendons under the coracromial arch

Current definition is multifactorial Stroke biomechanics Overuse and fatigue of muscles of the shoulder,

scapula, and upper back Glenohumeral laxity with subsequent shoulder

instability


Wanivenhaus et al. Sports Health 2012;4:246-251

Shoulder InjuriesIntrinsic factors Joint hypermobility Scapular dyskinesis Glenohumeral internal-rotation deficit Rotator-cuff imbalance Lack of flexibility, or stiffness Posture Core stability Increased thoracic kyphosis


Bak et al. Clin J Sports Med 2010;20(5):386-390.

Knee Injuries Stress to the medial compartment during whip kick Saphenous nerve compression / tension MCL Strain of the pes anserine muscle group Strain of abductor magnus/brevis

Patellofemoral pain during flutter kick Patellar tendonitis Mal-tracking of the patella


Gaunt et al. Br Med Bull 2012;103:45-88

Knee InjuriesPrevalence Greatest occurrence in breaststroke

swimmers at 86%Biomechanical factors Angle of hip abduction at kick initiation Adduction angle Adduction velocities



Lumbar Spine Injuries Facet joint sprain Spondylolysis Spondylolisthesis Degenerative disc disease



Lumbar Spine InjuriesPrevalence 68% of elite swimmers developed degenerative

disc disease, commonly at L5-S1 37% - 50% incidence of low back pain in butterfly

swimmers 47% in breaststroke swimmersBiomechanical factors Swimmers hyperextend to maintain a streamline

position


Wanivenhaus et al. Sports Health 2012;4:246-251

Freestyle

Hand entry Hand enters further away or crosses midline Thumb enters first

Pull-through Dropped elbow S-shaped pull-through (or excessive horizontal adduction)

Recovery Dropped elbow Body roll greater or less than 45 degrees

All phases Head in forward position

Pathomechanics

Virag et al. Sports Health 2014;6:218-224

Butterfly

Hand entry Hand enters further away from midline

Pull-through Decrease in activity of UFT, serratus anterior with no

change in Rhomboids Results in net-downward rotation of scapula

Hand-exit Increases infraspinatus activity

Pathomechanics

Heinlein et al. Sports Health 2010;2:519-525

Backstroke Similar to freestyle

Pathomechanics


BreaststrokePull-through Increased upper fibres of trapezius,

latissimus dorsi and subscapularisRecovery Decrease in scapular upward rotation

Pathomechanics


Subjects Characteristics

Provincial level High school

Stroke Breastroke (n=4) Backstroke (n=1) Butterfly (n=1)

Assessment

Observation Increase in thoracic kyphosis and cervical lordosis Rounded shoulders Hyperextension of the knee

Functional movements Single leg stance

Hip drop (Trendelenburg) Squat

Dynamic valgus Tibia laterally rotates (causes toeing-out) Lumbar hyperextension

Single leg squat Dynaic valgus

Assessment

AROM Decrease in dorsiflexion Decrease in shoulder arc of motion Increase in Lumbar extension

Also can occur with bilateral shoulder flexion (tight latissimus dorsi) Altered scapular mechanics

PROM Decrease in shoulder arc of motion Hip internal rotation

RROM Shoulder IR and ER Knee flexion

Assessment

Neural Dynamics Obturator Saphenous

Joint Stability Tests Lumbar spine stability (especially L4/L5, L5/S1) Shoulder joint stability tests

Special Tests FADDIR SLR Rotator cuff muscles Thomas test Shoulder Impingement tests Knee-to-wall

Assessment

Athlete Tracking Prospective, observational data

Swimming mechanics Swimming videos, EMG

Postural assessment Measurements, photographs

Physiological data Markers of fatigue (RPE, HR, HRV, performance)

Y-Balance Test – Upper Quarter (YBT-UQ)(Butler R et al. J Athl Train 2014;49:442-446)

Injury Prevention

Injury Prevention

Butler R et al. J Athl Train 2014;49:442-446

Y-Balance Test - UQ

Injury Prevention

Stretching Shoulder

Latissimus dorsi, pectoralis minor Scapula

Upper fibres of trapezius Hip flexors

Iliopsoas, rectus femoris

Soft tissue release Sub-occipitals

Mobilization Thoracic spine extension Thoracic spine rotation

Strengthen Rotator cuff

Infraspinatus, Teres minor Scapular muscles

Rhomboids, serratus anterior, middle and lower trapezius

Cervical spine Deep neck flexors

Lumbar spine Transversus abdominis,

multifidus

Shoulder Prehabilitation

Injury Prevention

Stretch Ankles

Gastrocnemius (generally have hyper-flexible hamstrings, leaving gastrocnemius tight)

Hip External rotators to promote an

increase in internal rotation Hip flexors

Neural dynamics Saphenous nerve Femoral nerve

Strength Knee

Hamstrings (very slow concentric and eccentric)

Quadriceps Hip

Adductor magnus and brevis Gluteus medius

Power Jump Squats (double and single

leg)

Knee Prehabilitation

Injury Prevention

Stretching Hip flexors

Iliopsoas, rectus femoris

Soft tissue release Sub-occipitals

Mobilization Thoracic spine extension,

rotation

Strengthen Cervical spine

Deep neck flexors Lumbar spine

Transversus abdominis, multifidus

Hip Hamstrings

Lumbar Spine Prehabilitation

1. Bak K. The practical management of swimmer’s painful shoulder. Clin J Sports Med 2010;20(5):386-390.

2. Butler R, Arms J, Reiman M, Plisky P, Kiesel K, Taylor D, Queen R. Sex differences in closed kinetic chain upper quadrant function in collegiate swimmers. J Athl Train 2014;49:442-446.

3. Chase K, Caine D, Goodwin B, Whitehead J, Romanick M. A prospective study of injury affecting competitive collegiate swimmers. Res Sports Med 2013;21:111-23.

4. Gaunt T, Maffulli N. Soothing suffering swimmers: a systematic review of the epidemiology, diagnosis, treatment and rehabilitation of musculoskeletal injuries in competitive swimmers. Br Med Bull 2012;103:45-88.

5. Harrington S, Meisel C, Tate A. A cross-sectional study examining shoulder pain and disability in Division I female swimmers. J Sports Rehab 2014;23:65-75.

6. Heinlein S, Cosgarea A. Biomechanical considerations in the competitive swimmer’s shoulder. Sport Health 2010;2:519-525.

7. Virag B, Hibberd E, Oyama S, Padua D, Myers J. Prevalence of freestyle biomechanical errors in elite competitive swimmers. Sports Health 2014;6:218-224.

8. Wanivenhaus F, Fox A, Chaudhyry S, Rodeo S. Epidemiology of injuries and prevention strategies in competitive swimmers. Sports Health 2012;4:246-251.

References

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