The following article is a guest post by Dr. John Mullen, DPT, CSCS a World renowned expert and speaker in sports training and rehabilitation. He received his Doctorate in Physical Therapy at USC where he performed research on swimming biomechanics and lung adaptations in swimming training.
Many think swim coaches prescribe adequate shoulder injury prevention. Unfortunately, misplaced precision encircles injury prevention of the shoulders in swimmers. I’ve worked with numerous clubs and swimmers and the injury prevention programs I see miss the mark completely!
Have you or have you had your team do the following?
- High volume band external rotations before a practice?
- Equal volume internal and external rotations before a practice?
- Unengaged band external rotations, not feeling the posterior rotator cuff engaged?
1. High volume band external rotations before a practice?
The posterior rotator cuff is a delicate structure whose main job is to stabilize the humeral head in the glenoid fossa. In swimming, this structure is stretched rapidly, followed by a recoil, stressing and damaging the shoulder over time. This damage and fatigue leads to excessive humeral movement and stress at the end of practice. If you do excessive band work before you get in the water you are exacerbating the fatigue of the rotator cuff muscles, impairing their ability to stabilize the shoulder and increasing the risk of injury. When shoulder pain arises in practice, is it typically at the beginning or the end of practice? Why perform excessive exercises fatiguing the shoulder before workout?
Solution: Instead, simply activate the posterior cuff, ensure it is engaged and ready to work optimally. A combination of self myofascial releases and low volume activation work can improve imbalances before swimming.
2. Equal volume internal and external rotations before a practice?
While swimming, every early vertical forearm (EVF) movement causes shoulder internal rotation. If a swimmer performs 10,000 of these motions a day in the pool (against water resistance), it is easy to imagine how an imbalance of the shoulder arises (the internal rotators become stronger than the external rotators). If the goal of a prevention program is to resolve the imbalance, how is performing equal volume internal and external rotation going to solve the problem? Bathla has found swimmers as young as 13 years old have muscular imbalances. How do you think doing equal volume internal and external rotation is going to solve this imbalance?
Solution: When performing prevention, a 3:1 ratio of external to internal rotation is key. Another possibility is a 3:0 ratio, one I use with success.
3. Improper band external rotations, not feeling the posterior rotator cuff engaged?
When a swimmer does a band external rotations, are they even engaging the posterior rotator cuff? From my experience, 20% of swimmers can engage this muscle correctly. Luckily, there is a simple solution: Have the swimmer touch the muscle during external rotation. Too often we want to increase resistance and load, encouraging poor motor patterns. We often skip the initial steps of motor learning: activation.
The common swimmer will pull a band, raise their shoulder (upper trapezius activation), retract their shoulder blade (rhomboids and middle trapezius activation) and not externally rotate their humerus (posterior rotator cuff activation). This is a highly problematic scenario and one which perpetuates swimmer’s shoulder.
Solution: When your swimmers are 10 – 12, teach them how to feel their posterior rotator cuff activate. This can be done in dryland and a group — I’ve done it many times. Teaching that a muscle gets harder when it activates is a simple concept, even a caveman (or 10-year-old) can do it!
I’ve introduced these simple changes at many clubs with great success.
These tips are helpful, but are you at risk of shoulder injury?
After treating thousands of swimming patients at my Santa Clara, CA Physical Therapy clinic, I find myself using the same 3 tests over and over.
- Shoulder ROM
- Resisted Shoulder External Rotation Test
- Hawkins Kennedy Test
Do you pass the tests? Remember, if you have pain in any of these, you are at a HIGH risk of shoulder injury. If you have shoulder pain during these tests, follow this video before.
Did it help? If so, don’t sit around, you need to get this taken care of! Go see a physical therapist or purchase the COR Swimmer’s Shoulder Solution and join the thousands who have reduced and resolved their shoulder pain!