Referred Shoulder Pain

I've talked about shoulder pain and rehabilitation in the past, click here, but why does it seem the location of shoulder pain is erratic? I've had a few high level coaches tell me treating shoulder pain is nearly impossible, since the pain can jump around, described as unpredictable. Whether you've had pain in the front, side, or back of your shoulder, it has likely slowed your swimming. This variability is due to trigger points of muscles. Each muscle has a common referral pattern.  This article will address this topic and uncover common areas of shoulder pain, potential cause and treatment.

Referral pain and trigger point

Muscle tightness may refer pain to a variety of locations. For example, the heart, which is a muscle, can tighten up and refer pain all over the body. This incident, known as a heart attack most notably refers pain down the left arm. The muscles of the shoulder are no different. Some of the muscles' referral patterns make sense, as many of them refer directly to the location of the muscle, but other muscles are different. In fact, the anterior neck muscles often refer to the head, commonly entitled tension headaches. Dr. Janet Travell extensively studied referral patterns and trigger points and described them as a
hyperirritable locus within a taut band of skeletal muscle, located in the muscular tissue and/or its associated fascia. The spot is painful on compression and can evoke characteristic referred pain and autonomic phenomena.”
These hyperirritable loci are commonly caused by an increase in muscle tension, causing tightness and symptoms (Travell, 1983).

Common Shoulder Trigger Points
Obviously swimming puts high levels of stress on the shoulder. This degree of stress causes many muscles to fire. As expected, fatigue can cause improper muscle firing, which leads to soreness. Soreness can lead to compensations, which overwork certain muscles, often times termed phasic muscles. The most commonly overworked shoulder muscles include:
  • Upper Trapezius- Trigger points are believed to occur from excessive elevation of the shoulder girdle. Trigger points can occur on the lateral neck or superior to the shoulder blade. The upper trapezius can refer pain to the bottom of the skull or anywhere along this large muscle.
  • Levator Scapulae- Trigger points often occur due to sustained elevation of the shoulders, causing excessive activation. The common trigger points are on the superior medial border of the scapula, along the muscle belly. This muscle can refer down the bottom of the shoulder blade or to the posterior deltoid.
  • Pectoralis Minor - Common trigger points are noted on the front of the shoulder and referred pain is typically seen on the anterior deltoid or down the inside of the arm. This muscle can become overworked from sustained anteriorly rolled shoulders and poor posture, a typical swimmer's posture.
  • Subscapularis - The subscapularis typically has trigger points on the muscle belly, but it refers pain to multiple locations: posterior and middle deltoid as well as the wrist and shoulder blade.
  • Infraspinatus - Common referral pattern down the front and back (around the deltoid tuberosity) of the arm, and trigger points are along the muscle belly.
  • Supraspinatus - Refers to the middle deltoid, with trigger points on the lateral aspect of the muscle belly.
These are the main muscles overworked, but the other rotator cuff muscles (supraspinatus and infraspinatus) can become injured from repetitive swimming. The supraspinatus is the the most commonly injured muscle in swimming and typically refers pain to the midtdle deltoid. The infraspinatus has a referral pattern down the front and back of the arm and trigger points along the muscle belly.

Conclusion

This dense article hopes to ensure swim coaches muscle tightness and improper firing can be from hypertonic (tight) muscles. These tight muscles can cause trigger points, referral patters and inhibit other muscles. These three items can disrupt biomechanics at the shoulder (possibly other regions) and impede swimming. If these problems are noted in a swimmer, light stretching can help, but soft tissue must be performed to completely relax the muscle and improve muscle length for proper muscle activation. Order the Swimmer's Shoulder System to learn the top methods for prevention, but this is only advised as prehabilitation and asymptomatic people. If pain is present, see a health care professional and stop the symptoms before the symptoms progress.

References
  1. Travell, J. Simons, D. Myofascial Pain and Dysfunction The Trigger Point Manual. Williams and Wilkins 1983.
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.

Lats on Lats on Lats

Lean wit it Rock (or Roll) wit it
Backstroke is a unique stroke. Despite the obvious difference in orientation, backstroke is more than freestyle on the back. Elite backstroke swimmers have two typical stroke styles discussed eloquently by Russ Payne on backstroke: rocking or rolling. These vastly different styles differ by the degree or rotation and/or depth of the catch. These variables must fit the athlete's body type and muscle fiber preference forcing individualization and analysis for each swimmer. However, one constant aspect of backstroke independent of the swimmer's anthropometrics is the muscle used during the catch, the latissimus dorsi (lats).
The lats contract during in each stroke of each style of swimming. This is why swimmers have large backs. Line up ten elite swimmers and the ratio of shoulder width to hip width is huge, much larger than "regular Joe's" or even other athletes. This large ratio this is due to the size the lats altering the upper body to a 'V'. No studies have analyzed the activity of the lats during each stroke or the phase of each stroke, but from my experience and humble opinion the lats are used more in backstroke than any other style. This article will discuss the lats and the resultant kinetic chain movement in backstroke if used properly, like the elite backstrokers.

Lats on Lats on Lats
The lats stretch over the entire backside of the body attaching from the sacrum and thoracolumbar fasica  to the inside of the humerus (upper arm) on both arms. This width of the lats resulted in its name, meaning broadest in Latin. The lats control shoulder extension, adduction and internal rotation.
Via Grant's Atlas of Anatomy
The lats also cause side bending of the body via the attachment to the sacrum.

Due to the high activity of the lats in swimming the lats are often tight. Unfortunately, tight lats have been shown to cause shoulder and low back pain (Arnheim 2007).

"Because the latissimus dorsi connects the spine to the humerus, tightness in this muscle can manifest as either sub-optimal glenohumeral joint (shoulder) function which leads to chronic pain or tendinitis in the tendinous fasciae connecting the latissimus dorsi to the thoracic and lumbar spine (Francis 1999)."

This information suggests lat stretching is necessary to improve lat length and decrease injury. I do feel lat stretching is beneficial, but in backstrokers, performing lat stretching until the cows come home is unnecessary. However, I feel lat length (at least in backstrokers) must be used during backstroke to prevent injuries and optimize reach, setting up the wiggle hips.

