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Swimming and Other Water Sports

Swimming has been the favorite participation sport of Americans for three decades. Some 30 million people in the United States swim for fitness, and 70 million swim at least once a year. Among women, swimming is the single most popular athletic activity; about 40 percent of women listed it as their number-one sport in a recent Gallup poll.

      Swimming has also become an "upscale" activity, with significantly greater participation among higher-income, better-educated groups, perhaps because people in these groups are more likely to own pools or can afford to go to swim clubs and health clubs with pools.

      Swimming is probably the most nearly perfect form of exercise, especially at the recreational level:

  • It is a non-weight-bearing exercise and imposes no stress on the bones and joints. Even people with bad backs can exercise in the water without fear of injury.

  • It exercises and strengthens the upper and lower body.

  • It is an exercise in which it is easy to reach the training range and maintain it.

  • It is an effective weight-control exercise. An hour of vigorous swimming burns about as many calories as running six miles in an hour.

  • It is a form of meditation. It calms your nerves in addition to providing a good workout.

  • It is a good exercise for people with exercise-induced bronchospasm.

      Exercise-induced bronchospasm is a condition where exercising causes wheezing and coughing. People with this condition are unable to warm and moisten the air to the lungs when they breathe hard. It's especially bothersome in cold, dry weather. People who can't exercise outdoors in cooler weather can swim indoors, where the warm, moist air around a pool prevents these symptoms.

      Swimming has additional advantages. With an indoor facility, it can be done year-round independent of the elements. Nor is age a barrier. Inwater calisthenics are excellent for older athletes who cannot do distance swimming for some reason. There also is much less stress on the body when it is supported by water, and this can help speed rehabilitation of injuries suffered in other sports.

      The risks for recreational swimmers are minimal. I occasionally treat an ear infection caused by excessive water in a swimmer's ear. Lack of facilities is more of a problem for swimmers. Some areas of the country just don't have any indoor pools available. As for those that do, the facilities are often crowded and expensive.


Swimmers may suffer disastrous injuries from diving into the pool. If your head hits the bottom, you can incur a severe head or neck injury ranging from a mild or severe concussion to a skull fracture or a broken neck, or cervical fracture. These injuries require immediate medical treatment and usually land the diver in an intensive care unit.

      To avoid these injuries, do not dive into a pool if you don't know how deep the water is. Diving in at a steep angle from the side can cause your head to hit bottom.


Dampness can cause bacteria to infect the outer ear canal. Once your ear has become infected, most doctors prescribe antibiotic drops. A less expensive and more effective treatment is Burow's solution, which can be found in any pharmacy. This solution changes the acidity of the ear canal and kills the bacteria.

      To prevent a recurrence of the infection, plug your ears with lamb's wool and lanolin when you swim, and wear a bathing cap. You can also use alcohol to dry the ear canal. Put some drops into the ear after swimming and then dry the ear with the corner of a tissue. Do not use a Q-Tip®. Putting anything deep into your ear can be dangerous.


Many people are sensitive to the high concentration of chlorine in swimming pools. If your eyes become red and irritated, an over-the-counter medication can clear them up. To prevent the problem, buy a good pair of swimming goggles.

      Goggles are necessary for swimmers, especially competitive swimmers, who spend hours at a time in the water. The chemicals in pools, salts in the ocean, and other eye irritants found in most outdoor waters can cause allergic reactions, resulting in an inflamed eye, and may permanently damage the cornea. Wearing swim goggles limits the amount of water that reaches the eye and reduces the possibility of infection.


Although swimming is not considered a sport that leads to injuries, competitive swimmers do incur problems, particularly with their shoulders. About half of the competitive swimmers over age 12 suffer from shoulder pain. One reason is that the concept of training for competitive swimming has changed. Swimmers now swim tremendous distances in training programs, some more than 10 miles a day.

      The most common injury in swimmers is a rotator cuff problem. The rotator cuff muscles, which hold the head of the shoulder in the joint, are not meant to be overstressed with the arm at an angle above parallel to the ground. All swimming strokes, except the breaststroke, place the arm in this over-the-head position and stress these muscles as the arm is pulled through the water. The stress on the rotator cuff muscles is similar to that imposed by the throwing motion in baseball or the serve in tennis.

