torso rotates as the shoulder exits the water in an
abducted and externally rotated position. The elbow
should remain above the hand until the hand enters the
water fingers first in front and just outside the line of
the shoulder. To keep the elbow high, the swimmer
must roll the body approximately 45°on the swim-
mer’s long axis. During the underwater phase, the
shoulder internally rotates and adducts to propel the
body forward. The elbow should point toward the side
wall during this phase. The upper trapezius, rhom-
boids, supraspinatus, and deltoid all function in com-
bination to position the scapula and humerus for hand
entry and exit New techniques emphasize an early
catch, early exit at the beltline, and a straight through
arm pull in lieu of the S-shaped pattern often described
(Pink et al, 1991; Schubert, 1990; Johnson, Gauvin,
and Fredericson, 2003).- The flutter kick helps stabilize the swimmer’s trunk.
This kick starts at the hip and simulates a motion sim-
ilar to kicking off a loose shoe. The knees should flex
only 30–40°. Flexion at the hip is minimal. - The swimmer must focus on the coordinated motion
of both the upper and lower extremity. If the swimmer
fails to kick throughout the stroke, the body will lose
some of its buoyancy and more drag is created. The
upper extremity will then compensate placing more
stress at the shoulders. - Bilateral breathing helps the swimmer develop equal
pulling strength in both arms and helps ensure equal
body roll on each side (Johnson, Gauvin, and
Fredericson, 2003). - The unique whip kick done in the breaststroke places
a valgus stress at the knee. Due to these mechanics,
breaststrokers have more knee complaints than swim-
mers competing in the other strokes. - When stroke mechanics need correction, the use of an
underwater video can help clarify the errors.
UPPER EXTREMITY INJURIES
SWIMMER’S SHOULDER
- Shoulder pain is the most common complaint in com-
petitive swimmers. Nearly 50% of collegiate and
master’s swimmers report shoulder pain lasting at
least 3 weeks (Stocker, Pink, and Jobe, 1995). - Swimmer’s shoulder refers to shoulder tendinopathy
or impingement. Typically the swimmer feels maxi-
mum pain at the beginning of the pull-through phase.
Often the swimmer will swim through this pain for
weeks until the pain is present throughout the entire
freestyle stroke.
•Fatigue, muscle imbalance, and shoulder laxity con-
tribute to the development of swimmer’s shoulder.
•Typical treatment includes ice, rest, anti-inflammatory
medication, and occasionally subacromial corticos-
teroid injection.- The swimmer should limit the total weekly mileage
and swim with various strokes. - Kickboard workouts can allow the swimmer to main-
tain fitness while resting the shoulders. The elbow
should be flexed to minimize irritation to the shoulder. - Prevention of future injury includes correcting stroke
mechanic problems while strengthening the rotator
cuff and scapular stabilizing muscles. - The serratus anterior, a scapular stabilizer, is one of
the most important muscles involved in the freestyle
stroke and therapy should be aimed to increase its
strength (Pink and Tibone, 2000). - Swimmers have been shown to have increased shoul-
der adduction and internal rotation strength, which can
lead to an imbalance in the shoulder. The swimmer
should focus on creating a balance by strengthening
the external rotators (Weldon and Richardson, 2001).
SHOULDER INSTABILITY•Repetitive shoulder rotation and vigorous flexibility
may contribute to stretching of the shoulder capsule
leading to possible subluxation.- Instability can be anterior, posterior, inferior, or a com-
bination. The more unstable the glenohumeral joint, the
greater the risk of developing a labral tear—a Hills-
Sachs lesion or a Bankart lesion. Radiographs includ-
ing an axillary view should be obtained. If a labral tear
is suspected, an MRI-arthrogram should be ordered. - The mainstay of treatment is rotator cuff muscle
strengthening. - If instability is persistent despite rehabilitation, sur-
gery to tighten the capsule may be warranted. Warn
the swimmer that a more stable shoulder may limit
their performance. - Indication for stretching is limited. If the shoulder
capsule is overstretched, the risk for instability and
injury is increased (Pink and Tibone, 2000).
ELBOW•Triceps tendinitis can develop as a result of the full
extension necessary in the backstroke.- The ulnar collateral ligament may be stressed in the
recovery phase of the freestyle leading to sprain.
•Treatment with rest, nonsteroidal anti-inflammatory
drugs(NSAIDs), and ice are appropriate.
532 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS