Swimming and elbow pain

Just when you thought there was one sport you could fall back on if running/cycling ruined you, perhaps think again. While swimming does have a much lower rate of injury than the other triathlon disciplines it can present some problems in its own right.

The particular issue that has been afflicting me recently is elbow pain, specifically medial epicondylitis (aka Golfer’s Elbow). I’ve been swimming regularly and consistently for a number of years now and so when I started to get elbow pain back in January 2016 I was puzzled. The pain itself centred around the bony protrusion on the inside of my left elbow, where a tendinous sheath inserts and from which many of the muscles of the forearm attach. These muscles are commonly involved in flexing and pronating the wrist, like you do during the catch and pull phases of a front crawl stroke.

medial-epicondylitis-golfers-elbow
Medial Epicondylitis (Golfer’s Elbow). Pronator teres, Flexor carpi radialis, Radius, Ulna, Flexor carpi ulnaris, Palmaris longus, Medial epicondyle. MendMeShop¨Ê ©2011

Now, normally you could put a swimming injury down to either poor technique or a significant change in training load. My technique is by no means perfect but I’m sure such a problem would have developed years ago if that was the root cause, while as I said previously I have not changed my training load significantly. Upon reflection, January 2016 was when I first started ski touring and I think over-gripping my poles as I frantically tried to stay upright while following my friend Zach around the mountains of southwest Montana was probably what first sparked it. Since then my consistent swim training has magnified the problem and not allowed it time to heal.

I would class this injury as major niggle rather than a Mike Tyson knockout and so have managed to continue training for the upcoming season without too much deviation. Below I discuss some of the questions it has raised and things I have tried.

Tedonitis or tendinosis?

‘-itis’ means inflammation, while ‘-osis’ means chronic degeneration as a result of tissue death (no inflammation). While the difference may seem subtle there are implications for treatment. There is now significant research to suggest that the vast majority of tendon related injuries are tedinosis, based upon histological tests indicating markers of tissue death but not inflammation. The difficulty with this is that the term ‘tendonitis’ is now so commonplace that a lot of medical professionals still wrongly use it. A quick Google search of ‘golfers elbow’ brings up a myriad of pages talking about inflammation and the role of NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen and diclofenac in treatment. The reality is that these are not helpful in treating tedinosis, should not be taken long term, and can have harmful effects on athletes if taken during periods of training.

Reassess your swimming

 In the first instance, you should get someone to check that the root cause isn’t likely a fault in your technique. If an issue does exist then it’s really helpful for you (the athlete) to be able to see this by getting your coach or a friend to video your stroke from all angles using a waterproof camera. Some key points to consider. There is already so much written about swimming technique but the main pertinent point to look for in your freestyle is the position of your elbow during the catch, pull and recovery phases.

One helpful thing I have learnt is to shake out my forearm and wrist during the recovery phase of each stroke while swimming distance. This promotes blood flow and relaxes the muscles.

For me, the pain associated with medial epicondylitis does not appear to be confined to one particular stroke but it is definitely related to how fast I swim. This means that while I have continued to swim through the injury I have tried to be mindful of the additional strain exerted by sprinting, and so have limited the amount I do.

Support the forearm

 The idea here is to reduce the strain on the tendon by applying a counter-force brace just below the injury sight. I’ve been trying the AirCast Pneumatic Armband ($12 on Amazon) recently but have not found it to make much of a difference so far. The key is finding the balance between it being tight enough to have an effect but not so tight that blood flow is restricted.

The other support I have tried is RockTape. There are many different taping methods you can try, just search on YouTube, I haven’t yet found one that is vastly better than any of the others. The advantage of taping is that you can swim while wearing it. I found it to be even less supportive than the brace though, and it does tend to come off quite quickly because of the location.

While I’m not particularly positive about these there’s certainly no harm in trying them.

Stretching, massaging and exercises

 Begin with massage and exercises before you start intensively stretching. The overall aim of this is to relax the attaching muscles, strengthen the surrounding muscles, break down scar tissue, promote blood flow and help collagen fibres align. If the injury heals without the collagen fibres aligning then they do not full function under load and can lead to permanent weakness.

Massage:

  • Use a golf ball, The Stick or just your opposite hand
  • Start off gently
  • Work from the elbow towards the wrist
  • Don’t aggravate the painful area any more
  • Work out any trigger points
  • Do little and often

Stretching:

  • Stretch all the muscles of the forearm
  • Plenty of videos on YouTube
  • The aim is to achieve a full, uninhibited and pain free range of motion
  • Again, do little and often

Exercises:

  • Focus on strengthening exercises that place the flexor muscles under eccentric load – This stretches the muscles out and promotes collagen alignment
  • Start off light!

I’ve just purchased a Thera-Band Flexbar. I’m going to try it and update this blog in a month or so. Exercise ideas for these are available here: http://www.youtube.com/watch?v=9P-QOaCoDWY

Gym training while injured

 Other than cutting back on swim speed work this is the other area where I had to make adjustments to my training.

Things I found made it worse:

  • Chin ups
  • Front squats
  • Overhead press
  • Heavy lifting
  • Exercises such as Russian twists with a heavy medicine ball whereby your wrist is placed in either a supinated or neutral position while pushing
  • Cleans

 

Happy training

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