Wiggle Hips
I'm going to use Aaron Peirsol for this demonstration, but any elite backstroker will work. Until underwater swimming videos became readily available, everyone assumed backstroke moved in a straight line rotating forwards. This misconception was taught to numerous children and is still taught on many pool decks. Unfortunately, we have taught swimmers wrong for years, as the top backstrokers wiggle their hips side to side like they are shimmying to the Macarena.



I have yet to hear a reasonable explanation for this wiggle, but I'm making a case for the lats. As stated, the lats cause shoulder extension, adduction and internal rotation as well as side bending (aka lateral flexion) at the thoracic and lumbar spine via their attachment to the thoracolumbar fasica and sacrum. This side bending will connect one whole side of the body and bring the shoulder and hip together. Approximation of the shoulder and hips on one side will cause the spine to move from a straight line to a 'C'. This 'C' shortens the side of the pulling arm causing the hips to move lateral. This occurs on one side then the other, appearing as a wiggle.

The other side of the coin
If one side shortens the other will elongate and lengthen. Therefore, shortening on one side induces lengthening on the other side. Not only will this cause a longer, optimal reach, but will act as dynamic mobility lengthening the lats hopefully decreasing rate of shoulder and low back pain in backstrokers.
As you side bend left, the right shoulder elevates
Head Steady 
As with all stroke adjustments, the wiggle will be awkward. However, this move may be more awkward and complex than other stroke corrections as it requires self-correcting of the head to keep the head still. For example, if the spine from the thorax to the sacrum side bends to the right, then the head will follow unless it is corrected. The head must side bent left to resist this motion to keep the head still. Remember the head is piercing water before the rest of the body and for the body to enter through one whole it must be stable via self-correcting!

Wrap-up
Realize there are different types of backstroke in elite swimmers. However, the main muscle involved in pulling is the same whether you rock or roll. Make sure you're connecting your head during this strong whole sided catch to ensure the head is stable and leading the way to time improvements.

References
  1. Arnheim, D.D., Prentice, W.E., Principles of athletic training. 9th ed. McGraw Hill, pp 570-574, 1997.
  2. Francis, P., Applied anatomy and kinesiology, supplemental materials. KB Books., p 19-25, 1999.
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 founder of Mullen Physical Therapy, the Center of Optimal Restoration, head strength coach at Santa Clara Swim Club, creator of the Swimmer's Shoulder System, and chief editor of the Swimming Science Research Review.

Friday Interview with Jeff Commings

1) Please introduce yourself to the readers (how you started in swimming,education, experience, etc.).
My name is Jeff Commings and I've been swimming for more than 30 years. I started when I was 4 as a way to have something to do at a boys' club in St. Louis. I graduated from the University of Texas with a degree in journalism and numerous All-America accolades. I was a part of the USA Swimming national team from 1989 to 1994, won a bronze medal in the 100 breaststroke at the 1991 Pan American Games and competed in the 1992 and 1996 Olympic Trials. (He forgot to mention he is the author of Odd Man Out).


2) Anyone on Swimming World has seen your practices, but what is your current training schedule and how did you decide on frequency/intensity?
I swim five days a week, usually taking off Saturday and Monday. My days off are just that -- no exercise! In my younger days, it was OK to swim six days a week at high intensity, with a day of rest. But now that I'm in my 30s, my body needs time to recover. I try to have one day each week focus on aerobic work in the pool, but that depends on the phase I'm in each season. Intensity also depends on the phase of the season. The first part of the season focuses on maintaining the aerobic base, with focus on technique and endurance. Most sets are at a fast pace with little rest. About eight or nine weeks from the taper meet, I do workouts that focus heavily on race pace training. That's doing repeats of fast swims of usually no more than 100 yards/meters at all-out speed, with rest at least twice as long as the fast swims.


3) How do you incorporate mobility and stretching into your training?
I stretch quite often, but I used to scoff at people who thought it was a vital part of being a good swimmer. The irony is that I have very inflexible ankles -- at least when it comes to flutter and dolphin kick. It also hurts my breaststroke kick, since my ankle flexion isn't very good at the end of the kick. Maybe that's genetic, but it could have been improved if I had realized that I could increase ankle flexibility as I was growing into my body. There was a guy on my college team that used to stretch 20 minutes or more after every workout. We laughed at him. Now, I would love to have the time for 20 minutes of stretching. It would help with the knots I get in my back and legs every day! Right now, I try my best to stretch for five minutes after swimming and about that much after dryland workouts. I always do some dynamic stretching before diving into the pool, and do a little more after about 500 yards.


4)What is the weirdest training you've done throughout your career?
After more than 30 years in the sport, you would think I would have an answer for this, but I don't! None of my coaches thought so far out of the box that I thought anything they gave me was weird. In college, we used to do a 400 fly for time every six weeks or so, but that wasn't weird. When I lived at the Olympic Training Center, I had to do a 2000-meter breaststroke for time once a month, to gauge my progress. It was agonizing, but not weird, because everyone does those.


5) What aspects of your swimming are you currently concentrating on?
As an "older" swimmer, I know I can't really get stronger, so I'm working on getting faster, or staying as fast as I am now, through technique improvement. I have been aided in this by Takahisa "Tako" Ide, an assistant coach at Phoenix Swim Club who has taught me a lot about streamlining on starts and turns and how to get the most out of my pull and kick with the same effort. I'm currently working on a suggestion he gave me for the finish of my kick. It's a little difficult to explain, but it involves not kicking back, but down and back. He uses Kosuke Kitajima as a model every time.


6) What drills/activities are you doing to achieve this?
Lots of breaststroke kick drills, which is basically an extra kick at the end of each stroke. I'm working on hand pitch on my pull, and that involves lots of sculling, and I really find it useful.


7) In your opinion, what was the biggest adjustment you made in your swimming career (stroke biomechanical, training, dryland)? Has there been any particular changes secondary to age?
When I started Masters, I had a few nasty habits in my backstroke. I managed to get rid of my head movement while in college, but I still had a severe scissors/breaststroke kick that I resolved to fix in January 2002, one of many New Year's resolutions that year. I put on fins every time I swam backstroke for three months, which got rid of the urge to kick breaststroke. By June, I had evolved from full-on breaststroke kick to a three-beat flutter kick with a little scissor kick thrown in. In November 2002, I broke 1:00 in the 100-meter backstroke for the first time in my life! I credit a lot of it to the improved kick.


