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Swimming: Injuries & Rehabilitation

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Posted on: Jan 20 2014

As the swimming season progresses, there is often an increase in swimming-related injuries.  We spoke with our resident swimming expert, Dr. James N. Johnson, to discuss common swimming injuries, prevention of injuries, and treatment plans.  Dr. Johnson is a Team Physician for the U.S. Olympic Swim Team, USA National Swim Team, Nashville Ballet, and the Nashville Aquatic Club.  After completing his Sports Medicine fellowship at Stanford University, Dr. Johnson decided to stay on as the University’s Team Physician for two years, before moving back to Nashville.

Due to Dr. Johnson’s experience at Stanford and his involvement with the U.S. Swim Programs, he has seen nearly every type of swimming-related injury.  His goal, both then and now, is to get patients back to doing what they love, and he finds that swimmers can get back in the water relatively quickly.  Unlike most sports, many swimming injuries will allow athletes to perform exercises in the water using the uninjured joints.

Dr. Johnson has found that the most common swimming injuries involve the shoulder joint. Shoulder injuries are so common, that 50% of swimmers will experience a shoulder injury during their career.  The injury usually presents as tendinitis of the rotator cuff, secondary to overuse.  In younger athletes, there tends to be more injuries to the labrum, which is the same structure that is commonly injured in baseball pitchers.  These injuries usually respond well to scapular stabilization programs, meaning strengthening of the large muscle groups that connect the shoulder blade to the torso.

Swimmers also commonly get injuries that occur in the low-back.  Athletes that are younger than 40, are prone to stress fractures in the low-back. These stress fractures can be caused by hyperextension, stress from diving, or underwater kicking.  In athletes over 40, low-back injuries are primarily degenerative disc changes, due to the repetitive nature of the sport.  These athletes will occasionally have acute disc herniations.  These injuries usually respond to a period of rest followed by rehabilitation that focuses on core strengthening.

Rehabilitation is very important for swimming injuries.  Developing strength through the torso will help connect the shoulders and the low-back, and prevent both types of injuries.  The main exercise that will help stabilize both the shoulder and the low-back, are standing rows.  This exercise will strengthen the muscles of the torso and shoulder, primarily the lower trapezius and the serratus anterior.

In addition, these overuse conditions of swimming will often respond to anti-inflammatories, and occasionally steroid injections, to relieve pain in the short-term. These methods can help maximize the patient’s ability to make progress in physical therapy.

Dr. Johnson has developed a program to get swimmers back in the pool as soon as possible, while still giving the injury adequate time to heal.  The 12-week program goes as follows:

  • The program begins by allowing swimmers to start swimming every other day for 20-30 minutes, alternating freestyle and backstroke for the first two weeks.  
  • During week 3, patients can swim five days a week for 30 minutes maximum, swimming 25 yard and 50 yard lengths with a 20-30 second rest, and low-level aerobic training.  
  • At week 4, patients can increase to five days a week for 40 minutes maximum, and can start to swim 100 yards, with a 30 second rest, but no more than 2,000 yards per workout.  Patients are able to do a warm-up swim of 300-500 yards and start alternating freestyle, backstroke and breaststroke.  
  • Weeks 5 -12, patients can increase workouts by 200-300 yards per workout, with 30 seconds rest.  
  • For weeks 12 and beyond, patients can decrease rest intervals and add traditional training, as tolerated.  This program works primarily for the mostcommon shoulder injuries of swimming and, with slight modifications, can often be adapted for swimmers suffering from injuries to other joints.

Not all injuries will respond to conservative treatment, but Elite Sports Medicine and Orthopaedic Center is fortunate to have excellent Surgeons who can address these conditions surgically.  In addition, our Spine Team is available to consult any of the low-back injuries that develop in swimmers that may not respond to physical therapy.

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