Breaststroker's knee: pathology, etiology, and treatment

Strength Training in Swimming

This narrative review deals with the topic of strength training in swimming, which has been a controversial issue for decades. It is not only about the importance for the performance at start, turn and swim speed, but also about the question of how to design a strength training program. Different approaches are discussed in the literature, with two aspects in the foreground. On the one hand is the discussion about the optimal intensity in strength training and, on the other hand, is the question of how specific strength training should be designed. In addition to a summary of the current state of research regarding the importance of strength training for swimming, the article shows which physiological adaptations should be achieved in order to be able to increase performance in the long term. Furthermore, an attempt is made to explain why some training contents seem to be rather unsuitable when it comes to increasing strength as a basis for higher performance in the start, turn and clean swimming. Practical training consequences are then derived from this. Regardless of the athlete's performance development, preventive aspects should also be considered in the discussion. The article provides a critical overview of the abovementioned key issues. The most important points when designing a strength training program for swimming are a sufficiently high-load intensity to increase maximum strength, which in turn is the basis for power, year-round strength training, parallel to swim training and working on the transfer of acquired strength skills in swim training, and not through supposedly specific strength training exercises on land or in the water.

Evidence-Based Musculoskeletal Care for Swimmers: A Critical Analysis Review

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Swimming is a popular activity with numerous health benefits.

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Swimming involves complex biomechanical movements that, especially if performed incorrectly, can lead to musculoskeletal injuries.

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The shoulder is the most commonly affected joint, although lower-extremity and spine injuries have also been reported.

Magnetic resonance imaging appearance of breaststroker's knee

Breaststroker's knee is an overuse syndrome resulting from similar repetitive movements in competitive swimmers that has been described in the orthopedic literature. The typical symptoms are medial knee pain with tenderness to palpation at the tibial collateral ligament or inferomedial patella. Despite these localizing symptoms on clinical exam, arthroscopic studies have failed to demonstrate a specific structural abnormality corresponding to this syndrome, although some have reported thickened medial synovial plica, medial-predominant synovitis or patellofemoral cartilage loss in association knee pain with breaststroke swimmers. We present a case of medial knee pain in a young breaststroke swimmer with magnetic resonance imaging (MRI) findings of marrow edema in the anterior aspect of the medial femoral condyle. To our knowledge, this is the first reported case of MRI findings in breaststroker's knee .

An Updated Review of the Epidemiology of Swimming Injuries

OBJECTIVE

To carry out a systematic review to update the scientific evidence on the incidence and prevalence of injuries in the swimming discipline, as well as the location, type, and mechanism of the injuries, and to assess whether studies are meeting methodological recommendations for data collection and injury surveillance. TYPE: Analytical-Systematic review.

LITERATURE SURVEY

The databases of PubMed and Sportdiscus were used to search for studies that describe the epidemiology of injuries in adult swimmers between 2010 and March 2020.

METHODOLOGY

Of the 864 articles identified, 14 studies were finally included in this review. The methodological quality of the studies was analyzed with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) scale and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

SYNTHESIS

The results showed a high prevalence of shoulder, knee, and lower back injuries among swimmers due to overuse. These injuries were mainly short-term tendon muscles; there were reported data differences between genders.

CONCLUSIONS

Despite the publication of an injury surveillance single and multisport events document and a consensus on data collection and injury surveillance in swimming, there are huge methodological limitations that do not allow firm conclusions. As such, more epidemiological studies following guidelines for data collection and injury surveillance are needed to establish differences by gender, age group, and swimming stroke.

Does sports participation (including level of performance and previous injury) increase risk of osteoarthritis? A systematic review and meta-analysis

BACKGROUND

To assess the relationship between sport and osteoarthritis (OA), and specifically to determine whether previous participation, in terms of level (elite or non-elite), type of sport, intensity or previous injury, was associated with OA.

METHODS

This systematic review was developed using PRISMA guidelines. Databases were searched (to May 2016). Narrative review and meta-analysis (with risk ratio (RR) and 95% CIs) approaches were undertaken where appropriate. Study quality was assessed using GRADE.

