Does Low Back Pain Resolve Itself?

Take Home Points for Does Low Back Pain Resolve Itself?
  1. Yes, low back pain typically resolves itself, yet underlying issues persist likely increasing the risk of re-injury.
Low back pain (LBP) is extremely common in the general and athletic population and swimmers
even have a higher risk of low back degeneration. Despite this frequency, no resolutions exist for eradicating pain. Luckily, most cases of LBP are acute and remiss over a month. This brevity in symptoms leads many not to seek treatment. However, resolution of pain, without treatment, may but a person at risk for a recurrent injury, as the recurrent rate of low back pain is extremely high.

This situation puts everyone in a bind, as everyone thinks they can wait out pain and get better. However, is waiting out the pain and having it resolve on it's own the best option? Sure, low back pain gets better in most people without any treatment, but is this passive treatment worth the risk of having a higher risk of recurrence?

Does Low Back Pain Resolve Itself?

Butler (2012) recruited fifty-four subjects without LBP and 33 people with a previous low back injury (LBI). In this study, electromyography of the core musculature and motion analysis was taken during the following task: 

“Subjects stood at a table (adjusted to standing elbow height) and performed three trials of lifting and replacing a 2.9 kg load using both hands in two reach conditions while minimizing trunk and pelvis motion. Subjects were required to move the load 4–5 cm off the table in a controlled manner and lower within a standardized 3-s count. An event marker identified lift, transition and lowering phases. Only the lift phase was examined given similar patterns were found for the two other phases. If trunk or pelvis motion was visible during the trial or upon review if the any of the three angular displacement traces exceeded 3, the trial was repeated (Butler 2012).”

The results showed a slight difference between the control and LBI, as the LBI group was slightly older and had a higher body mass index (BMI). Moreover, different movement patterns during the above tasks were noted between both groups. The LBI group also had higher muscle activation for the all the muscles except the external oblique, which showed decreased activation. 

Why is it Different?

All joints have passive structures (ie bones) and active structures (ie muscles). The higher muscular activation in the LBI group may be from a decrease in passive stability, requiring an increase in activity stability. Though high activation is assumed a good thing for stability, it may lead to increased fatigue and increased injury risk. This increases stiffness (stability) could also be a compensatory pattern for an underlying injury. A decrease in the external oblique activation may inhibit force distribution and overall core stability, as one muscle not working properly is theoretically disrupts stability according renowned spinal biomechanist Stuart McGill. 

These “scores indicates that the LBI group included individuals with inhibited as well as enhanced activation in local muscles, suggesting that there are potential subgroups. This may have implications for therapeutic interventions in that those with enhanced local activity may not benefit from therapies that focus on selectively activating deep muscles. Thus our results provide evidence of local muscle alterations although it is the first time that these impairments are reported during a functional but highly controlled task in those recovered from an episode of LBI (Butler 2012)”.

In summary, Butler concluded: “specifically, an overall increase in activity of abdominals and back extensors, increased agonist–antagonist co-activation strategy, reduced posterior oblique fiber activation and impaired local muscle responses to increased demand was found in the LBI

Practical Implications

Swimmers often have low back pain which symptoms quickly resolve. However, this study suggests underlying motor programming and impaired muscle activation exist after the resolution of symptoms. This makes it essential to seek rehabilitation or at least work on improving these imbalances, preventing a relapse. 

For some examples of core training, check out the COR Low Back Solution.

For more examples, consider purchasing Dryland for Swimmers.

  1. Butler HL, Hubley-Kozey CL, Kozey JW. Changes in electromyographic activity of trunk muscles within the sub-acute phase for individuals deemed recovered from a low back injury. J Electromyogr Kinesiol. 2012 Nov 28. doi:pii: S1050-6411(12)00195-2. 10.1016/j.jelekin.2012.10.012. [Epub ahead of print]
By Dr. G. John Mullen received his Doctorate in Physical Therapy from the University of Southern California and a Bachelor of Science of Health from Purdue University where he swam collegiately. He is the owner of COR, Strength Coach Consultant, Creator of the Swimmer's Shoulder System, and chief editor of the Swimming Science Research Review.

Thoracic Outlet Syndrome: What it is, How to Spot it, a Case Report, and Prevention!

