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Blood-flow Reistance (BFR) Training Improves Elite Athletes

A lot of research suggests blood-flow resistance (BFR) training increases strength, hypertrophy, and testosterone. At Swim Sci, we first broke down this phenomenon in 2010 (Blood-Flow Resistance Training)!. Since then, a lot more research has been published, even research on swimmers (see Swimming Science Research Review)! We have also been fortunate to have interviews with experts on the subject (Friday Interview: Dr. Alan Mikesky, and soon Zach Pope). Now, the benefits discussed have mostly been found in elderly or non-athletic populations.

However, a recent study looked at BFR training in elite rugby players and note:
"[g]reater improvements were observed (occlusion training vs control) in bench press (5.4±2.6 vs 3.3±1.4kg), squat (7.8±2.1 vs 4.3±1.4kg), maximum sprint time (-0.03±0.03 vs -0.01±0.02s) and leg power (168±105 vs 68±50W). Greater exercise-induced salivary testosterone (Effect Size: 0.84 to 0.61) and cortisol responses (ES: 0.65 to 0.20) were observed following the occlusion intervention sessions compared to the non-occluded controls; however the acute cortisol increases were attenuated across the training block (Cook 2013)".

This study adds evidence of performing BFR for sports enhancement. Now, the applicability for swimming is uncertain, as these benefits may simply have occurred from an improvement in ground reaction force (GRF). However, the possibilities of BFR are swimming performance, as well as health parameters (potential increased hypertrophy and bone mineral density, both two necessities for the aging swimmer) exist.


Recently, I started a training blog (selfishly to help track my progress and motivate me as I strive for my swimming goals). In a recent post, I describe how I use BFR. This new form of training still has many uncertainties, so please consult a physician before use. Lastly, if you are interested on being on a remote swim team which includes monthly Skype discussions and daily written workouts, contact us for more information!

References


  1. Cook CJ, Kilduff LP, Beaven CM. Three Weeks of Occlusion Training Can Improve Strength and Power in Trained Athletes. Int J Sports Physiol Perform. 2013 Apr 23. [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. He is the founder of 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.

Packed Neck for Swimmers Part II



We’ll begin this second installment with neck assessments.  Lot to cover this week, so let’s get right into it!

Assessment
There are many available assessment tools, but any that you use should address mobility (length), stability (strength) and timing.

Mobility – Chin tuck to chest with mouth closed.  If the swimmer can’t touch the chin to chest, there is a mobility restriction.

Stability – Chin tuck.  Can you pack the neck when asked to do so?  You can also perform this exercise while supine on the ground or a table.  
Timing – Situp test.  Does the neck become unpacked during the situp?  You can use a unweighted version of Dr. Mullen’s Eccentric Bosu Situp pictured below to assess muscle timing of the neck.  The same move without a Bosu will also provide valuable information about neck firing patterns. 
Assessments are ongoing throughout training and allow us to organize swimmers into the right categories for optimal interventions.
  1. No limitations.  -> Go hard!
  2. Can pack when thinking about it, but loses neck packing during loaded or complex movement -> Cue packed neck in training.  Coach ‘em up.
  3. Almost there, but need more time -> More emphasis on corrective work.  If no improvement, then proceed into category 4 below
  4. Can’t do it at all -> May need manual therapy intervention.
Not Just the NeckI’ll reiterate last week’s theme that packing the neck is a full body concept.  Isolated neck training should not encompass a large portion of a dryland program. If it needs to, you’re probably dealing with a patient.  However, neck exercises deserve a place in dryland warmups and as complementary exercises in supersets. See, Freestyle Flaw: Bobble Head for sample neck exercises.  

In Part I we talked about the neck as feed forward mechanism, but it is also part of the body’s audit systems which are a feedback mechanism.   We have natural audits everywhere.  Lactate production is an audit on energy expenditure.  The stroke count per length variability is an audit for stroke efficiency.   Pain is an audit for threats and damage.  Audits simply provide information when something has disturbed homeostasis so we can make adjustments, whether consciously or unconsciously.

One explanation for the neck as an audit is the close link to respiration.  Apical breathing (chest breathing) involves heavy use of accessory breathing muscles, which include the upper trapezius, levator scapulae, and sternocleidomastoids, among others.  When reciprocal inhibition occurs within Janda’s postural syndromes, hyperactivity in the accessory breathing muscles may inhibit the deep neck flexors making it harder to pack the neck.

