For Swimmers : Common Injuries, Treatment and Prevention tips
July 7, 2010
Do you swim leisurely or competitively? If yes, continue to read on.
Recently, one of our physiotherapists, Chng Chye Tuan was interviewed by Style:Men on the common musculoskeletal injuries face by swimmers in the July's issue. Do read on to find out what he has to share.
What are the common problems competitive/regular swimmers face?
The most common swimming injury is the rotator cuff impingement / tendonitis.
- Ball joint of the shoulder compress the tendon against the roof of the socket (acromion) in 2 phases of freestyle – the pullthrough and recovery phase.
- Pull-through phase in the freestyle stroke involves the arm pulling against the resistance of the water. The outstretched arm with internal rotation of the shoulder stresses the tendon and pinched it against the acromion. The pinching can irritate the tendons and give a sudden catching kind of pain.
- The recovery phase involves a body roll and raising the elbow up and out to allow the upper limb to recover out of water efficiently otherwise the shoulder will be working harder at an awkward position to pull the hand out of water.
- Repeated pinching will give rise to inflammation and fraying of the soft tissues.
What are the usual causes?
The usual contributing factors are mainly due to over training, poor technique, poor core muscles and unilateral breathing.
- Over training – when muscles are fatigued, the stabilising component from the rotator cuff muscles becomes compromised thus increasing the chances of the humeral head translating upwards and impinging the rotator cuff tendons. The ball component has to be centralised within the socket of the shoulder to optimise stability and muscle function.
- Technique – the freestyle and backstroke requires the swimmer to roll their trunk such that the drag is minimise and the propulsion force can be maximised. Too much drag will increase the resistence, tiring out the shoulder muscles sooner.
- Strong core muscles and truck control enable the swimmer to do a body roll along the longitudinal axis so that it is easier for the shoulder to pull the upper limb out of water.
- Unilateral breathing can develop a muscle imbalance leading to improper muscle activation and overuse.
What kind of treatments do you recommend?
An assessment of the shoulder girdle, spine and core strength will be performed to be able to properly manage a swimmer’s shoulder.
A key treatment to approach the swimming shoulder is to rehabilitate the rotator cuff muscles to be able to centralise the humerus at different shoulder positions.
Exercises will be prescribed to specifically target these rotator cuff muscles, correcting any imbalances. These exercises include strengthening the weak muscles to improve dynamic support and also stretching exercises to the tight muscles pulling the joint out of position.
As most competitive swimmers will not be able to cease training completely, kinesiotaping complements the rehabilitation therapy by improving the rotator cuff’s ability to stabilise the shoulder joint via better joint awareness from the corrective
Are there preventive measures that swimmers can take to minimise such problems?
Regular stretching exercises, core stability training and work on the techniques. During the early stage of feeling the impingement (catching or pinching) pain, seek help from a sports physician or physiotherapist as soon as possible.
Management for ITB friction syndrome
June 16, 2010
Training methods
Biomechanical Gait issues
Running Economy
May 7, 2010
Can you run faster AND easier? Yes you can, by improving your running economy.
What is Running economy?
Running economy is about how efficiently you run. A runner that uses less oxygen to run at a certain pace is said to be more economical or efficient.
One method to improve running economy is to minimise energy loss; by releasing stored potential energy to help propel your body forward.
Your body have several such potential energy stores that may not be fully utilised. To minimise energy wastage, you should make full use of
- your Achilles tendon as a trampoline,
- your core muscles as a winding mechanism,
- your legs as a pendulum and
- your body’s flight trajectory like the flight of a javelin.
Achilles tendon
Bouncing on a trampoline pushes the body upwards via the stored potential energy from the elastic fabric. If the trampoline is too soft or elastic, you will not get a good bounce up because energy is lost by the shock absorbing effect of a soft surface. If the trampoline is too stiff or inelastic, a lot of impact forces go through the legs and body, you also will not get a good bounce and put yourself at a higher risk of impact injuries. Once you “catch” the rhythm of bouncing on the trampoline, it is almost effortless to remain bouncing. This rhythm is known as the resonant frequency, a phase where stored potential energy is easily transferred to kinetic energy with no loss of energy. In reality, there will be some loss of energy and the key is to minimise this loss.
Our Achilles tendon stores energy and transfers it to push the foot off via a stretch-shorten cycle similar to a trampoline. Like the trampoline, the Achilles tendon should not be too flexible or there will be too much dampening or shock absorption. In addition, the calf muscles should be strong enough to stiffen the Achilles tendon and withstand the impact of landing on the foot; at the same time, pushing off with the recycled energy.