      When the swimmer's arm is in a full overhead position, the small rotator cuff muscles become stretched, allowing the head to slip around in the shallow socket. As it slips, it catches the biceps tendons, pinching them and causing pain.

      The treatment is to rest the shoulder for several weeks and then modify the training program by using a kickboard or doing the breaststroke to maintain conditioning. This should be combined with the shoulder-strengthening program for the rotator cuff muscles in Chapter 6. In the home strengthening program, men should limit the amount of weight to 15 pounds, and women and young swimmers should use only 10-pound weights. If heavier weights are used, the rotator cuff muscles will be assisted by the bigger shoulder muscles, and the exercise won't be as effective.

      If the home strengthening program with free weights is not effective, you may need physical therapy with exercises done on isokinetic machines. When you return to swimming, decrease your distance at first and then increase it very gradually.

      Another rotator cuff problem is an impingement syndrome. Repeated, heavy exercise over the years can cause the rotator cuff muscles to overdevelop to the point where they no longer fit in the bony cage in the shoulder. If this happens, you will need surgery to enlarge the space in the shoulder if you wish to continue to swim.


Continuously placing the arm in the full overhead position compresses the two ends of the shoulder bones together where the collarbone hooks into the shoulder. This causes the bone ends to become irritated and painful, and the small cartilage between the two bones can degenerate or tear. In severe cases, the outer end of the collarbone dissolves, which is called osteolysis.

      The management for this condition is to change your training program. Stay out of the water for a week. Use a kickboard for conditioning, but continue to rest the arm until the pain is gone. Use ice and anti-inflammatories during this time. If these treatments are unsuccessful, the joint may respond to a direct injection of cortisone. This will cut down on the inflammation in the bone and the joint. In severe cases surgical widening of the joint will be necessary.


The syndrome known as swimmer's knee primarily occurs among people who use the breaststroke. Similar to the process that leads to runner's knee, it is caused by the breaststroker's frog kick, which requires a sudden snap of the knee as the leg straightens out. The frog kick causes the kneecap to shift and to rub on the side of the groove, causing pain under the kneecap.

      This injury requires rest until the pain eases, icing, and anti-inflammatories. Aspirin seems to have a healing effect. Try eight aspirins a day until the pain subsides. Also try a swimming stroke that uses a straight leg kick until the knee has healed.

      To reduce pain on land, treat the problem as you would runner's knee: Use an arch support or orthotic device in your shoe and do quadriceps-strengthening exercises.


Horse trainers were among the first to recognize the benefits of hydrotherapy: They had thoroughbreds with sore ankles run through the surf. Now both racehorses and human athletes exercise in pools. Some professional baseball players swing a bat underwater to increase their strength, since water offers 12 to 14 times the resistance of air.

      Water aerobics classes are now popping up in health clubs. An hour of exercise in the water equals two or three hours on land. As you move your limbs through water, you tone your entire body, and your chances of injury are virtually nil.

      One advantage of rehabilitating an injury underwater is that you can begin range-of-motion exercises without placing weight on injured body parts. Not only is there no weight bearing in the water, but the buoyant effect of the water reduces the suspended weight of the affected part, so that you can move it with less stress. This allows you to begin your rehabilitation much earlier than on land. For example, if you are rehabilitating a pulled muscle in the hip, you may not be able to lift the weight of your leg and bring it through its complete range of motion in the air. Since your leg weighs much less underwater, you can do the exercise in a pool.

      Many professional athletes, such as basketball All-Pros Michael Jordan and Bernard King and All-World Athlete Bo Jackson, have rehabilitated knee, hip, back, and leg injuries in water. With the body supported by water, you avoid the pounding of the foot as it strikes the ground. Sports rehabilitation centers may offer a water tank with a treadmill on the bottom. You can simulate the same workout by putting on a life vest, holding on to the side of a pool, and exercising without the effects of gravity.


Canoeing and rowing are popular water sports that place a great strain on the body parts that generate the power of the stroke.

      In using either the single-bladed canoeing paddle or the double-bladed kayaking paddle, the shoulders and upper back bear the brunt of the work. This places stress on the rotator cuff muscles in the shoulder and can lead to a partial dislocation. Pulling the paddle through the water can also stress the elbow and cause biceps tendinitis. The constant rotation of the wrist may result in tendinitis or carpal tunnel syndrome. The strengthening programs for the rotator cuff muscles in Chapter 6 and the elbow in Chapter 8 can relieve the stress on these muscles and tendons. Carpal tunnel syndrome requires rest and possibly an injection of cortisone to reduce swelling.

