Summary

Acute injuries in the lower back were associated with approximately 5 days lost from swimming, while the mean time lost due to chronic lower back injuries was 8 months. Breaststroke swimmers have a significantly highe

Abstract

Increased Risk of Hip and Lower Back Injury in Breaststroke Swimmers: Epidemiologic Analysis of the Lower Back Injuries in NCAA Division I Swimmers

Introduction

Regardless of the stroke performed in competition, swimmers spend a considerable amount of their training time swimming freestyle. The repetitive nature of the swimming stroke can predispose elite swimmers to musculoskeletal injuries of the upper limb, knee, and spine. The incidence of lower back pain in elite butterfly and breaststroke swimmers has been reported to range between 22%-47%. In addition, repetitive hip internal rotation in breaststroke predisposes athletes to early development of femoroacetabular impingement syndrome (FAIS). The purpose of this epidemiologic study was to report the rate and type of lower back injuries observed among NCAA Division I swimmers and examine whether an association exist between lower back injury and increased risk of hip injury based on swimming stroke.

Methods

A collegiate institutional database was utilized to retrieve the lower back injuries recorded between 2015-2020 in NCAA Division I athletes participating in swimming. Data collected for each athlete included demographic information (age, gender), swimming stroke (freestyle, backstroke, breaststroke, butterfly), type of lower back injury (diagnosis), time lost from swimming due to lower back injury, and whether the athlete sustained one or more hip injury during their collegiate athletic career. Lower back injuries were classified as acute (30 or less days missed) or chronic (more than 30 days missed) and the mead time lost from swimming participation was reported for both categories. Descriptive statistics were also used to report the type and rate of lower back injuries, and to examine possible associations of swimming stroke with specific diagnosis and increased risk of hip injury. The level of statistical significance was set at <0.05.

Results

Sixty-eight lower back injuries were recorded in 63 swimmers (33 females, 30 males) over a five-year period. Female athletes had an increased incidence of lumbar injuries (52.4%) vs. male athletes (30%) but the difference was not statistically significant (p=0.703). Most athletes competed in freestyle (31/63 athletes, 49.2%) followed by breaststroke (13/63, 20.6%), butterfly (10/63, 15.9%), and backstroke (9/63, 14.3%). Table 1 summarizes the type and rate of diagnosis observed among swimmers with lower back injury. The majority of lower back injuries in swimmers were acute (54/68, 79%) and resulted in mean time lost of 5 (range:0-30) days. Fourteen of the 68 (21%) lower back injuries were chronic and resulted and the associated mean time lost from swimming was 8 (range:6-13) months range: (6-13). A concomitant hip issue was reported in 20 of the 68 back-injured swimmers. Breaststroke swimmers had a higher likelihood of concomitant hip and back injuries compared to all other stroke swimmers (p=0.014).

Conclusion

Lower back strain was the most common diagnosis in collegiate swimmers with lower back injury, followed by lumbar disc herniation. Acute injuries in the lower back were associated with approximately 5 days lost from swimming, while the mean time lost due to chronic lower back injuries was 8 months. The last maybe due multiple exacerbations of acute injuries within a short period of time which precluded the athlete from participating in swimming and/or because of their severity. Breaststroke swimmers have a significantly higher likelihood of concomitant hip and back injuries.