Core muscle
Imagine wringing a thick elastic band in a clockwise direction and then releasing it. The elastic band will unwind in the opposite direction and then get wound up again before unwinding again. The rotation and counter rotation will carry on until all the energy is lost. The core muscles of our trunk act just like this elastic band as they wind up to store energy, and release it by unwinding and rotating the trunk in the opposite direction. Unwinding of a "wound" up set of core muscles is easier if the core muscles is stiff, like a stiff spring coil. In contrast, a soft coil of rope doesn't explosively uncoil when released. This trunk winding-unwinding movement helps swing your pelvis forward, making it easier to take longer strides, covering longer distances with each same step.
Foot
As your foot swings in mid air during the flight phase, it acts like a pendulum to swing the foot further forward. Ideally, the leg should not go pass beyond the horizontal. If your foot is kicked up higher pass the horizontal, the pendulum effect will not be as effective because of energy lost. The foot tends to go higher either because of your running style or tight hamstrings.
Body
A common running fault often observed is where the body moves excessively in the vertical plane, thus not maximising energy moving forward in the horizontal plane instead. Like a javelin thrown too high, it covers a long travel distance but doesn't travel very far forward..
Have someone look at your running technique and look out for the above faults. Stretch your hamstrings (hypelink to article) and strengthen your core and calf muscles to run faster with less effort.
More Essential Stretches for Swimmers
May 4, 2010
Stretching is an important part of any warm up and cool down. Sport specific stretching allows you to warm up the specific muscles required for the sport. In swimming, the four competitive strokes are:
- Butterfly
- Backstroke
- Breastroke
- Freestyle
These strokes encompass the use of practically all the muscles in the body, the main muscles that are responsible for the movements that make up a stroke are called the primary muscles. Primary muscles used for all strokes are:
Other muscles that allow for controlled smooth movements are secondary muscles these are:
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There are many different types of stretches that a swimmer can use. The main types of stretching are:
- Static Stretching – Holding a position that stretches the muscle for ~ 30 seconds.
- Passive Stretching – Similar to static, but someone else holds the position for you.
- Dynamic Stretching – Controlled leg and arm swings that gently take you to the limits of your range of motion. It mimics the action of the muscles during the event. Often used in warm ups or in preparation for an event.
- Ballistic Stretching – Forcing a joint beyond its normal range of motion by bouncing into a stretched position. Unpopular these days due to the high risk of injury associated with it.
- Active Isolated (AI) Stretching – Using a muscle to stretch the opposite muscle by contracting one muscle and moving the opposite muscle in a stretched position.
- Isometric Stretching – Alternatively stretching a muscle and contracting it to facilitate its relaxation.
- Proprioceptive Neuromuscular Facilitation (PNF) – Combination of passive and isometric stretching.
A combination of these stretches is appropriate for swimmers. Try them out and see which ones help you most. Regular stretching improves force, and speed. One bout of stretching won’t make a difference.
Here are some examples of stretches that are particular the primary muscles used in swimming.
| Anterior deltoid, serratus anterior and pectorals stretch – Rotate your body so that you can feel a stretching sensation over the front of the shoulder and chest. | |
| Triceps stretch – With your opposite hand, pull your elbow downwards and towards your head so that you feel the stretch over your upper arm | |
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Posterior shoulder stretch 1 – Pull the arm towards the chest Posterior shoulder stretch 2 – Some traction can be applied by leaning the body away from the hand. Posterior shoulder stretch 3 – All your body weight should be positioned over your shoulder; your opposite hands helps to push the arm down towards the floor. The shoulder angle is kept at 90 degree, and so is the elbow joint. This stretch is felt at the back of the shoulder. |
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Latissimus dorsi stretch 1 – Accompany this stretch with breathing exercises. As you exhale, lean a little further over the side. Latissimus dorsi stretch 1:1 – Starting in a forward position, crawl your fingers towards to maximise the stretch, hold this position, then change your direction to one side to feel the stretch over the opposite side. Latissimus dorsi stretch 1:2 – Starting in a forward position, crawl your fingers towards to maximise the stretch, hold this position, then change your direction to one side to feel the stretch over the opposite side. |
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Hip stabilisers stretch 1 – To stretch your right hip, put the right leg diagonally behind the left, lean over to the left side, so as to increase the length and stretch over the right side. Hip stabilisers stretch 2 – Cross your right leg over a straightened left leg, and rotate to your right. You will feel this stretch through your lower back, but predominantly through your right hip. Hip stabilisers stretch 3 – This will stretch your right side, holding onto your left knee, gently pull it in towards your chest to feel the stretch on the outside and back of your right hip. Hip stabilisers stretch 4 – This will stretch your right side, holding onto your left knee, gently pull it in towards your chest to feel the stretch on the outside and back of your right hip. |
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| Quadriceps stretch – Keeping your knees and thighs together, stretch the front of your thigh by standing up straight and pushing your hip forwards. | |
| Hamstrings stretch – You don't need to flex your foot to stretch your hamstrings, let it relax and lean forwards from your hips, your back should not be overly arched. |
Tips to Run Pain Free
January 10, 2010
Recently our physiotherapist, Lenia, was featured in Shape magazine Jan 2010. Here is an excerpt from the article.
