Like any physical activity, swimming comes with its own collection of common injuries and ailments. While some injuries are more likely to occur with competitive swimmers, even those who show up at the pool for recreational activities can experience some common swimming ailments.
There’s a lot you can do to keep your pool’s atmosphere and community healthy and happy. It starts with getting a handle on the most common swimmer’s complaints, what they are, what causes them, how to prevent (ideally) and treat them. We’ve included some links where you can take a deeper dive into pertinent information.
An overview of the four most common swimmer’s injuries
The easiest way to start thinking about common swimmer’s injuries is to break them down by body area. Thus, the four most common swimmer’s injuries are:
- Swimmer’s shoulder
- Swimmer’s knee
- Spinal pain and fatigue (swimmer’s posture)
- Swimmer’s ear
The first three injury categories are just that – categories. They cover a wide range of potential injuries that can affect that area of the body, each of which has its own unique causes and cures.
Generally speaking, the leading cause of the first three injury categories is a combination of poor technique, bad alignment, and high repetition. That’s why these are all injuries that any competitive swimmer will likely experience at some point. The best ways to prevent these injuries from showing up on your swim teams are to:
- Train and enforce proper techniques on your swimmers
- Incorporate well-balanced strength and stretching exercises that help your swimmers develop healthy, stable joints and spine, along with the flexibility needed for an efficient stroke
- Don’t over train one movement — make sure to mix it up with other training swims or exercises that vary the repetitive motion
- Don’t impose sudden spikes in training intensity, either in duration or number of sessions, as the swimmer’s body may not be prepared for a significant change
We’ll dig into each of these categories more specifically below. However, first, we haven’t forgotten about swimmer’s ear. It’s a particular injury that anyone spending time in the water can get.
Swimmer’s ear – inevitable?
It’s not inevitable that everyone in the water will get swimmer’s ear. It is inevitable that as a pool owner, you will have students or recreational swimmers who get swimmer’s ear. There are steps and recommendations you can make to help prevent it, as well as guidance you can give to parents who have a child suffering from it.
Unlike the first three swimmer’s injuries listed above, swimmer’s ear isn’t a category. It is a precise ear injury to the ear’s outer canal. It’s important for parents to understand that swimmer’s ear isn’t the same as the typical child’s ear infection (that affects the middle ear), so they don’t try to treat it the same way. You can read more about what swimmer’s ear is and how to tell if you have it here.
Swimmer’s ear is caused by bacteria growing in excess water, which can collect in the outer ear. Having said that, it’s clear that the two most effective ways to prevent swimmer’s ear are to make sure your swimmers are swimming in clean water and that they take care to get all the water out of their ears and keep them dry.
As the pool owner, you have 100% control over the cleanliness of your pool and your facilities. Make that a priority and hold those directly responsible accountable for maintaining cleanliness and you’ll go a long way to helping your swimmers avoid swimmer’s ear.
However, the very fact of excess water in the ear creates an opportunity for bacteria to grow, regardless of the source. You can’t police your swimmers’ ears, but you can offer them and their parents, information on how to minimize their risk of holding excess water in their ears. Here’s a list of tips and tricks you can share on how to prevent swimmer’s ear.
The last, critical point to understand about swimmer’s ear is that it just doesn’t go away. If you or any your swimmers have it, it must be treated. Curing swimmer’s ear will require a doctor’s visit, but not one that’s a big deal. The doctor needs to take a look, perhaps do a little outer canal housekeeping, and prescribe the right eardrops to kill the infection. There are different types of swimmer’s ear infections — don’t assume they can all be treated with the same prescription — be sure you get the right medication.
If the suffering swimmer didn’t go to the doctor shortly after the swimmer’s ear infection began, there is a chance the infection could spread beyond the ear into something more serious. In that case, stronger antibiotics, which are administered orally or through an IV, may be required, or even a visit to an ear, nose, and throat specialist.
Bottom line: When you offer your parents and swimmers guidance on swimmer’s ear, make sure they understand how to recognize it and that they should see a doctor immediately. It will only get worse if they don’t get the right eardrop prescription.
The full scope of swimmer’s shoulder injuries
The shoulder is a complex joint. It is the only joint in the human body that can rotate 360 degrees, and swimming certainly likes to take advantage of that fact. Indeed, swimming makes extraordinary demands on the shoulder, requiring both extreme strength and flexibility to propel the body forward through the water’s resistance.