Recruitment of accessory breathing muscles and inhibition of the deep neck flexors accompanies poor use of the diaphragm.   Okoru (2011) found that oral breathers had worse cervical spine posture and decreased respiratory muscle strength than nasal breathers.   There are times when those accessory muscles is needed such as during extended periods of intense activity.  However, diaphragmatic breathing as a default setting spares the accessory breathing muscles.  As such, breathing can promote optimal recruitment of the deep neck flexors and allows the athlete to exploit the feed forward mechanisms offered via a packed neck.

A forward head position and unpacked neck will add stress elsewhere.  Sometimes the body adjusts and is asymptomatic, but often it does not.  Forward head position is also linked to upper extremity trigger points and headaches.   (Fernandez-de-las-Penas 2007, Hidalgo-Lozano-2011)  Pain affects neck flexor endurance (Harris, 2005), but improving endurance can help relieve pain (Falla 2006).  Manual therapy on the neck was also shown to improve grip strength in judo athletes (Botelho 2011).

An aside...
I’m going on a mini-tangent, but one indirectly related to the topic and directly related to the entire mission of this website.  A 2009 study (Wolf) from the American Journal of Sports Medicine looked at injury patterns in Division I swimming analyzing a single program from 2002-2007.  Notable findings:
  • 38% of swimmers suffered an injury outside of the water, which included both dryland and non-training incidents.
  • Freshmen were more likely injured than upperclassmen
That 38% number seemed a little high when I first read it, so I looked further and found another very similar study from more than ten years earlier (McFarland 1996). This study included only female collegiate swimmers.  Notable findings:
  • 44% suffered injuries in dryland training
  • ….and another 11% suffered injuries out of the pool! ( work hard…play hard?)
  • Most dryland injuries were from lower body training.  Pool injuries were upper body.
Here we have two studies over ten years apart with data showing the same thing: lots of swimmers are getting hurt outside the water during dryland training.   Whether improvement in upperclassmen injury rates resulted from freshmen adapting to the program or leaving altogether is unclear.

At the college level, we can’t necessarily implicate the coach for a high rate of dryland injuries, since the strength staff is likely the ones calling the shots in the weight room.   Because swimming is not a marquee sport like football or basketball (sad as that may be to admit), the senior strength staff and athletic training staff usually pick football and basketball for their assignments leaving swimming to a junior staff member covering several different sports.  Curiously though, the senior staff often finds a way to make time for the women’s volleyball team…and no, I’m not making that up.
Getting back on task!The whole reason for the aside was to reinforce the importance of attention to detail in exercise technique.   To have two studies in the research literature looking at college swimming both showing that close to half the team is injured in dryland is quite sad (and let’s face it, relatively speaking compared to other sports,  there aren’t that many studies out there looking at swimmers).   Attention to detail in such matters as neck posture may be the difference between an Olympic medal, NCAA Championship, or early retirement.

The discussion on front squats vs. back squats is a prime example of the intersection between safety and performance.  There’s a place for everything, including back squats, but if you can’t maintain cervical spine integrity or your predominant stroke flaws can be traced to a forward head position/unpacked neck…do we really want to reinforce this pattern with hundreds of pounds leaning on the back of the neck?  Just something to consider when weighing the costs and benefits of these options.  

This is not good…Pull ups are another area of the gym where we can groove the packed neck under a load.  Although I’m strict with form, I’m not going to “no-count” an otherwise legal pull up just because someone doesn’t have a perfectly packed neck over the top of the bar.  As a practical matter, some neck flexion and extension is permissible to avoid head-to-bar collisions.  However, an extended neck in the starting position often means a thoracic spine limitation, which may place the shoulder at risk. (See also Dr. Mullen’s inverted rows series for additional thoughts on proper execution of dryland pulling movements).
Packed neck = Good body position


Unpacked neck = Poor body positionWhen someone can’t pack the neck in an exercise like the pull up or an inverted row, the neck again functions as an audit and guides us into regressions, such as thoracic spine mobility work and the localized neck exercises referenced above.  Focusing on the neck will guide both our progressions and regressions for the program.  Consider the situp.  A basic situp or crunch may be easy for some to perform with a packed neck but difficult or impossible for others. 

Nice abs but weak coreSwimmers who can demonstrate a packed neck in a basic situp are candidates to move to advanced abdominal training (see Dr. Mullen’s Eccentric Bosu Situp article).  Someone who can’t do a situp with a pakced neck probably shouldn’t load the movement or do high repetitions.  Those who improve neck packing may find themselves able to progress more rapidly via improved recruitment patterns throughout the entire body.

