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Blog guest: Pavle Pejovic – Injuries and swimming

He used to swim under the Serbian flag. When he finished his swimming career he jumped into the field of rehabilitation and physiotherapy for athletes. From the point of view of a swimmer and a young physiotherapist, as a Swimming Dad #Blog guest, Pavle Pejović is telling us about the following topics: Are there cases when swimming is not recommended as a post-surgical rehabilitation, and can regular swimming prevent injuries and why?

How can swimming contribute to a faster recovery from injuries and when can it be a part of rehabilitation?

Swimming is an integral part of rehabilitation in a large number of different conditions. Both in post-surgical rehabilitation of shoulders, hips, knees or other joints, and in correction of spinal deformities in children.

I should underline here that there are two different types of activities one can do in the water which are used in the recovery process, namely swimming, and hydro-kinesitherapy which covers various exercises in the water.

Hydro-kinesitherapy is an obligatory part of the rehabilitation process from various injuries of the locomotor system. To understand why, let’s just go back to water. Water has two characteristics which we find useful for a recovery, and those are its density and the presence of the thrust force. The water density is significantly higher that the air density, and this is why the patient having a water therapy faces additional resistance to be overcome, which results in a stronger musculature. On the other hand, the water prevents sudden, uncontrolled moves which, due to poor motor skills, might bring to injuries over again. The thrust force makes the body have less mass in the water and thus the pressure on the locomotor system is reduced, which makes good conditions for the exercises to be done in a completely free position which is crucial in the initial phase of rehabilitation after various injuries.

Are there cases when swimming is not recommended and why?

Swimming plays a very important role in the rehabilitation after numerous injuries, but in some cases, it can lead to some negative effects. While hydro-kinesitherapy has a wide application in certain set-ups, swimming on the other hand is not recommended in the initial phase of rehabilitation after certain injuries.

If we are talking about full muscle and tendon ruptures, luxation (dislocation) of joints and more severe bone fractures, swimming as part of the rehabilitation process should be introduced only in the later stages, once the injured segment is functionally enabled. Also, the initial phase of the rehabilitation of the lumbar syndrome of various causes does not involve swimming at all. The reason for not including our sport in these phases is the very instability in which the body finds itself while swimming, which is definitely not beneficial for the patient in the recovery phase, it brings to additional spasm of muscles and consequently increases the pain level.

Can regular swimming prevent injuries and how?

Apart from boosting the capacities of cardio-respiratory system and general fitness, regular swimming activates the entire body and makes it stronger. This type of physical activity activates specifically the intrinsic back muscles which are of great importance for the stability of the spine. Also, rotation takes place in swimming backstroke and crawl, and in this way, we increase our mobility of the thoracic part of the spine which is of great importance for the kinetic chain of the body extension. Breaststroke stimulates the hip mobility while other styles are good for the mobility of ankles and shoulders.

The modern lifestyle and spending quite a lot of time in the sitting position and insufficient physical activity all bring to a limited scope of moves of our joints, which increases the risk of injuries during recreational sport activities. With regular swimming and proper exercises done on the dry however, we will improve the mobility of the abovementioned joints and the stability and strength of the spine which, as a result, prevents various types of injuries.

How often are injuries in swimming, compared to other sports?

If we are talking about swimming as a recreational activity, injuries are quite rare due to the abovementioned characteristics of the water as an environment. On the other hand, top level swimming carries the risk of various injuries which are specifically part of this sport.

The swimmer’s shoulder is a syndrome of the shoulder pain caused by a muscle disbalance. Namely, big muscles, musculus deltoideus and pectoralis muscles, get stronger while swimming, especially breaststroke, dolphin and crawl, and hypertrophy by frequently rotating the shoulder forward, while the rotator cuff muscles are underdeveloped and in a long run, injuries of musculus supraspinatus and musculus infraspinatus may occur. Apart from overtraining, this syndrome may occur also if we apply an improper technique. This type of injury can be efficiently prevented by regular stretching of the shoulder girdle muscles along with strengthening the shoulder external rotation muscles and the abdominal muscles.

The occurrence of the lumbar syndrome is unfortunately not rare in professional swimming. This syndrome is characterised by a strong pain in the lower back which is caused by various conditions (disc degeneration, muscle distention and rupture, injuries of SI and facet joints, bursitis, etc.). Even though it may occur in other swimming styles, this type of injury is most common in dolphin style due to the dynamic of this style which lays a significant stress on that part of the spine. To prevent this type of injury, you need to make your abdominal and back (core) muscles strong, as well as your gluteal muscles by stretching and relaxing of tense and shortened hip flexor muscles. In this way, the pelvis is prevented from inclining and additional compression on the lower discs of the lumbar part of the spine is also prevented.

Knee and groin injuries are also relevant when we are talking about this sport. Even though they are not as common as previously described injuries, it happens that these injuries might keep the swimmer away from the pool. Due to the dynamic of the breaststroke and characteristic moves made while making a leg kick, those who swim breaststroke will most likely suffer from this injury. When we’re talking about the knee, meniscus and collateral ligaments are damaged most often, while groin muscles, the so-called adductor muscles, are most likely to suffer. Prevention of these injuries is done by strengthening the abdominal and leg muscles, with the aim to improve mobility and to stabilise the hip joint along with working on a proper technique. It is also necessary to stetch the shortened adductor muscles.

Knowing that every professional sport carries a risk of various injuries, we can say that adequate training in the pool and outside the pool can significantly prevent them. On the other hand, sports on the dry carry a higher risk of injuries, especially in contact sports and those which require frequent changes of direction.


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