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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 LoadLAND WORK• Weights• Swimbench / pulleys• Flexibility• Cross-training
– Circuits / Running / Cycling
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