Besides the stuff Tako is teaching me, all my strokes have pretty much stayed the same as I got older.


8) Of all the testing sports performance testing you've done (underwater filming, blood lactate, etc.), what do you feel has been the most beneficial?
Underwater filming is extremely underrated. Your coach may be looking at your stroke and might see something, but he's not always at the right angle to see if your hand pitch is right or if you have a good underwater streamline. Likewise, you might feel like your stroke is correct, but I've always seen differently when I look at myself underwater. Last February, Tako filmed me underwater doing a 100 breast at an in-season meet. I was appalled at what I saw, but encouraged when I knew how to fix the flaws. Before then, I thought my stroke was fine, and that's because after many years, I had grown used to the flaws.


When I was training at the Olympic Training Center, I did every kind of test under the sun. Most of the results meant little to me, except for the simple thing of turning on the camera and following me down the pool.


9) You've been swimming for a while, what do you feel is the most important criteria for a life long love of swimming?
You mentioned the key word in your question: love. You have to love this sport, even when you don't perform as well as you want. I love to compete, and no matter the outcome, I usually walk away from the race feeling good that I did my best to race the guy next to me. I didn't have that love of the sport from age 20 to 26, and my swimming suffered dramatically. Masters swimming helped me rediscover how much I love swimming, and a lot of that comes from realizing that getting second place -- or fourth place or eighth place -- isn't the end of the world. Sometimes improvement doesn't come from working harder in the pool or fixing your stroke; it happens in the mind! I discovered that as I started making the goal of qualifying for the 2012 Olympic Trials.


10) What projects are you working on in and outside the pool?
Every day is a possible story to tell in the second edition of my autobiography, "Odd Man Out," though the second edition is many years away! I'm enjoying all the positive responses I'm getting from the first edition, which was published last year, and loving the fact that people are reading between the lines of my life and finding their own lives reflected back at them.


Thanks Jeff

Friday Interview with Felicia Lee

1) Please introduce yourself to the readers (how you started in swimming,education, experience, etc.).
My name is Felicia Lee and I’m 19 years old. I’ve been swimming since I was about three, starting in the water just to learn safety and then when I was four, I joined my first swim team because my brother did. I’m originally from Wayne, New Jersey but when I was 12 I relocated to Baltimore, Maryland to swim for the prestigious North Baltimore Aquatic Club in order to get faster. Since then, I’ve had the opportunity to compete internationally with the National Junior Team and the National Team, which I have been a member of since 2009. Currently I attend and compete for Stanford University.


2) What is your current training schedule?
A typical training schedule during the season would be swimming every day from 3:30-5:30 p.m. Monday thru Friday. Monday/Wednesday/Friday’s we also have morning practice from 6-8 a.m. and on Saturday we swim from 8-10 a.m. In addition to the pool workouts we have dryland/weights Monday to Friday from 2:30 p.m. -3:30 p.m.


3) How do you incorporate mobility and stretching into your training?
Before we start our dryland/weight workouts we also do a stretching routine to get the muscles ready for whatever might be in store for us. On my own, I like to stretch my hip flexors and quads a lot because they tend to get tight and sore the easiest.


4) What aspects of your back and fly are you currently concentrating on?
I think the most important aspect I am focusing on is utilizing and maximizing my potential in underwater kicking. I tend to not use this skill of the walls very efficiently, so this season I’ve been making a point to focus on it. This works for both fly and back.


5) What drills/activities are you doing to achieve this?
Recently Lea Maurer (my coach) has extended a stretch cord around the half way point of the pool…the goal of the game is to kick under the cord off of each walls. This gets especially tough as we increase in distance (usually starting at 50’s and moving our way up the 200’s).


6) In your opinion, what was the biggest adjustment you made in your swimming career (stroke biomechanical, training, dryland)?
In my swimming career, my biggest adjustment came from moving to Baltimore from my hometown of Wayne. Training with North Baltimore Aquatic Club was unlike anything I’ve ever experienced…..before moving I was only training about three to four times a week (as other days of the week would be taking up by practicing other sports) and then when I moved to Baltimore I expanded to five days. I also used to average only about 3,000 yards before moving, and that number definitely increased in Baltimore. It was a period of adjusting to being solely focused on swimming, having the mentality to push through workouts that were unlike anything I’ve ever done before, and an adjustment also on the social aspect as I moved because of swimming, so I had to make new friends and learn how to live without seeing my family everyday.


But in other terms, another huge adjustment would have been my last year of swimming at North Baltimore, so my senior year in high school. It was the year we added weights to our program and the initial shock on my body from it was almost unbearable. Being sore for an extended amount of days was really uncomfortable, and it took me longer than some of my teammates to get adjusted to handling weights and swimming. But throughout the year, it payoff was unreal, I have never felt so strong in the water.


7) Of all the testing sports performance testing you've done (underwater filming, blood lactate, etc.), what do you feel has been the most beneficial?
I like all the above that you mentioned. I’m a bit fan of the doing lactate sets (for example: 6x100’s best stroke/all out/on 10 minutes) and taking blood lactate afterwards. I did this a lot my senior year of high school and after you do the set and get your lactate a few times (say you do the set 8 times throughout the year at various points of training), it’s amazing to see the improvement your body has made to buffer lactate in your system. Aside from that, I think filming is also an important aspect to swimming because it really allows you to see where your technique needs the most improvement. Technique is such a little thing, but so important that can help drop a ton of time, and this can been seen with filming because you can analyze your stroke in slow motion, what ever angle (underwater or above water), and multiple times.


8) Over the past few years, what is the biggest change you've made with your training?
I feel like every time I change coaches, I’m making a big change in my training because each one brings something new to the table, a new perspective, a new philosophy, but all with the same end goal: of making me reach my full potential. I’ve learned so much from the coaches I had: from Paul Yetter to Bob Bowman, to now Lea Maurer and I’m grateful for the knowledge and advice they have given me.


9) What projects are you working on in and outside the pool?
In the pool, the project is always the same: figure out how to get better, stronger, and faster. Outside of the pool….another story, there are so many different and wonderful opportunities available at Stanford, so I’m always working on something new.