Take Home Points on Thoracic Outlet Syndrome: What it is, How to Spot it, a Case Report, and Prevention!:
  1. Thoracic outlet syndrome is a narrowing between your collarbone and first rib, putting pressure on your neurovascular structures.
  2. There are many neurovascular impairments at the shoulder.
  3. Monitor shoulder pain, symptoms, and alter sensation closely, and adjust prevention programs and biomechanics for greatest improvement.
Though shoulder impingement is the most common form of shoulder injury in swimmers, other cases of shoulder pain exist. These other syndromes impact other tissues, typically the nerual, arterial or vascular. Although these shoulder conditions are not well known, they still occur in overhead athletes. Asymptomatic pitchers even have impaired blood flow on their throwing side, a potential risk factor for Thoracic Outlet Syndrome (TOS). Some of these issues are treated conservatively, while others require surgery.

Types of Thoracic Outlet Syndrome

Knowing what occurs and the symptoms of tissues other than the muscular system is beneficial for a coach and rehabilitation staff. Here are some examples:
  1. Nerogenic Thoracic Outlet Syndrome: Compromising the brachial plexus. Symptoms are pain, numbness, tingling, and weakness. 
  2. Vascular Thoracic Outlet Syndrome: Compromising the venous or arterial system. The typical presentation includes pain, numbness, tingling, weakness, and/or the presence of vascular compromise. Venous TOS is more common than arterial TOS and is characterized by swelling and cyanosis, pain, and a heavy feeling. 
  3. Paget-Schroetter Syndrome: A thrombosis of the subclavian vein.

Clinical Tests for Thoracic Outlet Syndrome in Swimmers

There are manual and diagnostic test for identifying vascular compromise. Sadeghi-Azandaryani (2009) notes:

"Sensitivity of clinical tests was acceptable overall (mean 72%). The EAST test showed the highest sensitivity with 98%, followed by the Adson (sensitivity: 92%) and Eden tests (sensitivity: 92%). In contrast, the sensitivity of the Hoffmann test (47%) was low. Nevertheless, a positive EAST, Eden, Adson, Green-stone or Adson test was not associated with a poorer outcome (p≥0.05).

Systolic blood pressure was measured before and after exercise. Mean systolic blood pressure of the afflicted side in the group of patients with good or fair outcome (85.9% of all patients) showed an average systolic blood pressure of 123.1 ± 12.5 mmHg before exercise and 108.9 ± 12.8 mmHg after exercise (average decrease: 16.2 ± 9.6 mmHg). A decrease in blood pressure of more than 25 mmHg could not be found in this group. In the group of patients with a poor outcome, the systolic blood pressure before exercise was 140.6 ± 24.6 mmHg and 106.7 ± 21.8 mmHg after exercise (average decrease: 35.0 ± 14.1 mmHg). Statistical analyses showed that a distinct decrease in blood pressure after exercises was associated with a poorer outcome (p = 0.0027)."

Here are some of the most common tests:
  1. Roo's test: The patient stands and abducts shoulders to 90 degrees, externally rotates the shoulders, and flexes the elbows to 90 degrees. The patient then opens and closes the hand slowly for three minutes. The test is positive if the patient is unable to complete the test or experiences heaviness, numbness, tingling or pain.
  2. Adson's test: The examiner locates the radial pulse while arm is held in extension, external rotation and slight abduction. The patient is instructed to take a deep breath and turn head toward the test arm while extending the neck. If there is compression, the radial pulse will be diminished or absent. The goal of this test is to tense the anterior and middle scalenes.
  3. Costoclavicular test: The examiner palpates the radial pulse and then draws the patient's shoulder down and back. If the pulse disappears, the test is positive. The goal of this test is to provide compression of the costoclavicular space.
  4. Halstead maneuver: The examiner palpates the radial pulse and applies downward traction on the test extremity while the patient's neck is hyperextended and rotated to the opposite side. Absence of the pulse indicates a positive test.6
  5.  Wright test (hyperabduction test): The examiner palpates the radial pulse and hyperabducts the arm so the hand is brought overhead with the elbow and arm in the coronal plane. The patient takes a deep breath and may rotate or extend the neck for additional effect.
  6. Allen maneuver: The examiner palpates the radial pulse while positioning the shoulder in external rotation and horizontal abduction. The patient then rotates the head away from the test side.
Diagnostic tests also include a Doppler arteriography testing of the vascular system. If the compromise is neurogenic, nerve stimulation is sometimes used for diagnosis.