The Eyes Have ItOne purpose of dryland training is to train fundamental movements to become automatic when applied in the swim stroke.   If a packed neck becomes natural, that’s one less cue to think about when we get in the water.  As a complement to packing the neck, we must also consider the eyes, which drive our head and neck movements.  The eyes don’t get much attention, but they are important as a gateway to the world for the brain.  If we change neck habits we must also change vision habits, though the reciprocal may also occur.  In other words, retraining the eyes may also help pack the neck and facilitate all the good things that come from a packed neck.

Open water swimmers and triathletes tend to have higher freestyle head positions, as the eyes’ range of motion is inadequate for sighting without help from the neck.   In the pool, “staring at the black line” is more than just a figurative term, as looking downward will complement the cue to pack the neck.  However, as noted in Part I, freestyle head position is a very individualized trait and should be addressed with care.  In short axis strokes, optimizing gaze angle when above the water can help facilitate neck packing.  Knowing and practicing where to look can prevent excess neck extension both in block starts and in backstroke starts.  The key is achieve compatibility between gaze cues, head position, neck position, and thoracic spine mobility

Summary
This concludes not only Part II of our examination of Packing the Neck but also our Elite Characteristics series.  Consider this conclusion temporary as we are sure to update this information as our understanding evolves over time during our constant quest for improvement.  Hopefully you got as much out of reading it as I did writing it.

References
  1. Falla DJull GHodges PVicenzino B.  An endurance-strength training regime is effective in reducing myoelectric manifestations of cervical flexor muscle fatigue in females with chronic neck pain.  Clin Neurophysiol. 2006 Apr;117(4):828-37. Epub 2006 Feb 21.
  2. Okuro RTMorcillo AMSakano ESchivinski CIRibeiro MÂRibeiro JDBraz J Otorhinolaryngol. Exercise capacity, respiratory mechanics and posture in mouth breathers. 2011 Oct;77(5):656-62.
  3. Hidalgo-Lozano AFernández-de-Las-Peñas CCalderón-Soto CDomingo-Camara AMadeleine PArroyo-Morales M. Elite swimmers with and without unilateral shoulder pain: mechanical hyperalgesia and active/latent muscle trigger points in neck-shoulder muscles. Scand J Med Sci Sports. 2011 May 12. doi: 10.1111/j.1600-0838.2011.01331.x. [Epub ahead of print]
  4. Harris KDHeer DMRoy TCSantos DMWhitman JMWainner RS. Reliability of a measurement of neck flexor muscle endurance.  Phys Ther. 2005 Dec;85(12):1349-55.
  5. Wolf BREbinger AELawler MPBritton CL.  Injury patterns in Division I collegiate swimming.  Am J Sports Med. 2009 Oct;37(10):2037-42. Epub 2009 Jul 24.
  6. McFarland EGWasik M.  Injuries in female collegiate swimmers due to swimming and cross training.  Clin J Sport Med. 1996 Jul;6(3):178-82.
  7. Botelho MBAndrade BB.  Effect of Cervical Spine Manipulative Therapy on Judo Athletes' Grip Strength.  J Manipulative Physiol Ther. 2011 Nov 10. [Epub ahead of print]
By Allan Phillips. Allan and his wife Katherine are heavily involved in the strength and conditioning community, for more information refer to Pike Athletics.

Packed Neck for Swimmers Part I

It is now the homestretch of our Elite Characteristics series! We’ve worked our way from the ankles, knees, hips, thoracic spine, shoulders, and will culminate with the neck. Specifically, we’ll address the concept of packed neck for swimmers, which is one of the leading developments in the strength and conditioning field. Many are familiar with packing the shoulder for scapular stability and packing the low back for lumbar stability. Packing the neck, though less familiar to most coaches and athletes, carries a high return on investment is one of the first places to look for repairing postural flaws and plugging power leaks.
Why is a packed neck important for swimmers?

1. Decreased frontal exposure. A head position too high or too low will increase drag by expanding the swimmer’s frontal profile.

2. Balance. Extending the neck and raising the head can cause the legs to sink, which also leads to poor hydrodynamics via increased drag.

3. Protect the cervical spine. The cervical spine is a commonly injured area among swimmers. In my observation, neck injuries are underreported because they frequently present as low grade aches that athletes try to ignore, or as problems elsewhere in the body such as jaw pain, chronic headaches, shoulder injuries, or referring nerve pain into the arms.

4. Muscle length, strength, and timing. Reciprocal inhibition/Janda’s upper and lower crossed syndromes. Dr. Vladimir Janda is credited with first observing the phenomenon of reciprocal inhibition and the related postural syndromes of the upper cross and lower cross. In reciprocal inhibition, the glutes, abs, serratus anerior, lower traps, and deep neck flexors are prone to inhibition or weakness. These are known as the phasic muscles. The tonic muscles such as hip flexors, low back extensors, pectorals, upper traps, and levator scapulae are prone to tightness or hyperactivity.

