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Wareham DM, Fuller JT, Douglas TJ, Han CS, Hancock MJ. Swimming for low back pain: A scoping review. Musculoskelet Sci Pract 2024; 71:102926. [PMID: 38522227 DOI: 10.1016/j.msksp.2024.102926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/01/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Guidelines recommend exercise for treatment of chronic low back pain and prevention, but the amount and quality of evidence for different exercise modes is highly variable. Swimming is commonly recommended by health professionals, but the extent and quality of research supporting its relationship with back pain is not clear. OBJECTIVES The aim of this scoping review was to map the extent, characteristics and findings of research investigating the relationship between swimming and low back pain. DESIGN Scoping review. METHOD Four electronic databases (MEDLINE, EMBASE, CINAHL, and SPORT Discus) were searched from inception to February 2023. We included primary studies and reviews that reported an association between swimming and low back pain. Hydrotherapy studies were excluded. RESULTS 3093 articles were identified, and 44 studies included. Only one randomised controlled trial and one longitudinal cohort study were included. Most studies were cross-sectional (37/44; 84.1%), included competitive athletes (23/39; 59.0%), and did not primarily focus on the association between swimming and low back pain in the aims (41/44; 93.2%). Instead, most data available were largely incidentally collected or a secondary outcome. The reported associations between swimming and low back pain were highly variable regardless of whether the comparison was to other sports (odds ratio: 0.17 to 17.92) or no sport (odds ratio: 0.54 to 3.01). CONCLUSION Most available literature investigating swimming and low back pain is cross-sectional in design. We did not identify any clear pattern of association between swimming and low back pain, based on the available literature.
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Affiliation(s)
- Deborah M Wareham
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park 2109, NSW, Australia.
| | - Joel T Fuller
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park 2109, NSW, Australia.
| | - Tayla J Douglas
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park 2109, NSW, Australia.
| | - Christopher S Han
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia.
| | - Mark J Hancock
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park 2109, NSW, Australia.
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Hill L, Mountjoy M, Miller J. Non-shoulder Injuries in Swimming: A Systematic Review. Clin J Sport Med 2022; 32:256-264. [PMID: 33852442 DOI: 10.1097/jsm.0000000000000903] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/17/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The shoulder is the most common injury in swimming, followed by the knee and spine. The repetitive nature of swimming training may predispose a swimmer to injury. Several risk factors have been previously identified, but the level of evidence and level of certainty that these risk factors predispose a swimmer to injury risk has yet to be evaluated critically in a systematic review. DESIGN Systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. DATA SOURCES Data were obtained through PubMed, Cochrane, and Google Scholar. The database search was limited to articles that were published between January 1980 and December 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Level I, II, and III studies were included in this review. All studies must have been conducted in swimmers or swimming, a description of the specific pathology and provide at least one identified risk factor with an association (P < 0.05). RESULTS A total of 19 critically appraised articles identified 28 potential risk factors for musculoskeletal injuries in swimmers. The risk factors were grouped by the anatomical region: neck and back, pelvis and hip, and the knee. Only 2 risk factors were appraised at a moderate level of certainty, both occurring in the knee. The remaining 26 identified risk factors were appraised at a low level of certainty. There is a clear lack of research surrounding nonshoulder injuries in swimmers.
