Science of Performance: Return to Swimming After Injury, Part V

By G. John Mullen of SwimmingScience.net and CenterofOptimalRestoration.com, Swimming World correspondent

SANTA CLARA, California, January 31. SOME of you may think the muscle length, strength and timing (LST) mantra is too simple to prevent and improve musculoskeletal injuries in the shoulder. Assuredly, this simplistic approach has helped many swimmers. People often become so engulfed with the complexity of specific entities, that they overlook what works. I blame this for much of the confusion in prevention and rehabilitation. In fact, many of you may reject the LST, since many of you stretch, do bicep curls, and stand on stability balls, but still have injured shoulders.

Well, this is because you are strengthening and lengthening the improper muscles by improper means. Let's discuss the areas that need improvement and why they can prevent and improve injuries.

During a musculoskeletal injury, inflammation, repair, and remodeling phases occur. All animals try to protect themselves by preventing movement and harm, unfortunately, society prevents rest and proper progression through these phases. If you hurt your arm, you're likely to fight through the pain either by swimming, writing, typing, driving, etc. This elongates each phase, leading to numerous compensations, often times outweighing the initial injury. This forces our finely tuned body to need a tune up to fix the ship.

Just as ships float through many waves throughout the year, humans have many bumps throughout the day: poor posture, impaired strength, excessive inactivity in the general population, not to mention thousands of strokes in the pool. Luckily, our body can typically manage these stresses if everything is in working order. But when a tsunami occurs, the ship gets damaged, inflammation ensues, and compensations begin. We must provide the ship with the proper tools to restore equilibrium. Luckily, cheap tools are available to tackle the muscles with improper length, strength, and timing.

Compensations typically cause tight and long muscles. The tight muscles are overactive, trying to prevent excessive motion at the injured joint. These tight muscles put the body in an inefficient resting position, causing other muscles to elongate and weaken.

Compact Position
All strengthening exercises should be performed in the "compact" position unless instructed otherwise. This position is retracting and depressing the shoulder blade. The theory behind this position is to improve this muscle strength in an "over-corrected" or shortened position to return the muscles to normal resting length. After the exercise, the muscles that were weak and long should return to normal resting position and utilize normal strength. The compact position also provides a sturdy base for movement. The shoulder blades are like the hull of a ship, and without a strong hull a disaster will ensue even with subtle waves. The compact position provides a solid base to endure large waves. This compact position should not be practiced during daily movement, but should be used during all exercises, especially muscle timing.

Muscle Strength
Muscle strength for any sport is mandatory. However, the means to achieve this and the specific muscles to strengthen are foggy. Most coaches feel the rotator cuff muscles are the only shoulder muscles to strengthen to prevent shoulder injury since they are the most commonly injured. These muscles need to be strengthened, but their timing is most often the underlying discrepancy. Another common view involves multiple shoulder presses or overhead lifts to improve shoulder strength. This strategy can feed into muscles which are commonly tight and puts one at a higher risk of shoulder injury.

One Masters swimmer I'll never forget was an exercise maniac. She swam five to six times a week, lifted weights three times a week and performed yoga five times a week! This obsessive compulsiveness put high levels of stress on her body as she never wanted to give her body a break.

She went to one rehabilitation specialist in her town and received the typical external rotations with a band without success. She did not understand why her symptoms did not improve as she performed the exercises 10 times a day.

This swimmer was extremely mobile and exhibited minimal shoulder blade stability. Moreover, she never let her body recover; rest is essential to build muscle. A simple program of shoulder blade stability and short-term break from yoga allowed her to develop strength in her shoulder blade muscle and return to the pool without symptoms.

Another misconception surrounds Swiss Balls. Many coaches feel performing "Y, T, L, W" exercises on a Swiss ball and band internal and external rotations are needed to prevent shoulder pain. First of all, I guarantee your swimmers are compensating during these exercises if you don't use the correct Swiss ball set-up. If this Masters swimmer had performed the "typical" Swiss Ball position shown below, she would have used her excessive mobility to cheat during the movement. This leads to excessive low back movement and cheating, feeding to shoulder and low back pain.

As someone raises their arm, their shoulder blade upwardly rotates, elevates, and posteriorly tilts. If you watch a typical swimmer raise their arms overhead and view their shoulder blades, you can see all kinds of discrepancies and erratic movements. This simple task can challenge athletes, especially when lowering their arm slowly. Another abnormality is when the swimmer's shoulder blade "wings" and a coach could grab behind the shoulder blade. Winging can result from one weak upward rotator muscle – serratus anterior.

Another group of weak muscles are those in the front of the neck. These attach to the collar bone and influence movement on the collar bone, which connects to the scapular.

Wrap-up
Improving strength and control of the muscles around the shoulder and attaching to the shoulder blade is essential for a prosperous swimming career. Stay tuned for this week's Dryland Tip for the compact position and an appropriate Swiss Ball exercise.

Dr. G. John Mullen is a Doctor of Physical Therapy and a Certified Strength and Conditioning Specialist. At USC, he was a clinical research assistant at USC performing research on adolescent diabetes, lung adaptations to swimming, and swimming biomechanics. G. John has been featured in Swimming World Magazine, Swimmer Magazine, and the International Society of Swim Coaches Journal. He is currently the strength and conditioning coach at Santa Clara Swim Club, owner of the Center of Optimal Restoration and creator of Swimming Science.

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