Example Swimmer with Paget-Schroetter Syndrome

The patient was a 21-year-old male swimmer who noticed swelling and pain in his non-dominant arm. The patient was advised to ice and rest his shoulder. Then, ten days after the initial heaviness, the symptoms returned and the patient was advised to seek emergency care where a Doppler venous ultrasound could be performed. The results were negative. The patient demonstrated a cease of the radial pulse, swelling, and limb cyanosis with the Wright’s hyperabduction test. He also presented with ⅘ strength on the affected side, but 5/5 strength on the non-affected side. Despite a negative Doppler venous ultrasound, the vascular surgeon suggested a venogram, since a Doppler venous ultrasound is best used as a screening tool, not for diagnostics, since it has difficulty specifically measuring the subclavian vein due to the bony structures. The venogram showed a major block of the subclavian vein, venous stenosis, and concomitant thrombosis.

The patient was then administration heparin and a tissue plasminogen activator (tPA) over a three day period in order to achieve thrombolysis.This improved the thrombus by 70%, indicating 30% of the vein had undergone permanent thrombosis. The patient was then prescribed coumadin and Lovenox as a blood thinner. Electromyography (EMG) was also performed to rule-out a neurogenic case of TOS, which demonstrated no muscle membrane instability.

The swimmer returned to the pool with great success (winning the conference in the 100 and 200 breast), then received a resection of the first rib. After the surgery, the patient complained of pain medial to the shoulder blade and demonstrated shoulder-blade winning. Manual muscle tests were performed again and noted 5/5 strength in all muscles. Fine-wire EMG was conducted again and showed normal signs of all muscles except the serratus anterior which demonstrated signs of denervation (likely due to surgical complications to the long thoracic nerve).

Despite the findings of the serratus anterior, the patient started a physical therapy program and home program which resulted in improved EMG readings for the serratus anterior, three months postoperatively.

Thoracic Outlet Syndrome Swimming Prevention Techniques

Steady Streamline:

If the arms move excessively during streamline, the upper arm and neural structures are stressed. Maintain a stable arm position during all streamline, especially dolphin kicking.

Flatter Butterfly:

Some swimmers (like Michael Phelps) press their chest down as they enter their arms in butterfly, delaying their pull. This creates a position with the arm above the chest, stretching and stretching the brachial plexus (all the nerves and vascular areas).  Try starting the pull earlier, not allowing a position of arms higher than the chest. 

Deep catch:

Many swimmers have a "catch-up" style stroke. Unfortunately, this increases stress at the shoulder joint and vascular system. If working on less stress, have the swimmer have a deeper catch as the enter the water.

Neutral Hand Entry:

Entering without hand entry is paramount for all shoulder prevention, as excessive internal rotation increases shoulder stress.

Shallow Backstroke Catch:

Entering with a deep catch in backstroke stresses and strains the neurovascular structures in the front of the good! Instead, have a wider, more shallow catch, similar to Missy Franklin's technique. 

Thoracic Outlet Syndrome Dryland Techniques

Foam Roll Thoracic Spine:

SMR Scalenes:

SMR Pectoralis:

Nerve Mobility:

First Rib Mobilization: 

Anterior Neck Strengthening:

Scapular Strengthening:

Summary on Thoracic Outlet Syndrome for Swimmers

Some cases of TOS require drastic treatment, like surgery (first rib resection). Instead of dealing with potential surgery, keep a close eye on TOS symptoms and begin early with treatment and technique modifications at the first instance of symptoms. 

These are only some technique modifications and treatments, as each person is individual and different stroke biomechanics and rehabilitation/prevention programs are necessary for each person. Moreover, just because some swimmers perform with techniques which increase shoulder stress, doesn't necessarily result in TOS or injury. Therefore, if you are suffering from TOS, see a rehabilitation specialist for guidance and individualization.

If looking for more injury prevention techniques, consider purchasing the COR Swimmer's Shoulder System.