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Affiliation(s)
- Lee Hill
- Division of Gastroenterology and Nutrition, Department of Paediatrics, McMaster University, Hamilton, ON, Canada
- Department of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Margo Mountjoy
- Federation International de Natation (aquatics) (FINA) Sports Medicine, Lausanne, Switzerland; and
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Jim Miller
- Federation International de Natation (aquatics) (FINA) Sports Medicine, Lausanne, Switzerland; and
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Wirth K, Keiner M, Fuhrmann S, Nimmerichter A, Haff GG. Strength Training in Swimming. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095369. [PMID: 35564764 PMCID: PMC9100337 DOI: 10.3390/ijerph19095369] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/22/2022] [Accepted: 04/24/2022] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Klaus Wirth
- Faculty of Training and Sports Sciences, University of Applied Sciences Wiener Neustadt, 2700 Wiener Neustadt, Austria;
- Correspondence:
| | - Michael Keiner
- Department of Sport Science, University of Health and Sports, 85737 Ismaning, Germany;
| | - Stefan Fuhrmann
- Olympic Training and Testing Centre Hamburg/Schleswig-Holstein, 22049 Hamburg, Germany;
| | - Alfred Nimmerichter
- Faculty of Training and Sports Sciences, University of Applied Sciences Wiener Neustadt, 2700 Wiener Neustadt, Austria;
| | - G. Gregory Haff
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia;
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Kreulen RT, Spiker AM, Heinlein SA, Cosgarea AJ. Evidence-Based Musculoskeletal Care for Swimmers: A Critical Analysis Review. JBJS Rev 2022; 10:01874474-202204000-00002. [PMID: 35385413 DOI: 10.2106/jbjs.rvw.21.00200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Swimming is a popular activity with numerous health benefits. » Swimming involves complex biomechanical movements that, especially if performed incorrectly, can lead to musculoskeletal injuries. » The shoulder is the most commonly affected joint, although lower-extremity and spine injuries have also been reported.
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Affiliation(s)
- R Timothy Kreulen
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Andrea M Spiker
- Department of Orthopedic Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Andrew J Cosgarea
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
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Trikha R, Schroeder GG, Greig DE, Kremen TJ. Characterizing Health Events and Return to Sport in Collegiate Swimmers. Orthop J Sports Med 2022; 10:23259671221083588. [PMID: 35400141 PMCID: PMC8988675 DOI: 10.1177/23259671221083588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/30/2021] [Indexed: 11/28/2022] Open
Abstract
Background: There is limited literature characterizing the incidence, variety, and effects of injuries and illnesses observed in elite swimmers. Purpose: To describe the epidemiology of injuries and illnesses affecting elite intercollegiate competitive swimmers. Study Design: Descriptive epidemiology study. Methods: This retrospective study utilized a deidentified injury and illness database of National Collegiate Athletic Association Division I swimmers in the Pacific Coast Conference from the academic years 2016 to 2017 and 2019 to 2020. A health event was defined as an illness or musculoskeletal injury that was identified by an athletic trainer or team physician. Musculoskeletal injuries and nonmusculoskeletal injuries and illnesses were stratified by body location. Injuries were further characterized as career-ending, season-ending, missed time but the athlete returned to sport in the same season, or those that did not cause missed time. Relative risk (RR) was used to compare the percentage of athletes affected between women and men, with statistical significance being defined by a 95% CI not including 1. Results: Included were 641 collegiate swimmers (301 male, 340 female). There were 1030 health events among 277 women and 173 men, with 635 (61.7%) occurring in women and 395 (38.3%) in men. There were 540 musculoskeletal injuries reported, most of which involved the shoulder (n = 126; 23.3%), spine (n = 95; 17.6%), foot/ankle/lower leg (n = 81; 15.0%), knee/thigh (n = 67; 12.4%), and hand/wrist/forearm (n = 52; 9.6%). A total of 490 nonmusculoskeletal health events were reported and included events such as respiratory tract infections (n = 119; 24.3%), unspecified medical illness (n = 93; 19.0%), concussions (n = 58; 11.8%), ear infections (n = 25; 5.1%), and gastrointestinal illnesses (n = 24; 4.9%). Compared with male swimmers, female swimmers were at a higher risk of sustaining both musculoskeletal injury (RR, 1.5; 95% CI, 1.22-1.83) and nonmusculoskeletal injury/illness (RR, 1.32; 95% CI, 1.04-1.68). There were 58 documented concussions, with 8 (13.8%) being season-ending, but not career-ending and 14 (24.1%) being career-ending. Women had a higher rate of concussion (9.1% vs 4.3% for men; RR, 2.11; 95% CI, 1.13-3.96). Conclusion: This retrospective study identified the most common injuries and illnesses observed among elite collegiate swimmers. Awareness of the incidence and outcome of injuries and illnesses that affect competitive swimmers may allow for more targeted analyses and injury prevention strategies.
