In our first injury series article, we gave a thorough overlook on the most common swimming injuries for the shoulder, back, and knees. In part II, we want to help you apply some easy, and perhaps new exercises into your weekly dryland routine to protect your shoulders.
Injuries are so common in swimming that the higher the level of the competitive swimmer, the more likely the swimmer will have supraspinatus tendinopathy (p<0.0001) (Sain, et al., 2010). At the 2013 FINA World Championships in Barcelona, it was clear that some swimmers competed with an injury. The prevalence was significantly higher among females (36.7%) than males (28.6%) (p<0.005) (Mountjoy, et al., 2015). Sain and colleagues (2010) also make a strong case for how tendinopathy may arise. Their diagram is based on a running-rat model that simulates the stress put on shoulders in swimming and showcases that significant change can occur in the thickness of the tendon. They mean that with excessive repetitive swimming motions, specifically overhead internal rotation, the tendons around the shoulder take a direct hit, causing forceful trauma to the cells surrounding the shoulder. This results in the release of stress-activated protein kinase (JNK). Persistent JNK-activation has the potential to inaugurate apoptosis – cell death –, which results in thickening of the tendon. Collagen fibrils formed under these circumstances will undergo additional stress; the balance for equilibrium will be lost and this results in the deterioration of the tendon. Although Sain’s theory is yet to be confirmed, it prompts the question: Why there is such a high incidence of shoulder injuries in swimmers?
What & When
When we talk about injury prevention, it is extremely important to differentiate between injury prevention, and training to get faster. If injury prevention is synonymous with swimming, you want to start the early season with higher loads and more variations, and successively do little less the closer it gets to your taper meets, especially if you have, or have had a past shoulder injury. Some swimmers need more, some need less, and literature still is scarce on the frequency and volume to be in a “safe-zone.” Because, injury prevention is not specific to develop speed in the water; therefore, if you do too much of it too close to a championship meet, be wary that it could affect your performance negatively.
So, we know that supraspinatus inflammation is common. We also know that instability and subluxation can be a result of extreme repetitive overhead movements (Ciullo & Stevens, 1989). Lastly, Rodeo and colleagues has recently concluded that subacromial impingement is more dominant than subcoracoid impingement (83% vs. 37% respectively) in the 2008 United States Olympic swimming team (2016).
With this information, I know that the shoulder pain derives from excessive and powerful internal shoulder rotation, which can lead to inflammation and potential impingement. Therefore, the videos below are predominantly focusing on the posterior end of the shoulder capsule.
1) Slide Outs
Injury Prevention. An excellent, but difficult movement to execute correctly. The postural muscles need to be fully engaged with the spine locked. Only the shoulders are moving, with help by the scapula only. No up and down movements from the torso here. Neck in line with the spine, while “separating” the shoulders from the neck.
2) MB OH Slams
Injury Prevention. Humeral and scapula control in the overhead movement for better stability in the entry phase in all strokes, except breaststroke. It is suggested to start with a very light ball, and double the repetition number on your less skilled arm – yes, one side will be much more uncoordinated than the other!
3) Injury Prevention. Cable 1A Upright Row-External Rotation/Pull
Injury Prevention. This is a great variation to stabilize and balance the shoulder muscles, while engaging most of your back!
4) Wall Angels
Mobility. I am showing you two variations. As a swimmer, I had a terrible streamline, hence the small movements. The key is to slide down while keeping your lower back on the wall to ensure that you are engaging your postural muscles in this movement. Now, with your elbows and hands pressing against the wall, move them up as high as you can without disconnecting from the wall.
5) 1A Thoracic Circles
Mobility. Get completely on your side, and maintain pressure on the bottom shoulder, while pressing down on a foam roller with opposite leg. Now move your top arm, and engage your rhomboids, middle trapezius, and serratus posterior superior muscles through the sticky point when the hand goes from pronation to supination in an internal rotation motion with the humerus.
6) 1A Externally Rotated Lat Contract-Relax Stretch
Mobility/Recovery. These last two mobilizing exercises are influenced again, by Dr. Kelly Starrett. First, externally rotate the humerus to put the lats in a better line of pull. This is an active to passive stretch, where you are looking at activating and contracting the latissimus dorsi muscle as well as the smaller localized shoulder muscles. Then relax, let the band pull your arm away. Move around, rotate, contract again for 3-5 seconds, and relax.
7) 1A Externally Rotated Anterior Contract-Relax Stretch
Mobility/Recovery. The same idea is implemented here, but for your biceps tendon, pectoralis minor and major, going all the way up to the neck and sternocleidomastoid muscles.
I hope got something new and valuable out of this information. The shoulder works in complex manners and should be paid close attention to. If you want more in depth consulting, email us to firstname.lastname@example.org, or apply for a free strategy session to get individualized workouts specifically tailored to your needs!
Ciullo, J., & Stevens, G. (1989). The prevention and treatment of injuries to the shoulder in swimming. Sports Medicine, 7(3), 182-204.
Mountjoy, M., Junge, A., Benjamen, S., Boyd, K., Diop, M., Gerrard, D., & … Verhagen, E. (2015). Competing with injuries: injuries prior to and during the 15th FINA World Championships 2013 (aquatics). British Journal Of Sports Medicine, 49(1), 1-8.
Rodeo, S. A., Nguyen, J. T., Cavanaugh, J. T., Patel, Y., & Adler, R. S. (2016). Clinical and Ultrasonographic Evaluations of the Shoulders of Elite Swimmers. American Journal Of Sports Medicine, 44(12), 3214-3221.
Sain, M. L., Walton, J., Linklater, J., Appleyard, R., Kirkbridge, B., Kuah, D., et al. (2010). Shoulder pain in elite swimmers: primarily due to swim-volume-induced supraspinatus tendinopathy. Brittish Journal of Sports Medicine (44), 105-113.
Starrett, K., & Cordoza, G. (2015). Becoming a supple leopard: the ultimate guide to resolving pain, preventing injury, and optimizing athletic performance. Las Vegas: Victory Belt Publishing Inc.