Wednesday, February 3, 2016

Swimmers Shoulder and Swim Technique

Some general tips to manage our shoulders...

1. bar hangs should be used every time you are in the gym
2. be sure to stretch your pec minor
3. when you use swim cords -- work and stretch the opposing muscle groups -- external rotators are most important
4. posterior deltoid is another key one to stretch
5. ice after every swim _and_ every run when you are concerned -- running can irritate due to arm swinging

Swimmers shoulder is common and treatable. When inflamed and seeking to heal -- avoid paddles, fly, backstrong, bands and high intensity. It's one of the few times when pullbuoy only is ok! Also, short fins can be used. The cause is typically technique driven - use your down time to seek to improve your stroke mechanics. Enter down, pull straight back, relaxed swing recovery (straight arm, thump up).

Be sure to keep your scapula pulled down and in during the power phase of your stroke -- a "high" scapula in the pull phase can cause impingement.

Swimmer's shoulder is a common condition in swimmers causing impingement of the rotator cuff tendons in the subacromial space. This impingement can be the result of an inflammed rotator cuff or subacromial bursa; others include rotator cuff tear, AC arthritis, etc. The best way to treat this condition is rest, ice, physical therapy, stretching, weight training, and having a qualified swim coach video tape and analyze your stroke.

I have found that internal and external rotation exercises with swim cords, therabands, etc help strengthen the rotator cuff complex without causing extra impingement. Also, scapulothoracic stabilization exercises are helpful to strengthen the rotator cuff complex (example-- seated rows-- when the arms reach your abdomen, try squeezing your shoulder blades together and hold for a count or two.

Other scapulothoracic exercises include lying on a stability ball with your feet extended directly behind you-- extending your arms with a neutral cervical spine forming a "Y" and "T" with your arms and body. This is an isometric exercise. You should start this without weights then add weights as indicated. I try to hold this position for 15 to 30 seconds. I would avoid seated and standing shoulder presses which can cause further impingement and irritation to your rotator cuff complex. I hope that helps

— Brett Bastian

Question: Can you clarify what you mean when you say "enter down"? i'm assuming you mean enter with the thumb first, right? i've recently had a pretty reputable coach advise me to change my hand entry to little finger/index fingers first and want to make sure this isn't going to cause should problems as i already have a history of swimmer's shoulder.

— Andy L

Answer: Many tri-swimmers try to extend or glide with their entry. Reaching on entry can result in dropped elbow -- you can see it in most masters lanes -- hand enters then rises on extension as elbow drops. Pinky entry opens the shoulder a bit and reduces the change that you'll impinge with your catch

With "enter down", forget about trying to swim like Phelps. We don't have the strength, or flexibility to pull that off. So your goal is to get to the power phase of your stroke ASAP -- this means entering down (not forward) and pulling straight back.

Hey G -

You know, if my athletes didn't read your site, I wouldn't know what to do with my day. But here we go on swimmers shoulder. I deal with a lot of this EVERY weekend since (as you know) I coach 60+ triathletes and swimmers in our outdoor 50m pool here in the North Bay of SF. We use the 25 yard version of the pool at this time of year, and the skill level ranges from former NCAA champions to brand new swimmers. 25 yards because once a week when I see these swimmers I want them to focus on their stroke, not deal with fatigue of maintaining form for 50m. As you know LCM is a lot harder.

Your comments and of others on the posting are fairly correct and help. Triathletes that have joined swimming ranks usually suffer from a lack of rotation of the shoulders in their freestyle. Lack of shoulder rotation, or keeping the shoulders too level causes many swim related 'errors':

* If the shoulders do not rotate, then the extension of the arm at the top of our stroke is not a fluid, natural movement and then down pressure of the hand causes that stress on the shoulder.

* It also causes the movement of the hips from side to side since the swimmer thinks they are extending their arm, where in actuality they are extending their arm by knocking their hip out to one side and therefore gaining that extra reach. I call this 'snaking' through the water. With snaking - our arm that just entered, which thinks it stretched out further, actually moved across our body (since the hip moved out to opposite direction) and bingo - we are actually facing towards the side of the lane rather than directly forward. Our stroke follows our entry and we swim somewhat to that side. Next the other arm comes in, adds that little extra stretch, hips goes out to the opposite direction, and we swim somewhat to the other side of the lane. Hence snaking through the water. Similar to cycling, if we do not ride a straight line, we actually rode 114 miles in an Ironman. In swimming this means swimming 2.5 miles.

* Also, when not rotating the shoulders we have a flat arm in front of us and it is very difficult to keep that elbow the highest point of our stroke at all times. Next time you stand facing a flat wall, try to put both arms above your head. Measure on the wall how high (far) your reach goes up. Now, rotate your shoulder - not your hips too much - and notice how much further - and easier - your reach is. Often you see swimmers on TV doing this prior to their event, to stretch their lats and shoulder. Now, compare how much more pressure you can put on the wall pushing against it at the reach position for straight against the wall vs. with a rotated shoulder & slightly rotated hips. As you will see, big difference in reach, pressure and how are stomach muscles need to be engaged.

* Lastly, swimming with level shoulders and not rotating them means a greater surface area on the widest part of our body that is hitting the water. That slows all of us big guys with big powerful shoulders down dramatically. Just think how much less resistance in surface area when half of your shoulder is out of the water, rotating. Not to mention the benefit of a high elbow for the recovering arm with the shoulder that is out of the water.

So - what to do? Keep the following in mind when swimming freestyle:

* When swimming freestyle, remember to not gain your extra reach due to just stretching out the arm; rotate the shoulder and grab that extra glide. Slow, catch up drill is great for this. No rushing through it, make sure your shoulders turn as your other arm 'catches up'.

* When that arm is out there, balance your stroke & your leverage by pushing down with the pinky leading the way. This is a good drill to remembers since with fatigue the hand will flatten out anyways. Dropping the pinky often emphasizes dropping the shoulder. Coaches often associate thumb entry with keeping the elbow higher - and it does help - but rotating the shoulder is more important.

* Once your arm begins to push down, remember to keep the elbow high. At any point during your entire freestyle pull and recovery your elbow should be your highest point in your stroke. If you were to 'remove' your arm while it is at the bottom of your stroke - and you were to lay it on level ground - the elbow should still be the highest point.

* A good drill for many of the triathletes I coach swimming is to have them reach deep, down into the water under their stroke. I want them to over exaggerate for purposes of shoulder rotation. This means, when you are pulling through your stroke, let your hand go as deep under you as you can. Your shoulder will go with it and therefore rotate your upper body better. They often question how deep, but I always say as deep as possible - your arm will bend a bit automatically, so as deep as possible is good enough.

* And remember - when swimming - never to allow your stroke to 'cross over' 12 o'clock. 12 o'clock is that line that extends from your nose straight to the wall at the other end of the pool. If your arm crosses over that line you will snake towards where your hand entered. I usually suggest 11 o'clock for the left arm and 1 o'clock for the right. Then rotate the shoulder, then push down with good leverage in order to raise your body up a bit onto the water before your stroke starts pushing back in order to propel you forward.

There you have it. Triathletes should generally not get swimmers shoulder because of the volume - unless they are swimming more than 40,000 yrds. a week. As Gordo mentions - usually it is due to technique.

Chris Hauth

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