Swimming Injuries

Swimming is not only a popular leisure activity for adults and children alike, it’s also a low-impact form of exercise and a sport practiced on the junior, collegian, professional, and Olympic levels. When compared to many other sports, the risk of suffering a swimming-related injury, especially an acute one, is substantially less likely. However, swimmers are still at risk for many overuse and repetitive stress injuries.

How Do Swimming Injuries Occur?

As mentioned above, there is the risk of acute trauma, such as a head injury from a swimmer diving and hitting the bottom of the pool. But, most injuries in the sport of swimming are the result of repetitive use or overuse. Many swimming athletes compete and practice year-round. Some studies have shown that professional swimmers swim an average of five miles per day and can easily make over a million strokes per year.

The repetitive nature of the various types of swimming strokes and kicks place a great deal of stress on the muscles, ligaments, tendons, and joints being used to propel the body through the water. Poor swimming technique; suddenly changing the duration, frequency, or vigor of swimming activities; and improper physical conditioning are also risk factors for overuse injuries.

What Are Some Common Swimming Injuries?

The shoulder and knees are the two most common sites for overuse injuries in swimming. Here are some of the most common swimming injuries:

Swimmer’s Shoulder

Swimmer’s shoulder is a layman’s term used to describe several types of swimming-related shoulder pain around the rotator cuff.

The rotator cuff encases the shoulder joint and is comprised of the teres minor, infraspinatus, supraspinatus, and subscapularis muscles and a tendon for each muscle. Together, these muscles and tendons provide stability to the shoulder, power the shoulder rotating, and enable the head of the humerus to glide and rotate smoothly and securely within the shoulder joint.

Putting the arm above the head repetitively during certain stroke phases compresses the rotator cuff into adjacent bone and can cause one or more of rotator cuff tendons to become irritated and inflamed - a condition called rotator cuff tendinitis. The stresses placed on the rotator cuff during the overhead movements involved in swimming are much greater than those out of water, as water provides a greater resistance than air. Improper swimming technique and over-training can also be risk factors for injuries to the rotator cuff.

If the already irritated and inflamed tendons continue to be overused or stressed, the affected tendon(s) may start to break down at a cellular level, form scar tissue, and thicken - a condition called rotator cuff tendinosis.

Another possibility is a rotator cuff tear, with the supraspinatus being the most commonly torn rotator cuff tendon. A rotator cuff tear may be a partial-thickness tear that involves microscopic tearing or fraying of an otherwise intact tendon, a full-thickness tear as small as a pinhole or as large as a button hole of a mostly attached and still functioning tendon, or a full-thickness tear that additionally involves the tendon completely detaching from the humerus bone.

Swimmer’s Knee

Swimmer’s knee is also referred to as breaststroker’s knee due to the frequency it occurs while performing the whip-kick during this particular stroke.

The whip-kick causes the knee to rotate outwardly, thereby placing a great deal of stress on the medial collateral ligament (MCL) running along the inside (medial) aspect of the knee. This ligament connects the tibia bone to the femur bone and prevents the knee from being pushed too far medially under stress or from outside forces. Overuse or improper technique can cause an abnormal stretching or tearing of the medial collateral ligament to occur.

This is technically called a medial collateral ligament sprain and is graded based on the severity of the injury:

Grade I strain - stretching or microscopic tearing of the ligament fibers. The ligament remains fully functioning and the knee joint remains stable.

Grade II strain - moderate tearing of the ligament fibers. There may some joint laxity.

Grade III strain - significant (at least 90%) to complete tearing of the ligament fibers. The knee feels wobbly, loose, and becomes extremely unstable.