Injury Patterns in Division I
Intercollegiate Swimming
Brian R. Wolf, MD, MS
Alexander E. Ebinger
Michael P. Lawler, MA, ATC, LAT
Carla Britton, MS
Competitive Swimming

Training:

5-30 hours / week




1-2 practices / day
> 10,000 yards / day
Year round sport
Cross training now
very common

Iowa team


Weight lifting 3x/wk
Running
Strokes

Freestyle (crawl)


Yardage in practice
Endurance

Early pull through
Late pull through
Recovery
Late recovery

Flutter (scissor) kick



www.swim.ee/models
Strokes

Backstroke


Breastroke



Whip kick
Associated with knee
pain
Butterfly



Flutter kick
Dolphin kick
? Association with low
back pain
Individual medley

All four strokes
Common Swimming Injuries

Shoulder

Overuse, muscle fatigue






Treatment

>1 million strokes / year
Impingement
GH instability
“Swimmer’s Shoulder”


Kennedy 1978
Subluxation 
impingement
3mm laxity swimmers
compared to soccer

Tibone et al Clin Orthop 2002
Activity modification
Decreased yardage
 Kicking only

No hand paddles / pulling
sets
Analyze stroke

Dropped elbow or
Overextended shoulder on
water entry




Cuff and periscapular
rehabilitation
Gradual increase in
yardage
Shoulder

Surgery if all else fails

Laxity


Labrum tears


Capsular plication / open
capsular shift
Repair v. tenodesis
Impingement


Decompression
Close evaluation for
underlying laxity
Lower Extremity / Knee


Mostly associated
with breastroke
Groin injuries

Medial knee pain

Adductor muscle strain
during finish of kick




Grote AJSM 2004
Associated with wider
kick

MCL, medial synovium
/ plica, medial facet of
patella
Larger hip angles in
kick
Patellar tendinitis

Non- breastrokers


Flutter kick
Lifting / running
Spine

Axial loading


Bending / twisting


Cross training
Divers >> swimmers
Dolphin kick


Butterfly
Underwater swimming


Starts / turns
Extension stresses on
low back – pars injuries

Degenerative
changes


Degenerative disk
Facet injuries
Injuries in Swimming

Limited information on
epidemiology of
swimming injuries





McFarland Clin J
Sports Med ‘96
McMaster AJSM ’93
Richardson AJSM ‘80
Rovere AJSM ‘85
Kennedy AJSM ‘78
NCAA Division I Collegiate
Swimming Epidemiology



Estimated 42,000 male
and female athletes
have competed in last
25 years
Minimal information
exists documenting the
epidemiology of
collegiate swimming
injuries
U of Iowa observation:
high number of injuries
in freshman swimmers
Purpose



Describe the pattern of injuries incurred for
one NCAA Division I collegiate men’s and
women’s swimming and diving team over the
course of five years
Analyze time lost secondary to injury
Analyze patterns of injury relative to: gender,
team activity, position, stroke specialty,
scholarship status and year of eligibility
Study Hypotheses

Men and women incur similar rates of injuries
per exposures, with similar locations of injury

Injuries, rates, and location will vary by stroke
specialty

Freshman athletes will demonstrate higher
injury rates than upperclassmen.
Definitions

Injury: musculoskeletal problem suffered as a result
of team-related activity which resulted in a visit to an
athletic trainer or physician

Season: academic year from August 1 to July 31 of the
next year

Eligibility: freshman, sophomore, junior or senior

Activity: regular practice, competition, strength training,
conditioning, or cross-training

Position: sprinter (events ≤200m) or distance
Definitions Continued

Missed time injury: Any injury resulting in no participation
in a practice or game; or any injury sustained while athlete
was already missing time due to another injury

Stroke specialty: breaststroke, backstroke, butterfly,
freestyle, or individual medley (based on team media
guides)

Scholarship: any financial support related to swimming

Exposure: participation in one game, practice, strength
training, conditioning, or cross-training activity
Methods

Retrospective review of SIMS database

SIMS = Sports Injury Monitoring System
© 2006 – 2010 FlanTech, Inc.


Computer program detailing all athlete injuries
Entered daily by athletic trainers

Included all University of Iowa swimmers for
five consecutive seasons (2002-2007)

Systemic illnesses and injuries not related to
team related activities were excluded
Statistics

Mantel-Haenszel Χ2


Injury occurrence and
gender, position, stroke
specialty, eligibility and
scholarship
Relative Risk

Injury occurrence with
eligibility, gender and
stroke specialty
Results: Gender

Men



44 swimmers
90 swimming injuries
Injuries sustained by



Women


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32 different
swimmers (73%)
4.00 injuries per 1,000
exposures
50 swimmers
76 swimming injuries
Injuries sustained by


35 different
swimmers (70%)
3.78 injuries per 1,000
exposures
Results: Gender

No significant
difference:


injury rates, RR 1.33
(.81-1.37)
Proportion of injuries
that resulted in missed
time


Male 34.4% (31/90)
Female 39.5% (30/76)



4 male swimmers – 9
surgeries
 4 shoulder
 4 elbow
 1 foot
4 Female swimmers – 5
surgeries
 All shoulder
1 swimmer retired
 Female, bilateral
shoulder surgeries
Injuries by body region

Shoulder
 Most often injured
 Greatest percentage of
injuries causing time
missed (for locations comprising
>10% of all injuries)



Back / Neck #2
Body part injured / missed
time – no significance
statistically
Distribution of injuries
similar between gender
Injuries by Eligibility Year

Freshmen




Most often injured
for both men and
women
Highest mean #
injuries
Freshman women
sustained most
injuries of any group
and accounted for
49% of female
injuries
Injuries significantly
declined after
freshman year
X2, P=.03 women, =.04 combined team
# Men
Injuries by Position:
sprinters v. distance


Risk of suffering injury not associated with
position RR-1.26 (.93-1.70)
Proportion of injuries that resulted in missed
time similar
Injuries by Stroke Specialty


No significant
association between
stroke specialty and
rate of injury
Freestyle – most
common specialty

Strokes other than
freestyle more likely to
be injured

RR 1.33 (1.001-1.77)
Injuries by Stroke Specialty

No significant association:


Stroke specialty and injured body region
Stroke specialty and time missed
Injury by Team Activities

Practice

Male: 56% of injuries overall


Strength Training

36% resulted in time missed
Female: 61% of injuries overall


37% resulted in time missed
Male: 30% of injuries overall


34% resulted in missed time
Female: 28% of injuries overall

45% resulted in missed time
Injury by Team Activities

Practice

Shoulder most common


Men: n = 18, 36%
Women: n = 23, 50%

Strength Training

Neck and back most common


Men: n = 14, 52%
Women n = 8, 38%
Conclusions




No significant difference between gender for
injuries per team related exposure
Similar injury patterns between genders
No clear association of injuries with stroke
specialty and injured body region
4.0 and 3.78 / 1000 exposures

Wasik et al: 2.12 / 1000 exposures in women
collegiate swimmers
Conclusions

Freshmen sustained the greatest number of
injuries overall


Injuries decreased after freshman year
Reasons for Freshman Injuries


Increased yardage from high school to college
Addition of weight lifting regimen to practice
schedule
Discussion

Out of pool activities
resulted in nearly 40% of
the injuries in swimmers


Wasik et al: 44% in
women collegiate
swimmers
Cross training is very
common now in swimming


Many swimmers
unaccustomed to other
forms of training prior to
college.
Fish out of water???
Implications


Careful monitoring of freshmen progress and
injury reporting
Detailed instruction and supervision for
incorporation of weight training regimen
Thank You
Thank you