Common Injuries in Swimming and How to Prevent Them

By Dirk Smith, MSc, SDL (He/Him). 

Swimming is considered a low-impact sport, meaning that there are few forces either from ground contact or other players and the risk of developing a traumatic injury is low. The kind of injuries most commonly seen in swimmers are overuse injuries which are injuries that result from repetitive movements. Overuse injuries are caused by the repeated stress and tension on muscles, tendons and ligaments that without proper strength and tension can lead to inflammation and pressure build up within the tissue.
 
Inflammation and pressure can lead to pain, reduced flexibility, mobility and strength while impeding general performance that could lead to a prolong recovery period in which you will not be able to continue training or competing. This is why it is crucial for athletes to include training exercises that reduce the risk of developing overuse injuries.
 
Common injuries that swimmers experience include...

• Shoulder Impingement/ Rotator Cuff Tendinitis
  • Inflammation in the tendons connected to the rotator cuff muscle group that inhibit mobility and put pressure on the scapula and nervous system. Leading to pain and immobilization during overhead movements.
• Neck and Low Back Pain
  • Cause by poor posture from the increased tension in the muscles in the chest and hamstrings without comparable strength in the opposing muscle groups.
• Elbow Tendinitis
  • The same condition as tennis elbow, known as Lateral Epicondylitis and is most common in butterflyers and breaststrokers from the repeated movements of the stroke while the elbow is bent, downward forearm ,and upper arm rotation.
• Breaststroker’s Knee
  • The least common, but often the most serious of swimming injuries. Breaststroker’s Knee is tenderness and inflammation underneath the patella (knee cap) from the sheering forces of the breast stroke kick. In worst cases, this can lead to the development osteoarthritis in the knee or potentially can lead to a full knee blow out. 

For the first three injuries listed above, the most common causes are

• Inadequate warm up
• Lack of general flexibility
• Inadequate rest/recovery periods between practices
• Overtraining
• Poor stroke mechanics,
• Decreased Strength, especially in the Rotator Cuff, Shoulder, Core, Lower Back and Hips

In the case of the Breastroker’s Knee, the most common cause is poor mechanics within the breaststroke kick, which intervention directly from your swim coach to correct your kick will be necessary. However, there are still a few exercises to enhance that.
 
So, to keep you in the pool and minimize the risk of developing an injury, here are some dryland exercises you can incorporate into your training program that are easy to include. The exercises are all based on building muscular strength and endurance, as swimming is an “endurance” sport, it is important to train to perform multiple repetitions. For the exercises using an external weight, select a weight that allows you to perform the minimum number of repetitions with challenge but while also maintaining form. If your form breaks down, then select a lighter weight. If you are able to complete the maximum number of repetitions at the end of your last set without challenge, then select a higher weight at the next session. These exercises should be performed at least two to three times per week.

Shoulders/Arms- Mobility​

• Arm swings
  • With your arms relaxed and hanging at your side, start by giving yourself a hug and swinging the arms open and then hugging yourself again, alternating the top and bottom arms.
  • Keep the motion at a slow to moderate pace.
  • 2-4 sets of 10-15 repetitions​

• Arm circles
  • With your arms relaxed and hanging at your side, start swinging the arms forward and backwards like a pendulum, increasing the swing until you are able to draw a full circle with each arm. Alternate the arm circles and the directions.
  • 2-4 sets of 10-15 repetitions

• Wall Angels
  • Standing against a wall. Press your heels, butt, shoulders and head against the wall. Place your arms, elbows and hands against the wall with your elbows at shoulder level and your elbows at 90 degrees. Slide the arms until you reach streamline position, keeping in full contact with the wall. Slide the arms back down until the elbows are rested at your sides.
  • 2-4 sets of 10-15 repetitions ​

Shoulders/Arms- Stability​

• Overhead Farmer’s Carry
  • Holding onto a dumbbell or kettlebell. Raise the weight above your head straightening your arm. It is important to keep the arm straight so that the stability corrections come from the shoulder joint rather than the elbow. Find a path/ distance about 50 meters, ideally with turns or course changes and walk the distance while carrying the weigh. Switch arms and then repeat.
  • 2-4 sets of 3-4 repetitions 

Shoulders/Arms- Strength

• External Rotations
  • With a dumbbell in hand, bring the elbow up to the shoulder level. Keeping the elbow fixed at 90 degrees, rotate your shoulder to bring the dumbbell from the bottom to the top. Make sure you bring it up to the highest point, in line with the shoulder. Then slowly return it back to the starting position at the bottom.
  • 2-4 sets of 15-20 repetitions