Thanks Felicia, Good Luck this Season

Flip Turn Flaws


I'm a simple man with simple pleasures. I'm also a stickler on a few points:
  • People who don't turn off their phone in movies. Easiest thing in the world, vibrate or silent (preferably silent, but I've given up on this request and will accept vibrate). I mean you're not that important no one is, trust me I've worked all kinds of egomaniacs and each one is as much a loser as the next.
  • People who don't honk at others when they are slowing traffic. Come on! Everyone needs a quick honk from time to time to get moving, whether the person is shaving, texting or beating their children they may need a honk to refocus.
  • Grocery stores that don't open the self check-out, I mean what is it doing there? Four lines operated by one overseeing clerk is light years faster than one line period, open up the self check-out! Quit wasting everyone's life!
Why isn't anyone using this!
Get me on a pool deck or in a weight room and this list will exponentially grow. I'll save you the infinite list, but I'm going to pound one home...flip turns. No matter the skill level, if I step on deck at a Master's, age group or elite swimmer work out I always see improper, lazy flip turns.
If you're serious about improving your swimming, then I suggest getting to know the flip turn. Flip turns are the easiest way to improve your swimming times with minimal effort or skills.

Proper flip turns set apart elite swimmers from pretenders. I mean you can get away with sloppy turns, but you'll never be elite unless you fix them. Once you get to a certain level, you either accept this fact or your don't get any better, because no one can compete with the best when they lose a second on each turn (this goes for LCM, SCY and SCM).

I mean if you're not doing flip turns correctly, what are you doing? Flip turns are the easiest part of swimming and if you don't utilize them you're either hard headed or so unathletic you should grab a baton and try out for color guard.


Turn like an Athlete
Lucky for swimmers, not everyone does the sport. For example, everyone up to a certain age plays soccer or shoots a basketball, therefore being an elite soccer or basketball player requires the whole package (as far as athleticism). Don't take this the wrong way, but some of the top swimmers are not pure, blood thirsty, ACTN-3 double allele containing athletes. This is a great thing and allows the determined, hard workers to become great even without natural ability. However, this is a common excuse for sloppy turns.



In my opinion, one's ability to do a flip turn directly correlates with one's athleticism. It isn't the end-all, be-all, but it's a simple indicator of true athleticism. Flip turns are a complex motion, requiring multiple joint movements in every plane to function in synchronous rhythm, sounds so eloquent! The flip turn utilizes a flip, pseudo-squat and a full 180 degree of rotation. All functions every swimmer has to perform, unfortunately every athlete does not have these tools.



Tools for Improvement
Before I get into proper form, it is mandatory to have the proper tools to perform one correctly. The body is similar to a ship; unfortunately society's ship is made of gum, glue, toe nails and straw. We need to start building a stronger ship, tackling waves throughout life. The main aspects of this ship are proper length, strength and timing. To perform a proper turn, these three categories are mandatory. Before I discus the meat and potatoes of a proper turn, I'm going to talk about the issues that tend to pop up repeatedly with athletes I work with. A proper turn requires the following:

  1. Core strength
  2. Hip Mobility
  3. Ankle Mobility
  4. Hip Strength
  5. Thoracic Mobility
These are the mandatory movements for a proper turn. Here are some tips to improve and warm-up these areas prior to swimming.


Core Strength: Flip turns requires a full somersault and trunk flexion followed by rapid trunk extension. This requires core stability in combination with concentric and eccentric control. I recently discussed spinal flexion in great detail and Tad Sayce has discussed core strength in great detail. In my opinion, spinal flexion exercises with proper form and dosing are appropriate for swimmers.


A weak core is seen when swimmers go into a turn and they do not have the strength to accelerate into the wall. At first thought, it seems the athlete has poor range of motion since they do not fully tuck. But after further analysis, it is clear they have poor stability since many have full flexion range of motion outside of the pool. If an athlete does not have trunk stability, then they will not go into full range of motion as they are unstable.
Often times having an athlete engage in core exercises before swimming, will help them activate and control the motion. For this reason I have my athletes use 100% stabilization with the March II exercise for 5 repetitions prior to swimming to activate the muscles.
March II 

To improve strength of spinal flexion, my favorite exercise is the the eccentric bosu curl-up. This forces proper control and strength needed for flip turns.
Ecc Bosu Ball



Hip Mobility: The most common inhibitor of proper flip turns in Master's swimmers is poor hip flexion. However, age group swimmers are starting to show limitations in this range due to their bent over, World of Warcraft lifestyle. Hip flexion is often inhibited by numerous structures from tight hip extensors (glutes and hamstrings) to tight adductors or lacking hip internal rotation. Breaststrokers often have adequate hip internal rotation, unfortunately many swimmers cannot do breaststroke, likely due to poor internal rotation mobility.


Two drills to improve hip internal rotation are:
Lying hip IR/ER

Skiers



Another muscle we look at is the adductors. This tight muscle group can hold your legs together, preventing hip flexion and extension. This area can be enhanced with manual therapy or....
Spiderman Mobility



There are two groups of adductor, short and long adductors. To adequately stretch the long adductors, the knees need to be bent.
Kneeling Adductor Circles



The most important aspect of hip mobility is improving range of motion of the hip flexors. Once again, there are long and short hip flexors and both structures need to be mobile.
Kneeling Hip Flexor

Standing Psoas



Ankle Mobility: When a swimmer lands on the wall, their ankles rapidly approach 90 degree. After landing, the ankle rapidly pushes off and points into plantar flexion. Unfortunately, many triathletes cannot find proper mobility from being stuck in excessive dorsiflexion their whole life on a bike. Standing calf stretch with towel under their arch prevents pronation and forces proper mobility. Perform this mobility with the back leg straight and bent to focus on the gastrocnemius and soleus.
Ankle Dynamic Mobility



Glute Strength: Proper glute strength is a component of proper flip turns, unfortunately the swimming community is assless. Assless syndrome is beneficial for decreasing Eddy currents, but it can greatly impede an athlete's ability to explode off the wall! My favourite glute activation exercises:
Super Dog



Prone Alternating Arm and Leg



Thoracic Mobility: Thoracic mobility is essential for many proper functioning structures; however, it is quintessential in the flip turn since an athlete goes from rapid flexion to extension and rotation.


