Injury Preventio

n in Swimming

Mr Kevin Boyd FRCS(Tr&Orth) FFSEM (UK) DipSportsMedConsultant Trauma & Orthopaedic SurgeonChairman British Swimming Medical Advisory

Committee

Swimming is Unique !

• Outside of man’s natural environment

• Specific actions to allow breathing• No firm surface against which to

generate forces• Propulsion by the upper limbs• Negative effect of water drag

Injuries in Sport and ExerciseSurvey of 29 000 in England & Wales• 19.3 million new sporting injuries/year• 9.8 million substantive injuries/yearInjury risks:

– Rugby 57.7/1000 occasions – Soccer 19.3/1000 occasions– Hiking 4.2/1000 occasions – Swimming 2.3/1000 occasions Nichol et al BJSM 1991

Human Performance Continuum

PERFORMANCE OPTIMISED

UK Swimming Population: 4.5 million

HEALTH SUBOPTIMAL

HEALTH OPTIMISED

Causes of Sports Injuries

INTRINSIC• Age, sex, body composition• Muscle weakness/imbalance• Flexibility• Malalignment• Poor nutritional state

Causes of Sports Injuries

EXTRINSIC• Training methods• Surfaces• Equipment• Environment• Nature/rules of sport

Training Load

Training Load

POOL WORK• 70 km/week = 1400 lengths/week• 36 strokes/length• 48-50 weeks/year 1.25 million strokes per arm per year

Duration 8-10 years

Training Load

Training LoadLAND WORK• Weights• Swimbench / pulleys• Flexibility• Cross-training

– Circuits / Running / Cycling

Training Cycle

Training

Remodelling Adaptation

Tissue Breakdown

Recovery

INJURY

Acute Injuries

Overuse Injuries

Acute InjuriesTRAUMATIC• Head & C-Spine

– Diving– Correct technique

• Fingers / Feet• Falls

– Wet Environment• Drowning

Education & Discipline

Shoulder Problems

Aetiology – Tendinopathy– Impingement– Instability– Fatigue

Secondary Impingement Syndrome due to functional instability

Research - Impingement

Impingement 25% stroke time (range 4-56%)

Increased impingement with: - reduced shoulder tilt at catch ‘breathing side’

- late initiation of ER in recovery

- large IR in insweep Yansai & Hay MSSE 2000

Research – Muscle Imbalance

Prospective, controlled trial31 elite age group swimmers/20 controls

Initial 2/12 18/12ER/IR ratio1:1.96 1:1.78 1:1.47 Controls1:1.47Pain 16 1Instability 22 8

Holz Biomech Med Swim VII 1996

Research – Joint laxity/Pain

40 elite swimmersLaxity Score ± Apprehension

- Pain group 15/16 cf No Pain group 9.8/10.7

Significant correlation (p<0.05) between shoulder laxity and interfering shoulder pain

McMaster AJSM 1998

Shoulder Instability

• Spectrum of Instability– Acute traumatic v Multi-directional

• Functional/Dynamic instability– Imbalance– Fatigue– +/- Generalised Joint Laxity

Knee Problems• Chronic MCL sprain

– external rotation of ‘whip’ kick

• Patellofemoral– Maltracking– CMP– Instability

• Plica syndrome• Meniscal tears

Back Problems

• Postural• Ligament strains /

Muscle sprains • Spondylolysis

– Pars stress injury– Butterfly /

Breaststroke

Prevention• Education

– Athlete / Coach

• Progressive training loads• In-build Recovery periods• Limit non-sport demands• Minimise psychological stressors• Ensure optimal nutritional status

Responsive to Change

Prevention

• Correct postural / muscular imbalances– Muscle / Ligament Length– Endurance

• Optimise Core Stability• Attention to technique /

biomechanics• Stretching *BEWARE*

Summary• Swimming is a safe sport• Demands of elite Swimming are

large• Individual ability to cope• Primary prevention is the priority• Swimmer, Coach and Therapist

working together in the pool

Thank You