“KNEE PAIN is the most common of all sports injuries”
PATELLOFEMORAL PAIN / ANTERIOR KNEE PAIN
Commonly the problem is with the tracking of the patella (knee cap).
Weakness of the VMO (inner part of quad) allows patella to track laterally.
When misaligned and not in its groove, patella is prone to irritation and
inflammation caused by friction of repeated movements.
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related to musc imbalance which allows poor patellar tracking
typically weak VMO & ABductors coupled with tight ITB, ADductors & Hams
high risk of the patella riding laterally during the breast-stroke kick
MEDIAL KNEE PAIN
MENSICUS INJURY
Meniscus = Fibrocartilagenous cushion structures that protect
bone ends in knee
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Injured during combined bending and twisting movements as the
meniscus can become trapped and tear.
The signs of such an injury include a popping and snapping noise, and
buckling and possible locking of the knee.
More common in weight bearing activities and cross-training.
BREAST STROKE KNEE [most common knee pain in swimmers]
Aka MEDIAL KNEE PAIN/strain of MCL
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MCL = ligament which stabilizes inner aspect of knee
Common in breast stroke kick due to nature of movement and valgus
stress placed on medial knee - Exceeding the elastic limits of the
ligament will cause damage and injury
Chronic micro-injury can produce laxity in ligament and growth plate
injury in young swimmers; early intervention is key for good recovery
RELATIVE REST (from breast stroke) until swelling is under control
then gradually increase pain-free distance
Critical that kick technique is evaluated: In breast-stroke kick, allow
knees to separate only as wide as hips. When the knee center is
narrow or wide of the hip center, it causes increased stress on the
MCL.
FOOT/ANKLE PAIN
MOST COMMON = TENDONOSIS at the extensor retinaculum
 caused by repeated extreme plantarflexion in flutter or dolphin kick
 Characterized by pain and/or crepitus on top of foot
 FIX - RELATIVE REST: arm only training, decrease inflammation,
strengthen muscles
BACK PAIN
Spondlolysis, Scheuermans’s kyphosis, Mehanical LBP common
More time spent training face down in water leads to over-development of
trunk extensors/back muscles (without adequate abdominal strength and
hamstring flexibility)
FIX – ROM exercises for the whole spine and CORE strengthening
NECK PAIN
REPETITIVE STRAIN due to repetitive rotation of the Cervical Spine (neck)
during freestyle
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lack of body roll forces the neck to rotate further with each breath
breathing only on one side creates imbalance in musculature
extension of neck also predisposes to strain
CERVICAL FACET SYNDROME = Over time, repetitive strain and
overstretching of ligaments causing facet joint dysfunction, malposition, pain,
and protective muscle guarding
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FIX - must adjust/mobilize, tx the muscles, ice and stretch and rest… all
concurrently
DRYLAND TRAINING / CROSS TRAINING
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as we discussed in our Shoulder session, cross-training and rehab is
critical for a number of reasons I’m sure you all remember  (make you
a stronger swimmer, and resistant to injury)
its important to include a range of exercises for the lower body followed
by quality stretches.
CROSS-TRAINING INJURIES of the lower extremities are common
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running, biking and weight lifting are main offender