Shin splints are caused by weak shin muscles or faulty running biomechanics while plantar fasciitisis the result of tight calf muscles that reduce the foot's ability to absorb shock. Here are some tips to stay on track. Read more
Osteoarthritis Knee
December 25, 2009
Osteoarthritis (OA) of the knee is a degenerative condition where the cartilages of the knee wear away. Pain, stiffness and swelling are common symptoms of an OA knee. In this article, we look at the three factors that lead to the development of OA knee – Aging, Physical Attributes and Muscular Causes. Of which two of these factors, Physical Attributes and Muscular Causes, can be addressed with physiotherapy management. We will focus more in detail on the exercises and treatment for OA knee in a follow-up article.
Aging
OA Knee
Physical Attributes
The three key physical attributes are:
- Obesity - A heavier person will load their knee joints more, wearing out their cartilages faster than a lighter person.
- Knee alignment – A bow legged or knock-knee appearance will cause an uneven compression of the knee. Either the outer or inner compartment knee respectively will take up most of the load upon weight bearing and cause more wear and tear.
- Foot type -
- People with flat feet or whose feet over pronate tend to roll their knee inwards upon weight bearing similar to a knock-knee above.
- A person with high foot arch or whose feet under-pronate absorbs less impact with each foot fall. More impact goes up through the leg and the knee will have to work harder to cushion the impact.
Muscular Causes
When the muscles around the knee do not contract strong and fast enough in a coordinated fashion to absorb the impact of walking or running, the knee joint takes up the remaining forces of the impact.
- Tight muscles pull joints closer to each other.In an OA knee where the joint space is already reduced, tight muscles will increase the compression of the joint space. Muscles with reduced flexibility are also less coordinated and slower in reaction time. The muscles that tend to be tight are the quadriceps, hamstrings and calves.
- Weak muscles. The quadriceps muscles is the main muscle group that help to support the weight of the body and off loads the knee joint. It is very common for this muscle to atrophy because of disuse. The knee pain deters the patient from loading the knee and this will gradually lead to weakness of the knee which will affect the ability to cushion the impact. This pain, disuse, weakness cycle will continue without treatment.
Weak gluteus medius muscle can aggravate the degeneration of knee cartilage because its function is to keep the hip joint stable, especially in walking. This is often seen as a waddling gait where the hip sway with big movements side to side. The thigh muscle have to work a lot harder to stabilise the wobbly hip and if they are unstable, the knee joints will have to bear the weight.
The management of these factors are summarised in the following table. In our upcoming article, we will further discuss the specific exercises and treatment for OA knee.
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Physical Attributes |
Management |
| Weight | Weight loss programme |
| knee alignment | - training of muscles – orthotics |
| foot type | - orthotics |
| Muscular Causes | Management |
| Tightness | Stretch Quadriceps, Hamstring and Calves |
| Weak | Strengthen Quadriceps and Gluteus Medius |
Q angle and knee pain
November 25, 2009
What is Q angle?
The Q angle describes the angle of the knee from a frontal view. The Q angle gives an idea how the thigh muscles functions to move the knee and also how the knee cap (patella) tracks in the groove of the knee joint. A normal knee cap should move up and down within the groove with flexion and extension of the knee. When the Q angle is excessive, the knee cap tends to track out of alignment and hence causes wear and tear (degeneration) of the cartilage behind the knee cap.
What is the normal Q angle? The normal Q angle measured in standing is about 15 degrees and anything more than that is considered a risk factor for knee injuries. Ladies tend to have a wider Q angle due to their wider pelvis compared to their males.
