With the U.S. Olympic Team Trials in swimming happening in Indianapolis this month and the Paris Olympics starting in July, many amateur swimmers may be inspired to brush up on the breaststroke or learn the butterfly.

Swimming is a super sport for anyone wanting to stay fit. It carries a low risk of injury, and it helps improve lung capacity, muscle tone and flexibility while burning calories. Many people find being in the water is a wonderful way to relieve stress and improve overall wellness.

“Swimming is a great mix of cardiovascular as well as resistance training,” said Kimbre Zahn, MD, a family and sports medicine physician with Indiana University Health and an assistant professor of clinical family medicine at the IU School of Medicine. “You get that beneficial aerobic exercise while also building muscle mass.”

Zahn serves as team physician for IU Indy Athletics. A former collegiate swimmer for Purdue University, Zahn is also a member of the USA Swimming Medical Team. She and other IU Health providers will treat athletes’ injuries at the Olympic trials at Indianapolis’ Lucas Oil Stadium, where the nation’s best swimmers are vying for a spot to compete at the Paris 2024 Summer Olympic Games.

Although injuries are rare during swimming competitions, they are common during the intensive training period leading up to an event.

“Risk factors include overtraining, inadequate recovery, poor technique, muscular imbalances and weakness, and hypermobility,” Zahn said.

“Swimmer’s shoulder” is a common complaint for swimmers of all levels. It’s a catch-all phrase for several types of shoulder injuries — and can happen in sports other than swimming.

Shoulder pain is often caused by rotator cuff tendinopathy — inflammation or tears in tendons, the tissues connecting muscle to bone around the shoulder joint. Pain can also occur from impingement, where the tendons and bursa (a fluid-filled sac overlying the rotator cuff) are pinched between the arm and the top of the shoulder bones with overhead activity.

Low back pain can occur in butterfly swimmers due to repetitive bending and extending of the lumbar spine, and acute lumbar injuries may occur with starts and turns, Zahn said. Breaststrokers, especially those with poor kicking technique, are more prone to knee and hip injuries, she added.

“Swimmer’s ear” is the most common non-orthopedic issue. It’s an infection of the outer ear canal that can occur when water stays in the ear after swimming. The moist environment helps bacteria to grow. Exercise-induced asthma can also be a problem for some swimmers.

If any of these conditions develop while or after swimming, it’s best to see your primary care physician.

It’s also worth noting that drowning is the third-leading cause of unintentional injury death worldwide and the No. 1 cause of death for children ages 1 to 4 years old in the United States. Swimming lessons can not only prevent injuries but can also save lives.

Injury prevention strategies for swimmers

Zahn offers some tips to help swimmers avoid injuries while enjoying this beneficial sport:

• Warm up: Ensure adequate warm up with low-intensity swimming before each swimming session. For those competing in meets, warm-up should be repeated prior to each event, especially if there is a considerable time gap between events.
• Stretch: Stretch after warming up. Ensure focus on all major muscle groups and stretch both sides equally. Gradually increase intensity of stretching but avoid overstretching, which can lead to hypermobility and a loss of power at full range of motion. Incorporate dynamic stretches (moving while stretching rather than holding a position, i.e. a walking lunge).
• Warm down: Cool down with low-intensity swimming at the end of your session to prevent muscle soreness and promote recovery.
• Nutrition: Ensure adequate nutrition to optimize athletic performance, support recovery, and reduce the risk of injury.
• Stroke techniques: Learning to use proper swimming techniques greatly reduces the risk of injuries.
• Equipment: Avoid overuse of equipment, such as hand paddles, that can increase the risk of shoulder complaints.
• Targeted exercises: Incorporate regular exercises that strengthen the rotator cuff muscles and scapular stabilizers.
• Focus on your core: Develop good core strength. Try these core exercises from the Mayo Clinic.
• Rest and recovery: Modify activities and training if you develop persistent pain or soreness. See your primary care physician if symptoms persist.

Members of the IU community can find more tips on physical activity and other resources for overall wellness at healthy.iu.edu.