Because the shoulder has so many parts, there’s a lot of opportunity for injury. Some of the most common manifestations of swimmer’s shoulder are:
- Rotator cuff tendonitis or tears
- Impingement syndrome, which occurs when the muscles in the rotator cuff press against the shoulder bone
- Tears in the shoulder cartilage, which destabilize the shoulder in its socket
- Bursitis, which is the inflammation of the bursa sac that sits as a cushion between two bones in the shoulder. With overuse, this sac can get inflamed or wear down, causing pain.
Thus, the highly repetitive nature of swim training, coupled with the high demands made on the shoulder from swimming, make swimmer’s shoulder a common ailment with competitive swimmers.
Once a swimmer is suffering from swimmer’s shoulder, it’s critical to alter the training regimen until the shoulder is healed. Here’s a list of some exercises that can be useful to help rehabilitate swimmer’s shoulder. Use this list as a jumping off point. Every swimmer’s shoulder injury is unique to that swimmer, as it must be taken in the context of that swimmer’s other physical, and training, particularities. Always consult with the swimmer’s orthopedist and trainer, when developing and overseeing any swimmer’s rehabilitation.
Preventing swimmer’s shoulder is an even better idea. Make it a point to include specific dryland exercises in the workout schedule that are intentionally geared towards protecting the shoulder from injury. Look for exercises that:
- Improve shoulder stability and flexibility, and don’t overlook the inner rotator cuffs!
- Develop strength across both shoulders and arm muscles in a balanced way, avoiding the overdevelopment of one side.
- Includes exercises that focus on rear deltoids and increase scapular strength to balance out the repetitive use of front deltoids and internal rotation.
There are always some in-the-pool best practices to avoid swimmer’s shoulder, but they also apply to other common injuries, so look for that list a bit further down.
Swimmer’s knee – the bane of breaststroke swimmers everywhere
While swimmer’s shoulder is most likely to occur to freestyle swimmers, it’s a common risk for all swimmers regardless of stroke. In contrast, swimmer’s knee is primarily a risk for those who focus on the breaststroke. Those leg whips can put tremendous strain on the swimmer’s knee, in particular on the medial collateral ligament (MCL). The MCL is the ligament on the inside of the knee that connects the upper and lower leg bones.
Swimmer’s knee can initially manifest in general pain or fatigue in the knee. As it progresses, the knee can swell or become inflamed. Advanced swimmer’s knee shows up as intense pain when moving the knee or putting any stress on it. Lastly, untreated swimmer’s knee can cause a swimmer’s knees to both push inward to the point of touching. Often called “knock-kneed,” this creates a general state of misalignment that can seriously impair a swimmer’s competitive and everyday life.
To help prevent swimmer’s knee, look for dryland exercises that:
- Strengthen the leg muscles that provide knee support, like the quadriceps and hamstrings.
- Improve the flexibility and rotation of the hips. Poor hip abduction puts strain on the knees.
In the pool, don’t forget to include knee-centric warm-ups, including kick drills and gentle breaststroke laps that get things moving, rather than working hard.
Bad posture and bad technique: a devolving cycle of poor performance
That stereotypical look of shoulders being front-rolled, curving down to flat lumbar and finishing with a pelvis tilted back is what’s called “swimmer’s posture.” It’s not a compliment. The intense, repetitive training of swimming uses muscles and movements that can push a swimmer into this resting, dryland posture if trainers and coaches aren’t careful.
Swimmer’s posture may not be painful itself or an injury per se, but it is a misalignment that increases drag on the swimmer’s body, accelerates fatigue, and increases the likelihood of developing swimmer’s shoulder or knee.
Having swimmers go through a consistent, comprehensive stretching routine is key to maintaining good posture and preventing swimmer’s posture. The time to do the stretching routine is after the muscles have had some time to go through the recovery process from swim training. So, swimmers should have a stretch routine developed for them that they run through a few hours after completing a swim. These stretches should focus on stretching out those muscles that tighten the most during the swim. Working this counter-balance into the training schedule can help keep the swimmer’s posture in a more naturally aligned position.
If a swimmer already has swimmer’s posture (and face it, many of them do), then the same sorts of counter-pose stretching can help re-align the spine.
