Athlete

Mike Lawler,  M.A., ATC, LAT

Senior Athletic Trainer

The University of Iowa

October 14, 2004

Aquatic Sports

•             Swimming – Club, Scholastic, Collegiate, Olympic,                              Masters

•             Diving – Springboard, Platform, Cliff

•             Synchronized Swimming

•             Water Polo

•             Open Water Swimming – fresh & salt water

•             Deep Water Diving

•             Surfing

Each is unique in style and presents with unique problems

Swimming Facts

•      Conservative estimates reveal approximately 400,000 overhead strokes during a 10-month swimming season for male swimmers and 660,000 strokes for female swimmers

•      57 % of world class swimmers are troubled with shoulder pain

            Herring SA and Nilson KL: Clinics in Sports Medicine. Vol. 6, No. 2, 1987

Swimming Facts

•      Collegiate swimming training involves twice a day workouts, up to 5 hours a day in the water, 6 days a week, 9 months out of the year

•      Workouts also include weight training, dry-land training, cardiovascular training

•      Collegiate divers will dive twice a day, 5-6 days per week and include dry-land training

•      Swimmers and divers begin in their sport at a young age

•      By the time they enter college, they have averaged 6000 meters daily swimming, 11 months per year, for 8-10 years

            Donnelly WH and Indelicato PA, Clinic in Sports Medicine. Vol. 5, No. 1, 1986

•      Elite swimmers often swim up to 11 two-hour workouts per week. 80% of these athletes also participate in weight training, which generally consists of three 30 to 50 minute sessions per week. The typical daily training distance averages 10,000 to 15,000 yards, of which 75% to 90% is freestyle.

•      In one year, a swimmer may move their shoulder to its extreme range of motion in approximately 2 million arm strokes.

     Kammer CS, Young CC, Niedfeldt MW, The Physician and Sportsmedicine,

     Vol. 27, No. 4, 1999

   Swimming is an enjoyable and healthy activity. However, done to excess, it may, and often does lead to injury.

“Swimmer’s Shoulder”

•      Kennedy and Hawkins made the first anatomical investigation into the causes of pain in swimmer’s shoulders. Since their study, the term “swimmer’s shoulder” has been routinely used to describe any painful problem

•      The most common musculoskeletal problem in competitive swimmers

     McMaster WC: The Physician and Sportsmedicine, Vol. 14, No. 12, 1986

•      Often referred to as impingement

•             Classic causes of painful “swimmer’s shoulder”:

•         Subacromial bursitis

•         Rotator cuff tendonopathy

Atypical or Overlooked Causes of Shoulder pain

•             Cervical Spine – referred pain from disc dysfunction and spondylolysis

•             Thoracic Outlet Syndrome (TOS) – Impingement of brachial plexus and vascular supply to arm on the first rib or against the scalene muscles

•             The Acromioclavicular Joint – degenerative changes through repetitive overhead motions; osteolysis of the distal clavicle

•             Proximal humerus tumors

•             Shoulder instability

Atypical Injuries to the Shoulder

•             Subluxation or dislocation

•             Entry into the wall

•             Entry into the water

Injuries to the Wrist and Hand

•             Fingers

•         MCP, DIP, PIP joint sprains and dislocations

•         Result from fast entry into wall

•             Wrist

•         Repetitive trauma in diving

•         Radiocarpal abutment bruising

•         Carpal-metacarpal abutment – carpal bossing

•         Sprains

•         Tendonitis

Knee

•             “Breaststroker’s Knee

•         In a survey of the major swimming clubs of Canada , Kennedy and Hawkins studied 2,496 competitive swimmers. Of the 261 swimmers who had orthopaedic complaints, 70 had knee problems. All of the knee problems occurred in breaststrokers and the use of the whipkick.

Kennedy JC, Hawkins RJ: Breast stroker’s knee. Physician and Sportsmedicine2: 33-38, 1974

“Breaststroker’s Knee”

•             Injury or strain of the medial collateral ligament (MCL) of the knee

•             Symptoms of tenderness along the MCL and/or local tenderness under the medial facet of the patella

•             May or may not have increased laxity with valgus testing

The Whipkick vs. Frog Kick

Brendan Hansen of the United States swimming the prelims of the 100 meter breaststroke at the 2004 Summer Olympic Games, Athens, Greece

Foot and Ankle

•             Tendonitis or tenosynovitis of extensor tendons where they are firmly bound over dorsum of ankle by the extensor retinaculum

•         Caused by flutter and dolphin kick - extreme plantar flexion, then back to neutral

•         Irritation of extensor tendons by fins

Elbow

•             Medial Epicondylitis

•         Irritation of flexor mass of forearm at origin on medial epicondyle of humerus

•         Primary cause is arm pull in butterfly, backstroke, breaststroke and less in freestyle

•         Repetitive trauma or stress

•             Ulnar Nerve Subluxation

•         Symptoms: paresthesia in hand, pain in cubital tunnel

•         Tx.: Ulnar nerve transposition

•             Accessory Triceps Tendon

•         Symptoms: painful snapping at medial epicondyle of humerus

•         Tx.: resection of accessory tissue.

