Injury Modifications
2 injury guides
Guidelines for safely modifying workouts when dealing with common injuries. Always consult a healthcare professional for specific medical advice.
Lower Back
Lower back pain in swimmers often results from repeated hyperextension, particularly during butterfly stroke and dolphin kick. The lumbar spine undergoes significant extension forces during undulating movements. Common mechanisms: - Butterfly: Repeated lumbar hyperextension during body undulation - Dolphin kick: Extension loading on lower back - Flip turns: Spinal flexion-extension cycling - Breathing patterns: Hyperextension during head lifting
Warning Signs
- ⚠Radiating leg pain
- ⚠Pain worsening during or after swimming
- ⚠Numbness or tingling
- ⚠Difficulty with flip turns
Red Flags - Seek Immediate Care
- ●Saddle anesthesia (numbness in groin area) - cauda equina syndrome, go to ER
- ●Bladder or bowel dysfunction with back pain - go to ER
- ●Bilateral leg weakness - go to ER
- ●Progressive neurological symptoms
When to Seek Professional Care
- →Any red flag symptoms
- →Radiating leg pain
- →No improvement after 4 weeks of modification
- →Pain affecting daily activities
General Principles
- •Core engagement protects the spine during swimming
- •Butterfly and dolphin kick are highest risk movements
- •Kick amplitude reduction can significantly help
- •Bilateral breathing reduces asymmetric loading
- •Hip flexor flexibility affects lumbar position
Contraindicated Movements
Recommended Exercises
McGill Big 3 (bird dog, side plank, curl-up)
3 sets × 10 reps
Core stability without spinal flexion/extension
Dead bugs
3 sets × 10 reps
Core control in supine position, mimics swimming
Hip flexor stretching
2 sets × reps
Tight hip flexors increase lumbar extension
Glute bridges
3 sets × 15 reps
Hip extension strength and glute activation
Return to Full Training
Criteria:
- ✓Pain-free with daily activities
- ✓Can swim freestyle comfortably
- ✓Core exercises pain-free
- ✓Gradual return without setback
Progression:
- 1.Week 1-2: Pull-only or gentle freestyle, core work daily
- 2.Week 3-4: Add flutter kick, monitor response
- 3.Week 5-6: Add other strokes as tolerated
- 4.Week 7+: Gradual return to butterfly if needed
Shoulder
Swimmer's shoulder is a broad term for shoulder pain in swimmers, typically involving rotator cuff tendinopathy and/or impingement. It affects up to 70% of competitive swimmers at some point. The repetitive overhead motion of swimming (thousands of strokes per week) creates cumulative microtrauma.
Warning Signs
- ⚠Pain increasing during swim (stop immediately)
- ⚠Pain at night disturbing sleep
- ⚠Clicking or catching sensation
- ⚠Weakness in arm elevation
Red Flags - Seek Immediate Care
- ●Sudden weakness with inability to lift arm (complete rotator cuff tear) - seek evaluation
- ●Acute injury with deformity (possible dislocation) - ER evaluation
- ●Significant weakness developing over time - may indicate larger tear
- ●Numbness or tingling in arm - nerve involvement
- ●Shoulder instability (feeling of shoulder slipping out) - seek evaluation
When to Seek Professional Care
- →Any red flag symptoms
- →No improvement after 3 weeks of rest and modification
- →Pain radiating down arm
- →Significant weakness or instability
- →History of shoulder dislocation
- →Unable to lift arm overhead
General Principles
- •Swimmer's shoulder is an overuse injury - reduce volume first
- •Pain during swimming usually indicates inflammation
- •Technique flaws often contribute to shoulder problems
- •Strengthen rotator cuff and scapular stabilizers
- •Avoid painful ranges of motion until healed
Contraindicated Movements
Recommended Exercises
Rotator cuff strengthening (external rotation, Y-T-W)
3 sets × 15 reps
Strengthens rotator cuff to prevent impingement
Scapular stability exercises (rows, face pulls)
3 sets × 15 reps
Improves scapular control for better shoulder mechanics
Thoracic spine mobility
2 sets × 10 reps
Better thoracic mobility reduces shoulder compensation
Backstroke and breaststroke
1 sets × 10 reps
Balances stroke patterns and reduces freestyle-dominant loading
Ice after swimming
1 sets × 15 reps
Reduces inflammation during acute phase
Return to Full Training
Criteria:
- ✓Pain-free daily activities for 1 week
- ✓Pain-free easy swimming (50% volume) for 2 weeks
- ✓Full range of motion restored
- ✓Rotator cuff strength symmetrical
- ✓Technique corrections implemented
Progression:
- 1.Week 1-2: Rest or kick-only if tolerated
- 2.Week 3-4: Easy swimming with fins, backstroke emphasis
- 3.Week 5-6: Gradual return to freestyle, 50% volume
- 4.Week 7-8: Increase volume, reintroduce tempo work
- 5.Week 9+: Full training if pain-free