Swimming and knee problems: breaststroker's knee, rehab and safe return

Why swimming is usually kind to the knee

Water supports body weight, so the knee moves without the impact of running or the twisting of field sports. For people with knee osteoarthritis, those carrying extra weight, and patients recovering from injury, the pool is often the place where they can exercise for longest with the least pain. Many people in Qatar with sore knees find swimming or water exercise the one activity they can keep up through the hot months.

That does not mean the knee is never stressed. The kick, the push-off from the wall, and slips on wet surfaces all have their own risks.

Breaststroker's knee and other swimming problems

• Breaststroker's knee: pain on the inner side of the knee from the whip kick, which bends the knee and turns the lower leg outwards while the legs snap together. It mainly strains the MCL and the inner joint structures, and is most common in competitive breaststroke swimmers and those increasing training quickly.
• Kneecap pain: patellofemoral pain can be aggravated by forceful push-offs and by fins in kick sets.
• Flutter kick strain: usually mild, felt at the front of the knee or thigh with large volumes of kick training.
• Slips on the pool deck: wet tiles can cause twisting injuries, kneecap dislocations and falls onto the knee, particularly in children and older adults.

Warning signs worth checking

Mild aching after a hard session that settles by the next day is common. Have the knee examined if:

• Inner knee pain is getting worse and now appears with every breaststroke session
• The knee swells after swimming or after a slip
• You feel catching, locking or the knee giving way on land
• Pain is present at rest or at night

After surgery, redness, discharge or increasing pain around a wound needs prompt review, and you should stay out of the water until it is checked.

Technique and prevention for swimmers

Most swimming knee problems respond to changes in technique and load:

• Build breaststroke volume gradually and mix strokes within a session
• Narrow the breaststroke kick slightly so the knees stay closer together
• Warm up with easy front crawl and gentle hip and knee mobility before kick sets
• Limit long kick sets with fins if the front of the knee is sore
• Strengthen the hips and thighs on land to support the kick
• Walk, do not run, on the pool deck, and wear sandals with grip

Swimming in Qatar: pools, sea and heat

In Doha, many people swim in residential and hotel pools, and competitive swimmers train at facilities such as the Hamad Aquatic Centre in Aspire Zone, which has a 50-metre pool. In summer, outdoor pool water can become very warm, which makes long or intense sessions tiring and dehydrating even though you are in water. Swim early or late, drink before and after, and choose indoor or shaded pools when possible.

For sea swimming, entering and leaving the water over uneven seabed or rocks is when knees are twisted, so take care and wear water shoes if needed.

Swimming after knee injury or surgery

Pool work is often one of the most useful parts of knee rehabilitation, but the water must wait until the wound has healed. In most cases that means the skin is fully closed and dry and your surgeon has checked it, usually somewhere around two to three weeks after surgery, but it varies by operation and by wound.

Once cleared, walking in chest-deep water, gentle leg movements and aqua jogging are usually introduced first. Front crawl with a gentle flutter kick, or with a pull buoy to rest the legs, often follows. Breaststroke kick twists the knee and is usually delayed after ACL reconstruction, meniscus repair and MCL injury, often for around three months or more depending on the repair. Dr. Gelber will tell you which strokes are safe for your knee and when.

When to see a knee surgeon in Doha

See a knee specialist if inner knee pain from breaststroke does not settle with rest and technique changes, if the knee swells or locks, or after a slip that leaves the knee painful and swollen. At Aman Hospital, Dr. Pablo Gelber examines the ligaments, meniscus and kneecap, and arranges imaging if it will help. Most swimming-related knee problems are treated without surgery, with load changes, physiotherapy and a gradual return to the stroke.