Swimming

Swimming is one of the few activities that use all the major muscles in the body. As a cardiovascular activity that engages often-unused muscles; it also displaces up to 95% of our body weight and is therefore an excellent activity for people who are overweight or pregnant and who wish to exercise.

Swimming is one of the safest exercises, and is recommended:

As a way to improve cardiovascular ability
To improve muscle tone.
Help rehabilitation post injury.
Work overall core stability.
Chronic back pain sufferers find that undertaking swimming as an exercise helps back pain immensely by strengthening muscles.

However swimming is not something that comes naturally to humans and we are the only mammals that have to learn how to swim. Due to a lack of teaching and practice, many of us cannot swim to the calibre we desire and bad technique can often lead to specific overuse injuries.

Swimming Injuries

Swimming is primarily a shoulder movement and this function demands the coordination of many muscle groups.

Shoulder muscles.
Shoulder stabilisers, also known as the "rotator cuffs".
The muscles that stabilise the scapula or shoulder blade.
Upper and lover back muscles.
Abdominal and pelvic muscles.

Swimmers Shoulder

Swimmers shoulder is an overuse injury involving the supraspinatus tendon, which is one of the rotator cuff muscles, or the biceps tendon. Technical flaws in swimming stroke can lead to an overextension of the supraspinatus tendon, leading to joint instability and loss of blood supply or "wringing out" of the tendon during the out-of the water recovery and pull phase.

Dropping the elbow during these phases can cause irritation of the rotator cuff muscles. Thus a specific swimming technique is recommended to avoid irritation without losing speed:

The hand exits the water at the shoulder blade and not the hip ensuring the elbow is higher than the hand.
This high elbow recover phase is only possible by rotating the body by 70-100 degrees per stroke.
In the entry and catch phase of the stroke the hand should be in front and just outside the shoulder entering too far in or too far out causing a greater load on the joint and is therefore inefficient.

If your shoulder is in an inflamed state it is wise to avoid:

Hand paddles and kickboards
Weight training
Excessive or incorrect shoulder stretching

However an imbalance in shoulder flexibility can also antagonise shoulder pain. Thus it is advised to stretch:

Internal Rotators
External Rotators
Pectoralis Muslces
Biceps
Triceps
Upper Back
Neck

Build up certain shoulder stabilisers is also advised to avoid shoulder injury in swimmers:

Rotator Cuff
Scapula Stabilisers
Core Muscles

Elbow Injuries

The high elbow position recommended to avoid shoulder injury can also avoid lateral epicondylitis or "tennis elbow" among swimmers. The tendons of the elbow at the lateral epicondyle, become inflamed, due to repetitive strain.

Foot and ankle injuries

This type of injury is not very common however tendonitis of the ankle joint can occur and ankle sprains are also a factor from incorrect flip-turn technique.

Back Injuries

Often the source of lower back pain in swimmers can be a result of an underlying back pathology. Mechanical low back stress can also occur from flip-turns and poor body position in the water.

Treatment should include avoiding flip turns, re-examination of technique, physical therapy and...

Core strengthening
Back strengthening
Back Stretching
Hamstring Stretching