RESULTS

46 studies were included. Narratively, 31 studies reported an increased risk of OA, with 19 demonstrating an increased risk in elite athletes. There was an increased risk after sports exposure (irrespective of type; RR 1.37; 95% CI 1.14 to 1.64; 21 studies). It remained uncertain whether there was a difference in risk of OA between elite and non-elite athletes (RR 1.37; 95% CI 0.84 to 2.22; 17 studies). The risk was higher in soccer (RR 1.42; 95% CI 1.14 to 1.77; 15 studies) but lower in runners (RR 0.86; 95% CI 0.53 to 1.41; 12 studies). 9 studies showed an association with the intensity of sport undertaken and OA. 5 studies demonstrated a higher prevalence of OA following meniscectomies and anterior cruciate ligament tears. Overall, the evidence was of GRADE 'very low' quality.

CONCLUSIONS

There was very low-quality evidence to support an increased relationship between sports participation and OA in elite participants. It is unclear whether there is a difference in risk between elite and non-elite participants with further prospective studies needed to evaluate this. Pooled findings suggested that significant injuries were associated with OA in soccer players.

Medical Care of the Aquatics Athlete

Competitive swimmers are affected by several musculoskeletal and medical complaints that are unique to the sport. 'Swimmer's shoulder,' the most common overuse injury, is usually caused by some combination of impingement, rotator cuff tendinopathy, scapular dyskinesis, and instability. The condition may be treated with training modifications, stroke error correction, and strengthening exercises targeting the rotator cuff, scapular stabilizers, and core. Implementation of prevention programs to reduce the prevalence of shoulder pathology is crucial. Knee pain usually results from the breaststroke kick in swimmers, and the 'egg beater' kick in water polo players and synchronized swimmers. Lumbar back pain also is common in aquatics athletes. Among the medical conditions of particular importance in swimmers are exercise-induced bronchoconstriction, respiratory illnesses, and ear problems. Participants in other aquatics sports (water polo, diving, synchronized swimming, and open water swimming) may experience medical ailments specific to the sport.

"Motionyms": activity-related musculoskeletal and medical problems (or "not an eponym!!")

Many common conditions in sports medicine are eponymous; that is, they are named for the person first describing or popularizing the diagnosis. But other medical conditions are named for the action or activity that is associated with the pathology. This article lists and references these conditions, and suggests that this group of conditions should be called "motionyms".

Are joint injury, sport activity, physical activity, obesity, or occupational activities predictors for osteoarthritis? A systematic review

STUDY DESIGN

Systematic review with meta-analysis.

OBJECTIVES

To identify risk factors for osteoarthritis (OA) of the knee, hip, and ankle, including joint injury, sport, physical activity, overweight/obesity, and occupational activity, in all age groups.

BACKGROUND

OA is a significant health problem worldwide, affecting up to 10% of men and 18% of women over 60 years of age. There has not been a comprehensive review examining modifiable physical risk factors associated with the onset of OA. This evidence is important to inform the physiotherapy management of individuals following onset of OA.

METHODS

Twelve electronic databases were systematically reviewed. The studies selected met the following criteria: (1) original data; (2) joint injury, sport activity, physical activity, overweight/obesity, and/or occupational activity investigated as risk factors; (3) outcomes included OA (hip, knee, and/or ankle); and (4) analytic component of study design. The data extracted included study design, years of follow-up, study population, OA definition, risk factors, and results (effect estimates reported or calculated where available). The quality of evidence was assessed based on a modified version of the Downs and Black checklist.

RESULTS

Joint injury, obesity, and occupational activity were associated with an increased risk of OA of the knee and hip. Sport and physical activity produced inconsistent findings. Joint injury was identified as a significant risk factor for knee OA (combined odds ratio = 3.8; 95% confidence interval: 2.0, 7.2) and hip OA (combined odds ratio = 5.0; 95% confidence interval: 1.4, 18.2), as was previous meniscectomy with or without anterior cruciate ligament injury for knee OA (combined odds ratio = 7.4; 95% confidence interval: 4.0, 13.7). There is a paucity of research examining risk factors associated with ankle OA; this review identified only 2 studies with this outcome.

CONCLUSION

Joint injury, obesity, and occupational activity are associated with an increased risk of knee and hip OA. Some findings remain inconclusive, including levels of physical activity and sport specificity in individuals who do not suffer an injury. Early identification of individuals at risk for OA provides an opportunity for physiotherapy management or other interventions to modify risk-related behavior. There is a need in the literature for additional high-quality studies, such as prospective cohort studies, that minimize potential bias in examining the relationship between physical risk factors and OA.

