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Fluid Motion
Monday May 12, 2008

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When it comes to swimming, not all strokes are equal. A recent study by the Polytechnic Institute of Bragança, Portugal, published in the International Journal of Sports Medicine, measured and compared the total energy expenditure of 26 competitive swimmers using the four main competition swimming strokes.

Total energy expenditure of the swimmers was recorded over a large range of velocities using a new portable technique that measured cardiopulmonary and gas exchange parameters breath by breath for each swim in order to analyze oxygen consumption and other energetic parameters.

Results showed that the freestyle stroke was the most economic, followed by the backstroke, butterfly, and breaststroke.

This research supports what coaches and PTs involved with the sport have known for years. “When you look at a swimming program, it usually requires swimming 4,000 to 10,000 yards each practice,” says Jim Tyndall, PT, ATC, CSCS, a physical therapist at Methodist Sports Medicine in Indianapolis, who works with high school and college swimmers. “The majority of those yards will be freestyle. It is the fastest, most efficient stroke.”

Freedom from injury?

Despite its efficiency, Tyndall says injuries can still occur with freestyle.

“Most injuries occur because of overuse,” he says. Among the most common injury is “swimmer’s shoulder,” which can manifest as a soreness of the rotator cuff, shoulder impingement, or tendonitis.

Wendy Weil, PT, ATC, OCS, MA, had firsthand experience with swimmer’s shoulder before it was well understood or accurately treated. As a competitive swimmer, Weil won the bronze medal for the 800 meter freestyle in the 1976 Olympics and a gold medal in the same event at the Pan American Games the year before.

But shoulder injuries hampered her last two years of swimming in college and ended her competitive career. Studies show that as many as 75 percent of swimmers have a history of shoulder pain that interferes with training or competing.

“The single most important thing people need to do that swim on a regular basis is to get some private lessons to correct stroke flaws,” says Weil, who owns her own practice in McLean, Va.

The most common problems she sees in freestyle are crossing the arms past midline, keeping the head too high, scissoring the legs, not being balanced or floating properly in the water, not rolling the body, picking up the head to breathe, dropping the elbow anywhere in the stroke, breathing too often, and pulling too soon with the leading arm.

But the three other main strokes also present physical drawbacks, Tyndall points out.

“The butterfly causes the most amount of stress on the shoulder,” he says, while the breaststroke can cause knee injury, especially in the medial aspect.

Although the backstroke is probably the easiest on the body, it can cause injury to the head and arms by misjudging the wall, Tyndall says. Also, because the stroke is similar to freestyle, only backward, the same shoulder pain can erupt from overuse, he adds.

Breathing to just one side while swimming is another pattern that creates physical stress. “Breathing bilaterally evens out the body,” he says. “It causes your body to rotate on its long axis.”

Weil observes that swimmers may begin experiencing injuries as soon as early adolescence for several reasons, including muscle imbalances between the agonist and antagonist muscles, tight versus weak muscles, poor posture, and lack of flexibility. Young swimmers may increase their yardage in practice too quickly, and not get enough sleep or eat enough protein, especially within 30 minutes of working out.

Rapid growth spurts in adolescents also can bring injury to a young swimmer. “The muscular development tends to lag about two years behind bone growth,” Weil says.

Wet to dry tactics

As with most sports, strong core muscles can prevent many injuries from happening, experts say.

“The arms and core body muscles should be doing the majority of the work in swimming, not the legs,” Weil says. “The legs are primarily for balance and should incorporate either a two- or four-beat kick.”

She recommends swimmers do dry-land stretches and exercise along with swimming to avoid injury. “Swimmers should always do another activity that promotes weight-bearing, such as walking, elliptical training, or stair climbing,” Weil advises. Weight training also is important for properly maintaining upper body muscles, she says.

If swimmer’s shoulder or another swimming injury occurs, Tyndall recommends decreasing yardage during practice and using a kickboard, holding it underneath instead of bringing the arms on top, to avoid pinching the shoulder. He advises to start with the breaststroke, even though it is the slowest of strokes, because it causes less stress on the shoulders.

Swimmers recovering from leg injuries can use a pull buoy, a closed cell foam device to put between the legs, to reduce reliance on the lower extremities to stay horizontal in the water, he says. Freestyle is generally recommended with the pull buoy, although it may be used with other strokes.

Tyndall recommends that swimmers recovering from shoulder injuries use fins to increase kick and decrease stress on the shoulders. The use of hand paddles, often part of high school and college swim programs, should be eliminated during the recovery period, he says, due to increased loading on shoulder structures.
In general, a return to the water after an injury should be gradual, Weil says.

“If someone has been out of the water for awhile recovering from an injury, I usually start them back with just 500 to 1,000 yards of mostly drill work,” she says. “For more competitive athletes, they might start with 1,500 to 2,000 yards — I advise them to do that level at least two times before they increase yardage, and to go up in 500 yard increments.”

Resources

    • USA Swimming: www.usaswimming.org.
    • Barbosa, T. M., R. Fernandes, K. L. Keskinen, et al. 2006. Evaluation of the energy expenditure in competitive swimming strokes. Int J Sports Med 27(11): 894-9.
    • Dreese, J. and B. C. Matson. 2006. Shoulder multidirectional instability in swimming athletes. TheACC.com. January 4. www.theacc.com/sports/c-swim/spec-rel/010406aae.html.



Teresa McUsic is a medical writer for the Gannett Healthcare Group. To comment on this story, send e-mail to pteditor@gannetthg.com.


Monday May 12, 2008
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