1. Injury Prevention in Swimming
Mr Kevin Boyd
FRCS(Tr&Orth) FFSEM (UK) DipSportsMed
Consultant Trauma & Orthopaedic Surgeon
Chairman British Swimming Medical Advisory Committee

2. 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

3. Injuries in Sport and Exercise
Survey of in England & Wales
19.3 million new sporting injuries/year
9.8 million substantive injuries/year
Injury risks:
Rugby /1000 occasions
Soccer 19.3/1000 occasions
Hiking 4.2/1000 occasions
Swimming 2.3/1000 occasions
Nichol et al BJSM 1991

4. Human Performance Continuum
HEALTH OPTIMISED
HEALTH SUBOPTIMAL
PERFORMANCE OPTIMISED
UK Swimming Population: million

5. Causes of Sports Injuries
INTRINSIC
Age, sex, body composition
Muscle weakness/imbalance
Flexibility
Malalignment
Poor nutritional state

6. Causes of Sports Injuries
EXTRINSIC
Training methods
Surfaces
Equipment
Environment
Nature/rules of sport
Training Load

7. 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

8. Training Load

9. Training Load LAND WORK Weights Swimbench / pulleys Flexibility
Cross-training
Circuits / Running / Cycling

10. Training Cycle Training Recovery INJURY Remodelling Adaptation
Stress to the system involved
Excess or insufficient
Recovery
INJURY
Tissue Breakdown

11. Acute Injuries
Overuse Injuries

12. Education & Discipline
Acute Injuries
TRAUMATIC
Head & C-Spine
Diving
Correct technique
Fingers / Feet
Falls
Wet Environment
Drowning
Education & Discipline

13. Shoulder Problems Aetiology
Tendinopathy
Impingement
Instability
Fatigue
Secondary Impingement Syndrome due to functional instability

14. 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
4 trials 2 speeds +/- paddles
All swimmers impinged 15% in water 10% in recovery
Stroke technique not consistent
Overhead activity greater demands than what shoulder is designed for
Impingement increases in quality not quantity in paddles

15. Research – Muscle Imbalance
Prospective, controlled trial
31 elite age group swimmers/20 controls
Initial 2/12 18/12
ER/IR ratio 1:1.96 1:1.78 1:1.47
Controls 1:1.47
Pain
Instability
Holz Biomech Med Swim VII 1996

16. Research – Joint laxity/Pain
40 elite swimmers
Laxity 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

17. Shoulder Instability Spectrum of Instability
Acute traumatic v Multi-directional
Functional/Dynamic instability
Imbalance
Fatigue
+/- Generalised Joint Laxity
Chronology v direction

18. Knee Problems Chronic MCL sprain Patellofemoral Plica syndrome
external rotation of ‘whip’ kick
Patellofemoral
Maltracking
CMP
Instability
Plica syndrome
Meniscal tears

19. Back Problems Postural Ligament strains / Muscle sprains Spondylolysis
Pars stress injury
Butterfly / Breaststroke

20. Prevention Education Progressive training loads
Athlete / Coach
Progressive training loads
In-build Recovery periods
Limit non-sport demands
Minimise psychological stressors
Ensure optimal nutritional status
Responsive to Change

21. Prevention Correct postural / muscular imbalances
Muscle / Ligament Length
Endurance
Optimise Core Stability
Attention to technique / biomechanics
Stretching *BEWARE*

22. 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

23. Thank You