  1. Nitz AJ, Nitz JA. Vascular thoracic outlet in a competitive swimmer: a case report. Int J Sports Phys Ther. 2013 Feb;8(1):74-9. 
  2. M Sadeghi-Azandaryani, D Bürklein, A Ozimek, C Geiger, N Mendl, B Steckmeier, J Heyn Thoracic outlet syndrome: do we have clinical tests as predictors for the outcome after surgery?Eur J Med Res. 2009; 14(10): 443–446. Published online 2009 September 28. doi: 10.1186/2047-783X-14-10-443
By Dr. G. John Mullen received his Doctorate in Physical Therapy from the University of Southern California and a Bachelor of Science of Health from Purdue University where he swam collegiately. He is the owner of COR, Strength Coach Consultant, Creator of the Swimmer's Shoulder System, and chief editor of the Swimming Science Research Review.

Kinesiotape for Swimmers: Length, Strength and Timing. Part II

Take Home Points on Kinesiotape and Swimmers:
  1. The evidence does not suggest that kinesiotape aids athletic performance
  2. Kinesiotape may affect knee mechanics and improve pain in those with patellorfemoral pain syndrome
  3. Kinesiotape has been shown to increase acromiohumeral distance, potentially limiting risk for shoulder impingement symptoms. 
This is not a new topic to this blog (See Part I). But like any topic, one snapshot of the evidence is never the final word. So is there anything new to report in the literature on kinesiotape, especially as it may relate to swimming?

Overall, the general consensus is that the performance effects of kinesiotape are negligible to non-existent. Fortunately though, there appear to be no detrimental effects on performance (minus the potential opportunity cost of forgoing other potentially more effective mechanisms). 

In a recent systematic review, Drouin (2013) noted, “There is scant evidence to support kinesiotaping techniques as a successful means of affecting athletic-based performance outcomes such as improved strength, proprioception and range of motion, in healthy persons.” This appears to be definitive statement on the effects of kinesiotaping, but does it end the discussion?

One problem is that in most studies, kinesiotape is applied randomly as opposed to particular subjects for whom kinesiotaping is theorized to work. While the latter approach may sacrifice objectivity for potential bias, the latter may be more reflective of how the intervention is applied in real life. Be careful of labeling any intervention as “good” or “bad” as a blanket statement. Instead, the follow up should be “good or bad for whom?” It is a mistake to justify kinesiotape for performance based of any supporting literature for injury/pain, just as it is mistaken to outright dismiss kinesiotape as a clinical adjunct based on a lack of evidence to support performance improvements. 

Swimmers often focus on taping for the shoulder, but don’t forget the possibilities in the lower extremities, particularly for dryland and breaststroke. Song (2014) recently found that kinesiotaping caused significant shifts in patellar positioning in females with patellofemoral pain syndrome compared to the application of sham tape or a no tape condition during a single leg squat. However, both the sham tape and kinesiotape were successful in pain reduction. 

One especially pertinent study for swimming (Luque-Suarez 2013) published after our previous blog post, examined whether kinesiotape affects acromiohumerdal distance in healthy subjects (a potential measure of shoulder impingement risk). Authors of this randomized controlled trial noted that although the kinesiotape group had significantly greater increases in acromiohumeral distance compared to the sham taping group, direction of taping did not matter.


Overall, little has changed in the evidence on kinesiotape, especially regarding the lack of support for its theorized improvement on performance. However, recent studies have opened relatively new lines of inquiry regarding potential improvements in knee and shoulder biomechanics, both of which may be helpful for swimming health and technique.


  1. Luque-Suarez A1, Navarro-Ledesma S, Petocz P, Hancock MJ, Hush J. Short term effects of kinesiotaping on acromiohumeral distance in asymptomatic subjects: a randomised controlled trial. Man Ther. 2013 Dec;18(6):573-7. doi: 10.1016/j.math.2013.06.002. Epub 2013 Jul 4.
  2. Song CY1, Huang HY1, Chen SC2, Lin JJ3, Chang AH4. Effects of femoral rotational taping on pain, lower extremity kinematics, and muscle activation in female patients with patellofemoral pain. J Sci Med Sport. 2014 Jul 24. pii: S1440-2440(14)00135-2. doi: 10.1016/j.jsams.2014.07.009. [Epub ahead of print]
  3. Drouin JL1, McAlpine CT, Primak KA, Kissel J. The effects of kinesiotape on athletic-based performance outcomes in healthy, active individuals: a literature synthesis. J Can Chiropr Assoc. 2013 Dec;57(4):356-65.
Written by Allan Phillips is a certified strength and conditioning specialist (CSCS) and owner of Pike Athletics. He is also an ASCA Level II coach and USA Triathlon coach. Allan is a co-author of the Troubleshooting System and was selected by Dr. Mullen as an assistant editor of the Swimming Science Research Review. He is currently pursuing a Doctorate in Physical Therapy at US Army-Baylor University.

