Back Pain in swimmers Aetiology Risk factors: Suboptimal technique Inadequate core stability Tight paraspinal musculature Excessive load and abrupt changes in load 52
Back Pain in swimmers Aetiology Deconditioning of anti-gravity (postural) musculature Pain Overactivity and tightening of paraspinal muscle groups Repetitive extension stresses Suboptimal core stabilisation strategies 53
Back Pain in swimmers Preventative Strategies 1. Screening to identify those at risk 2. Technique correction 3. Targeted preventative conditioning programs 4. Load management 54
Back Pain in swimmers Preventative Strategies Screening tests: Postural assessment Standing Streamline Lumbar range assessment Hip range assessment Core stability assessment 55
Screening tests Standing Streamline Draw a pumbline Wrist Elbow Shoulder Hip Knee Ankle 56
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Back Pain in swimmers Preventative Strategies Screening tests: Prone hip extension Goal 15 59 45
Back Pain in swimmers Preventative Strategies Screening tests: Hip flexor length test 60 46
Back Pain in swimmers Preventative Strategies Screening tests: Hip flexion >100 61 46
Back Pain in swimmers Preventative Strategies Screening tests: Core stabilisation assessment: 1. Realtime ultrasound imaging 2. Functional tests 62
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Back Pain in swimmers Preventative Strategies Reinforce correct technique Common technique errors that contribute to back pain: Uphill body position Poor dolphin kicking technique Poor kicking technique Assymetric rotation Hyperextension push offs Land based + water based movement learning
70 000 x /annum 69
Back Pain in swimmers Preventative Strategies Implement a targeted preventative conditioning program Should be: Swimmer and swimming specific how specific? Regular Aim: Counteract the negative effect of intense exercise in an antigravity environment 71
Back Pain in swimmers Preventative Strategies Goals of preventative conditioning programs: 1. Develop ability to move well through adequate range The lumbopelvic girdle Disassociation of movement Correct strategies for movement 2. Develop dynamic core stability using correct muscle strategies 3. Develop strength and endurance of the core stabilisers in swimming specific actions 72
7 movable joints 73
Back Pain in swimmers Preventative Strategies Implement progressive load management Prescribe appropriate: Absolute volume Relative volume (age, size, tx history) Implement progressive loading 10% increases for soft tissue adaptability Prescribe adequate recovery strategies (Active + Passive) Technique limited loading?
Back Pain in swimmers Management Strategies 1. Technique investigation and correction 2. Load modification 3. Physiotherapy 4. Further investigation 75
Back Pain in swimmers Management Strategies Load modification Relative rest from aggravating stroke/action Limit volume or intensity or both NB: Fins may increase load Pool bouy may increase load 76
Back Pain in swimmers Management Strategies Physiotherapy treatment Symptom management Release restricted joints and tissues to reinstate movement patterns Retrain lumbopelvic girdle movement 1. Range 2. Activation patterning 3. Strength/endurance 77
Back Pain in swimmers Management Strategies If the injury is not amenable to Physiotherapy, Physiotherapist or GP will advise the need for further investigations: Radiological investigations Sports Physician Spinal orthopaedic or neurosurgeon 78
Back Pain in swimmers Implications for coaches 1. Swimmers should be screened to identify those at risk of developing back pain 2. Swimmers should undertake conditioning programs targeted at preventing back pain 3. Correct technique must be reinforced early in stroke development 4. Coaches should consider training loads and recovery in workout prescription 79
Hip and Knee Pain in Swimmers Epidemiology 3 rd most common musculoskeletal complaint Incidence highly variable (approx. 25-40%) Lack of research Breastrokers most common 81
Hip and Knee Pain in Swimmers Aetiology Risk factors: Congenital factors Knock knees Pronated feet Wide hips Wide breastroke kick Inadequate hip internal rotation 82
Hip and Knee Pain in Swimmers Aetiology Common painful pathologies in swimmers knee: 1. Patellofemoral joint syndrome (PFJS) 2. Medial collateral ligament (MCL) injury 3. Myofascial adductor strain 4. Femeroacetabular impingement (FAI) 5. Iliotibial band friction syndrome (ITBFS) Occasionally: Patellofemoral joint dislocation!
Hip and Knee Pain in Swimmers Aetiology Patellofemoral joint syndrome 84
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Hip and Knee Pain in Swimmers Preventative Strategies 1. Screening 2. Technique correction 3. Preventative conditioning 4. Load management 90
Hip and Knee Pain in Swimmers Preventative Strategies Screening Hip internal rotation range Hip quadrant testing Tibial external rotation Quadriceps strength Hip internal rotation + tibial external rotation = 90 91
Screening Hip internal rotation range 92
Hip and Knee Pain in Swimmers Preventative Strategies Technique correction Narrow knees Push back 94
Hip and Knee Pain in Swimmers Preventative Strategies Implement targeted preventative conditioning programs Goals: Hip internal rotation range (40-50 ) Hip stability and control Adequate quadriceps and adductor strength Correct movement sequencing for breastroke kick 96
Hip and Knee Pain in Swimmers Management Strategies If acute traumatic (e.g. patellofemoral dislocation) immediately to ED 1. Technique investigation and correction 2. Load modification: Relative rest from aggravating movement/activity 3. Ice for symptom relief 4. Compression and elevation to manage swelling 5. Referral to Physiotherapist 97
Hip and Knee Pain in Swimmers Management Strategies Physiotherapy management of swimmers knee: Symptom management including education and advice Tissue management Reinstating range of motion Reinstating specific activation patterns and movement sequencing Conditioning the movement patterns (strength, endurance) 98
Hip and Knee Pain in Swimmers Implications for coaches 1. Swimmers should be screened to identify those at risk of developing hip or knee pain 2. Swimmers should undertake conditioning programs targeted at preventing hip or knee pain 3. Correct technique must be reinforced early in stroke development 4. Coaches should consider training loads and recovery in workout prescription 99
Injuries in swimmers Summary The nature of injuries in swimming: Often non-traumatic, gradual onset Associated with particular stroking components Associated with: Suboptimal technique Inadequate physical condition Unbalanced loading Predisposing factors Repetitive microtrauma leads to macrotrauma
Injuries in swimmers Summary The nature of injuries in swimming renders a large amount of them: Preventable Amenable to Physiotherapy
Using Physiotherapy in competitive swimming programs For injury prevention AND improving performance Strategies: Screenings Preventative conditioning programs Coach, athlete, parent education On-deck observation and assessment sessions Race meet attendance 102
Using Physiotherapy in competitive swimming programs Perform Screenings 2x/annum >12/13 yrs completing >5x/week Australian Swimming Screening Protocol 103
Using Physiotherapy in competitive swimming programs Plan and implement Preventative programs Group/individualised At home/pool/gym 104
Using Physiotherapy in competitive swimming programs Plan educational resources Presentations Handouts Workshops 105
Using Physiotherapy in competitive swimming programs Incorporate Physiotherapy knowledge: On-deck observation and assessment sessions Race meet attendance Coach: Physiotherapist: Technique Human movement 106
Using Physiotherapy in competitive swimming programs Physical Therapies can help to prevent and manage injury, and improve the performance of competitive swimming teams These actions are enhanced by creating an integrated working relationship between coach, athlete, therapist, conditioner, biomechanist 107