Articles

Back in the Water: Swimming
Aquatic Sports for Spinal Injury Rehabilitation

by Marilyn M. Robertson, M.D., Neurologist

Should you take the plunge? For many patients who are recovering from spinal injuries, the aquatic sports are appropriate for rehabilitation because of water's unique physical properties.

The Unwatered-Down Facts:

1. A person who is vertically immersed up to neck level in water experiences an approximate 90% reduction in gravitational forces. Risk of re-injury is minimized because there are fewer shear forces acting on the spine.
2. Hydrostatic pressure enhances sensory joint position feedback (your body is more aware of movement in the water verses out of the water), to the central nervous system, and is likely to lead to improved kinesthetic awareness.
3. Water turbulence and temperature, in combination with hydrostatic forces, may constitute a "sensory overload," and raise or alter pain thresholds.
4. The hydrostatic forces of water cause an increase in venous blood return to the heart and augmentation in cardiac stroke volume, resulting in benefits for the cardiovascular system.
5. The viscosity of water, or resistive force to movement, is used to the swimmer's advantage through strengthening and conditioning exercises. In terms of energy expended, swimming one mile is the equivalent of running four miles.
6. Swimming engages practically all muscle groups of the body. Aquatic rehabilitation programs are designed for a variety of spine patients. Among them are those who cannot train on land; those who prefer the water environment, and/or those whose land training has reached a maximum level.

A person who is vertically immersed up to neck level in water experiences an approximate 90% reduction in gravitational forces.

It is recommended that spine stabilization be achieved before returning to prone, or inclined swimming. Spine stabilization may be accomplished with land or water based exercises that are specifically designed to teach dynamic control of the mechanical spine forces. These exercises help avoid repetitive injury. Many aquatic programs begin with stabilization exercises. These typically consist of six elemental exercises which are performed with graded levels of difficulty.

FREESTYLE SWIMMING: STROKE SMART

Once spinal stabilization is achieved, the advance to freestyle swimming is possible. Proper stroke technique is critical. Improper stroke technique can lead to an exacerbation of back pain and injury.

The most frequently encountered error is postural "craning" while in the breathing phase of the crawl stroke. Craning, or lifting of the head, places excessive strain on cervical spinal segments, and contributes to poor lumbar mechanics. The head should be thought of as an extension of the spine. When swimming the crawl, the head and body should rotate as a single axial unit -from side to side.

The natural curve of the spine should be maintained during lateral rotation while breathtaking. The arm that is located opposite the side of breathtaking should be fully extended in front of the head on the water surface plane.