Point number 4 is our focus in this series. Considering the deep neck flexors within the phenomenon of reciprocal inhibition brings us full circle from previous weeks. The lower trapezius supports the shoulder girdle and allows for the ranges of motion achieved by elite swimmers. Abdominals help maintain a tight streamline, drive rotation in long axis strokes, create undulation in short axis, and allow for expression of power in starts and turns. Serratus anterior is essential for optimal breathing patterns and overall stability. The glutes drive posterior chain activation and are vital muscle group in Dr. Mullen’s ongoing quest to find a cure for Assless Swimmer Syndrome (Is poor posture slowing you down?)!

Inhibition of the deep neck flexors usually occurs not in isolation, but instead as part of an overall pattern. If the deep neck flexors are inhibited, the body must find stability in the neighboring muscles such as the upper traps, pecs, and levator scapulae. When these muscles are tight, the swimmer is at risk for a variety of shoulder injuries and stroke flaws. 

Human growth from infancy through adult bipedalism is contingent on sequential maturation and co-activation of the phasic muscles listed above. Inhibition in any of these muscles leads to compensations, which manifest as tightness or shortness in other muscle groups. Look again at that list above and the tight areas should look familiar as common problems in the swimming world…
  • Hip flexors (psoas) –> kicking flaws
  • Low back –> weak core, limited body undulation
  • Pectorals, upper traps, and levator scapulae –> shoulder mechanical flaws, thoracic spine mobility limitations
Deep neck flexors operate as a feed-forward mechanism to encourage optimal muscle timing (Falla 2004). A feed-forward mechanism is a neurological activation pattern resulting in activation or inhibition elsewhere without conscious thought. Another example of a feed-forward mechanism is taking a firm grip on an object to activate scapular stabilizers (See Dr. Mullen’s Dryland Mistake: Bench Press Part I and Part II for more on role of grip strength). It behooves us to exploit feed forward mechanisms to accelerate learning and promote automaticity of quality movement habits and stroke mechanics. 

Teaching an athlete proper neck mechanics who has never had neck stability can be a beautiful sight, much like Clark Griswold getting to experience the magic of his Christmas lights finally working! Many things fall into place elsewhere in the body independent of conscious thought.

The packed neck in swimming
Fly
Neck stability supports body undulation, although the neck does not remain packed during the entire stroke (we need to breathe at some point). The best butterflyers return the neck to a packed position and maintain cervical spine alignment when pressing the chest down. Weaker butterflyers extend the neck toward the bottom of the pool, which is an inefficient way to create undulation. 

Back
A packed neck keeps the body in proper alignment. During starts, many swimmers throw their entire head back and extend the neck. While some neck extension is permissible, too much can lead to poor timing and loss of power. Below, Natalie Coughlin shows that you can maintain a packed neck during the entire start cycle.

Breast
 A common breaststroke flaw is lifting the head to look forward. Packing the neck stabilizes the whole body for a strong pull and kick.

Packed neck
NOT a packed neck
Free 
Head position in freestyle can be a controversial topic. Some coaches want swimmers to stare directly at the bottom of the pool, which is more consistent with a packed neck. Others permit a higher head position and allow mild neck extension. While I’d be cautious to overhaul an idiosynchratic yet effective stroke grooved by millions of yards, improvements in neck stability can transfer to other areas of the body based on the feed-forward mechanisms of deep neck flexor stimulation. Even if a neck is not packed to the maximal extent, neck stability is important to keep the neck movements within a certain range. A higher head carriage is acceptable…head bobbing is not. 

Block starts 
Watch track and field athletes setting up and exploding out of the blocks: Head is down. Neck is packed. Remember that activation of the deep neck flexors is tied to activation of the glutes and relaxation of the hip flexors. As such, neck posture is critical to pre-load energy for release via triple extension of the ankles, knees, and hips when the gun goes off.
Conclusion
The packed neck for swimmers is not an absolute in the water, but is an underutilized power source. Stroke aficionados can undoubtedly find examples in each stroke of swimmers winning Olympic medals without packed necks. However, if you sample the averages of the fastest swimmers in the world, you’ll likely find high levels of neck stability specific to stroke demands. In the next installment, we’ll explore how to assess neck stability, how look to coach the packed neck on dryland, and how to transfer these concepts into the water.

References
  • Falla D, Rainoldi A, Merletti R, Jull G. Spatio-temporal evaluation of neck muscle activation during postural perturbations in healthy subjects. J Electromyogr Kinesiol. 2004 Aug;14(4):463-74.

