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WDSC Medical Information

Medical Information - Advice

ASTHMA SWIMMER'S EAR
SWIMMER'S SHOULDER BREASTSTROKER'S KNEE
BUTTERFLY BACK
   
There are many ways in which you can help your club, either by becoming a member of the committee that is responsible for running the club, or just by volunteering for a project, specific task, or assisting in an non-official capacity at our open meets.

As part of the registration of all competitive swimmers, the ASA requires a medical declaration form to be completed by all those taking regular medication. A new form must be completed each year, even if the medication prescribed has not altered. For any competitor under the age of 18, the form must be completed and returned by the parent or guardian, but must still be signed by the competitor.

For those competitors with Asthma, the most common drugs are listed on the form. It should be noted that if you require oral steroids (e.g. prednisolone) to control a severe asthma attack, you must not compete for two weeks following the last dose.

The following information is for interest rather than diagnostic purposes, and includes common problems seen in swimmers. If you have any worries about your health please visit your GP. Forms can be obtained fropm Simon Shaw (Club Secretary), or from the ASA web site: www.britishswimming.org under club information.

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ASTHMA
Asthma affects 1 in 7 children and 1 in 25 adults in the UK. It is therefore a condition of which coaches and club officials have to be aware as many asthmatics swim for exercise. Swimming is a sport at which asthmatics can and often do excel, as the warm, moist air of the pool does not trigger an attack.

What is asthma?
Asthma is a disorder of the small airways of the lungs, which become sensitive to certain triggers, leading to them narrowing when they become inflamed. This results in the sufferer becoming wheezy, short of breath or having a cough. The triggers vary from person to person, but often include colds and viral infections, pollens and moulds, pets, dust, tobacco smoke, emotion and stress, cold air, and some medications. Attacks can also be precipitated by chloramines found in pools cleaned with chlorine, or by exercise (execise induced asthma). Following diagnosis by a medical practitioner, it is MANDATORY for the swimmer or his/her parents to declare this to the ASA together with details of medication they are taking.

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Management of Asthma
It is now routine for care to be shared with the patient taking some responsibility for their condition in conjunction with the GP, and Asthma clinic. A peak flow meter will help measure the performance of the lungs, giving a clear idea of how well controlled the patient's condition is. Drug therapy is usually a combination of preventers and relievers. Both are inhalers which are colour coded for easy identification. Relievers (bronchodilators) help to open the airways, and are usually used after symptoms appear, but also sometimes give brief protection against triggers such as exercise or chloranimines before they appear. Preventers are taken regularly and help prevent an attack from occurring. They protect the lining of the airways and make them less likely to narrow when triggered.

Most asthma treatments are recognised under ASA law, but there are some availble which are banned such as salbutamol tablets, and the older inhalers such as isoprenaline, ephedrine and orciprenaline.

Asthma drugs permitted in sport:
Salbutamol - e.g. ventolin, by inhaler only
Terbutaline - e.g. bricanyl, by inhaler only
Beclomethasone - e.g. becotide, by inhaler only
Salmeterol - e.g. serevent
Sodium cromoglycate - e.g. intal
Montelukast - e.g. singulair
Budesonide - e.g. pulmicort, by inhaler only
Fluticasone - e.g. flixotide, by inhaler only
Theophylline - e.g. nuelin

There is a mximum permitted level of salbutamol, that being no more than 2 puffs four times daily.

A swimmers relief inhaler should be immediately available during training and competition. It should not be used regularly throughout a training session as this would indicate poor control of symptoms and that treatment needs reviewing.

If a swimmer has an attack in the water they should be removed immediately from the water. They should be calmed and reassured, and given one or two puffs of their reliever. If there is no response in 10 minutes then this can be repeated. If the swimmer remains distressed, ids unduly short of breath, has a rapid pulse and/or respiratory rate, or in severe cases, is cyanosed (blue), medical help should be sought as a matter of urgency.

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SWIMMERS EAR
Swimmers ear is an inflammation of the outer ear canal - 'otitis externa'. It can be caused by irritation or infection with bacteria or fungi! It results in discomfort, itching, ear discharge and rarely hearing loss. Retained water within the ear canal seems to predispose to the problem, and it is worsened by removal of ear wax and/or abrasions to the ear canal caused during cleaning. In established infections, antibiotic ear drops will be required initially but the use of drying ear drops (containing acetic acid and alcohol, available from chemists) will help keep the ear dry and prevent the problem from reoccurring.

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SWIMMER'S SHOULDER
Swimmer's shoulder is a well recognised pain syndrome following swimming that accounts for 60% of overuse injuries in swimmers. The exact process involved is not clear, but most believe that it is a combination of factors resulting in an impingement syndrome - the loss of the normal, smooth, gliding motion and trapping of the soft tissues under the point of the shoulder. In part there is an inflammation of the tendons of the rotator cuff muscles, but it may also be a result of joint instability. Laxity of the shoulder joint due to injury, natural flexibility, flexibility training and muscle imbalances can lead to excessive movement within the shoulder joint further inflaming the tissues beneath the point of the shoulder.

Treatment for mild problems is by increasing warm-up periods and allowing only pain-free activities. Icing the shoulder following training will help reduce pain and inflammation. The coach should also review technique for any potential contributory factors. Muscle imbalances can be corrected by simple strengthening exercise. For more severe problems, the shoulder may need resting completely by doing kick work only, and/or alternative exercises such as running or cycling. Physiotherapy and anti-inflammatory madications may also be helpful. Once the pain has settled, a gradual increase in swimming load over a period of 4-6 weeks should enable return to the former level.

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BREASTSTROKER'S KNEE
Knee pain in swimmers is particularly common in breaststrokers. In inexperienced swimmers, poor technique of the 'whip' kick can lead to problems, though it may also be present in elite swimmers due to the force and frequency of kicking. Typical breaststroker's knee is felt to be a chronic strain of the medial collateral ligament that stabilises the inside of the knee.

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Minor discomfort is again treated with increased warm-up periods, and avoidance of the intense work that will commonly bring on pain. Thigh stengthening exercises and assessment of technique is also necessary. Ice packs should be used from an early stage, and for further levels of pain, physiotherapy and medication is helpful. resting the knee by not performing breaststroke kick, and the use of a pull-buoy should be started to allow the swimmer to remain in the water.

Other problems may also occur with repeated knee bending such as instability of the patella (knee cap) or cartilage damage. Again, physiotherapy, but also occasionally surgery, may be required.

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BUTTERFLY BACK
Lower back pain is not uncommon in elite swimmers, often resulting from the butterfly and the recently developed 'undulating' technique of breaststroke. This is caused by repeated arching over (hyperextension) of the lower back. This can cause excess strain on the bony structures of the spinal column, sometimes resulting in stress fractures. Treatment is with a short period of rest, followed by a stretching and strengthening programme with a physiotherapist. Kicking drills, where the upper body remains relatively stationary due to the use of an arm float, are thought to exacerbate symptoms due to the relative hyperextension of the spine.

Persistent pain, impaired training and no improvement after 3 - 4 weeks should ideally be investigated further.

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Consultation of Medical Treatment
ALL medication taken on a regular basis including dietary or nutritional supplements should be declared.

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Contact Details
WDSC c/o: Wycombe Sports Centre
Street/Road: Marlow Hill
Town: High Wycombe
County: Buckinghamshire
Postcode: HP11 1SX
Email: WDSC Committee
Club Line: 01494 410 075