Back

•             Low Back Pain

•         Dx.: Facet irritation, lumbar disc pathology, Spondylolysis (pars interarticularis stress fracture), Spondylolisthesis, erector spinae  strain

•         Causes: dolphin kick with butterfly stroke and freestyle stroke coming out of a turn

•         Diving: hyperextension with hurdle on diving board or entry into water

•         “Walkout” from split position requiring hyperextension of lumbar spine

Hyperextension       Extension from flexion

•      Hip Adductor Injury in Competitive Swimmers.

   Grote K, Lincoln T, Gamble JG. AJSM, 32:104-108, 2004

Abstract

»    The authors conducted a survey of 296 competitive swimmers to assess the incidence and importance of interfering groin pain in breaststoke swimmers          

Results

»    Breaststroke swimmers were more likely to have current groin pain (6.92%) than individual medley swimmers who did not compete in pure breaststroke events (0,P=0.015)

Conclusion

»    Results indicate that breaststroke swimmers are at significant risk of groin injury, groin injury is positively correlated with increased magnitude of breaststroke training, and groin injury may prevent participation in practices and competitions

Medical Problems

•             Otitis Externa – “swimmer’s ear”

•          Caused by Pseudomonas Aeruginosa or Aspergillus organisms – gram negative, strictly anaerobic bacteria pathogenic to man

•          Tx: colistin sulfate or polymyxin B-neomycin-hydrocortisone, routine use of ear drops of isopropanol and vinegar, tight-fitting swim cap

•          Self-manipulation using a cotton swab should be avoided

•             Nasal and Sinus Pain

•          Upper respiratory infections, sinus infection

•          Tx: decongestant, antibiotic from physicianInfectious conjunctivitis – “pink eye”

•             Infectious Conjunctivitis – “pink eye”

•          Bacterial infection of conjuctiva

•          Sx: Stringy discharge that may cause eyelids to stick together, especially after sleeping, swelling of conjuctiva, redness tearing, irritation and/or gritty feeling

•          Tx: Antibiotic eye drops or ointments that cover a broad range of bacteria

•          Tx: Disinfect goggles, discard contact lenses, don’t share towels, water bottles, wash hands, avoid touching eyes

•          Swim? Debate on whether chlorinated pool water is effective in killing bacteria. Usually we do not swim for 24-48 hours from starting medication.

•          Alternative workout – stationary bicycle, Stairmaster

•             Asthma – EIA

•          More common among swimmers than any other athletes because they were encouraged to begin swimming as exercise treatment for their troubled breathing

•          Warm, humid environment make breathing easier, however enclosed environment may worsen asthma in poorly venilated pools with heavy chlorine odors

•          Reversible airway obstruction caused by bronchospasm

•          Tx: Pharmacologic agents

»       Long-term control – corticosteroid: Flovent, Serevent, Aerobid, Vanceril, AzmacortSingulair, Tilade, Intal

»       Quick-relief – beta agonist or bronchodilator: Proventil, Ventolin, Maxair

•             Infectious Mononucleosis

•          A viral infection usually caused by the Epstein-Barr virus

•          Illness may last four weeks

»       Incubation period is 30 to 50 days

»       Preceeding phase lasting 3 to 5 days consisting of headache, malaise, anorexia, and chills

»       Illness phase lasting 7 to 21 days characterized by fever, fatigue, pharyngitis, lymphadenopathy, and splenomegaly

»       

•          Dx: Medical examination, heterophile antibody test or monospot test

•          Tx: Rest, fluids, OTC medications, corticosteroids in severe cases. Ultrasound of spleen to monitor illness resolution.

6.  Dermatologic problems

•         Dry skin – prolonged, repetitive exposure to water

»       Tx: showering  with moisturizing soap and applying lotion after showering or swimming

•         Sunburn – prolonged expoure to sun, especially when training in outdoor pools – southern climate schools, Hawaii training trip

»       Tx: sunscreen that holds up in water

7.  Dehydration

•         Swimmers, like all athletes, sweat when they workout

•         Loss of fluids affects body temperature stress on the cardiovascular system

•         Tx: hydration and rehydration

»       water, sports drinks

8.  “Green hair”

•         Blond-haired swimmers often aquire a bright green hair color associated with sun exposure

•         Chlorine is commonly blamed, but actual cause is swimming pool coppor-based algicides that deposit in the hair matrix

•         Tx: prevented with regular shampooing and reversed with the use of 3% hydrogen peroxide bleaching lotion applied for 2-3 hours

9.  Marine Animal Bites

•         Open water swimming

•         Toxic effects of marine venoms, bites

•         Jellyfish, spiny fish, octopus, shark

•         Tx: seek medical help, anti-venom

Hypoxia Training – Hypoxia Breathing

(Breath Control)

•      Training with a decreased concentration of oxygen that causes the constriction of blood vessels which, in turn, help muscles work more efficiently with what oxygen is available.

•      Breathing less frequently or not breathing at all.

•      Dangers are headaches, hyperventilation, loss of consciousness, and drowning

•      Certified athletic trainers or lifeguards on duty during training session.

Dry Land Training

“a fish out of water”

•             Orthopaedic injuries

•         Sprains – ankle, knee, wrist

•         Strains – low back, hamstring, calf

•         Fractures

•         Dislocations

Team function

Ultimate frisbee   Basketball     Soccer

Conclusion

•      There are common injuries associated with being a swimmer.

•      There are, however, injuries and illnesses inherent to the aquatic sports but atypical to other sports.

•      A thorough knowledge of ALL aquatic sports and a multidisciplined approach to the medical care of the aquatic athlete is required.