Having poor thoracic mobility will inhibit extension as the athlete pushes off the wall, preventing proper streamline.
Foam Roll Mobility



Wrap-up
These are some tools to improve your ship to be able to handle a proper turn, next week we will hit the biomechanics of the turn, get to work on these in the mean time.



By Dr. G. John Mullen, DPT, CSCS. He is the founder of the Center of Optimal Restoration and head strength coach at Santa Clara Swim Club.

Dryland Mistakes: Spinal Flexion

This series will delve into the most common exercises used in swimming dryland programs. Each week I will discuss why they are performed, why they shouldn't be performed or how they are being performed incorrectly, then options for improvement.

Step away from the oven, this hotly debated topic can be felt from Santa Clara, CA to Dubai. This debate isn't exclusive to swimmers, but ranges from strength and conditioning to allied health care professionals. It's hard to believe a body weight (mostly) exercise with minimum range of motion can be such a cause for concern. 

The wake of this debate started when research was released correlating the problems associated with repeated spinal flexion. These studies were done on cadaveric porcine (pig) spines and resulted in disc herniations and the association between spinal flexion and disc herniations began. This early research was performed by Dr. Stuart McGill and lead the way for anti-crunch cults and activist for the New Rules of Lifting have become dominant. These activists have transformed popular belief and have recently made crunches seem more terminal than pancreatic cancer. While this simple association seems appropriate, is the topic of crunches this cut and dry or are crunches/sit-ups getting a bad wrap?  

This confusion has led to a cloud of confusion and exacerbation of the inverse knowledge theory, the more theories, the less is known about the subject. Don't worry this comprehensive look at crunches and spinal flexion will tackle the 300-lb obese coach in the room and cut the fat to looking at the bare bone essentials when it comes to crunches/sit-ups regarding proper form, integration into programming and methods for improvement.

Ecclesial Teaching

All professions have leaders and followers, coaching is no different. These leaders are often highly vocal and persuasive, passing on their ideas and views on various subjects. The followers are excellent at integrating systems and passing on information. Unfortunately, the leaders can be too confident and/or wrong and the followers can be too passive and gullible.

This logic does not simply lie on crunches, but even coaching and training philosophies. Often times, coaches continue to perform training programs which they have seen work for a few athletes, but who is to say these athletes will not improve with any program they believe in. The mind is a powerful tool and if athletes believe in what they are doing and they are talented they will succeed if the program is at least 50% (pulled this out of the air, but I feel at least 50%) at par with the best thing for them. Another consideration is that there are multiple "perfect training programs" for athletes. Unfortunately, this idea is often shot down like Cullen Jones at the end of a LCM 200 fly as all coaches believe their program is superior to all others.

This current mind set is the opposite of scientific reasoning and will continue to impede progress in the sport. An open mind to all theories and belief must be considered, then after all the considerations a proper approach and attack must be applied, then reflected.

After looking at the research, it appears (like many things), a considerable amount of spinal flexion exercises can be beneficial in your dryland training programs. Unfortunately, most coaches are either in the "crunch instead of brunch" or in the "death crunch" camp.

Research Reproductions

Unfortunately, research and abstracts can be misleading and used to support certain approaches without fully showing a complete consensus.

In the porcine studies noted earlier there were numerous "claims" made by researchers and readers of the papers. The most glaring is this study wasn't directly performed on humans, ...here are some of the questions regarding these studies:
  • Improper Regimen: This study did not mimic typical crunching regimens performed by coaches or general population. This study used repeated lumbar flexion for approximately 1,000 straight movements.
  • No Muscles or Disc? The pigs were also stripped off their muscle and the discs were not functioning properly due to dehydration. Unlike theses pig, most of us (synchronized swimmers may be an exception) have muscle to help protect the spine. Moreover, we have disc filled with fluid allowing pressure to change due to the center of pressure. For example, if we crunch forward, the fluid moves backward. If we lean back, the fluid moves forward. These are generalizations, but fluid movement does occur and help distribute pressure.
  • Spine Size: These models have much shorter spines, changing pressure distributions.
  • Proper Form: If done properly (we'll go over this later), the crunch should exhibit minimum to no movement in the lumbar spine. In fact, all the motion should occur in the thoracic spine with the lumbar spine stable. This stability is essential for all athletes, especially for those who athletes who can do an elevated split while feeling a mild stretch in the adductors...mild, flexibility and instability are close cousins, make sure your athletes have proper stability to match their mobility!
What's Good

As a Doctor of Physical Therapy, I only hear colleagues discuss the problems and potential harm of crunches/sit-ups. We are turning into a group of hypochondriacs and I wouldn't be surprised to go to a clinic and see the whole place covered in bubble wrap. Let's not kid ourselves therapist, benefits can occur from spinal flexion especially in athletics when performed properly.

Improved Nutrition Distribution: A crunch will move disc fluid. This fluid will move all over, but if basic physics prevail, the fluid should move towards posterior.

Rectus Abdominal Hypertrophy: Simply put crunches will build rectus abdominus hypertrophy, allowing the body to handle more stresses and adapt to aberrant movements. This improvement in muscle mass is mainly due to the eccentric phase of the exercise, making this superior to the isometric abdominal exercises which lead to less hypertrophy.

Athletic Performance: Believe it or not, crunches will enhance athletic performance. Spinal flexion is common during athletics. The recuts abdominus is the main spinal flexor and spinal flexion is used repeatedly in swimming, think as obviously as flip turns and as broadly as butterfly kicking.

Magical Number?
The piggy models have an finite number of spinal flexion movements before discs herniated and chaos ensued. Despite the aforementioned "problems" with their study, many health care professionals, personal trainers and coaches don't prescribe the crunch secondary to this mythical number. However, there are many professional athletes who have disproved to this issue. Many elite, professional and Olympic athletes have performed millions of crunches throughout their life and not all of these athletes exhibit low back pain. Are all of these persons outliers or do they perform proper technique? I don't think so.

Many of these professional athletes support crunches/sit-ups almost bragging about the volume they perform daily. Legendary football player Herschel Walker boosts the fact he performs 3,500 sit-ups daily!  This may be a bit extreme, but no one can deny is athletic prowess.