Weekly Round-up

Each week we aggregate recent swimming journals and blog posts relating to swimming biomechanics, physiology, nutrition, psychology, etc. If you wish to add, please add an article in the comments section.

Journal Round-up

  1. Backstroke swimming: exploring gender differences in passive drag and instantaneous net drag force.
  2. From early to adult sport success: analysing athletes' progression in national squads.
  4. Sleep or swim? Early-morning training severely restricts the amount of sleep obtained by elite swimmers.
  5. Study of major factors developed among young swimmers during the practice session and competition causing interference of their performances.
  6. Factors determining swimming efficiency observed in less skilled swimmers.
  7. Inter-arm coordination and intra-cyclic variation of the hip velocity during front crawl resisted swimming.

Blog Round-up

  1. Volume 20, Issue 1, "Strength Training 7"
  2. Creatine + Sodium Bicarbonate: Two New Studies Show You Can Make the Most-Researched Ergogenic Even Better W/ a Few Grams of Baking Soda - Sign. & Non-Sign. Benefits
  3. Dealing with Anticipated Stress
  4. 6 Reasons Why Kids Should Play Sports
  5. Are the Hamstrings Really Primarily Fast-Twitch?
  6. Training Asymmetries with FMS Principles
  7. Random Thoughts on Sports Performance Training: Installment 6
  8. Creatine for Swimmers
  9. Future of Swimming Training
  10. Dryland for Swimmers: Don't Fall into the Traps!
  11. Swimming for Chronic Pain
  12. Friday Interview: Dr Chris Mills and Dr. Mitch Lomax Discusses Breast Influence on Biomechanics

Friday Interview: Dr Chris Mills and Dr. Mitch Lomax Discusses Breast Influence on Biomechanics

1. Please introduce yourself to the readers (how you started in the profession, education,
credentials, experience, etc.).
Dr Chris Mills
I completed my PhD in 2005 at Loughborough University in the UK, where I was funded by British Gymnastics to investigate force dissipation characteristics of landing mats and gymnasts with the aim of reducing injury. I continued to focus my research on lower and upper body soft tissue motion and for the past 6 years have worked closely with the research group in breast health at the University of Portsmouth. As a part of this group we work closely with garment manufactures to improve their design, as well as conducting fundamental scientific research studies. Most of the research within breast biomechanics to date has been land based however recently a swimwear manufacturer approached our group with an interesting project. We combined our experience of breast biomechanics, swimming mechanics and physiology (via Dr Mitch Lomax, who has contributed to your website in the past) to investigate the effect of breast support on trunk motion during swimming.
I’m a Sport and Exercise Scientist and a Senior Lecturer in Sport and Exercise Physiology at the University of Portsmouth, UK. I gained both my PhD (2007) and MSc (with distinction, 2001) from Brunel University, UK, and my BSc (Hon) from Luton University (1998). I’m an accredited Sport and Exercise Scientist with the British Association of Sport and Exercise Sciences (BASES), Chartered Scientist (Science Council). I have been an advisor to the Amateur Swimming Association of England and was involved in the preparations of the English Pistol Shooting squad for the Commonwealth Games in Glasgow. My main sporting research interest is in swimming and predominantly breathing limitations.

2. You recently published an article on breast displacement in freestyle and breaststroke. Is there any other research on this area in swimming?
At present there is very limited research on breast mechanics, let alone the movement behavior of the breasts in water and the impact breast support has on swimming technique. Clearly more research is needed in this area to ascertain whether swimming costume design modifications could benefit performance.

3. What did your study look at?
We were interested in investigating whether varying levels of breast support influence swimming technique. On land, a lack of sufficient breast support has been shown to decrease performance and increase pain, however we did not know if the same was true in water. We were also particularly interested to understanding whether regular swimsuits afforded any support to the breast during swimming.

