Butterflier’s Back and Breaststroker’s Knee: The Many Injuries Swimmers are Pre-Disposed To

The competition season is just about to begin and the workouts are getting tougher by the day. It is especially now that swimmers need to take utmost care to avoid initiation of an injury. Today’s article will give you a low down on the various injuries that swimmers are predisposed to.

Swimming is such a unique sport that works on the upper and lower limbs improving, cardio-respiratory fitness/ endurance as well as strength in a non-weight bearing environment. Irrespective of whatever is your main stroke, the repetitive motion/micro trauma of especially freestyle; the only stroke that all swimmers practice in bulk has been linked to musculoskeletal injuries (Wanivenhaus F et al., 2012).

The NCAA (National Collegiate Athletic Association) conducted a 5-year survey suggesting that elite swimmers can be predisposed to at least 4 injuries per 1000 hours of training for men and 3.78 injuries per 1000 hours of training for women. The shoulder, knees, hip, neck and spine are all potential areas for injuries with shoulder being the most common.

What Causes Injuries

Injuries could be acute or chronic. Since swimming does not involve any combat, injuries are most often chronic than acute. Although acute strains and cramps could occur as a result of inadequate warm up, over stretching, poor hydration etc., chronic injuries are usually a result of many overuse causes including;

  • Physical: Swimmers may have joint alignment issues, ligament instability, muscle weakness, muscle imbalance & asymmetry and poor flexibility.
  • Nutrition related: High intensity bouts in long hours of training can often deplete the muscle of its glycogen stores which can trigger fatigue. Stroke mechanics often change when muscles are fatigued and a repetitive wrong form can then put additional pressure on joints.
  • Training related: Poor swimming techniques, a poorly planned training program, a mis-match between swimming practice and swimming events participated in; swimming too much, too hard, too fast way beyond one’s capacity etc. can all increase the risk of injuries (Mitchell T).


  1. Shoulder impingement:
    1. Impingement syndrome is also called as swimmer’s shoulder and is a condition that affects the shoulder joint.
    2. The shoulder joint is supported by a group of muscles called the rotator cuff muscles.
    3. Due to any of the above causes, when the tendons of these muscles swell (rotator cuff tendonitis) there is gradual onset of pain or sometimes shooting pain restricting movement.
    4. This is usually observed in freestyle and butterfly when the arms are required to move backwards during the pull. The treatment involves anti-inflammatory medicines, pain killers and ample of rest.
  2. Breaststroke knee injury:
    1. As the name suggests, it is usually found in swimmers whose main stroke is the breaststroke.
    2. It is especially caused due to poor technique. During the whip kick movement, the rotation action of the knee often pressurizes the ligament that is present along the inner side of knee.
    3. Overuse whilst following a wrong technique can stress the ligament resulting in swelling and tenderness.
    4. Medications to reduce swelling and pain followed by stretches, adequate warm up and cool down, correcting the wrong form all help in treatment/ prevention of this injury.
  3. Butterfly back injury:
    1. The continuous arching of the spine in elite butterfly swimmers puts pressure on the lower spine.
    2. There might be a mild discomfort initially but overuse of the lower spine may cause persistent pain and could finally restrict movement.
    3. Rest coupled with analgesics is usually suggested.
    4. Swimming is often considered an activity that eases back pain however it is simultaneously advised that individuals with back pain should avoid butterfly.

Injury Prevention Mantra

  1. Recognise a bad stroke form: All professionals involved should be alert and identify changes in stroke form including a dropped elbow in the recovery phase, wide hand entry or early exit. All of these changes in stroke are attempts to alleviate the pain during swim.
  2. Incorporate prevention strategies: Since most injuries are due to repeated trauma to the muscle fibers, training volume and intensities along with frequencies need to be monitored carefully. A strengthening and flexibility program for the shoulders, core and the back as a part of dry land is essential to reduce the risk of injuries in elite swimmers.
  3. Incorporate rehab exercises: If the athlete experiences pain, warm up time should increase and cool down stretches should be incorporated in the initial stages of pain. If it is a shoulder injury, avoidance of hand paddles and pulling sets are important. The use of kick board and fins may help. Swimmers may also use a counterforce strap around the bicep to alleviate the tension. Usually swimmers find breaststroke easy to perform than other strokes. If it is a knee injury, stretches of the quadriceps and hamstrings are essential along with overall strengthening of the leg muscles. Usually complete rest is not advised unless it is a severe injury (Wanivenhaus F et al., 2012).

The treatment may vary as per specific causes and specific injuries observed. However, sports medicine professionals, orthopedics, sports physiotherapists are predominant professionals to help swimmers recover from injuries. It is equally essential to continue to eat well as we learnt in our previous article regarding various nutrients important for recovery. Without healthy eating, recovery from an injury may take longer than necessary hampering swimming practice and making it difficult to come back in form.

Author: Mihira A R Khopkar

B.Sc. Dietetics, M.Sc. Sports Nutrition


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