Lateral epicondylitis, commonly known as tennis elbow, is characterized by pain and tenderness on the outer side of the elbow. This discomfort originates from the common extensor tendon, particularly the Extensor Carpi Radialis Brevis (ECRB), which attaches to the bony bump on the outside of the elbow. The injury is an overuse issue resulting from repetitive strain, loaded gripping, and forceful wrist extension, causing microtrauma and degeneration in the tendon. Swimming is a low-impact exercise option for managing this condition, but its suitability depends on careful technique modifications and understanding the strain certain movements place on the injured tendon.
How Aquatic Exercise Supports Tendon Recovery
Moving in water offers therapeutic advantages for individuals dealing with a tendon injury like tennis elbow. Buoyancy significantly reduces the effect of gravity, allowing the arm to move with less stress on the elbow joint and tendons. This reduction in impact permits maintaining or improving the arm’s range of motion without the high-force loading typical of land-based exercise.
The hydrostatic pressure exerted by the water compresses the tissues in the submerged limb. This pressure assists in managing swelling and promotes improved blood circulation in the forearm muscles and tendons. Since tendons naturally have a poor blood supply, enhanced circulation accelerates the delivery of nutrients necessary for tissue repair. Water-based exercise also provides gentle resistance that helps maintain muscle strength and endurance in the surrounding shoulder and forearm without excessive strain on the lateral epicondyle.
Analyzing Specific Swim Strokes for Elbow Strain
The specific mechanics of different swim strokes determine their risk level for aggravating tennis elbow. Strokes involving a forceful “catch” or pull phase, combined with wrist extension or gripping, place the most direct strain on the lateral elbow tendon.
The Freestyle (Front Crawl) and Butterfly strokes are considered the highest risk for exacerbation. During the freestyle’s underwater pull, the forearm muscles must generate considerable force, and any wrist flick or tight grip can overload the compromised ECRB tendon. The butterfly stroke similarly requires powerful, simultaneous pulling motions that generate high resistance and strain across the elbow joint.
The Backstroke and Breaststroke are better tolerated, as they involve less forceful gripping and different biomechanics. The backstroke’s recovery phase is performed outside the water, reducing resistance. Its pull phase does not require the same level of forceful wrist extension as the freestyle. The breaststroke can also be performed in a relaxed manner, involving a smaller, less strenuous arm motion that minimizes strain on the lateral elbow.
Technique Adjustments and Safety Precautions
To safely incorporate swimming, technique adjustments are necessary to protect the healing tendon. It is recommended to strictly avoid any gear that artificially increases the load on the forearm muscles. This includes hand paddles, which dramatically increase surface area and resistance, and resistance gloves, both of which force the forearm extensors to work harder.
Swimmers should prioritize using equipment that shifts the workload away from the arms. Employing a kickboard allows the legs to provide propulsion while the arms rest or perform gentle, non-propulsive movements. Using a pull buoy between the legs eliminates the need to kick, allowing focus on a smooth, controlled arm stroke with minimal effort.
During the swim, consciously focus on maintaining an open hand and a relaxed grip, avoiding the impulse to clench the fingers or make a tight fist. Reduce the force used during the underwater pull phase, aiming for a smooth glide rather than a powerful, high-resistance stroke. If sharp or increasing pain occurs in the outer elbow during a session, the activity must be stopped immediately to prevent further tendon irritation.
Integrating Swimming into a Comprehensive Recovery Plan
Swimming should be viewed as a means of maintaining cardiovascular fitness and joint mobility, not as a standalone cure for tennis elbow. The condition requires a multi-faceted approach, and swimming serves as a low-impact alternative to painful activities.
A full recovery plan must include periods of rest from the activity that initially caused the injury, as well as targeted physical therapy. Physical therapists often prescribe specific exercises, such as eccentric strengthening, where the forearm muscles are loaded while lengthening. These exercises help reorganize the tendon structure and build strength in a controlled manner.
Stretching exercises for both the wrist flexors and extensors are important to improve flexibility and reduce tension in the forearm musculature. Before starting or returning to any swimming routine, seek professional medical diagnosis and guidance from a physical therapist or physician. They ensure that pain is appropriately managed and that swimming is integrated safely alongside formal rehabilitation protocols.