The repetitive nature of swimming, while beneficial for cardiovascular health, can place immense stress on the joints and tendons, leading to pain. For athletes who spend significant time in the water, a persistent ache in the elbow interferes with training and performance. Understanding this specific overuse injury is the first step toward a successful recovery and a return to pain-free swimming.
What Exactly is Swimmer’s Elbow
The condition commonly referred to as Swimmer’s Elbow is medically identified as medial epicondylitis. This overuse injury affects the tendons connecting the forearm muscles to the humerus bone at the medial epicondyle, the prominent bony bump on the inner side of the elbow. These tendons belong to the wrist flexor and forearm pronator muscle groups, which are responsible for bending the wrist forward and turning the palm down.
When subjected to repetitive strain, the tendon tissue develops micro-tears and degenerative changes, leading to chronic pain. Individuals typically experience tenderness directly over the inner elbow. The pain often intensifies during activities requiring a strong grip or when flexing the wrist against resistance. Over time, a weakened grip and a dull ache radiating down the forearm can also become noticeable symptoms.
Why Swimmers Develop Elbow Pain
Swimmers are susceptible to this issue due to the high volume of repetitive strokes that engage the forearm muscles. The underlying mechanism is the cumulative effect of overuse, where training demands exceed the tendon’s capacity for recovery. A sudden increase in yardage or intensity, such as adding significant distance to a weekly routine, quickly overloads the forearm tendons.
Improper stroke mechanics are a major contributing factor, forcing the elbow into stressful positions during the underwater pull phase. A common flaw is the “dropped elbow,” where the elbow collapses and the hand pulls straight down instead of maintaining the high-elbow, early vertical forearm position. This action places excessive strain on the medial tendons as they stabilize the wrist against water resistance. An aggressive wrist snap or flick at the end of the pull-through can also hyperextend the wrist, stressing the flexor-pronator muscle group origin at the inner elbow.
Immediate Steps for Managing the Injury
Managing a painful flare-up requires implementing relative rest by modifying the activity level that caused the pain. This means temporarily reducing swimming volume, avoiding high-intensity pull sets, and eliminating the use of hand paddles or other devices that increase forearm load. Applying ice to the inner elbow for fifteen to twenty minutes several times a day can soothe localized tenderness and manage acute symptoms.
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) may be used short-term for pain relief, but they do not address the underlying tendon issue. Consulting a physical therapist is recommended for a formal assessment and targeted rehabilitation program. They often prescribe gentle, progressive stretching for the wrist flexors and recommend a counterforce brace. This brace is worn just below the elbow to change the angle of pull on the tendon and reduce tension at its attachment point.
For persistent or severe pain that does not improve after several weeks of conservative management, professional medical intervention is necessary. A physician may recommend physical therapy focusing on eccentric strengthening exercises, which are crucial for tendon healing. Advanced treatments such as corticosteroid or platelet-rich plasma (PRP) injections may be considered, but surgery is reserved only for the most extreme and non-responsive cases.
Preventing Recurrence Through Proper Conditioning
Preventing recurrence requires refining stroke technique and committing to specific off-deck conditioning. Working with a coach to ensure a high elbow catch and a straight, stable pull-through significantly reduces harmful forces on the inner elbow tendons. Reviewing stroke mechanics helps eliminate the tendency to over-reach or cross the midline, which twists the joint and increases strain.
Consistent, targeted strength training is necessary to build resilience in the forearm and surrounding stabilizing muscles. Exercises like eccentric wrist curls, performed slowly and with light resistance, are effective because they strengthen the tendon while it is lengthening. Balancing the strength of the forearm flexors with the extensors helps stabilize the elbow joint. Incorporating shoulder and rotator cuff stability exercises ensures that larger muscle groups generate power, preventing the smaller forearm muscles from being overworked.