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Affiliation(s)
- Rishi Trikha
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | - Danielle E. Greig
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Thomas J. Kremen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Trinidad A, González-Garcia H, López-Valenciano A. An Updated Review of the Epidemiology of Swimming Injuries. PM R 2020; 13:1005-1020. [PMID: 33010194 DOI: 10.1002/pmrj.12503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 11/11/2022]
Abstract
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.
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Atilla H, Akdogan M, Öztürk A, Ertan MB, Kose O. Musculoskeletal Injuries in Master Swimmers: A National Survey in Turkey. Cureus 2020; 12:e8421. [PMID: 32642337 PMCID: PMC7336593 DOI: 10.7759/cureus.8421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background This study aimed to determine the frequency of musculoskeletal injuries in master swimmers in Turkey. Methods A questionnaire was formed and distributed to all master swimmers registered with the Turkish Swimming Federation. The collected data included age, sex, the age to start swimming (SAS), weekly training time (WTT), weekly training distance (WTD), any painful episode that lasted more than 10 days in any of the body regions within last one year, any confirmed diagnosis of musculoskeletal disease by a physician, and history of musculoskeletal surgical operation. The descriptive data were presented, and multiple comparisons were made according to demographic characteristics. Results There were 88 male swimmers with a mean age of 47.1±13.2 years (range, 26-89 years). Of the 88 athletes, 27 (30.7%) had no pain in daily activities, and 61 (69.3%) reported pain in at least one region, with a total of 118 pain zones reported. The shoulder was the most common painful body region (n:37, 42.0%), followed by the lower back (n: 24, 27.3%), neck (n: 19, 21.6%), back (n:12, 13.6%), and knee (n:9, 10.2%). The mean age, SAS, WTT, WTD, and distribution of stroke preference were similar in subjects with or without reported pain and diagnosis (p>0.005). Any painful body region and diagnosis were equally distributed in all swimming styles (p>0.05). The most common surgeries were lumbar disc disease (16.7%) and meniscectomy (16.7%). Conclusion Compared to the findings in the current literature, master swimmers do not have as many musculoskeletal problems as their younger counterparts. The problems seen in master swimmers are lower but similar to those in competitive elite swimmers. From the musculoskeletal health perspective, swimming is safe for the master age group. Swimming can be safely offered to elderly patients who underwent even musculoskeletal surgery.
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Affiliation(s)
- Halis Atilla
- Orthopaedics and Traumatology, Dıskapı Yıldırım Beyazıt Education and Research Hospital, Ankara, TUR
| | - Mutlu Akdogan
- Orthopaedics and Traumatology, Dıskapı Yıldırım Beyazıt Education and Research Hospital, Ankara, TUR
| | - Alper Öztürk
- Orthopaedics and Traumatology, Dıskapı Yıldırım Beyazıt Education and Research Hospital, Ankara, TUR
| | - Mehmet Baris Ertan
- Orthopaedics and Traumatology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, TUR
| | - Ozkan Kose
- Orthopaedics, University of Health Sciences, Antalya Education and Research Hospital, Antalya, TUR
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Wanivenhaus F, Fox AJS, Chaudhury S, Rodeo SA. Epidemiology of injuries and prevention strategies in competitive swimmers. Sports Health 2012; 4:246-51. [PMID: 23016094 PMCID: PMC3435931 DOI: 10.1177/1941738112442132] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Florian Wanivenhaus
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York
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Gaunt T, Maffulli N. Soothing suffering swimmers: a systematic review of the epidemiology, diagnosis, treatment and rehabilitation of musculoskeletal injuries in competitive swimmers. Br Med Bull 2012; 103:45-88. [PMID: 21893484 DOI: 10.1093/bmb/ldr039] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
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.
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Affiliation(s)
- Trevor Gaunt
- Centre for Sports and Exercise, Mile End Hospital, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London, UK
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