Shoulder Internal Rotation for Swimmers: Part II

Last week in Part I, we discussed the importance of shoulder internal rotation and factors that may inhibit this movement. In Part II this week we’ll cover assessments and corrections for internal rotation deficits.


Assessment
Assessment is important to identify whether the swimmer is physically capable of performing specific tasks in the water. While there are many different styles to swim efficiently, the demands of creating optimal shoulder angles are exacting, particularly for the early vertical forearm Of all the dryland assessments, internal rotation is one of the most robust to predict movement limitation in the water. If you can’t create the angles for an early vertical forearm on land, you likely won’t find the angles in the pool.


Getting an accurate measurement of shoulder internal rotation can be tricky due to the ease of cheating. Subjects will often cheat, albeit unintentionally, by shifting the joint anteriorly and by destabilizing the scapula. Below Tony Gentilicore demonstrates an internal rotation test that includes scapular stabilization.
Stabilizing the shoulder is important not only for accurate measurement but also to for interrater reliability (Wilk 2009). A discerning eye can tell if a swimmer anteriorly rotates the shoulder joint, but such qualitative information is hard to communicate accurately to others. Select assessments help elite coaches, not only to identify weaknesses but also to track the progress of your interventions.


Length-Strength-Timing
Dr. Mullen’s Length-Strength-Timing triangle is helpful to identify training priorities for those with an internal rotation deficit. Rather than randomly picking exercises, let’s have a plan to address these specific areas of performance.


Length – Within the glenohumeral joint, shortness of the posterior rotator cuff has been linked to glenohumeral internal rotation deficits (Borich 2006). Also consider the surrounding tissue as well. Shortness of the pectorals, neck muscles, and upper trapezius can contribute to the postural dysfunctions we discussed in Part I.


Light stretching can be useful in this area, but be careful due to the delicate makeup of the rotator cuff. Just because you stretch the general area does not mean the muscles that you are trying to stretch will actually stretch. You may end up stretching the tissue that is already mobile into instability, while the tissue that needed stretching never actually stretched. Tightness may also be the body’s way to create stability.


When stretching the posterior side of the joint, keep a neutral neck. Don’t do what the guy in the second picture is doing. It drives me crazy to see people do this stretch with sloppy posture, crooked neck, and upper back…all of which likely contributed to the person needing help in the first place!
Good Stretch


Bad Stretch
Another common posterior capsule stretch is the cross body stretch.
Is that a shoulder stretch or a mean gesture?
While this stretch is more for adduction than internal rotation, many swimmers do this stretch for generalized posterior capsule flexibility. This stretch usually feels good, but overuse can destabilize the joint. Encourage joint centration by stabilizing the scapula and by balancing a pull with a push into the opposite hand. This tactic trains mobility and stability simultaneously, which leads to the second side of the triangle…


Strength – Length means very little without strength. One reason I preached caution above is that tightness in the posterior capsule can be the body’s way to compensate for a stability deficit elsewhere. The posterior rotator cuff is a last line of defense if other tissues don’t do their jobs.


Interestingly, external rotation strength (the antagonist movement of internal rotation) was unrelated to posterior capsule tightness in a recent study of professional baseball players (Laudner 2011). Does this mean we’re wasting our time with posterior cuff strengthening? I’d say no, as shoulder strength involves far more than external rotation alone. In the context of internal rotation, strength helps connect mobility and timing, which leads us to the final leg of the triangle…


Timing – Two areas to consider in timing are firing patterns and scapulohumeral rhythm. Firing patterns refer to muscles firing in the right sequence. Wadswroth (1997) found that non-injured swimmers had predictable firing patterns whereas injured swimmers had random firing patterns. Whether the pain caused the abnormal firing or the other way around is unclear, but it is clear that timing matters.


Scapulohumeral rhythm is the coordination of the scapula with the glenohumeral joint. If these joints are not coordinated, injury and suboptimal mechanics are likely. Conversely, coordinated joints allow for efficient expression of power. Lin (2006) observed alterations in scapulohumeral rhythm in comparing subjects with posterior tightness versus those with anterior tightness. Improving length and strength can improve timing, but optimal timing requires more specific training interventions.


Training
Most readers are familiar with the standard rotator cuff exercises for internal rotation. In fact, many of you probably saw at least one swimmer today dutifully hooking up their Theraband to a backstroke pole and performing a full routine of internal and external rotations before getting in the water. Since a Google search of “Shoulder Internal Rotation exercises” yielded 116,000 results in 0.16 seconds, I probably don’t need to generate another article demonstrating Theraband and light dumbbell exercises that you probably know already. Instead, I’d like to highlight on one area that doesn’t get nearly enough attention, which is the role of the breath to train shoulder movements.


