Musculoskeletal conditions and swimming

This fact sheet explains how you are able to participate in swimming and other disciplines, if you have a musculoskeletal (MSK) condition such as arthritis or back pain.

Introduction

Musculoskeletal conditions are those that affect the muscles, bones, joints or nerves. They include specific conditions such as osteoarthritis and rheumatoid arthritis, but also some very common problems such as back, neck or shoulder pain.

Over 20 million people in the UK live with arthritis and other MSK conditions. Symptoms can vary considerably from day to day and may affect multiple joints or just one. Some types of arthritis can be linked to other conditions as well – for example, psoriatic arthritis and the skin condition psoriasis.

If you’re experiencing pain in your muscles, joints or bones it can be very tempting to rest. Many people fear that exercise might increase ‘wear and tear’ to their joints. But joints and muscles are designed for movement and are very good at repairing themselves.

Although a short period of rest may be beneficial if your pain is related to a particular injury or strain, too much rest can actually make things worse in the longer term, as the muscles start to weaken. This can lead to further pain when you do try to become active again.

Keeping active is the best way of keeping your joints and muscles healthy, as well as being good for your general health. Losing weight through exercise can help reduce the load on weight-bearing joints.

Some of the benefits of exercise in water for MSK conditions

Exercising in water is often recommended for people with arthritis and other MSK conditions, for a number of reasons:

• The water helps to support the weight of your body, reducing strain on painful joints.
• Water provides a degree of resistance for you to work against, which can help to strengthen your muscles
• Movements in water are easy to adapt if you have a disability.
• There are also benefits to conditions that are sometimes associated with MSK conditions such as obesity, diabetes and cardiovascular disease.

Swimming is an excellent form of exercise for a musculoskeletal condition, as it will take some of your joints through their full range of motion in a way that sometimes might be difficult or painful out of the water.

What other aquatic activity options are there?

In addition to swimming, there are many other aquatic exercise and activity options. Many pool activities like aqua aerobics or even aqua walking (walking lengths in a pool) can be completed in the shallow end of the pool.

Below are some activities you may find on offer at your local pool or that you could complete in the pool.

Aqua Aerobics: group classes of exercise and movements in the pool, often to music, with an instructor leading the class.

Aqua Walking: walking around the pool with the water resistance requiring more effort to walk than on land.

Water Wellbeing: instructors who have achieved the ‘Aquatic Activity for Health’ qualification providing one to one or small group water-based activities tailored for people living with health conditions.

Good Boost: personalised aquatic rehabilitation programmes provided on waterproof tablet computers, with options for group sessions led by a facilitator or individual. Home exercise options also available.

Aquatic Physiotherapy: aquatic physiotherapy with supervised exercises, techniques and advice from a specialist physiotherapist in a warm hydrotherapy pool. Apart from the benefits mentioned above, the warmth of the water can be beneficial for painful joints or aching muscles.

Whatever you choose to take part in, it’s a good idea to speak to the swim teacher or instructor beforehand about your condition and the movements you find difficult so that modifications can be made.

What you need to know when considering swimming with a musculoskeletal condition

• If you’re new to swimming or aquatic activity, or if you haven’t exercised much for some time, it’s worth getting in touch with a physiotherapist. They will be able to help you plan a programme to build up your activity gradually in terms of time and/or intensity.
• Swim England’s poolfinder website may help you to search for the right pool to suit your needs: swimming.org/poolfinder/.
• You might want to check whether your local pool offers specific sessions or separate lanes for swimmers of different abilities. Or you could ask about lessons if you want to learn to swim or improve your swimming technique.
• Consider what time of day is best for your condition when planning when to swim.
• Check how you will get into and out of the pool. Is there a sloping or stepped entry point or a hydraulic chair lift or hoist if you’re not comfortable with using a ladder to get in and out?
• If you want to do exercises in water rather than swimming, ask if you can use the children’s or teaching pool at quiet times – this will usually be shallower and often warmer than the main pool.
• Some people may be advised to take painkillers before exercising, but it is important to speak to a healthcare professional about this before doing so.
• If you’re having a flare-up of your arthritis or if you feel generally unwell, then you might want to take a short break from swimming or aquatic activity until you start to feel better.
• If you have also had surgery, there is another fact sheet available titled: ‘Swimming and aquatic activity before and after surgery’ to help you.

