Anterior cruciate ligament (ACL) injuries are a common injury in ground-based sports, particularly in women (read: the ACL killing your fantasy team). Luckily, we are swimmers and ACL injuries are extremely rare. However, every sport has its areas which are injury-prone. In swimming this is the shoulder.
Recent literature suggests the effectiveness of performing neuromuscular lower extremity warm-ups for preventing ACL injuries in ground-based sports. This raises the question: would a neuromuscular shoulder warm-up prevent shoulder injuries?
Unfortunately, the literature has not been performed/published on this notion, but shoulder injury prevention programs already exist. Therefore, are these programs truly preventing injuries or simply tiring muscles, increasing their risks for injury? I often encounter two camps of shoulder injury prevention during swim meets or team consultations:
1. The little to no injury prevention group. This group walks onto the cold pool deck, throws off their parkas, dives in, and begin swimming near race pace without any warm-up.
2. Excessive shoulder injury prevention. This group doesn't consider getting into the water until 30 minutes of random tugs on an exercise band, fatiguing shoulder muscles, but offering little in terms of neural coordination. Think about it: If you're doing this much isolated prevention, you're likely neglecting other areas which deserve attention!
Unfortunately, both of these camps are likely incorrect, as moderation is the key to life and likely shoulder injury prevention. The key is to find a medium, which neurologically activates the muscles involved in injury prevention, theoretically waking them up, in an orderly, finely tuned fashion. Unfortunately, overly tight muscles from repeated movements (swimming) restrict ideal movement patterns. This is extremely important in those with a history of shoulder pain, as pain will alter movement patterns. Moreover, past injuries likely persist in altered movement patterns, even after the pain has resolved, a term called functional lesion from renowned physician Dr. Vladimir Janda in the 1960s, but more recently supported in the low back pain history (Butler 2012).
This makes providing a low volume of correct movement patterns essential for an ideal neuromuscular shoulder warm-up. Once again, low volume, as overly fatiguing the shoulder muscles, likely results in an increased risk of injury. This makes injury prevention, especially a neuromuscular warm-up, a fine line, as a neuromuscular warm-up is a systematic, target warm-up, not just stretching or fatiguing the rotator cuff muscles in isolation.
Luckily, there are methods to enhance these criteria, but a systematic plan is necessary. One thing I've implemented with great success is the role of improving specific tight or overactive muscles prior to motor control exercises. The reasoning behind this plan is to restore a more optimal resting length to the muscles, allowing them to fire optionally as they lie in a more ideal position.
Once these muscles are arranged in a better position, or improving soreness or pain, the muscle is ready to fire in a more optimal pattern. This is when utilizing systematic strengthening and motor control is possible. At this time, teaching movement patterns utilizing head and arm rotation are key, especially one's incorporating upper arm distraction and head rotation.
Another vital area is the role of the shoulder blade stabilizers. I often see many swim and strength coaches' telling athletes to pack or stabilize their shoulders while their arm is over their head, unfortunately this position decreased joint space between vital rotator cuff muscles in the acromion. This makes stabilization key during low shoulder flexion motions. It also makes it necessary to teach swimmers how to move their shoulder and shoulder blade properly as their upper arms move, since this occurs in swimming. However, before advanced movement occurs, improving the physiological and neuromuscular strength must be accomplished in a shortened position, helping return these maladapted muscles to a higher functioning position.
Now this seems like a lot, but similar to flossing, a little goes a long way! Simply five to 10 minutes of injury prevention prior to workout can help prevent the majority of injuries. This simple tune-up also provides time for a systems check. These steps are outlined in the Swimmer's Shoulder System, with two and three day a week programs for an improved and elongated swimming career!
Butler HL, Hubley-Kozey CL, Kozey JW. Changes in electromyographic activity of trunk muscles within the sub-acute phase for individuals deemed recovered from a low back injury. J Electromyogr Kinesiol. 2012 Nov 28. doi:pii: S1050-6411(12)00195-2. 10.1016/j.jelekin.2012.10.012. [Epub ahead of print]
G. John Mullen is the owner of of the Center of Optimal Restoration and creator of Swimming Science. He received his doctorate in Physical Therapy at the University of Southern California. G. John has been featured in Swimming World Magazine, Swimmer Magazine, the International Society of Swim Coaches Journal, STACK Magazine, and is the creator of Swimming Science.