• Bicep Curl with Wrist Turn
  • With a dumbbell in hand, extend your arm and keep your elbow pressed into your side. With a tall and level posture, bring the dumbbell up by bending the elbow until it’s at the shoulder. Then rotate the dumbbell so your palm is facing away from you. Rotate the dumbbell back and slowly bring it down back to the starting position.
  • 2-4 sets of 10-15 repetitions

Core/ Posture- Mobility

• Dead Bugs
  • Lying flat on your back with your head, shoulders and butt on the ground. Raise your arms up in front of you, lift your legs up so that your knees are also in front of you while maintaining a 90-degree angle in your knee joint. Take your right up and extend it over your head so its behind you while simultaneously extending your left. Return back to the starting position and repeat it again with your left arm and right leg. Make sure you keep your hips, shoulders and head on the ground throughout the exercise.
  • 2-4 sets of 10-15 repetitions per side

• Inch Worm
  • Start standing with your feet hip width apart, bend down and bring your palms to the floor, bend your knees as needed but do your best to straighten your legs. Walk your hands forward until you’re holding a plank, your wrists should be directly underneath your shoulders. Either walk your hands back or your feet forward to return to the starting position.
  • 2-4 sets of 10-12 repetitions

Core/ Posture- Stability

• Bird Dogs
  • Using a mat, start on your hands and knees. Your knees should be directly underneath your hips and your hands directly underneath your shoulders. Extend your right arm and left leg directly in front and behind you, reaching as far as you can toward each end. Balancing on your other hand and knee, bring your elbow and knee together and then extend out again.
  • 2-4 sets of 15-20 per side. 

Core/ Posture- Strength

• Plank w/ Hip Twist
  • Start in a regular plank position. With your elbows directly underneath your shoulders, holding a tight core, hips and shoulders on the same level. Maintaining this position, rotate the hips on the long axis so that one side is closer to the ground. Return to the center and repeat with the other side.
  • 2-4 sets of 15-20 repetitions

​Hips/Knees- Mobility

• Lying Hip Rotations
  • Lying flat on your back, feet flat on the ground and your knees bent. Lower both knees to the same side, until they are resting either on the floor or as close as they can get. Return to the starting position and repeat for the opposite side.
  • 2-4 sets of 8-10 repetitions 

​Hips/Knees- Stability

• Single Leg Bridge
  • Using a mat, lay flat on your back, feet flat on the ground and knees bent. Raise up your hips to create a straight line from knees to shoulders. Pushing your hips up and squeezing your butt, slowly lift and hold one leg off the ground.
  • 2-4 repetitions of 30-60 seconds per side. 

​Hips/Knees- Strength

• Goblet Squats
  • Utilizing a kettlebell or dumbbell, start standing in a wide stance with your toes pointing outwards at a 45-degree angle and upright posture. Hold the weight close to your chest with your palms facing inward and your elbows out. Squat down as low as you can until your hamstrings are resting on your calves, keeping your chest and head up, back straight and feet flat in the ground. In the downward position, remember to push the knees outward and then return to starting position.
  • 2-4 sets of 15-20 repetitions

• 90/90 w/ Internal Rotation
  • Using a mat, lay flat on the ground close to a wall. Your head, shoulders and butt should be in contact on the ground. Bring your feet up and press them against the wall with your hips and knees at 90 degrees (90/90, get it?). Maintain the position and holding a tight core. Separate your right foot from the wall, keeping your knees together, push your right ankle out to the side and back to the starting position. For an extra challenge, use a resistance band around the ankles.
  • 2-4 sets of 15-20 repetitions per side

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It is important to recognizing the distinction between “mobility” and “flexibility.” Mobility is defined as how freely a joint can move through its own range of motion via muscle contraction. Whereas flexibility is about increasing the overall length and stretch capabilities of the muscle passively. So, for this context, the mobility exercises are dynamic stretches, which means that they move through a range of motion actively as opposed to static stretching which is about passively pulling on the muscle to increase the length. In a follow up article, Coach Dirk will go into more detail about stretch training for swimmers to improve overall flexibility.
 
If these exercises seem like a lot, don’t worry! These exercises are not just exclusive toward injury prevention either and carry over other benefits that we will explore in other articles. By building your mobility, stability and strength with these exercise, you will see improvements in your own performance as well as daily life. As we do more articles that dive into (pun intended) strength and conditioning for swimmers, you will see these exercises and variations commonly used in a variety of applications that will serve to improve your performance, strength and capabilities as an athlete. 
​By Dirk Smith