As we discussed in Part I, Internal rotation deficits are often linked to poor scapular positioning, both at rest and in motion. Training the breath is one of the most underutilized yet powerful tools to ingrain movement and is useful for training internal rotation. Many are familiar with the use of breath for stability, such as in the Valsalva maneuver to lift heavy weights, but we can also use the breath for mobility.

Exhalation drives spinal flexion and internal rotation. Conversely, inhalation is tied to extension and external rotation. Sitting at your computer, if you let all the air out of your lungs, you’ll notice that your spine will round and your shoulders will internally rotate. If you do this forcefully such as in the cat vomit exercise, you note the same movements. Watch the video in its entirety and you’ll observe a dramatic increase in the tone of the latissimus dorsi, which is an internal rotator of the shoulder.


This tactic is valuable because it trains the shoulder to not only work with the scapula, but also to work with the surrounding muscles that drive the countless breaths we take in our lives. With proper integration of the breath, we can improve scapulothoracic rhythm unconsciously. The more unconscious we can make internal rotation (and breathing is about as unconscious as we can get) the better it will translate to our learning in the water. Since tension is often driven by neurological factors, breath training can also help restore a parasympathetic state in the body to facilitate recovery.


You can advance the cat vomit exercise with quadruped thoracic rotations. A forceful exhalation on the down movement will facilitate internal rotation of the grounded arm. Balance this with exhalation on the upward movement to rotate and extend the spine.

Quadruped rotation is only one example of how this can be done. The same concepts apply in other exercise positions (from lying supine to single leg stance), and can even apply in creative dryland activities like boxing and rock climbing. Stability happens automatically when a punch connects. You don’t have to teach someone to stabilize their shoulder when they connect…it just happens. Rock climbing is similar. Just grab a hold and hang on!

Some might ask “why are we adding flexion and scapular protraction if those positions predispose the shoulder to problems?” Remember that just because someone has a rounded upper back doesn’t mean they are mobile in that area. Training must be balanced and any training program will include an appropriate dose of extension and posterior activation to balance flexion and internal rotation.


Conclusion
Hopefully this series has convinced you that internal rotation is not something to be feared. Internal rotation is essential for movements in all four strokes. With an appropriate balance of muscle length, strength, and timing we can maximize all the range that our shoulder can offer. Small changes in joint control can pay enormous dividends in allowing for efficient recovery over the water and for powerful arm angles underwater.


References

  1. Laudner, KG, Moline, M, Meister, K. There is no Relationship Between Glenohumeral External Rotation Strength and Posterior Shoulder Tightness in Baseball Players. J Sport Rehabil. 2011 Oct 19.
  2. Borich, MR, Bright, JM, Lorello, DJ, Cieminski, CJ, Buisman, T, Ludewig, PM. Scapular angular positioning at end range internal rotation in cases of glenohumeral internal rotation deficit. J Orthop Sports Phys Ther. 2006 Dec:36(12):926-34.
  3. Wadsworth DJ, Bullock-Saxton JE. Recruitment patterns of the scapular rotator muscles in freestyle swimmers with subacromial impingement. Int J Sports Med. 1997 Nov:18(8): 618-24.
  4. Lin, JJ, Lim, HK, Yang, JL. Effects of shoulder tightness on glenohumeral translation, scapular kinematics, and scapulohumeral rhythm in subjects with stiff shoulders. J Orthop Res. 2006 May:24(5):1044-51.


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

Thoracic Mobility and Body Undulation Part II

In the last installment we discussed the importance of identifying T-spine limitations.  The most important question to ask is “What is preventing the swimmer from moving the thoracic spine properly?”  Placing swimmers into four categories of limitation can help identify the best intervention.
  • Conditioning – This swimmer has few (if any) stroke limitations and movement limitations, yet fatigues in longer races and/or lacks power in sprints.
  • Coordination – This swimmer has the necessary movement capacity for technical proficiency, but still has significant stroke flaws.
  • Stability – This swimmer has mobility but lacks the stability to match.
  • Mobility – Mobility limitations are just that: the swimmer can’t achieve adequate range of motion either passively or actively.  Swimmers with fixed kyphosis (mostly seen among masters and triathletes) commonly fall into this category.
Dryland screening is critical is to establish which mobility/stability limitations before addressing conditioning and coordination.  You won't know where the swimmer is unless you check!  We should strive to improve each category simultaneously, but must tailor the relative emphasis toward each swimmer’s needs.  Most coaches already know that the ceiling of improvement is small if you try to condition a flawed stroke.  If mobility or stability limitations are present, we should know what the limitations are before trying to correct the stroke.  Stroke modifications must harmonize with the swimmer’s present physical abilities.