More Research Contraindicating Spinal Flexion
The three piggies study is not the only research paper looking at spinal flexion and spine health. Numerous studies have looked at this movement and hypothesized the risk/benefit of the movement. Search PubMed and you will find a plethora of articles, it took me 10 minutes to find 13 articles doubting the efficacy of crunches and not recommending the movement. 

More Problems

The finite number of flexion movements isn't the only case against crunches/sit-ups. Many people believe repeatedly performing this movement will lead to poor posture. Spinal flexion focuses on strengthening and hypertrophy to the rectus abdominus. This muscle runs from the ribs and sternum to the pelvis. If this muscle is over worked and tight, it will shorten and cause a rounded back (kyphosis)...at least this is the theory. Their theory is based on the idea of "adaptive shortening". Adaptive shortening is the process of holding a muscle being statically in one position for a long duration, causing a shortened muscle. Adaptive shortening is a physiological response to a statically shortened muscle where the sarcomeres become overlapped and shortened.

Unfortunately, adaptive shortening is a long process and based on people wearing slings and casts...a bit of a stretch (no pun intended) from crunches. Another flaw this theory assumes is that the rectus abdominus only shortens during spinal flexion, but . spinal flexion utilizes shortening and elongating (concentric and eccentric motions).

A more appropriate concern is that the idea of crunches may create a muscle imbalance and perpetuate/lead to injuries. This problem could arise if improper programming is performed and each athlete performs an infinite number of crunches (anyone have problems with the term infinite numbers, the SCSC Pro Swimmers had a lot of issues. Another popular subject is which precious metals would be most popular during a Zombie Apocalypse....what do you think?).

Another group of people feel that crunching leads to over working the chest, shoulder and neck muscles leading to improper breathing. This does occur, but once again it is due to poor programming and unqualified people running strength and conditioning programs. Also, thousands of case studies of athletes make the argument against this case.

Non-Functional

Alright, you've managed to read this far give yourself a nice butt tap, good work. Now you may be convinced that doing crunches won't perpetuate dysfunction and give you injuries, but are they functional, sport specific movement? Functionality with every exercise is the biggest and best fad in lifting. I admit, I use functional training, but not for everything! One must ask themselves, what is the desired output?  Once this is determined, then the appropriateness of functionality can be determined. I train multiple sprinters who need to work on force production. I'm not going to have them doing horizontal presses with 5 pound ankle weights. These athletes will be doing heavy, explosive lifts to increase growth hormone release and overall force production necessary to get their ass to the other end AS FAST AS POSSIBLE!!! Functionality has it's purpose, but don't be closed minded, if you are move to China I heard they need some more drones.

Proper Form

I mean, I've already been to numerous clinics where an unqualified volunteer or random homeless people fresh off of Skid Row are instructing "proper" exercise form to their clients. This runs rampant in personal training where those with genetically gifted bodies are yelling at stay at home wives to get their ass in gear to physical therapy/chiropractics where the patient is tossed over to an assistant or aide.

As stated, there should be no lumbar movement during the crunch; movement should derive from the thoracic spine. Therefore, the range of motion may be decreased, but the effort required will still be high. Cue the athlete to move the chest towards the sky, lifting their shoulder blades off the floor.


Progression

The dryland mistake I see during crunches is with proper form and sequence. Proper sequence must be achieved. Also, I feel the crunch should not be the beginner exercise, if done properly this should be a moderate to advance abdominal exercise. First and foremost, pure core stability with ZERO spinal movement must be achieved in all athletics. Once stability is achieved, then

then sport specific exercises (long and short axis) can be pursued, but not before stability is achieved!!





By Dr. G. John Mullen, DPT, CSCS. He is the founder of the Center of Optimal Restoration and head strength coach at Santa Clara Swim Club.

Thoracic Mobility and Body Undulation

Just about every aspect of swimming technique has evolved dramatically over the past few decades. One of the most significant changes has been the refinement of body undulation in the underwater kick and in the short axis strokes. The underwater dolphin kick has become such a weapon that we now have rules that limiting use.  Attend any elite NCAA competition and the winning team typically has better underwater kicking than the other team, especially at NCAA Championships where the 200 fly is now performed mostly underwater.  Fly and breast have both become more efficient and hydrodynamic thanks to the modern understanding of the body dolphin motion. 

One thing that stands out in watching the best swimmers in history is their ability to extend the thoracic spine (“press the chest down”) Thoracic spine extension not only sets up an effective catch, it also helps elevate the hips to drive the back half of the undulation. These combined movements help the swimmer take advantage of the undulation without having to dive deep beneath the surface.


Von Loebbeke (2009) used 3D computer imaging to analyze the underwater dolphin kick of Olympic swimmers and found two key points about humans’ ability to body dolphin: 
1) humans have less efficient body undulation than real dolphins (shocking!!!) 
2) undulation efficiency does not rely on any specific kinematic parameters but instead depends on the body movement as a whole. 

Unlike many studies that involve “moderately trained” subjects or “elite swimmers” with age-group level race times, the subjects included real elites such as Lenny Krazelburg and Gabrielle Rose. 

Limiting Factors
If the most efficient dolphin motion is the product of full body movements, the next question is “what prevents us from achieving the ideal?” One of the most common physical limitations inhibiting effective body undulation is thoracic immobility. There are two main reasons why this spinal segment is problematic for many swimmers. 

First, kyphosis (upper-crossed posture), afflicts not just swimmers but all humans, particularly those in mechanized western societies. Anyone who has difficulty extending the spine on land likely won’t fare much better when asked to coordinate the movement into a complete fly, breaststroke, or underwater dolphin kick. Many coaches understandably get frustrated when tried-and-true drills and technique cues don’t work, but they fail to recognize the underlying physical limitations affecting the swimmer. Limitations usually aren’t permanent (especially with younger swimmers), but we must recognize when they exist and how to fix them.