LEVEL OF EVIDENCE

Prognosis, level 2a-.

Epidemiology of injuries and prevention strategies in competitive swimmers

Context:

Competitive swimmers are predisposed to musculoskeletal injuries of the upper limb, knee, and spine. This review discusses the epidemiology of these injuries, in addition to prevention strategies that may assist the physician in formulating rehabilitation programs for the swimmer following an injury.

Evidence Acquisition:

A literature search was performed by a review of Google Scholar, OVID, and PubMed articles published from 1972 to 2011.

Results:

This study highlights the epidemiology of injuries common to competitive swimmers and provides prevention strategies for the sports health professional.

Conclusions:

An understanding of swimming biomechanics and typical injuries in swimming aids in early recognition of injury, initiation of treatment, and design of optimal prevention and rehabilitation strategies.

Soothing suffering swimmers: a systematic review of the epidemiology, diagnosis, treatment and rehabilitation of musculoskeletal injuries in competitive swimmers

BACKGROUND

This review details the examination, diagnosis, treatment and management of injuries encountered by competitive swimmers. Primarily, these involve the shoulder, however, the spine, knee and hip can be involved. Using the Coleman methodology score, we show that the methods used in obtaining and reporting clinical findings and intervention results could be improved. Where possible, we suggest improvements.

SOURCES OF DATA

A literature review was conducted in English, Italian, French and German using PubMed, Google Scholar and Ovid search engines with strict inclusion/exclusion criteria.

AREAS OF AGREEMENT

Poor technique, and high training intensity and distance are the most common cause of missed swim practice and competition through injury.

AREAS OF CONTROVERSY

Few articles agree on a single method of each of clinical examination, diagnosis, treatment and rehabilitation.

GROWING POINTS

Articles are consistently retrospective with few investigating spine, hip and knee injuries.

AREAS TIMELY FOR DEVELOPING RESEARCH

Clinical findings and rehabilitation methods should be reported using a more structured method possibly based on the Coleman methodological scoring system.

Overuse injuries of the knee

Overuse injuries are a common cause of morbidity in athletes. They occur after repetitive microtrauma, abnormal joint alignment, and poor training technique without appropriate time to heal. Overuse injuries are frequent in the knee joint because of the numerous attachment sites for lower limb musculature and tendons surrounding the joint. MR imaging is regarded as the noninvasive technique of choice for detection of internal derangements of the knee. This article describes the characteristic findings on MR of the common overuse injuries in the knee, including patellar tendinopathy, iliotibial band syndrome, cartilage disorders, medial plica syndrome, and bursitis.

Hip adductor injury in competitive swimmers

METHODS

The authors conducted a survey of 296 competitive swimmers to assess the incidence and importance of interfering groin pain in breaststroke swimmers.

RESULTS

Breaststroke swimmers were more likely to have current groin pain (6.92%) than individual medley swimmers who did not compete in pure breaststroke events (0, P = 0.015). Breaststroke swimmers (42.7%) were also more likely than individual medley swimmers (21.5%, P = 0.000622) or nonbreaststroke, nonindividual medley swimmers (5.8%, P = 0.00000311) to have been unable to train breaststroke in practice during the past year due to groin injury.

CONCLUSION

Results indicate that breaststroke swimmers are at significant risk of groin injury, groin injury is positively correlated with increased magnitude of breaststroke training, and groin injury may prevent participation in practices and competitions.

Knee pain in competitive swimming

The high volume of training in competitive swimming results in cumulative overload injuries. Knee pain ranks second to shoulder pain as a common complaint in competitive swimmers. Most knee pain occurs on the medial side of the knee and, most commonly, in breaststroke swimmers; however, knee pain may accompany all strokes. This article reviews the incidence of knee pain, the biomechanic and anatomic factors predisposing to injury, specific injury patterns, injury diagnosis, and the treatment and prevention of injury to the knee in swimmers.

Thigh Strains in Competitive Breaststroke Swimmers

Although shoulder and knee injuries are the most common injuries in swimmers, thigh/groin strains have recently been identified as a critical area in elite competitive breaststroke swimmers. A survey of high-level collegiate breaststroke swimmers revealed a 33% incidence of this hip flexor adductor injury. A comprehensive treatment and prevention program is detailed in this paper.