      The constant kneeling in a canoe can cause housemaid's knees, a form of bursitis. This also responds to a cortisone injection. Use of a kneeling pad in the bottom of the canoe can help prevent a recurrence.

      Rowing injuries occur mostly in the back and the knees. Rowers, who tend to be tall and have long backs, are susceptible to pulled back muscles. These should be treated with ice, stretching, and then restrengthening, as described in Chapter 7. A rower will occasionally rupture a disc, which usually requires surgery.

      Driving the legs from a flexed to a straight position can irritate the kneecap if it's misaligned and can lead to a form of runner's knee. You can correct this problem by wearing an orthotic while rowing, as well as in everyday shoes, and by doing the limited leg extension exercises in Chapter 11.


Board sailing, or wind surfing, combines surfing and sailing into a new way to have fun on the water. Attaching a sail to a surfboard allows the board sailor to zoom through the waves with more speed and control than a surfer has.

      Board sailing injuries occur mostly in the shoulder. Shoulder stress from controlling the sail against a sudden gust of wind can lead to rotator cuff muscle strains and shoulder tendititis. The constant pulling on the sail can also cause a form of tennis elbow on the inside of the elbow. The standard rotator-cuff-strengthening program described in Chapter 6 can be used to treat the shoulder injuries, and the elbow exercises described in Chapter 8 can treat the tennis elbow.

      Surfers must get used to being thrown against the sea floor or being hit by a surfboard. The seriousness and site of the injury determines the treatment. Bruises should be iced immediately and rested; a deep cut or fracture needs immediate medical attention. There's not much a surfer can do to prevent injuries except to avoid surf that is beyond his or her capabilities.

How to Improve Your Swimming

Swimming works all of the body parts, so you need a total-body conditioning program. It is extremely important to keep the rotator cuff muscles and shoulder joints tight, so you should make shoulder-strengthening exercises part of your regular workout routine. You should use free weights rather than an exercise machine, since the free weights allow you to isolate the rotator cuff muscles. Exercise machines require you to lift too much weight, thus forcing you to use other shoulder muscles in addition to your rotator cuffs.

      Swimmers know that they can swim farther and faster if they train with weights. The U.S. women swimmers have become the leaders in the women's weight-training movement because of their recent success. Many world records have been broken since women began to train with weights regularly.

      As in any sport, warming up and stretching are important. A few minutes of stretching before and after swimming will make your stroke smoother and more efficient and will help relieve muscle soreness.

      If you are just starting to swim, try to swim continuously for at least 10 minutes. Once you can do that comfortably, increase your swim time by 2 minutes every third session. Then try to add a set of 10 sprints of about 50 yards each. Rest for about 30 seconds in between.

      Canoers need a program to strengthen the upper body to increase both the strength of their pull through the water and their endurance. Rowers need general strength training, since leg drive, back strength, and upper-body strength are all important. Back flexibility exercises will also help prevent muscle pulls.

      Board sailors also need upper-body strengthening and should concentrate on the upper trunk, shoulders, and arms.

      Lower-body strength is the key to controlling the surfboard. Surfers should do leg extensions, leg curls, leg presses, and calf raises. Since surfing requires good balance, I recommend the balance training described in Chapter 19 as well.

Get a Stroke Coach

More recreational swimmers are turning to swimming coaches to boost their performance. A coach can provide a structured, systematic fitness routine. A coach can also help you set realistic goals and then help you achieve them. For triathletes, a coach may be necessary to guide the transition to a new sport.

      If you don't have good stroke mechanics, your time spent swimming will be more of a chore than a pleasure. All parts of your stroke are integrally linked. Head position and kick determine how high you ride in the water. The timing of your breathing affects your alignment and, to some extent, the path of your arms as you swim.

      A coach can teach you how to cover the same distance with fewer strokes, making you a more efficient swimmer. Even older swimmers can become faster by learning to be more efficient through improved technique.

      To find a coach, check with your local "Y," high school, or college. The most reliable coaches are certified by the American Swimming Coaches Association.

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