Q-angle
How to measure Q angle? The Q angle is an intersection of two lines. First line joins the ASIS (bony protrusion in the front of the pelvis) to the middle of the patella. Second line runs from the protrusion on the top of the shin bone (tibial tuberosity) below the patella and upwards through the middle of the knee cap.
Common injuries related to a wide Q angle:
- Iliotibial band friction syndrome (ITBFS)
- Anterior knee pain or Patella Femoral Pain Syndrome (PFPS)
- Anterior cruciate ligament injury (ACL)
Injuries because of an excessive Q angle can be categorised into 3 main reasons.
1. Muscle imbalance :
A large Q angle pulls the knee cap outwards due to the stronger lateral pull from the quadriceps and tight ITB. Coupled with a weakness of the inner aspect of the quadriceps (Vastus Medialis Oblique, VMO) the knee cap will track laterally instead of smoothly up and down within the knee groove. This maltracking causes the cartilage behind the knee to wear off or degenerate and hence the pain.
2. Biomechanical compensation:
An excessive Q angle can alter the movement pattern especially in the foot. The knee will tend to point inwards (valgus or knock-knee appearance) which encourages the foot to roll inwards (pronates). Over-pronation can lead to a number of injuries especially in runners.
3. Joint laxity/instability:
When the knee point inwards, the ligaments on the inner aspect of the knee gets overstretched and lax, therefore compromising the stability of the knee joint. The Anterior Cruciate Ligament (ACL) also undergoes a lot of stress in this position. Interestingly the larger Q angle in females has been attributed as a main reason why females are at a higher risk of sustaining an ACL injury.
How to manage a wide Q-angle?
You can reduce the risk of injuries by targeting the reasons above.
Muscle imbalance: Stretching on the ITB, strengthening the VMO and Glut medius to enable proper tracking of the knee cap.
Biomechanics: Get a customised orthotics to control excessive pronation and reduce the stress to the knee.
Joint Laxity/Stability: Balancing exercises to train knee proprioception and stability.
ITB friction animation
November 20, 2009
Iliotibial band friction (ITB) syndrome is a common running injury due to a tight ITB. In a previous article, we explained the reasons why the ITB tightens up. To make it easier to understand how a tight ITB causes friction and inflammation, click here to see an animation of ITBS.
Different Compensation Strategies During Jogging by Low Back Pain Sufferers
November 2, 2009
I am sure all athletes have experienced the effects of muscle fatigue. You will use your body differently, trying to compensate by moving your limbs in a more comfortable way. Try going down stairs right after a marathon and you get the picture.
An interesting question is, do everyone compensate using the same strategy? Apparently not. A recent study¹ shows people with recurrent low back pain jogs with a different compensation strategy compared to healthy individuals after a set of fatiguing lower back muscle endurance exercise.
The exercise was to hold the lower back in an extended position until their muscles shows signs of fatigue on surface electromyography (EMG).
The low back pain group was found to jog with a more extended or arched lower back and had more hip movements whereas the normal healthy group runs with a more forward flexed trunk. This may be why it is a common for people with chronic low back pain to complain of hip muscle soreness and fatigue after endurance exercises.
It is a known fact that chronic low back pain sufferers have poor core muscle function. This adaptation of running with an extended back may be a strategy to stabilise the lower back without the need to use core muscles and yet able to continue running. On the other hand, healthy individuals are able to use their core muscles as a natural trunk stabiliser and prevent unnecessary movements.
Parallels can be drawn with long hours of sitting where the body requires muscle endurance to sustain in a single position. When fatigue sets in, the body may adopt a different strategy to try to protect the back and inadvertently creates a wrong movement pattern or mal-adaptation. Therefore, correcting wrong movement patterns and strengthening of the core muscles are important aspects of treating chonic low back pain.
Reference:
1. Hart JM, Kerrigan DC, Fritz JM, Ingersoll CD. Jogging Kinematics After Lumbar Paraspinal Muscle Fatigue Journal of Athletic Training. 2009; 44(5):475–481
Picture: www.amercianrunning.org
Stretches for Swimmers
October 23, 2009
Muscle flexibility is very important in swimming as events are won by milliseconds. A flexible body will help to improve your swimming performance by achieving maximal propulsion from each stroke. Here are some recommended stretches that can be done to improve your flexibility. Read more
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See the Therapist
For an appointment to consult with one of our physiotherapist for treatment, kindly call us at : +65 6226-3632 (4 Lines)
or SMS us at +65 9232 2661 or email us at enquiry@coreconcepts.com.
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Lenia Teo, B.HSc(physio)
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