Think of it like a recipe: conditioning, coordination, stability, and mobility are all ingredients.  The mix of these ingredients will change depending on what you are trying to make.  The best results come from adding the right ingredients in measured quantities; not from adding whatever we like without regard to how the ingredients mix.  Chocolate is great for chocolate brownies, but adding excess chocolate when the desert needs more milk or flour can ruin an otherwise good dish!


Screening and correction
The T-spine is a challenging area for even the best coaches and therapists.  What does the patient/athlete often do in the hours and days after a session?  Goes right back to the posture that we just spend an hour trying to correct!  Ergonomic awareness cannot be overstated.   Not only do elements of the short axis strokes encourage spinal flexion, the rest of life weighs us down and tries to undo the progress we make in the gym and the clinic.  Cars, desks, and heavy backpacks are the enemy of the T-spine.

Don’t assume anything with hypermobility.  Many swimmers appear hypermobile in the low back and the glenohumeral joint, but are actually limited in the T-spine.  Just because a swimmer can twist himself or herself into a pretzel does not mean they can move the T-spine in a manner required for the short axis strokes.  Extreme mobility in the lumbar spine can hide thoracic spine limitations, but this condition is hardly optimal and often unsustainable.

Great lumbar and cervical extension…but what about the T-spine?
Wall slide – A simple screen that’s also specific to fly and breast is the wall slide, offered by friend of the blog Dr. Brett Winchester and his co-author Dr. Craig Liebenson (2007).
If someone fails the wall slide, either by not being able to assume the start position or by not being able to move from the start position, we can investigate other areas such as the latissimus dorsi, pectorals, and scapulae to hone into the cause of limitation.  The wall slide can also be modified both as a screen and as an exercise based on starting position.  Lying supine (face up) is the easiest variation.  Situp position with knees bent and then moving to seated against the wall are both intermediate variations between supine and standing.  Always note the swimmer’s face angle (is it parallel to the ground?) and rib cage position (neutral or elevated?)

Breathing – Misuse of the primary inspiration muscles is closely tied to thoracic spine limitations.  Pay close attention to Dr. Mullen’s series about breathing for more details on the mechanics.  From a screening standpoint, know that breathing dysfunction can be both a cause and effect of thoracic mobility problems.   Faulty breathing transfers the load to the secondary breathing muscles, which biases the T-spine toward flexion due to hyperactivity of the upper traps, SCM, and pectorals.   It’s often hard to discern whether mood, conditioning, or habituation is the primary driving force behind breathing dysfunction.  However, we do know these all matter and deserve attention when trying to improve this area.

Soft tissue – (Foam roll, tennis balls, lacrosse balls).  If you read this blog frequently or are up to date with the current practices in the field, none of these implements are new.  What’s important is understanding how best to fit soft tissue work into a program.  Pair soft tissue work with exercise for optimal results.  Many people use these tools and even get massages, but neglect to follow-up and frequency with exercise to lock-in better posture and movement. 


Just as no single component of exercise should stand alone, soft tissue work will not achieve optimal results if not paired with exercise corrections.
Stability – Mobility means nothing if you don’t have stability to match.  Stability for the T-spine comes from the deep neck flexors, lower traps, and serratus anterior.  Addressing neck position in posterior dominant exercises can help provide stability for the T-spine mobility to express itself.  Note this picture of Eric Cressey below.  Taking away neck extension and demanding neck flexor activation forces mobility to come from the T-spine.  If the swimmer cheats with the neck, out of the water, there’s a good chance he or she will do the same in the water!


Mobility exercises can also train stability.  Cobra pose is quite popular both in yoga and as a temporary antidote for many with stiff lower backs (Dr. Mullen may have something to say about this in his low back series…).  However, modified Cobra pose can be used to train T-spine extension and neck stability.  Rather than arching the entire back and neck as in normal Cobra, keep the belly on the ground and the neck neutral (“packed”), as doing so forces the movement to come from the T-spine.  Press into the ground to create stability to support T-spine mobility.


Why is all this important for swimming?  
During the catch on fly and breast when the T-spine is at full extension (pressed toward the bottom of the pool), we want the neck neutral and eyes neutral or looking slightly upward.  An extended neck during the catch not only hinders one’s ability to press the chest down, it also distorts balance and is horribly un-hydrodynamic due to increasing the swimmer’s frontal surface area.  Neck extension is undoubtedly necessary to breathe outside water in butterfly, but if a swimmer can’t perform an exercise like the deadlift with a neutral neck and can’t provide the stability needed for an effective catch and T-spine extension in the short axis strokes, we should address the basics of posture and positioning first.

