Pain is an extremely complex, individualized experience. For this reason, different people may have the same injury, yet interpret pain entirely differently. Nonetheless, if a swimmer has pain, then they'll change their biomechanics and movement patterns. Unfortunately, these adjustments aren't always beneficial, as some move away from ideal biomechanics for pain relief. Once an altered or less efficient movement occurs repeatedly, the connection in the brain wires and becomes the preferred movement pattern even after the painful stimulus!

Remember, if it fires, it wires!

Breaststroke requires a high degree of knee flexion (nearly 130 degrees) with large hip internal rotation (approximately 40 degrees), combined with hip adduction. Knee flexion and hip internal rotation allows the foot to travel far away from the midline of the body, while hip adduction snaps the feet together during the inkick (the “whipping” portion). These contorted positions compress the outside of the knee and stretches the inside of the knee. Stretching the medial knee component is most problematic and is the most common site of knee pain in swimmers, as one study found most swimmers with knee pain had pain on the medial aspect of the knee (Vizsolyi 1987).

In the other strokes, high knee flexion causes stress on the patellar tendon. Unfortunately, essential biomechanics for stroke propulsion in every stroke stresses the knees.

Unfortunately, many breaststroke swimmers simply discontinue kicking breaststroke at the onset of pain, never to do it again. This is why many Masters or Senior swimmers opt out of the kick completely and replace it with a dolphin kick.

I don't know why swimmers dismiss breaststroke kick so quickly, but grind and swim through shoulder pain without second thought. Perhaps this is from a lack of understanding of the source of knee pain, as the knee pain commonly tricks many swimmers into thinking the knee is the problem. However, most of my cases of knee pain are immediately resolved with a few adjustments and tricks at the hip.

Here are some quick tests and tips for resolving breaststrokers knee pain:

Here are three tests for assessing hip range of motion and knee pain during the breaststroke kick.

Breaststroker's Knee Tests

Having a test is mandatory. If you don't perform a test, then retest, you'll never know what helps! Try these tests before any treatment!

1. For a simple test, lie on your stomach and perform a breaststroke kick. If it causes pain, this is your test!
2. If the first test doesn't cause any discomfort, have a friend resist your feet while during a breaststroke inkick.
3. For a range of motion test, lie on your stomach and let your legs drop to the side.

Try Self Myofascial Release (SMR) to the Tensor Fasciae Latae (TFL)

The tensor fasciae latae (TFL) is a small, but deadly muscle. I’ve seen people lie on this spot, thinking it wouldn’t be tender and before I know it they jump off the floor! Yes, this spot is a scorcher, but it is worth it, especially if you have knee pain or limited hip range of motion.

This muscle is commonly overworked in breaststroke swimmers, as it helps separate (abduction), flex and internally rotate the hips.

For the SMR, simply take a tennis ball or baseball and place it directly on the TFL. I suggest lying completely on your side, then slowly lowering your body weight onto the ball. Hold this position for 1 - 3 minutes. Some discomfort, like a massage, is expected. However, it should not cause extreme pain.

Conclusion

Always remember, perform one of the tests, then perform the TFL SMR and re-assess. Follow these tips and you'll resolve your breaststroke knee pain in no time!

References:

1. Rodeo SA.  Knee pain in competitive swimming.  Clin Sports Med. 1999 Apr;18(2):379-87, viii.
2. Soder RB, Mizerkowski MD, Petkowicz R, Baldisserotto M.  MRI of the knee in asymptomatic adolescent swimmers: a controlled study.  Br J Sports Med. 2012 Mar;46(4):268-72. Epub 2011 Apr 3.
3. Vizsolyi P, Taunton J, Robertson G, Filsinger L, Shannon HS, Whittingham D, Gleave M.  Breaststroker's knee. An analysis of epidemiological and biomechanical factors.  Am J Sports Med. 1987 Jan-Feb;15(1):63-71.