4. What were the results of your study?
Key findings suggested that although trunk motion was not altered with varying levels of breast support, a swimsuit was no more effective at reducing the movement of the breasts than not wearing one at all! Despite trunk motion not being effected by breast support conditions, ongoing research hopes to determine whether other aspects of swim stroke mechanics (such as hand path etc.), that may influence swim performance, are effected by the amount of breast support.

5. What were the practical implications for coaches and swimmers from your study?
Female swimmers with larger breasts may wish to consider wearing an additional sports bra under their swimsuit to reduce breast motion and compress the breasts against the chest wall (decreasing the trunk moment of inertia and the possibility of the breasts obstructing the desired hand path during swimming). Our findings revealed that a sports bra (traditionally used for landing based activities) was more effective as reducing breast motion than a swimsuit.

6. Do you think the same results would have occurred with faster women? Hi-tech suits? Women of smaller breast size?
This is difficult to answer however if the women swim faster the drag created would also increase. If the breasts are not ‘restrained’ sufficiently this may increase the ‘bagging’ effect (from our paper) and increase form drag and hence decrease performance. Hi Tech suits usually have a higher level of compression (similar to compression garments on land), however we have not tested this. Unpublished research from the group has found that upper body compression garments do reduce breast motion during land based running. It may be possible that a similar increase in compression may also reduce breast motion (similar to that of the sports bra in this study). Women with smaller breasts do not experience the same magnitudes of breast motion (on land) therefore in the water they are also likely to experience reduced magnitudes of breast motion when compared to women with larger breasts. The ‘bagging’ effect and potential increases in form drag may not be as great for women with smaller breasts.

7. Does male pec size influence swimming? Could this be one reason why "bulkier" male swimmers anecdotally did better with the full body suits?
This is a difficult one to comment on and really outside our area of expertise. The only aspect to consider is that men pecs are mainly muscle and hence are used to generate joint motion; however the female breast does not contain any muscle (just mainly fat and glandular tissue), hence minimizing their form drag may be beneficial to swimming performance.

8. What can swim suit manufactures do to improve swim suits for women?
I would recommend an increase the amount of compression afforded around the breasts to move their center of mass closer to the trunk and help to streamline their shape to decrease form drag. A higher neckline may also help to decrease the ‘bagging’ effect described in our paper. Possibly some structured support, similar to an encapsulation bra. Finally, appropriate sizing, that can cater more for trunk circumference and breast sizes variations, within a, for example, UK size 12 swimsuit.

9. What research or projects are you currently working on or should we look from you in the future?
We currently have two more papers under review associated with breast motion during water based activities. We are also seeking collaborative links with garment manufacturers interested in developing this area of research.

Future of Swimming Training

Take Home Points on the Future of Swimming Training:

  1. Smart technology is on the verge of dramatically enhancing swimming performance, be ready for the revolution.
Swimming is one of the most biomechanically difficult sports. Unlike other sports, swimming works against water while in a horizontal position. The unfamiliar horizontal position makes all stroke corrections more difficult. Water also creates resistance during any motion, making improvements harder! This motion creates drag impeding performance to a greater degree than air resistance.This makes receiving feedback difficult. In fact, Stefan Szczepan beautifully described his work and the role of immediate feedback in swimming.

We reviewed Szczean and Zatoń (2014) research in the latest Swimming Science Research Review. Zatoń (2014) split sixty-four male swimmers into a control and an experimental group. The experiment consisted of 4 freestyle swimming trials of 25 meters. The first two trials were pretest and the third and fourth trials were the experimental trials. In the experimental trials, the swimmers were instructed to "reach out further". 

There was significant improvement in stroke length, stroke rate and swimming velocity.

Future of Swimming Training

Overall, there is a lack of immediate feedback in the sport of swimming despite the shown benefit. As technology decreases prices, these methods must be integrated more in swimming. Whether the feedback is through telemetry systems or visual cues, having immediate feedback will reduce errors. As technology, systems my provide automatic feedback based on performance

Biomechanics, Injury Prevention and Coaching

For example, MOOV has created a "smart watch" which provides instantaneous feedback during running. Full disclosure, I consult with MOOV, so I first hand understand the potential of this product. Imagine a device which you wear on your wrist and lets you know when your hand speed is slowing, force production is decreasing, or hand path is altering, then coaches you for improvement! This can improve biomechanics, reduce injuries, increase motivation, and other improve swimming!

