What Swimmers Need to Know About Shoulder, Knee, and Hip Replacements

Prescott Masters Swim Team member Brigid Bunch knew she’d swum into the danger zone when shoulder pain awakened her at night. The ice, rest, and occasional cortisone shots that once eased her discomfort no longer provided relief. Eventually, her orthopedic surgeon recommended surgery. Bunch underwent surgery on both shoulders in 2018 and last year had one knee replaced.

When swimmers receive the prognosis that hip, knee, or shoulder surgery is their best option, it can be challenging to endure the surgery, time away from the water, and the slow transition back into swimming.

Although recovery times and outcomes vary, physical therapists Lori Strobl and Arlette Godges shed light on what can be expected and how swimmers often return to the water performing better than before.

Interventions for pain

Lori Strobl is a Masters swimmer, physical therapist, and rehabilitation manager at Bon Secours Mercy Health in Virginia. Strobl recommends that swimmers experiencing chronic joint pain consult with a physical therapist, primary care physician, orthopedist, or a sports medicine physician. “These practitioners can appropriately diagnose the source of the pain a swimmer is experiencing.” She emphasizes that the cause of each swimmer’s discomfort can be different.

A physical therapist may prescribe exercises that address postural or muscular imbalances and recommend modified training, Strobl says. This may be sufficient to lead the swimmer to full recovery if the tissue impairment or damage isn’t too extensive or hasn’t gone on too long.

Masters swimmer, Level 3 USMS Coach, and physical therapist board-certified in orthopedics and geriatrics, Arlette Godges encourages swimmers to seek professionals with knowledge of proper body alignment and swimming technique to improve their chance of full recovery.

To reduce inflammation and pain, Godges recommends swimmers decrease jarring, high-impact exercise, practice movements for fluid range of motion, and “decrease poorly aligned repetitive shoulder movements.”

A physician may order imaging to identify the damage. An X-ray or CT scan can detect bone fractures or degenerative joint disease. An MRI identifies injuries to tendons, ligaments, cartilage, and muscles.

Sometimes surgery is the only option. Swimmers need to consult with a surgeon as soon as possible in cases where “the cartilage is so worn down or damaged that proper articulation of the joint is not possible and movement is causing more pain, inflammation, or worse compensatory adjustments in the body,” says Godges.

“When chronic joint pain is resulting in a loss of generalized function or missed swim practices, for example, it might be time [for surgery],” says Strobl.

Two All-American Masters swimmers dive back in post-surgery

Brigid Bunch had three successful shoulder surgeries in 2018. Rehabilitation with physical therapy “was imperative to a successful outcome,” she said. “My flexibility is 100 percent back. I don’t have any pain anymore. I can pull with paddles as much as I want.”

While full shoulder surgery recovery happened within weeks, it took many frustrating months for Brigid to bounce back after a full knee replacement surgery. “It was brutal,” says Bunch. “I had a month of physical therapy to regain movement in my new joint. My knee doesn't feel like my own yet. I still get sore while swimming breaststroke, but I am making progress each week.”

In addition to swimming, cycling, and running track, Sun City Grand Geckos coach Cokie Lepinski played basketball, volleyball, softball, and tennis for years. Joint wear and tear eventually led to chronic pain in her right knee. “I tried PT, acupuncture, synovial disc injection, and PRP—platelet rich protein,” she says.  Eventually, meniscal repairs and a partial knee replacement were required.

Lepinski underwent a partial knee replacement six years ago. “I wasn’t sure that a partial was in my best interest over the long haul, but the doctor convinced me that there was no need for a full replacement.”

She waited two weeks for the surgery scar to heal before diving back into the pool. “The water is my place of healing.” Physical therapy sessions helped Lepinski regain better range of motion in the joint.

Regaining her breaststroke kick took time and patience. “I experimented with spurts of flutter kick. As stiffness decreased, I tried tiny moves such as just barely flexing the foot. I progressed slowly. What really helped was sticking to my PT exercises to work on increasing range of motion. Pain and swelling were minor or nonexistent and range of motion improved. Dolphin kick was a minor issue as it felt more impactful to the knee than flutter kick, but it was only a few weeks before my dolphin kick returned to normal. By six months I was racing breaststroke at meets.

“I believe that returning to the water early played an important role in my recovery. My time in the water helps my psyche immensely. You have to be in tune with your body and pay attention to the most minor of twinges.

“My surgeon has said that having strong quads and hamstrings presurgery was instrumental in a rapid recovery.”

Protocols for getting back in the water

Each type of joint surgery has specific protocols to follow post-surgery for optimal results. “Incision healing, swelling, tissue health, and the physical pool environment” all determine when a patient can return to swimming again, says Strobl. Because all cases are different, always check with your surgeon before resuming exercise beyond your prescribed PT.

Strobl’s recommendations for post-surgery activity once a swimmer has been cleared to enter the pool include:

• Water walking, water jogging, standing pool exercises, and easy swimming
• Swimming with pullbuoy or with limited kicking
• Avoid pushing off wall with surgical leg

Godges offers recommendations for recovering total hip replacement, total knee replacement, and shoulder surgery patients.

Total hip replacement:

• Pool walking (once hip area healed and tissues firm)
• Pool swimming with open turns for two to three months (once cleared)

Total knee replacement:

• Return to pool after four to six weeks
• Avoid flip turns and breaststroke for two to three months until range of motion and coordination return

Shoulder surgery:

• Extensive time in an immobile position (sling)
• Lengthy rehab
• Non–weight bearing exercises to regain mobility
• Strengthening program to stabilize joint and to improve mobility

Post-surgery performance expectations

Post-surgery athletic performance depends on a variety of factors, says Strobl. “If a patient has a total joint replacement with a return to full (or close to full) range of motion, adequate/normal strength, and is able to perform swimming strokes in a similar manner to presurgical technique, the expectations for performance can be fairly close to preoperative levels. Having frank conversations with your physician and your physical therapist are the best means of developing an appropriate expectation for improvement and performance,” says Strobl.

Godges says a new joint can be game-changing for many athletes. “Joints wear out. Surgery is not a pill and a fix-all. It is helpful and appropriate when structures are no longer optimal for function. Not fixing the problem will lead to damage in other areas, or limit functional, pain-free mobility. With good performance-based rehabilitation, a patient should be better than before the surgery,” she says.

It's been eight months since Bunch had her knee surgery. Despite continual progress, she’s still experiencing some minor issues. Her surgery leg sinks more than normal when she’s sculling and the knee drags out of streamline off the wall on her backstroke breakout. And for the good news? “I did my first 5 x 100 breaststroke kick set this week,” she says with a smile. Bunch also plans to race in Spring Nationals in Irvine.