Breaststrokers Knee

Introduction

Competitive swimming combines strength, flexibility and endurance for a full body workout. Many swimmers commit to an intense training/competition schedule from a young age. The repetitive nature of the strokes can leave the swimmer vulnerable to injury.It is estimated 86% of breaststrokers have experienced knee pain at some point in their competitive career. This article will explore what makes the knee so susceptible to injury in breaststroke and preventative tips.

It is estimated 86% of breaststrokers have experienced knee pain at some point in their competitive career. This article will explore what makes the knee so susceptible to injury in breaststroke and preventative tips.A breakdown of the breaststroke kick.

A breakdown of the breaststroke kick.

The breaststroke kick consists of 6 phases

  • Initial Position – Glide
  • Recovery
  • Catch
  • Outsweep
  • Insweep
  • Leg lift and back into Glide

An efficient stroke requires a high degree of knee flexion and hip internal rotation. This allows the foot to travel away from the midline of the body producing the ‘frog like’ kick.
These extreme positions compress structures on the outside of the knee. Simultaneously structures on the inside of the knee get stretched.

Pain on the inside of the knee is the most commonly reported symptom in breaststrokers. The inside of the knee has many structures which can become inflamed. This includes the medial meniscus, ligaments, and bursae (fluid filled sacs). Symptoms often progress from being a purely training related issue to a persistent pain during day to day activities.

Modern lifestyles do not promote good hip mobility and muscular balance. The majority of individuals find their days are mostly sedentary, even if they train frequently. How you use your body outside of the pool is equally important.

Tips to prevent breaststrokers knee

Evaluate Stroke Technique

Remember the breaststroke kick is about hip motion not knee motion. Emphasing propulsion from the knee will promote injury regardless of whether the kick is wide or narrow. Ask an experienced coach to evaluate your stroke mechanics.

It’s not just about the knee

For recurring knee pain it is important to get a diagnosis from a qualified practitioner. This might be a physio, osteopath or sports therapist. Identifying factors that predispose and maintain your knee pain ensures symptom resolution is long term. This often means looking away from the site of pain.

Improve hip mobility

The risk of knee injury is minimised by good hip mobility in all ranges. As discussed previously good internal rotation is an important component of the breastroke kick. If an individual has hip restriction the body will attempt to compensate elsewhere. This might include widening (abducting) the legs or promoting excessive movement at the knee. Both adaptations stress knee structures by encouraging excessive movement and increase risk of injury.

Strengthen the Quads and Glutes

The glutes and quads are the powerhouse of the breaststroke kick. Gluteus Minimus and Medius assist in internal rotation of the hip while the quads help drive you forwards.

The angle of the hip and knee during breastroke can encourage the knee cap to be pulled outwards (lateral tracking). This can cause irritation behind the kneecap and some discomfort. Strengthening the quads, with particular focus on the Vastus Medialis (the teardrop shaped muscle on the inside of the thigh) can help keep the kneecap central.

For older athletes a land based conditioning programme including squats, leg press, lunges and leg extensions can be beneficial. For younger swimmer or those without access to a gym bodyweight exercise will be sufficient to gain strength and flexibility.

Keep training varied

While recovering from a knee injury keep breaststroke specific volume to a minimum. Club training sessions are usually varied and work through a range of strokes and drills. If swimming alone mix your strokes to avoid re-aggravating knee symptoms.

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References

Vizsolyi P, Taunton J, Robertson G, Filsinger L, Shannon HS, Whittingham D, Gleave M.(1987) Breaststroker’s knee. An analysis of epidemiological and biomechanical factors. Am J Sports Med.15(1):63-71.

McMaster, M.C., (1996) Swimming injuries. An overview. Sports Med. Nov;22(5):332-6.

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