Dryland and Recovery

Athos, a smart clothing, is capable of measuring muscular activity when worn! If Athos, or another company, can create waterproof clothing, then huge advancements in muscular training and recovery are possible. Imagine knowing when a muscle is completely fatigued from the resting neuromuscular activity...pretty cool! If this product isn't made waterproof, it still a beneficial product for dryland, knowing exactly which muscles are activity during each exercise. 

Sleep and Recovery

Sleep and recovery have huge potential for swimming improvement. Currently, recovery and sleep and not individualized, although everyone is unique and individual recovery patterns are needed. There are products like BioForce HRV and other smart watch technologies which track sleep and heart rate variability, a potential marker for monitoring recovery. 

Nutrient Levels

One possibility for training and monitoring is blood analysis without skin penetration. As far as I know, this technology doesn't exist. However, if someone can create a device which continuously monitors nutrient levels in the blood or via saliva, exact nutrient levels is possible. This can maximize energy, recovery, and performance!


If these products are accurate, then the world of swimming and coaching will be transformed. For example, a swimmer is held responsible throughout the main set, not allowing them to "slack" or take an unnoticed break. For the coach, the device will monitor biomechanics more accurately and continuously than the coach. For injuries, knowing when pain starts during a set and seeing the muscular activity or biomechanical deviation at this point in time will influence technique and reduce injuries. Also, knowing when and what to eat for maximal performance, as well as knowing how much sleep is needed for maximal performance has exciting potential! Once again, this will change the sport, so harnessing technology and analyzing data will become even more paramount for success. Make sure you are ready for the next phase of sports enhancement!

  1. Zatoń K, Szczepan S. The impact of immediate verbal feedback on the improvement of swimming technique. J Hum Kinet. 2014 Jul 8;41:143-54. doi: 10.2478/hukin-2014-0042. eCollection 2014 Jun 28.
By Dr. G. John Mullen received his Doctorate in Physical Therapy from the University of Southern California and a Bachelor of Science of Health from Purdue University where he swam collegiately. He is the owner of COR, Strength Coach Consultant, Creator of the Swimmer's Shoulder System, and chief editor of the Swimming Science Research Review.

Creatine for Swimmers

Take Home Points on Creatine for Swimmers:
1. Creatine monohydrate is the most effective and most researched form of creatine supplement
2. 20% of athletes do not respond to creatine supplementation
3. May improve competition performances in shorter races (i.e. 50m, 100m, 200m)
4. May aid in training intensity during dry-land training and ultra-short race pace training
5. May hinder competition performances in longer races

You have probably heard of creatine before.  But do you know what it actually is? How it works? Or the possible role it can play for swimmers?

First, it is important to know that creatine is not prohibited by WADA.  It is also widely accepted as an ethical performance-enhancing supplement, and is in no way, shape, or form associated with steroids. It is also important to know how creatine works in the body so that we can start to understand the concepts and uses of a creatine supplement.  The following are the basic facts that you or your athletes need to know about creatine’s role in the human body.

Internal Creatine (In The Body)

Lets start with phosphocreatine, or creatine phosphate (CP).  CP is a naturally occurring energy store in the human body. Creatine is a peptide containing a high-energy phosphate. CP’s role is to donate its phosphate group to form ATP (our body’s primary source of energy).  This occurs as our muscular ATP stores become depleted, typically within the first 10 seconds or so of maximal intensity exercise (e.g. 25m sprint).  This is often known as our ATP-CP energy system. 

External Creatine (Supplements)

Does it actually work?

In short, yes, creatine supplementation works.  Resting CP levels are typically around 125mmol/kg of muscle.  However, the body seems to be able to store around 160mmol/kg before hitting a ceiling where it will not store any more.  About 80% of athletes who supplement creatine will experience an increase in ATP-CP related performance.  This is due to a rise in resting CP stores from around 125mmol/kg to the 160/mmol/kg limit.  (20% are considered “non-responders” wherein they rest closer to their ceiling or their ceiling is below average, or more likely a combination of the two).  For “responders”, the almost 30% increase in muscular CP directly translates to increased duration of the ATP-CP system function.  Simply put, more creatine means more energy for muscles.