Musculoskeletal injuries in competitive swimmers

Competitive swimming is a rigorous sport being engaged in by an increasing number of young athletes. In swimmers, shoulder pain is the most common musculoskeletal complaint and is usually due to supraspinatus or biceps tendinitis. Glenohumeral instability (often multidirectional) can also be a cause of shoulder pain in swimmers and may be more common than has been reported. Surgical treatment is seldom indicated. Physical therapy modalities and training modifications are the mainstay of treatment. Medial knee pain in breaststroke swimmers and extensor tendon inflammation over the dorsum of the foot are less common injuries and respond to conservative therapy. These overuse syndromes are best prevented by proper training schedules, strength training, flexibility exercises, and avoidance of errors in stroke technique. The rehabilitation program for a competitive swimmer should be chosen with an understanding of the goals of the swimmer and the cooperation of the coach.

Breaststroker's knee. An analysis of epidemiological and biomechanical factors

Competitive swimmers have a high incidence of breaststroke-related knee injuries. Although previous investigators have implicated the terminal phase of the kick in the injury mechanism, athletes often complain of pain during the initial phase of rearward thrust. Disagreement in the current literature surrounds the precise anatomical derangement(s) constituting "breaststroker's knee." The purpose of this investigation was to delineate the epidemiology, anatomy, and pathobiomechanics of breaststroke knee injuries. Descriptive data were obtained by surveying 391 athletes. An extremely high incidence of knee pain was documented both among breaststroke specialists (73%) and nonbreaststrokers (48%). Age, years of competitive swimming, and specific training characteristics were positively correlated with knee pain. Both the medial collateral ligament and the inferomedial patellar border were involved. A further 21 swimmers were assessed in detail using four methods: interview, physical examination, Cybex II isokinetic quadriceps and hamstring testing, and cinematographic analyses. The interview and physical examination data supported the conclusions derived from the descriptive data, while Cybex testing and kinematic film analyses failed to demonstrate statistical differences between the injured and noninjured groups. Although kinematic film analyses did not demonstrate statistical differences between cases and controls, dramatic differences in the injury rate were noted when hip abduction angles at kick initiation were less than 37 degrees or greater than 42 degrees. This bimodal increase in injury rates suggests that modification of hip abduction at kick initiation, in conjunction with altered training regimens, will lead to a reduction in medial knee joint stress and hence fewer breastroke injuries.

Anterior glenoid labrum damage: a painful lesion in swimmers

The diagnosis of swimmer's shoulder has long connoted a malady usually perceived to be impingement syndrome. However, as greater understanding of shoulder mechanics and diagnosis has been applied to the shoulder of swimmers, it is apparent that they too suffer from a variety of problems common to all overhead sports. This paper describes the functional instability problem of labral damage in the swimmer. Isolated labrum damage is part of a spectrum of anterior shoulder problems. This lesion is particularly disturbing to the swimmer, and its successful management through arthroscopic means is a boon. Correct diagnosis is paramount if a treatment is to be successful. The lesion in swimmers is described as well as its diagnosis by examination and computerized tomography (CT) arthrography.

Frequency, associated factors, and treatment of breaststroker's knee in competitive swimmers

Thirty-six competitive breaststroke swimmers were interviewed and examined for knee pain specifically related to the breaststroke kick. Eighty-six percent of the subjects had a history of at least one episode of breaststroke knee pain, while 47.2% had breaststroke knee pain that occurred at least once a week. There was a significant relationship between more frequent knee pain and increasing swimmer's age, increasing years of competitive swimming, increasing breaststroke training distance, and decreasing warm-up distance. The subjects with frequent knee pain were found to have less internal rotation at the hip joint. The most common site of breaststroke knee pain was the medial portion of the knee, with specific sites differing among the individuals. The medial synovial plica syndrome may be a cause of breaststroke knee pain, since 47% of subjects with weekly knee pain had tender, thickened medial plicae. Palpation of those plicae produced pain similar to that experienced with the breaststroke kick. The findings in this study suggest that reducing or eliminating breaststroke training distance should be an initial measure in treatment. Applications of ice, changes in kick technique, stretching exercises to increase hip rotation, and administration of aspirin may also be effective. The breaststroke training distance should be increased very gradually in the early season, and warm-up distance should be adequate to help prevent the symptoms of breaststroker's knee.