Sports Medicine: Just the Facts

CHAPTER 90 • SWIMMING 533

LOWER EXTREMITY INJURIES

BREASTSTROKER’S KNEE

• Commonly seen in athletes who do the whip kick in
  the breaststroke.


• The valgus force created at the knee leads to medial
  collateral ligament sprain (Rodeo, 1999).


• Often poor kick technique contributes to medial col-
  lateral ligament(MCL) sprain. The swimmer needs
  instruction on proper technique for prevention.


• The mainstay of treatment includes rest, ice, and anti-
  inflammatory medications.

PATELLOFEMORAL PAIN

• The symptoms typical of patellofemoral syndrome
  also occur in swimmers.
  •Treatment includes rest, ice, NSAIDs, and quadriceps
  strengthening. Swimmers should be encouraged to
  train using a foam buoy between the thighs in order to
  rest the knees.


• Some swimmers may benefit from a neoprene patella
  stabilizing brace, which would substitute for McConnell
  taping.

FOOT/ANKLE PROBLEMS

• Extensor tendinitis may occur from the flutter kick or
  dolphin kick.
  •Treatment includes rest, ice, and NSAIDs. Rest
  from the flutter kick is best achieved using a foam
  buoy.
  •A lower extremity stretching program focusing on
  improved range of motion at the ankle will help in the
  recovery and prevention.


• Local foot injury can occur if the swimmer kicks the
  side of the pool or gutter. This usually results in abra-
  sions or contusions but may cause a fracture.


• Proper flip-turn technique will prevent foot injuries.

BACK INJURIES

LOW BACK STRAIN

• The butterfly and breaststroke require hyperextension
  of the lower back to maintain body position and com-
  plete the stroke. The body-roll done by freestyle and
  backstroke swimmers can also cause strain, especially
  when the swimmer tires.

•Treatment must include back plus abdominal

strengthening and instruction on technique.

• The use of muscle relaxants is controversial.

SPONDYLOLYSIS/SPONDYLOLISTHESIS

• The hyperextension of the back required specifically
  in the butterfly and breaststroke can predispose a
  swimmer to the development of a spondylolysis.


• The swimmer will often complain of pain during flip-
  turns and starts.


• Spondylolysis rarely progresses to spondylolisthesis.


• Rest is the mainstay of treatment. Rarely will the ath-
  lete require bracing or surgery.

MEDICAL PROBLEMS COMMON

IN SWIMMERS

ASTHMA

• In most of the country, swimmers train in enclosed
  pools that are both warm and humid. Athletes with
  asthma often gravitate to this environment because it
  is less asthmagenic.


• Coaches and trainers need to be aware of the asth-
  matic swimmer and have appropriate emergency
  treatment at the pool.
  •A study involving the 1998 Winter Olympic games
  swimmers revealed that 22.4% of swimmers reported
  either use of asthma medications or diagnosis of
  asthma or both (Weiler and Edward, 2000).

OTITIS EXTERNA

•Otitis externa, or the more common term swimmer’s

ear, is one of the most common medical problems

encountered by daily swimmers. The hours that swim-

mers spend submerging their ears in pool or open

water lead to ear canal maceration and infection.

•Topical treatment is effective. The swimmer should

remain out of the pool for 2–3 days.

• Preventive measures include drying the ear with a
  drying agent such as Vosol otic drops or a homemade
  mixture of 50% vinegar and 50% alcohol.
  •Avoid traumatizing the ear canal with Q-tips.

CONJUNCTIVITIS

• Bacterial conjunctivitis and chemical conjunctivitis
  present similarly as a red eye. Most bacteria are killed