What NOT to do
Sometimes knowing what NOT to do is just as important knowing what TO do.  For certain athletes, a program emphasizing crunches, bench press, back squats, or dips may undermine efforts to correct T-spine limitations.  None of these are “bad” exercises, including the oft maligned crunches as Dr. Mullen pointed out.  What makes exercises “bad” is poor programming and poor execution.  However, since athletes often lift with limited or no supervision, we must consider all the relevant factors when assigning exercises.
Coaches must think prescriptively rather than programmatically.  If a swimmer needs to improve T-spine extension, flexion-biased exercises are usually not the priority.  Because an exercise worked for swimmer “A” does not mean it will be appropriate for swimmer “B” at this particular moment.  Earn the right to explore a greater library of exercises by demonstrating proficiency with the fundamentals of mobility, stability, and stroke technique.  If improving T-spine extension is a priority, find out where the limitation lies and prioritize exercises based on their role in correcting the limitation.

Reference:
Liebenson, C. Winchester, B.  A Key Link in the Locomotor System: The Upper Thoracic Spine. Dynamic Chiropractic.  June 17, 20011, Vol. 29, Issue 13.


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

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.

Training Hip Rotation in Breaststroke

Last week we discussed the importance of hip rotation in breastroke, both for performance and for injury resistance. This week we’ll explore four critical aspects of dryland training to improve hip rotation: Tissue quality, joint centration, mobility, and coordination.
Self-massage: 
Many athletes looking to improve mobility go directly to stretching, which is often ineffective when used as the lone intervention. Improving tissue quality helps us stretch the right muscles when we stretch. If tissue quality is poor in a hip rotator and that muscle is unable to move properly, stretching the hip into rotation will add unintended stress to surrounding joint systems and the muscles of the hip not designed for rotation. For information on hip pain in swimmers, see Dr. Mullen’s recent video: 

Tools of the trade for self-massage include foam rollers, PVC pipes, lacrosse balls, softballs, and tennis balls. Foam rollers or PVC pipes work best for the groin, quadriceps, and ilotibial band. The various balls are effective for the glute medius, posas, tensor fascia lata, piriformis, and quadratus lumborum. Be sure to avoid pressure on the bony structures of the pelvis and hips.


Some question the need for the youngest athletes to perform tasks like foam rolling or using lacrosse balls for self-massage, since many of them are too young to have developed poor tissue quality. In my opinion, being responsible for bringing a lacrosse ball and/or softball to practice (in addition to their other swim gear) builds accountability at a young age. Further, exposing kids to this warmup and/or cooldown ritual establishes sound habits for the rest of their careers.
Joint centration
A joint out of position can disturb optimal muscle firing patterns. Hip rotators won’t be available for rotation if the body relies on these muscles to hold the joint in place. If the body has a choice between performance and preservation, it will usually choose preservation!
Self-massage before exercise can help calm down overactive muscles and make it easier to re-train the “ball” of the femur to sit more comfortably in the “socket” of the pelvis. A common hip dysfunction is for the femoral head (the “ball”) to sit too anteriorly in the joint. Below is one exercise to coax the femoral head into the posterior capsule.

Mobility
Once we prep the muscles for movement and establish joint centration, we are then ready to add mobility. Below is one exercise to train hip internal rotation. There are many exercises to do the job, but this one is easily coachable, user-friendly for a large group setting, and easily repeatable as homework while watching TV.
For external rotation, please see Dr. Mullen’s recent video on at Swimming World:

Coordination
Many athletes are familiar with mini-band lateral walks to train the lateral hip muscles. Here is one variation from Tim Vagen more specific to breaststroke with the knees narrower than the feet.
Another option is to place an additional mini-band near the ankles to cue tibial external rotation, which is also advantageous to the breaststroke kick.
Conclusion
There’s no doubt that some athletes are born to swim breaststroke. Children with the right pelvic anatomy and early exposure to the stroke have a clearer path to greatness. However, due to suboptimal control of the hip joints and use of the hip muscles, most swimmers don’t achieve their potential in the stroke. A system of improving tissue quality and joint centration before stretching and strengthening can improve return-on-investment during breaststroke training in the water.
Guest Post by Allan Phillips. Allan and his wife Katherine are heavily involved in the strength and conditioning community and more about them can be found at pikeathletics.com