Science of Performance: Tips for Breaststroker’s Knee Part II

By G. John Mullen of SwimmingScience.net and CenterofOptimalRestoration.com, Creator of Swimmer's Shoulder System,Swimming World correspondent
SANTA CLARA, California April 24. IF you missed part I, read it first!

Loosen the Ankles
Another area requiring large range of motions is the ankle. In the other strokes large degrees of plantar flexion (pointing toes) are necessary for success. Breast is a little different … I know, not surprising.

Breast requires supination, a composite motion of plantarflexion, adduction, and inversion. This position is achieved during the 'inkick' of the stroke.

Similar to the hips, excess sitting keeps our body in the opposite position for optimal swimming range of motion. Also, if the swimmer has stiff ankles, then more motion will occur at the knee and knee injury will likely ensue.

Also, if a swimmer has low amount of ankle mobility, they will flex their knee more. More knee flexion equates to more knee joint stress. Also, hip and knee flexion are synergistic, likely causing simultaneous knee and hip flexion, and a swimmer moving like a cannonball through the water.

It is also important to have good tissue quality of the calf. One of the calf muscles (the gastrocnemius), crosses the knee joint and is used excessively during swimming. Therefore, it is important to prevent poor tissue quality, as any tightness will prevent smooth and proper ankle movements.

Strengthen the Supinators!
It is pointless if a swimmer has full range of motion, but does not have the strength to move through the range of motion. Methods to improve the strength of the supinators can be basic and isolated, likely progressions are available!

If an athlete has flat feet, then they really need to focus on improving the strength of the supinators for a propulsive inkick. Think about it, flat feet are the opposite of supination, therefore improving this range is important for the inkick.

Lastly, if you live in a warm climate, ditch the sandals. Wearing sandals increases foot pronation. Foot pronation causes hip internal rotation and increases the stress on the medial knee.

Strong Core
The core is a confusing subject. Despite common belief, the main role of the core is to maintain a stable base for the body to propel itself through the water. Many people perform core exercises or perform mobility work where the low back is stressed and stretched. The low back must be stable, not mobile!!! Low back mobility is associated with low back pain. Trust me, if you need anything it is low back stability not mobility.

At COR, we focus on this ability with simple exercises focusing on kinesthetic feedback, and then progressing to more complicated core stability. In every stroke, the low back is stable and in a straight line. Quit performing core movements or stretches which increase flexibility of the back.

To reiterate, the core stabilizes the low back. The low back controls movement at the hip and knee. If the core is weak, then the knees will buckle like you're a 12-year-old girl at a Justin Bieber concert!

Improve muscle inhibiting the core
Many people feel strengthening muscles is the only way to improve strength. More than often, tight muscles around the core prevent the core and hip muscles from firing properly. Therefore, one must provide the tools to improve tight muscles, inhibiting the strong, or you will be stuck hammering a square block into a circle hole. Learn from my mistakes, it doesn't work!!

The main inhibitors of the core are:
Tensor Fascia Latae
Iliotibial band
Psoas
Quadratus Lumborum

These are not the only muscles which inhibit the core, but are the main contributors.
Muscles length is improved via soft tissue techniques. I prefer tennis ball/baseball mobilizations or manual soft tissue if you can afford the service. Follow the rules for muscle length:

1. Lie on the tennis balls with your knees bent, unless instructed otherwise.
2. The more sensitive or tender the area, the slower you should go (vigorous rolling is rarely necessary). If extremely tender, just lie on the ball.
3. Stop if the exercises cause pain.
4. Perform for 30 seconds to three minutes.

Improving core and hip timing
Performing single leg training isn't sexy, but it is effective in improving leg strength and proprioception. Proprioception is the ability for a joint to know where it lies in space. Once a joint knows where it lies in space, it is able to fire at the appropriate time.

A lot of research indicates those with knee pain or a history of knee injury exhibit poor proprioception. This is highly problematic; think about it, how can you control something if you don't know where it is? I mean, most parents can't control their kids when they're on a leash next to them.

Single leg training outside of the pool forces the athlete to improve muscle timing, ideally translating to the pool.

Improving the timing between the core and the hips is essential. Often, an athlete with poor core and hip strength will use their low back to compensate. This is common in breast as the swimmer comes up for a breath. Ensure the athlete has not only strong core and hip musculature, but the ability to differentiate the two muscle groups.

Stop the Long Muscles
The rectus femoris and hip adductors are troublesome muscles. These long muscles have attachments at both the knees and hips. This unique feature makes these muscles commonly tight. Also, tightness at one area, the hip for example, can lead to problems at the other attachment, the knee. Ensuring these muscles have adequate flexibility and tissue quality is essential.

Moreover, these tight muscles can inhibit strength of the glutes through pseduoparalysis.

In many swimmers, the hip flexors are tight for an extended period. Long periods of muscle tightness potentially lead to adaptive shortening. This is the phenomena of the muscle changing its physiological resting position. Adaptive shortening is improved with long static and contract/relax stretching.

Lay off the Hip Flexors!
Speaking of adaptive shortening of the hip flexors, lay off them! In dryland, people do squats, lunges, wall squats, then drink protein powder expecting to get faster. If you follow this approach, your knees may not hurt now, but I can guarantee they will in the future! Overworking the front half of your body may look good in the mirror, but increases your risk for knee injury and as we all known different swimming programs is successful, but not swimming isn't one of them!

Like I said last week, spend more time on the backside and have a balanced training program, I suggest two hip extension exercises for every quadriceps dominant movement.

Conclusion
Preventing injuries, improving biomechanics and eliminating/reducing/correcting compensations are methods performed by coaches and swimmers on a daily basis. Knowing when to refer your swimmer to a trained professional is a tough decision, but if the aforementioned methods are not improving your athlete, or if pain prevents them from swimming properly, the knee pain is likely out of your realm of expertise.

Additionally, if the above techniques are performed prior to injury, athletes can reduce their likelihood of injury and time away from the pool. A long and healthy swimming career is essential and necessary for lifelong swimming success, the underlying goal of every swimmer and coach.

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, and the International Society of Swim Coaches Journal.

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