Secondly, propulsion and recovery in fly and breast involves shoulder internal rotation, scapular elevation, along with force production and stability from upper trapezius, levator scapulae, pectorals, and sternocleidomastoid (Deppler, 2002). Chronic activity and shortness in these muscles along with chronic internal shoulder rotation and scapular elevation are hallmarks of upper crossed posture…bad for thoracic extension and “pressing the chest down”, but essential for propulsion and recovery. Finding the correct balance is essential, stay tuned...
Getting it right in the in these strokes requires going from one extreme to another nearly instantaneously, which is why relatively few on the planet can do it well. The swimmer must initiate the catch with an extended T-spine (“push the chest down”) and then immediately begin the pull with a group of muscles that should have previously been relaxed. Although the arms are not involved the underwater dolphin kick for starts/turns, body undulation requires excellent T-spine flexion and extension. Most people get the flexion part…doing flexion AND extension gets much tougher! 

Wrap-up
In the next installment, we’ll address ways to identify thoracic mobility limitations and offer corrective strategies. Successful corrections both in and out of the water depend on our ability to appropriately classify the limitation to provide the most effective interventions.

References:
Von Loebbecke A, Mittal R, Fish F, Mark R. Propulsive efficiency of the underwater dolphin kick in humans. J Biomech Eng. 2009 May;131(5):054504.

Deppeler, D. Spine Pain in Swimmers: Possible Causes and Treatment Strategies. North American Institute of Orthoaedic Manual Therapy newsletter. Volume VII, Issue 2, 2002.

By Allan Phillips. Allan and his wife Katherine are heavily involved in the strength and conditioning community, for more information refer to Pike Athletics.

Swimmers vs. Body Builders

I'm going to share a secret with all of you...the best method to gain strength is to EAT. This means eating anything and everything. The bigger one is the more mass he can move. Eating more will increase your muscle cross sectional area, increase the amount of muscle cross-bridges and increase force production. Unfortunately, in swimming and many other sports, too much mass can yield high water resistance, this is why bodybuilder's aren't typically on the pool deck (Just because they wear Speedos, doesn't mean they can swim).
Many swimmers need to build relative strength. Relative strength is an athlete’s ability to produce a maximum amount of force for their size. As most of you know, I'm not a big guy, approximately 5 feet 10 inches in height and 160 pounds. I'll never forget the looks I received while working with NHL and NBA players when I lived in Los Angles. I know everyone wondered why these elite athletes were taking orders from a "scrawny" white kid who showed up suited and booted for training. I even know other personal trainers from various backgrounds look down on me for my size, but I strive for similar goals with my athletes -- relative strength.


Hell, head to the DMV and you will find many individuals which are bigger than me because they eat and get bigger (most likely have cardiovascular disease or type II diabetes, but that's erroneous in this case). However, you often times do not see a little guy performing immaculate feats of strength on a regular basis. Who doesn't remember Gil Stovall making the Olympics? This 5'8" Olympian would be passed by everyone, even swimmers with no acknowledgement of his athletic talent. At COR, we strive to achieve athletic greatness for athletes of all sizes, realizing the importance of being strong for a specific weight.


As a relative strength athlete and with this my focus, I have been fortunate enough to have an enlightened perspective on the nutritional and athletic needs for these types of athletes, without adding non-functional mass (however, this is mandatory in some instances).


Unfortunately, many strength coaches and personal trainers get into training to improve absolute strength. This leads to mass confusion about which forms of training are best for absolute strength athletes. I remember being in college and reluctant to training designed for athletes with an entirely different need, this happens far too often and is inhibiting elite athletes from reaching their swimming optimization. How many strength coaches know a lick about swimming? How can they design programs surrounding the needs of swimmers if their main goal is to get as big as possible or help a football player add 50 pounds on the offensive line....


To help debunk these absolute strength coaches and confused minds, I have put together a top five lie list associated with relative strength training. These principles have been practiced to help athletes break through plateaus in training and reach for the next level.


Lie Number 1: Weight Lifting will Put on Mass


This old adage will never die! This has plagued the swimming community as long as instructing swimmers to do an "S-Curved" catch (the S-curve is relative to body rotation, it doesn't need to be stressed...a topic for another day). Improving relative strength is essential and resistance training with various repetition training needs to be utilized to improve muscular imbalances, prevent injuries and optimize performance. This will be achieved with various rep ranges.


Some people feel performing low volume on every exercise with maximal load will not put on mass, others feel doing high repetitions with low load will not put on mass. These thoughts are both incorrect as one needs to implement variable loads. One wouldn't do 2 reps on a prevention exercise! Also, lifting heavy weights for a few repetitions help many athletes, since swimming requires different stressors.


Lie Number 2: Weight Change is All the Same


Many athletes eat terrible, simple carbohydrate and excessive diet soda, leading to extra blubber. Though it may be true whales utilize blubber to float, swimmers need to strive for improvements in body composition. Just a few days ago, I was on deck with one of my older swimmers and he joked that him and I had lower body fat percentage than the rest of the team and performed much less volume. I chalk this solely up to dietary alterations and being able to utilize high muscle mass to burn fat mass. Also, the blubber is probably not making you a better athlete (mile swimmers and open water athletes may benefit from a little extra blubber, but not as much as everyone thinks). I discussed body composition in an earlier post, discussing the confusion and ignorance of society and actual body fat percentage, this happens in the swim community as well.


Everyone claims to have approximately 3% body fat, but this is highly untrue and perpetuate from ignorant trainers at the gym. To have a true body fat percentage reading a DEXA scan is mandatory. If I had to estimate I'd say the majority of your male swimmers have approximately 12-15% body fat and your females are closer to 20%. I'm not trying to shatter your confidence, I'm being honest, we all have work to do on body composition. All male swimmers should be striving for 8-10% body fat and females between 13-17%. Not to puff my own chest, but I've always had an extremely lean and defined physique and the lowest I have ever been on the DEXA is 9%, so I doubt your male athletes are walking around with sub 5%!




Lie Number 3: Weight Lifting is Dangerous


A weight lifting program with proper instruction and monitoring is no more dangerous than hours in the pool, simply put. This is why swim coaches need to get their ass in gear and become familiar with proper lifting techniques or reach out to a qualified professional when necessary. I mean I don't mind working with swimmers and injuries, but it's sad to hear the horror stories of injuries which could have been easily prevented. While I'm ranting, how is the United States ranked 12th in the world for broadband connection speed...ridiculous!


