April 9, 2019

Keeping you in the pool instead of on the deck: Injury Prevention for Swimmer’s Shoulder

Last time we talked about what Swimmer’s Shoulder is, the anatomy of the shoulder complex and how this is diagnosed. We touched briefly on treatment of swimmer’s shoulder which should begin with an anti-inflammatory focus. However as much as diagnosis and treatment is important, we need to focus on prevention. The best way to prevent swimmer’s shoulder from occurring is to focus on proper technique, building volume gradually and making sure to avoid muscle imbalances by proper strength training. 
Technique Focus

How we swim is important to make sure that with the repetitive nature of each swim stroke, we are not causing further damage. Now technique pointers are not my strong suit, as I am not a swimming coach, but after years of doing this sport and having some great coaches along with being a physical therapist, I have learned a thing or two. Here are my pointers on technique and please make sure that if you have true concerns in this area that you reach out to a coach for a swim analysis.

● Watch the position of your hand relative to the elbow when it exits the water for the recovery. You should have a high elbow and low wrist. You should never have your hand coming above your elbow.

● Keep the recovery hand relatively wide (but not too wide) as it is less likely to cause impingement compared to a really narrow hand placement before the pull.

● Be careful not to cross the center line of your body. Your hand should enter in front of the shoulder.

● Be aware of body rotation at the catch. You only want to roll about 20-30 degrees to each side in order to limit shoulder impingement at the catch.

● It is important to think about your hand-elbow position at the catch too. As you start to pull, try to get your hand deeper than your forearm ASAP. The elbow stays out slightly wider than the hand, and it’s a straight pull from there at shoulder width – not an ‘S’ pull

Warm up exercises
A good warm up before you get in the water can help you ‘wake up’ your rotator cuff and shoulder complex, so that those muscles are ready to work when you hit the water. Because when you suddenly throw them into a long warm-up set followed by intense,  never ending intervals after not having to do much during the day, they don’t perform well  The best way to approach this is with some basic muscle activation exercises for the scapular stabilizers and rotator cuff immediately before swimming This will get the shoulder out of a position of potential impingement and ready to perform effectively.

● Bilateral external rotation with elbows at your side x 30 reps

● Chicken wing with the back of your hands on your low back along the top of your hip bones. Push elbows forward and backward x 30 reps

● Bilateral external rotation at 90 degrees. Hands and forearms start parallel to floor at shoulder height, then rotate to goal post position & back to horizontal x 30 reps

● Shoulders & elbows flexed to 90 degrees. Maintain that position while horizontally adducting and abducting the arms x 30 reps

● Streamline position then drop elbows back & down to ‘I didn’t do it’ position x 30 reps

● Shoulder circles forward and backwards x30 reps

Check out the video for these warm-up drills Swim Warm-up Drills

Strengthen the stabilizers
Lots of swimmers think the major muscles used for swimming, such as latissimus dorsi and pectoralis are the key to improving performance and preventing shoulder pain. But swimmers are already training these muscles extremely hard every day in the pool.  Instead, it’s the weak links that need to be targeted, such as the stabilizers for the shoulder and the scapula.  These smaller stabilizers get left behind with normal training and correcting these imbalances is proven to prevent pain and help you go faster. Here are some of those muscles that need to be focused on to work on scapular stabilizing.

Holding elastic band with both hands, draw back the band as you bend your elbows. Keep your elbows near the side of your body.
Shoulder Extensions
While holding an elastic band in front of you with your elbows straight, pull the band down and back towards your side.

Prone “T, Y, I”
Lie face down with your elbow straight and arms out to the side. Next, set your scapula by retracting it towards your spine and downward towards your feet. Then, slowly raise your arms towards the ceiling keeping your elbow straight the entire time as shown.
Your thumbs should be pointed in the upward direction as your arm raises.

Lying face down with your arms stretched out upwards as shown, slowly move your arms upward towards the ceiling as you squeeze your shoulder blades downward and towards your spine.

Lying face down with your arms by your side, slowly move your arms upward towards the ceiling as you squeeze your shoulder blades downwards and towards your spine.

Shoulder External Rotation
You do not need to do all of these on the same day but alternate between the different positions listed below
Lie on your side with your elbow bent to 90 degrees. Place a rolled-up towel between your arm and the side your body as shown. 
Squeeze your shoulder blade back and down toward your buttocks and hold that position. 
Next, roll your arm upwards from your stomach area towards the ceiling while maintaining your arm against the towel and with your shoulder blade held down and back the entire time. Lower your arm and repeat. 

Bilateral Shoulder External Rotation
Standing or sitting with upright posture, hold the middle of a piece of Theraband with both hands. With your elbows at your side and bent at 90 degree angle, pull your hands outward and hold for 3 seconds. You should feel your shoulders roll backward and your chest move forward. 

Lying face down with your arm hanging down and elbows straight, draw your elbow up and back. Next, slowly twist your shoulder to raise your fist upwards yours your head as shown. 

Start by holding an elastic band or sports cord with your arm up at 90 degrees away from your side and elbow bent to 90 degrees. Your forearm should be directed forward in the beginning position as shown. Next, roll your shoulder back so that your forearm is directed upward. 
Maintain your shoulder blade in a retracted and downward position the entire time.  

Pushup with the “Plus”
Assume normal pushup position on stomach. Push up away from the floor into a plank position. Push your chest even farther away from the floor, so that your shoulder blades are flat against your back and not raised up.

Full Can Scaption
Place feet shoulder width apart. Then raise arms simultaneously at a 45 degree angle in front of you with thumbs facing up. Make sure to keep shoulders down and arms straight. 

Ball on the wall for Shoulder Stabilization
While standing with an upright posture, press the ball against the wall and slowly glide your hand on the ball in directions listed below:
circles left/right

Please remember that these exercises might be done initially without any weight. Slowly add weight as tolerated. These muscles groups should be worked about 2-3 times per week.

Swimming, biking and running take a lot of time, believe me I know. However, strength training and injury prevention is critical to be able to enjoy the sports that we love today, tomorrow and for years to come.