As summer comes to an end and we transition into fall, we also begin the competitive swim seasons for the YMCA, USA swimming, high school modified and high school varsity swim programs. Swimming is a great sport that can be an excellent life long activity long after retirement from competitive swimming. Many swimmers will continue to swim in masters programs or transition into triathlon. Through all of this the common denominator of all swimmers is that they all have unstable shoulders. The very thing that makes them good at swimming is also the thing that can be their biggest weakness. So how do we keep the key anatomical component for swimming loose enough to excel but strong enough to keep the system from falling apart?
There are several factors that need to be taken into account when training a swimmer. First, the shoulder must be protected at all cost. You don’t swim effectively without a healthy shoulder. Performing dry-land activities that are known to be injurious to the shoulder, is counter productive. Because swimmers have loose and essentially unstable shoulders they also have the corresponding poor reaction time. If the rotator cuff muscles cannot react to force or loading fast enough then the shoulder is left vulnerable. This happens when the swimmer is asked to use training methods they are not prepared for, ultimately leading to injury. The shoulder joint or glenohumeral joint has evolved into a distractive joint rather than a compressive joint. For example the hip joint is a compressive joint because it is weight bearing and is designed to handle compressive loads and will respond to compressive training. The shoulder joint on the other hand has evolved into a distractive joint made for hanging. Unfortunately, our litigious society has all but eliminated any type of training that involves hanging because of potential injury and parental litigation. Ideally activities such as monkey bars, gymnastic rings and rope climbing should be regular exercise from a young age to maintain healthy shoulders. When there is a large gap in this type of stimulation, for instance a child stops this type of activity at age 9 and then wants to pick it up again at age 14 it is like starting over. Too much time has gone by and the shoulder does not have the strength or reaction time to handle the new body weight and size. The 14 year old will now have to rebuild a base of strength, stability and reaction time to match the new body weight and size. This can take an extended period of time to do safely and this lengthy period rarely fits the expectation of coaches, parents and the athlete.
When starting a dry-land program the swimmer should focus on slow and controlled movement patterns to build baseline strength and to work at the current rate of reaction time. Swinging and ballistic type movement patterns such as kettle bell swings or kipping pull-ups (often seen in Cross-Fit workouts) should be avoided until the athlete has a base of strength comparable to the anticipated future load and needed reaction time. Gradual distractive loads should be introduced as well as limited Closed Kinetic Chain (CKC) or compressive exercises.
Swimmers that attempt to train through pain often end up with pathologic laxity of the shoulder and a physical exam finding known as “glenohumeral hinging”. At this stage the shoulder blade or scapula fails to function properly and becomes limited in its ability to move through normal movement patterns during the swim stroke. This causes the shoulder joint or glenohumeral joint to be overused. The resultant pathologic laxity can lead to tears inside the shoulder joint. Recognizing “hinging” as early as possible is the best way to prevent a catastrophic shoulder injury that may require surgery and possibly the end of a swim career.
If a swimmer complains of shoulder pain they should stop the inciting activity, apply ice to the painful area for 20 minutes up to three times per day, assess the shoulder joint for pathological laxity (looseness) and evaluate the entire training program to find the culprit that may have been the underlying cause of the injury. The dry-land program should be evaluated for known “shoulder killers” and the pool schedule should be evaluated for dramatic changes in volume, intensity, and stroke.
Ultimately swimmers do not become better swimmers because they lift a house full of weights, or perform strength drills from American Ninja Warriors. Swimming is an efficiency sport. When swimmers become efficient they swim faster. Dry-land training should be used specifically to strengthen existing weaknesses and give the swimmer the tools to improve efficiency in the water. Performing fashionable and popular strength drills from television shows will not make you a better swimmer, but the odds say it will put you on the shoulder injury roller-coaster. This is a ride you want to avoid.