Specific tips for psoriatic arthritis

• If you have psoriatic arthritis, which is characterised by patches or dry flaky skin (plaques), swimming is encouraged unless the plaques become open wounds.
• Chlorinated water could aggravate psoriasis, however, a regular skincare routine including showering and applying moisturising creams after swimming, should help to minimise the risk of this.
• Salt water is particularly beneficial for affected skin, improving appearance. Sunlight with outdoor swimming, combined with appropriate sun cream use can also help the condition.

Tips during and after swimming

Before

1. If you find it hard to motivate yourself to go to the pool, consider going with a family member or friend, or making an action plan.
2. Before swimming, try doing a short warm up in the pool, this could include walking in the water, sculling and stretches.

During

1. If you are unable to put your face in the water consider wearing goggles. This will enable you to adopt a more streamlined position in the water, helping improve your swimming technique and reducing discomfort on your neck and low back.
2. Try learning some of the aquatic skills such as aquatic breathing, floating, gliding and changing position in the water. These skills will help improve your swimming technique and reduce the strain on your body when swimming.
3. Floatation aids such as noodles, floats, kick boards or armbands may be helpful if you need to develop your technique or rest one part of your body while exercising another.
4. Start slowly and gradually build up the time and number of days you spend in the water. This will give time for your body to recover but allow you to enjoy the benefits of swimming.
5. If you experience pain while exercising, stop what you’re doing that might be causing the pain. If you feel able to, try a different stroke or something different such as walking through the water instead. If this doesn’t help, you should stop your exercise session and seek advice from your healthcare team before exercising again.
6. If a particular swimming stroke seems to cause you problems, you may benefit from some lessons to improve your technique. Or you could try combining different strokes, for example, if you find that backstroke aggravates your shoulder pain, consider sculling with your arms by your side instead. Find a stroke or variation that works for you.

After

1. It’s quite normal to feel tired after exercising in water, and your muscles may ache a bit too afterwards.
2. If you have any joints that are hot and swollen, you could try using an ice pack or a bag of frozen peas wrapped in a damp tea towel. Put this on the affected joint for around 15–20 minutes at a time.
3. You may find applying warmth (e.g. a hot water bottle) or a warm bath helps with aching muscles.
4. It is normal for your muscles to feel tired, stiff or to ache a day or two after exercising. If these feelings are excessive you may have overdone it. Try doing a bit less next time or take more rests, and then try to build up again gradually.

Specific tips for other disciplines

Open water swimming

Swimming regularly in your local pool is a good way of building up your fitness and stamina but if you’re thinking of trying open water swimming in a lido, the sea, lake or river, you may need to do some additional training first. It is best not to swim alone outdoors, so it might be a good idea for to join a club. Some clubs run introductory courses and training programmes, or can help you prepare for an event. You’ll also be able to get advice from other members.

• Do: Think about the temperature of the water. Swimming in colder water could reduce discomfort for some MSK conditions but could also cause some additional discomfort in certain joints, although a wetsuit may help and may also help you float.
• Do: Check the weather in advance and how you will get into and out of the water.

If you are swimming abroad

Do:

• Make sure you take a copy of your prescription and extra medication, supports and supplies than you would normally need, in case any get lost or stolen.

Consider:

• Local pool hygiene and safety standards as these may be variable.

Additional advice

For further information

• Moving Medicine resource: movingmedicine.ac.uk/consultation-guides/patient-info-finder/?p=adult&c=mskpain.
• Fact sheet on swimming and aquatic activity before and after surgery: swimming.org/justswim/before-and-after-surgery/.
• Good Boost aquatic and home exercise application: goodboost.ai/.
• Get started with open water swimming: swimming.org/openwater/how-to-start/.
• Versus Arthritis: versusarthritis.org/.

Listed below is the current fact sheet library for people with health conditions.

To view and download fact sheets written specifically for people who support or advise swimmers, head to our Health and Wellbeing pages.