CP is the body’s internal form of creatine. Like I said above, CP is creatine bound to phosphate.  Creatine monohydrate is THE basic form of supplemental creatine.  Wherein a creatine molecule is bound to 1 water molecule.  And, with so many variations of creatine on the market, it would take quite a while to find the research and compare each and every type of creatine.  So, instead of getting into all of this, I am going to focus on the supplementation of creatine monohydrate, as it is the most researched and proven to work (You’ll have to take my word for it).

Dosing Protocol

So bottom line, creatine monohydrate does its job of increasing CP stores.  Next lets talk about how to use this supplement.  The following is a typical, well-researched procedure for supplementing with creatine:

·      Loading phase (5 days) – 20g of creatine monohydrate, taken in 4 separate servings throughout the day (4x5g). 

·      Maintenance phase – 5g of creatine monohydrate taken once per day. Realistically, even 3g/day would probably do fine for maintaining saturated CP stores.

Typically creatine monohydrate will come with a 5g scoop.  If yours doesn’t have a scoop, 1 tsp is approximately 5g.  Now the loading phase is not necessary to maximize creatine phosphate (CP) stores, but it will allow you to do so quicker (approximately 5 days).  Without a loading phase, a maintenance dose will eventually maximize creatine phosphate stores, but will take much longer (20-30 days). 

Some research indicates that taking a serving of creatine following a training session may be the most effective way of absorbing it.  However, the reality of it is this: when you take your creatine probably won’t make a difference since you will be maxing out your CP stores regardless. 

The take home message here:

Don’t get too anxious about timing your creatine ingestion.  Just try and get 5g/day.

If you miss a dose one day, carry on as if it never happened, it takes 4-6 weeks for CP stores to return to normal levels. It won’t happen to you in a day!

Uses for Swimmers

Remember which energy system creatine is fuelling.  The ATP-CP system lasts seconds, not minutes!  Creatine supplementation will improve performance in shorter races (i.e. 50m Freestyle) rather than longer ones.  It is interesting to note that when CP donates its phosphate to form ATP, it binds up a H+ ion.  H+ ions are responsible for muscular acidosis, which decreases muscle contraction strength.  You may know this better as that “lactic acid burning”.  So, swimmers competing in races than venture into a few minutes’ duration (e.g. 100m, 200m races) may benefit from increased CP stores as a result of creatine supplementation.

However, even swimmers that don’t compete in 50m, 100m, 200m races may still benefit from creatine supplementation in their high intensity training (e.g. ultra short race pace training USRPT).  Additionally, if these athletes are doing weights in dry-land training with the goal of producing some nervous adaptation, then creatine will help them hit those last few reps with speed. Keep in mind that the harder a swimmer can go in practice or training, the greater their adaptation will be.  This will translate to improved competition performance. 

A typical side-effect is weight gain of several pounds.  It happens quite rapidly.  This is fine, safe, and expected.  With increased CP stores in muscles comes increased water retention as well.  Now, this creates an interesting issue from the propulsion/drag standpoint.  For athletes that compete in 50m, 100m, 200m races, having loaded CP stores probably “outweighs” the weight gain, because of the improved power output in those races.  Athletes who compete in longer events may want to utilize a creating supplement in training to elicit greater adaptation, but cycle off before a competition to lose the additional water weight.  If this is the case, the athlete should cease supplementing creatine for about 4 weeks before the competition.  This should be adequate time for CP stores to return to normal levels, and the body to shed the excess water weight.

By Kevin Iwasa-Madge BASc, CISSN owner of iMadgen Nutrition, and as a former top-5 finisher in the world as a freestyle wrestler, Kevin embodies the lifestyle of an elite athlete. Kevin completed his undergraduate degree at the University of Guelph in the Applied Human Nutrition. This clinically focused program allowed him the opportunity to address a range of diseases from a nutritional approach. After graduation Kevin attained his certification in sports nutrition from the International Society of Sports Nutrition. 

Athletically, Kevin has been an elite wrestler for over 10 years, competing for both the University of Guelph and Team Canada. Kevin is a former First Team All-Canadian, Academic All-Canadian, and Canadian Champion. As a varsity athlete, Kevin was short-listed for the prestigious Student-Athlete of the Year award. He currently trains with and competes for the Guelph Wrestling Club and National Team. Over the years, Kevin has worked with a range of individuals, from those looking to improve their overall health, to rugby player, football players, swimmers, professional fighters, wrestlers, endurance athletes and more.