Training best practices to avoid swimming injury
Since the common causes of any type of swimming injury are overuse and poor technique, the best training practices to avoid injury are designed to prevent both those circumstances.
The overuse of certain muscles is the result of overtraining them. Overtraining occurs when there’s:
- Too much time spent training on the same stroke or strokes that are using the same muscles in the same way, without proper rest breaks or recovery time.
- Not enough recovery time between swim sessions.
- A sudden increase in swim intensity or duration.
Any type of overtraining puts excess strain on the swimmer’s body and increase the risk of injury. Some best practice tips to avoid overtraining include:
- Mix up the strokes being trained in the same session.
- Use kickboards or modified strokes to take the pressure off the upper body for portions of the session.
- Always have swimmers go through proper warm-ups, out of and in the pool, before starting a swim training session.
- Align training intensity with the swimmer’s age, physical capabilities, and goals.
- Encourage and solicit regular feedback from swimmers as they’re training.
Prevention and early detection are the best options for handling swim injuries, so your swimmers need to feel they’re able to let you know what’s going on with their bodies. Continuing to train while a swimmer feels excessive fatigue or is having difficulty concentrating puts them in a danger zone.
Of course, one of the most destructive aspects of overtraining is overtraining while using poor technique. A swimmer can still overtrain with an excellent technique, but the risks to health and swim times are so much higher when overusing the body with bad mechanics and technique.
Many of the minutiae that make swim technique and mechanics the best, or provide the most significant advantage to the swimmer, may be debatable or subject to a coach’s style. Either way, here are general best-practice principles:
- Bilateral breathing will maintain proper posture in the pool, while unilateral breathing can create an imbalance.
- The upper body should rotate in the direction of the arm entering the water. If the spine stays flat in the water instead of slightly rotating with the arm, this creates a strain on the shoulder, arm, and spine.
- Avoid thumb-first entry into the water. If the hand enters the water thumbs first, the entire arm is rotated internally in an awkward way.
- Kicking should happen from the hips down to the knees, not just with the knees. This will not only provide more power but will lessen the workload on the knees.
Best practices should become routine at the pool and during practice. It’s vital to make sure that all pool staff, coaches, and trainers, are on-board with the best practice standards you set at the pool.
Ugh – swimmer’s itch and chlorine rash
Both of these rashes are unsightly and uncomfortable and can happen to any swimmer. The first point to note is that swimmer’s itch and chlorine rash are not the same things.
Swimmer’s itch is contracted by swimming in open water (fresh or salt water), not pools. It’s caused by parasites present in water birds and snails. The parasites can burrow into the skin, creating an itchy rash.
Chlorine rash, as the name gives away, is a reaction to chlorine. Thus, it’s only contracted by swimming in a pool or hot tub. Chlorine is naturally irritating to the skin. Thus, the dry skin and hair that’s common to swimmers. At proper levels, the chlorine is keeping your pools clean and your swimmers safe. Even when you’re using the right amount of chlorine, there are times when the chlorine is still concentrated enough in the water to increase the risk. For example, right after a cleaning or chlorine shock treatment, the chemicals are highly concentrated. Try to schedule cleaning and treatments at times that provide enough of an interval for the chlorine to dilute through the pool before swimmers jump in.
Even so, repeated exposure to chlorine can cause a swimmer to develop a chlorine rash when they haven’t before. Chlorine rash is not just for those with sensitive skin, although such swimmers may develop the rash more easily.
While swimmer’s itch and chlorine rash have different causes, they present similarly — red, irritated skin that itches. The good news is that they both can usually clear up without a doctor’s intervention within a few days, or a week, with some home and over-the-counter remedies. The most important treatment is not to scratch the rash. You’ll see many of the treatments are geared towards calming the rash and relieving the urge to scratch. Scratching will not only prolong the rash, but it can also often make it worse. If the swimmer’s itch or chlorine rash hasn’t cleared up in a week, then the swimmer should see a doctor.
Keep the spotlight on fun and prevention
Making pool time both fun and safe, with a documented program on injury prevention, is the best way to encourage active regular attendance – even for the competitive swimmers who show up every day.
When you make injury prevention a standard part of your operations, all swim classes, and training sessions, it becomes second nature to your staff and swimmers. Expecting the best practices to be followed in order to avoid injury won’t eliminate them. That’s impossible. However, it will decrease their likelihood and keep everyone in the pool.