Swimmer’s knee is a common overuse injury causing discomfort around the kneecap, often interrupting consistent training. This condition is frequently diagnosed as Patellofemoral Pain Syndrome (PFPS) or a strain of the medial collateral ligament (MCL), particularly affecting breaststrokers. The repetitive stress on the knee joint can lead to a dull ache or sharp pain, which often feels worse during or immediately after swimming. Understanding the root cause is the first step toward effective recovery and preventing relapse. This article outlines immediate pain relief steps, long-term strengthening, and necessary technique adjustments.
Understanding the Causes of Swimmer’s Knee
The unique mechanics of the breaststroke whip kick are the primary source of strain. This powerful kick requires the knee to repeatedly move into flexion, external rotation, and forceful extension, placing significant stress on the medial, or inner, structures of the joint. The medial collateral ligament (MCL) and surrounding soft tissues are vulnerable to this repetitive outward turning motion.
The risk of injury is compounded by muscle imbalances outside the pool. Weakness in the hip abductors, gluteal muscles, and core allows the thigh bone to rotate inward, causing improper kneecap tracking during the kick. When training volume or intensity increases too quickly, supporting muscles cannot keep pace, leading to mechanical overload. Symptoms typically include inner knee pain during the whip phase, which can progress to discomfort while walking or climbing stairs.
Acute Phase: Immediate Pain Management
When knee pain first appears, the immediate goal is to reduce inflammation and protect the joint from further damage. The first action is to implement the RICE protocol, starting with immediate rest from the activity causing pain. The swimming motion that hurts must be stopped to prevent the strain from becoming chronic.
Applying ice for 15 to 20 minutes several times a day helps minimize swelling and numb the pain. Compression using a soft bandage and elevation of the leg further assists in controlling swelling. For short-term relief, non-prescription nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen sodium may be used. These medications should only be taken for a few days to two weeks and are not a substitute for addressing the underlying mechanical problem.
Comprehensive Rehabilitation and Strengthening
After the acute pain subsides, the focus must shift to addressing the muscular deficits that contributed to the injury. Consulting with a physical therapist is recommended, as they can design a program tailored to the swimmer’s specific needs. The long-term treatment strategy centers on strengthening the muscles that stabilize the hip and knee joint, taking stress off the medial knee structures.
A primary focus is strengthening the hip abductors and gluteal muscles, which stabilize the pelvis and prevent the thigh from rotating inward during movement. Exercises such as lateral band walks, clamshells, and single-leg squats help build this foundation. The inner quadriceps muscle, the vastus medialis obliquus (VMO), needs targeted work to ensure proper kneecap tracking, often through exercises like mini-squats and straight leg raises.
Flexibility is equally important, requiring consistent stretching of tight muscle groups like the hip flexors and hamstrings. While land-based exercises are performed, maintaining cardiovascular fitness is possible through low-impact cross-training activities. Water walking, cycling, or using an elliptical machine allows the swimmer to stay conditioned without the forceful impact or knee rotation of the breaststroke kick. The return to swimming must be gradual, monitored closely, and initiated only once land-based exercises are pain-free.
Modifying Swimming Technique to Prevent Relapse
Preventing the return of swimmer’s knee requires adjustments to technique while in the water. The primary area for modification is the breaststroke kick, focusing on reducing the width and force of the whip motion. Swimmers should concentrate on keeping the knees aligned with the hips, avoiding excessive separation that increases stress on the medial ligaments.
Focusing on a more “north-south” movement rather than a wide “east-west” sweep significantly decreases external rotation at the knee. Training aids can be incorporated to reduce the load on the knees. Using a pull buoy between the legs eliminates the kick entirely, allowing the swimmer to maintain upper body fitness and technique without knee strain. A thorough warm-up routine, including dynamic stretches and a slow easy swim before the main practice, prepares the joints and muscles for the repetitive demands of the stroke.