Kenal, K. A., & Knapp, L. D. (1996). Rehabilitation of injuries in competitive swimmers. Sports Medicine, 22, 337-347.

Because of the excessive number of movement repetitions competitive swimmers are very likely to develop overuse injuries of the shoulder, back, and knee. The combination of hypovascularity, repetitive and often constant fatigue, poor stroke mechanics, and progressive instability of a hypermobile joint results in shoulder impingement. The commonest cause of shoulder problems is excessive joint mobility (glenohumeral joint instability).

Back injuries are most commonly due to disc degeneration, hyperextension, or myofascial involvement.

Medial knee pain is most common in breaststroke swimmers and may be due to excessive valgus and rotatory stress. Frequent symptoms are patellofemoral pain, medial collateral ligament stress syndrome, and medial synovitis.

Treatment for these problems involves reduction in inflammation, alterations in technique that reduce and stabilize hypermobile joints, postural correction, strengthening of joints that undergo high levels of stress, and optimal rather than excessive flexibility.

Implication. Flexibility is important in swimming however it can be overdone. If shoulders and knees are specifically exercised to achieve excessive flexibility then the extra mobility in the joint leads to medical problems. The degree of flexibility that is warranted is one that facilitates good techniques without stressing joint mobility to an unnecessary level.

Flexibility exercises should be accompanied by specific strengthening exercises for the muscles that maintain joint integrity (to avoid hypermobility).

If techniques are poor, such as excessive use of the internal rotators of the shoulders in crawl stroke, then the "balance" of a swimmer's skeletal system will be disrupted and injury will eventually occur.

Good technique, reasonable flexibility, and strengthening exercises to maintain joint integrity will go a long way to avoiding injury in swimmers.

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