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

By G. John Mullen of and, Swimming World correspondent

SANTA CLARA, California, November 30. "DR. John, my shoulder feels like someone left a fork inside it." It's not every day I hear such a descriptive term applied to shoulder symptoms, especially from an athlete whose primary language is not English.

I looked in the pool to see one of the Norwegian National Team members rubbing her shoulder; I had her hop out to take a quick look. A few questions were racing through my mind as she hopped out, does she always have shoulder symptoms during kick sets? What strokes cause her symptoms? What phase of these strokes cause her symptoms? How long has she had these symptoms? Will getting out of the pool hurt her shoulder? Why does she wear her cap like a helmet…must be a Norway thing?

She climbed out of the water, favoring her uninjured shoulder, then walked over to me on the frigid pool deck of Santa Clara Swim Club. I asked her a plethora of questions ranging from frequency of her symptoms, to what strokes and phases of her strokes are most symptomatic. Following my inquiry, I had her perform precise shoulder movements to discover what was causing her symptoms and obtained a clear picture of weak shoulder blade stabilizers and posterior rotator cuff muscles. She told me she has had symptoms for the past four months and they were more pronounced during the "catch" of her freestyle.

We immediately moved from the pool to the weight room and performed a session to improve muscle tone, immediately leading to improved strength. After 15 minutes, she was asymptomatic with the same movements. It is all fine and dandy that her symptoms improved, but the cause is not resolved and her symptoms will return in the pool. Therefore, specific guidelines are mandatory to ensure proper shoulder health and injury prevention. Unfortunately, swimming is a unique sport where missed time in the water impedes success, especially during crucial moments before big competitions. This series will address why missing a few days in the pool greatly alters your "feel" in the water, making you feel like a wet noodle, the health care professionals' and coaches' view on shoulder symptoms and realistic guidelines to return to swimming.

Wet Noodle
Swimming is a unique sport requiring forward movement through an atypical medium, water. This unnatural movement requires countless hours of training to achieve proper biomechanics and to gain awareness in the pool. If a track star misses a few days, they are able to hop on the starting blocks and perform best times…sounds nice! If a swimmer misses a few days, they will hit the water like a wet noodle and be light years off their best times. This difference is due to high neural input required in swimming.

Neural input is why "feel" is essential and discussed on every pool deck. One obvious reason swimming requires high neural input is because swimming is a foreign activity. People cannot swim without lessons; if you throw a toddler in the pool, they will drown. Many other sports utilize natural motions: turning, cutting and jumping performed by toddlers many times during the day. These motions aren't only in childhood, I haven't run a 5k in a few years, but I guarantee if I left on a 5k run I'd feel fine at the beginning, then I'd die. Think about it, even if you don't jog or run, you walk around each day of your life. Swimming is nearly the opposite as you never swim unless you do a practice or race your bathtub toys. If you're in adequate cardiovascular shape, but miss a few workouts, you walk around on deck mentally tackling the water, standing on the block, flexing down, and attempting to perform a front flip off the block…finally in the water it feels like water is rushing off your hand, karate chopping the water. After feeling like Shawn Bradley on Little People, Big World, the neural system improves as your body adapts to water, diminishing this awkward sensation.

Unlike running, where force production is the main component for velocity, drag is the most important variable in swimming. Obtaining an optimal hydrodynamic position is essential and "feel" can control this positioning. Having "feel" controls body position, decreases drag and leads to elite swimming. Unfortunately, missing a few days decreases one's ability to control water and correct body position, leading to swimming like a brick wall.

In running, air is a relatively static medium. Wind occurs, but is less noticed unless high amounts occur. In the water, even slight currents are felt, completely changing body orientation. This is due to the higher density of water. The dense water will alter your movements, leading to a less hydrodynamic position if you miss only a few days of practice. Controlling water is essential and missing a few days will let water and waves control you. Don't miss time in the water, control the water, don't let it control you!

Time Away From the Pool
After an injury, many health care professionals recommend taking time away from the activity contributing to symptoms. This approach isn't only with swimming, but as discussed, time away from swimming is more disruptive for progress than other sports. When college scholarships, advertisements and Olympic dreams are on the line, any unnecessary vacations from the pool impede progress, impairing "feel" and a hydrodynamic position in the pool.

The series' next installment will tackle the reasoning behind taking time off from the pool from a health care professionals' perspective and coaches' perspective. Hopefully, you recognize the importance of feel in the water, even during an injury. Unfortunately, many health care professionals do not understand this concept and if you see anyone about a bum shoulder the first line of treatment includes rest for 2-3 weeks. If during a main training phase, this can greatly impede swimming potential and frankly ruin your season. Coaches are often on the other spectrum, calling all shoulder pain as "muscle pain" having the swimmers get back to their 10×200 butterfly with paddles. This approach can perpetuate shoulder symptoms and lead to a longer recovery. Part II will discuss why these camps take each stand and provide a methodical method to return to the pool to maintain "feel", while improving shoulder symptoms.

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.