Anyway, weight lifting should be a must for all athletes and especially swimmers. Swimmers have highly developed areas of their body (shoulder internal rotators, hip flexors, etc.) which can become more balanced outside of the pool in the weight room.


I'm also going to break a bit of bad news to all your high school and collegiate coaches, half of your female swimmers have a devastating, life altering disease which you can help reverse....Osteopenia (pre-osteoporosis). Everyone has heard of the older adults falling down, breaking their hip and dying soon in the hospital. If you are not using resistance training with your team, you might as well write them a prescription for Boniva in 2020 and tell them to work on their balance. If you think I'm over reacting, look an extract from a recent study:


"Study demonstrated more discouraging results as the collegiate female swimmers had lower bone mineral density (BMD) during the preseason by 10-15% compared to all other sports with the largest difference in the lower body, pelvis and spine mineral density. In fact, their total body BMD of 1.121 g/cm2 puts them more than two standard deviations from the mean for their age, indicating a risk for osteoporosis"


Put this on top of any eating disorders your females may have...help them by getting them in the weight room. Don't perpetuate the problem, help stop it in the tracks, remember as coaches we must improve our swimmers health in the present and future.


Lie Number 4: You Have to Starve Yourself


Some swimmers (mostly females...not to point fingers) have the misconception that strict dietary restrictions are necessary to prevent large mass gains. This is far from the truth, dangerous and impedes performance. Relative strength athletes' consumption is far more important than their absolute strength counterparts. If a swimmer does not eat adequately, their body will run on fumes and will be forced to use gluconeogenesis to form glucose (energy) by degrading amino acids. This outcome is disastrous for performance and health. Building lean body mass (muscle) is essential for optimal performance and maintaining correct fat mass. Lean body mass is the most metabolic form of mass in the body, this is why large muscle bound individuals can consume more calories, they need to feed the beast!


Instead of volume restrictions, nutrient timing and food selection are healthier and beneficial options. Some swimmers will not eat during workouts, to avoid putting on more mass. These swimmers also feel that workout drinks like Surge are a bad idea and lead to weight gain. This is far from the truth and I feel these skinny minnies need Surge and similar drinks more than their bigger counterparts. Small athletes can typically go for a while, and then they suddenly hit a wall. Sometimes an extra boost is needed to scale this wall, preventing increased levels in cortisol and skeletal muscle catabolism. These two physiological results are the reason why skinny jean guys feel like Muammar Gaddafi after a tough workout. Don't exercise on fumes, fuel the fire.




Being able to maintain a higher training frequency is essential for swimmers. No matter if your program is more yardage based like Gregg Troy or analytical like Dave Salo, frequency is the key for these athletes. Think about it, neural drive is a huge component in swimming; this is why a swimmer can miss only 1-2 days of swimming and feel like a wet noodle when they return to the pool. This is also why weak individuals on land can be so good in the water; they have the neural drive and "feel" for the water. Frequency is the key, no coach will deny this. Provide yourself with the tools to handle the frequency and recover.


Lie Number 5: Eccentrics/Negatives Build Mass


This statement does not apply to many swim coaches, because unfortunately many swim coaches do not know what eccentric means. Let’s break down the three phases of muscle contraction: concentric, isometric, and eccentric. To illustrate the differences lets use a bicep curl (you know curls for the girls!)
Curls + bluetooth=infinite girls

  • Concentric: This is the common action associated with muscle contraction. In the bicep curl, when you lift the weight towards your upper arm you are performing a concentric contraction.
  • Isometric: Isometric literally means zero movement. When you hold the weight at the top of your bicep curl you are performing an isometric hold
  • Eccentric: As you lower the weight, the muscle fibers are stretched and ripped apart. This highly damages the muscle and causes increased soreness (have you ever been sore 24-48 hours after performing an exercise, you are experiencing DOMS: Delayed Onset Muscle Soreness secondary to the eccentric phase of the motion).

Despite the belief of eccentrics or negatives making an athlete huge, these forms of movement can be beneficial in the following ways:
  1. Improve tendinopathies. If you've read any of my pieces, you will know that every athlete's body is messed up. Every swim team has swimmers with tendinopathies and labral tears left and right. Eccentric movements help strength and heal tendinopathies, specifically tendinosis.
  2. Improved connective tissue health. If you are performing longer eccentric exercises, then the time under tension (TUT) is increased. This is valuable in connective tissue health.
  3. Improve strength. Using supramaximal lifts can help an athlete gain confidence holding a weight. Moreover, it can help build tendon strength. This should be used sparingly, but must be used during specific phases of training.
Wrap-up


I hope this article cleared up some items about resistance training and swimming. There are many benefits for resistance training and swimming, if you don't perform resistance training you are behind the ball. However, make sure a proper individualized program is performed. Many swim coaches do not know the basics of resistance training, so you may have to look elsewhere for training (not a knock, many strength coaches don't know what they're doing either).


If you don't resistance train as you feel it will make you too big or you were told by your coach it won't help, it is time to start erasing the lies. Don't spread the lies any further, begin passing along the truth today!


References
  • Carbuhn A, Fernandez T, Bragg A, Green J, Crouse S. Sport and training influence bone and body composition in women collegiate athletes. J Strength Cond Res. Jul 2010;24(7):1710-1717.
  • Cressey, E. Relative Strength Myths. T Nation. 
  • Guadalupe-Grau A, Fuentes T, Guerra B, Calbet J. Exercise and bone mass in adults.Sports Med. 2009;39(6):439-468.
  • Hallström H, Melhus H, Glynn A, Lind L, Syvänen A, Michaëlsson K. Coffee consumption and CYP1A2 genotype in relation to bone mineral density of the proximal femur in elderly men and women: a cohort study. Nutr Metab (Lond).2010;7:12.
  • Mudd L, Fornetti W, Pivarnik J. Bone mineral density in collegiate female athletes: comparisons among sports. J Athl Train. 2007 Jul-Sep 2007;42(3):403-408.
  • Velez N, Zhang A, Stone B, Perera S, Miller M, Greenspan S. The effect of moderate impact exercise on skeletal integrity in master athletes. Osteoporos Int. Oct 2008;19(10):1457-1464.
By Dr. G. John Mullen, DPT, CSCS. He is the founder of the Center of Optimal Restoration and head strength coach at Santa Clara Swim Club.