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Wednesday, January 4, 2012

The Physiology Of Chafing In Salt And Fresh Water

HUNTINGTON BEACH. There are three types of chafing: skin-on-skin, fabric-on-skin and hair-on-skin.

chafing can be caused by stroke technique, sighting, swimsuit types, salt concentration in the water, water temperature, facial hair, duration in the water, and body type.

Most people use lubricants (Vaseline or other types of petroleum jelly, lanolin, TriSlide, Body Glide, Aquaphor) to prevent chafing in salt water.

But many people use lubricants to prevent chafing in freshwater swims and in some long pool training sessions. Open Water Source looked closer at the subject by talking with several physicians who are experienced open water swimming physicians.

Dr. Nick Olmos-Lau gives a brief overview of sea water chemistry. "Seawater is a solution primarily composed of salt ions:

Listed in order of descending abundance by weight are: chloride, sodium, sulfate, magnesium, calcium, potassium, bicarbonate, bromide, borat, strontium and others (listed in order of descending abundance by weight). As water evaporates, sea salt is deposited on the skin as crystals. Variations in the composition of waters from different seas are thought to be mainly due only to the changes in the amount of water present. The first salts that precipitate are calcium carbonate and some amount of magnesium carbonates. This is determined by water density. Calcium carbonate (CaCO3) is limestone, a very gritty, rough and irritating substance
."

Dr. Olmos-Lau continues on why chafing occurs so often in the seas and oceans. "The effect of sea salt on the skin is either a micro or macro-abrasive. Ocean salt is often used for skin cleansing or therapeutic baths. However, prolonged skin immersion (>72 hours) may result in dermatitis, hydration (hypo or hyper) and or maceration.

Continuous skin friction can produce skin damage or abrasions of variable severity. This starts at the surface involving the epidermis first. If it goes deeper into the dermis, it can produce severe pain – similar to a burn – and/or bleeding. Below the dermis sits a layer of fat. If the skin is well-padded or the fat layer is thick, the skin protrudes. This exposes more skin to friction and produces more severe “burns”. In other words, more slender people report that they are less likely to abrade."

Dr. Olmos-Lau also explains the hair-to-skin chafing, "I have had severe burns with bleeding related to beard friction on my shoulder in the ocean. These were very painful.” He gives advice known by many. Petroleum jelly doesn't last, but is useful in long pool swims. Lanolin adheres to the skin more, but the smell of natural lanolin is repellent. However, there are diluted compounds that are useful."

Dr. Peter Attia adds, "I chafe within 1-2 hours without any barrier. The best barrier for me is A&D ointment, but for short swims, petroleum jelly is good enough. In the pool, I chafe with swims over 3 or 4 hours." He brings up a point of discussion for future research. "I've never paid attention to the difference in water temperature, ceteris paribus, for a given salt concentration."

Dr. Heather Hopkins who practices on Kauai, Hawaii and is a FINA Medical Delegate, describes the ocean environment, "Ocean water has a host of other chemical and organic ingredients, critters, and possible pollutants which I can imagine bind to or injure the lipid bi-layers of cells, alter the normal waterproof nature of skin. At normal sea concentrations, I would assume all salt crystals are dissolved, but other friction producers and skin irritants could be present and unaccounted for."

She speaks for some portion of the open water swimming community. "I never chafe in a lake or pool, but begin chaffing almost immediately in the ocean despite trials of various balms and ointments."

Karah Nazor, Ph.D. on the other hand, chafes in both the pool and in salt water with the damage obviously gets worse with prolonged and repetitive movements. "I've chafed my whole life. In high school, we used to call the chafing spots "swickies" for swim + hicky." She speaks for many in the open water swimming community. "I chafe in salt water more quickly and a whole lot worse. In salt water, swickies form in more places and the sores are a lot bigger and therefore more prone to infection. They can become painful and the burning sensation become intolerable."

Karah, who uses Bag Balm which has lanolin and petroleum jelly, expands on Dr. Olmos-Lau’s chemistry lesson. "The ocean salts dissociate in water into the component ions. The ions in ocean salts include sodium, (Na+), chloride (Cl-), sulfate (SO42-), magnesium ion (Mg2+), calcium ion (Ca2+), and potassium ion (K+). Pool water doesn't have all of these salts. Once the skin is broken, the salts and ions in the sea water cause our cells to lyse or break open which exposes more cells underneath. This is due to the lower salinity of the cells in our body than the salinity of sea water."

Dr. Jim Miller of the FINA Sports Medicine Committee offers additional practical advice:

Look at the suit and at any seam, a lubricant needs to be applied. Some athletes apply it inside their suit where a seam runs.
• Watch the athlete's stroke mechanics. Someone who breaths even slightly late will catch their chin on their shoulder producing a rub. Remember to look at the dynamics that they use for sighting in which case the rubbing site may be at the back of their neck.
• With a pool swimmer, lubricate them anywhere you can imagine. They do not have enough experience to know where they will get into trouble. You can evaluate them after a long practice swim to see where they are rubbing and then adjust accordingly. Even if they are doing pool swims of many hours they do not have sighting or stroke adjustments for waves and currents. They never have to change directions or maneuver. All this matters.
• The choice of lubricant is individual, but I have never found anything better then anhydrous lanolin. It is messy, but it says in place and makes for completely disgusting finishing pictures. It also does not affect the stitches or integrity of wet suits or long suits. Vaseline affects stitching as do some other petroleum-based products.
• Salt water is much more irritating and as the athlete begins to chafe it burns and results in them changing their stroke mechanics.
• Another affect of salt water is that the athlete will be riding differently in the water with a resultant change in stroke mechanics and new rubbing sites.
• None of the lubricant products have any thermal benefit, but they may change the athlete's sensation of cold.
• Chafing is important due to the potential for cellulitis which can set up at the site of the skin breakdown. Pain then affects performance and, if enough area is involved, may have thermal affects
.

Podiatrist Dr. Lyle Nalli also adds to what Dr. Hopkins mentions. "The salt water is a living estuary of bacteria. I tell my patients NOT to get in the water after surgery. And ocean water is the last resort. A typical pool has chlorine and other elements that make the environment for bacteria difficult."

First photo above shows Alex Kostich after the Distance Swim Challenge. Second photo above shows professional marathon swimmer Alejandra Gonzales of Mexico having skin lubricants applied uses rubber gloves.

Copyright © 2011 by Open Water Source

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