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RER Value Guide

Slow (0.7)
A1 band - warm-up, recovery, cool-down sets
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Intense (1.00)
A3 band - aerobic power, VO2max sets

Data Source: Zamparo P, Bonifazi M (2013). Bioenergetics of cycling sports activities in water.

Coded for Swimming Science by Cameron Yick

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Quick Food Reference

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Tension of Kinesiotape Doesn't Matter for Floor Touch Improvement

Allan Phillips has discussed kinesiotape (KT) in two previous posts:
  1. Kinesiotape and Swimmers Part I
  2. Kinesiotape and Swimmers Part II
In his first post, he concluded:

"[o]verall the evidence is incomplete, but not definitive in either direction. Most notably, Kinesiotaping has not been tested thoroughly in combination with other procedures. It’s possible that taping may have different effects done as a standalone treatment versus when used to reinforce a clinical procedure (spinal manipulation, massage, dry needling, etc).

My personal opinion is that Kinesiotape may have actual effects but the mechanisms are still unknown. It may take several years to separate taping from the methods that it is frequently paired with. It is still too early to call it a placebo or alternatively, a miracle treatment. That said, because much anecdotal evidence exists with very little observed side effects (other than tape addiction), Kinesiotape deserves consideration as a method to improve muscle length, strength, and timing, especially when used to support other interventions."

Luckily, research is surfacing about KT and questioning the use of this tape, particularly the scientific reasoning behind its principles.

The study below analyzes how KT is applied and as Allan has said previously: 
"[k]eep in mind that research does not account for nuances in how tape is applied, as I can tell you firsthand that the craftsmanship of trained clinicians far exceeds “locker room” self-application. This may be one area in which clinicians are ahead of researchers. I’ve recently spent a lot of time volunteering in a clinic recently that frequently uses Kinesiotape. One point noting is that clinicians with formal training from tape companies have far more techniques in their arsenal than someone who just throws tape on areas that feel tight or sore. If you fully immerse yourself in the system, there’s actually quite a depth of thought in the techniques, even if those techniques have not been tested by formal research."

Does Kinesiotape Application Matter?

Thirty-nine females (18 – 27 years) performed the Schober test, marking the midpoint of the two posterior-superior iliac spines (S2 level) and then other two points 5 cm below and 10 cm above the initial level. The distance between the three points was measured in the standing and bent over position.

The subjects were split into three groups:

1)    Control.
2)    Kinesiotape without tension (just laying down the tape).
3)    Kinesiotape with tension (applying 15 – 50% tension on the tape).

Subjects were assessed 24 hours with the tape one, 48 hours with the tape on, and 30 days after the tape removal. The tape was applied for 48 hours.

Results of Kinesiotape Application

The average Schober test results before KT was 6.07 cm. No significant differences were found between the averages obtained from the Schober test before applying the KT, 48 hours with the tape on, and 30 days after the removal in any of the groups.

However, there were significant improvements for the KT with tension and without tension for the fingertip-to-floor distance at 48 hours.


Results of Kinesiotape Application

It seems KT with or without tension improves fingertip-to-floor mobility. This suggests the method of application may be over complicated and unnecessary for improvement in range of motion. The mechanism of improvement is still speculative. 

If looking to improve fingertip-to-floor mobility, consider applying KT with or without tension. These results may differ in people with low back pain or other conditions.

Reference:
  1. Lemos TV, Albino AC, Matheus JP, Barbosa Ade M. The effect of kinesio taping in forward bending of the lumbar spine. J Phys Ther Sci. 2014 Sep;26(9):1371-5. doi: 10.1589/jpts.26.1371. Epub 2014 Sep 17.
The Swimming Science Research Review educates coaches with ongoing sports science literature. With the influx of online information makes it difficult to stay up-to-date with informative, accurate research studies. The Swimming Science Research Review brings you a comprehensive research articles on swimming, biomechanics, physiology, psychology, and much more!

This monthly publication keeps busy coaches and swimming enthusiast on top of swimming research to help their programs excel, despite being extremely busy.

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.

Michael Fröhlich Discusses Cold Water Immersion for Athletes

1. Please introduce yourself to the readers (how you started in the profession, education,
credentials, experience, etc.).

From 2000 to 2006, I worked at the Olympic Training Center Rhineland-Palatinate/Saarland (Germany) with elite athletes projected to participate in the Olympic Games in Sydney in 2000 and in Athens in 2004. Since 2006, I have been a qualified teacher and associate professor for sport sciences at Saarland University.

2. You recently published an article on cold water immersion (CWI) and strength gains. What are the different types of CWI and what temperatures appear most ideal?

Cold water immersion is one of many different cooling types, such cooling vests, cooling packs, drinking cold water, cryogenic chambers, etc. CWI can be differentiated into whole-body CWI and partial-body CWI. In partial-body CWI, for example, a single leg or single arm was cooled. On average, whole-body CWI was significantly more effective than partial-body CWI. Immersion of only a small part of the body, such as a single arm, does not cool down the body core as effectively as whole-body CWI.

3. What did your study look at?

Most of the published studies analyzed only short-term recovery effects, whereas the adaptation aspect has been widely neglected. So in your study we analyzed the adaptation,, effects of strength training after a routine CWI.

4. What were the results of your study?

The main result of your study was that strength training adaptations were reduced by 1-2% after a 5-week strength training regime, with the trained leg being regularly cooled directly after training compared to an uncooled control condition.

5. What were the practical implications for athletes?

Based on the results of our study, it has been concluded that CWI can have a negative impact on strength training adaptation in persons with strength training experience. It has also been shown that small deteriorations in training adaptation in the long term could be balanced with the possible beneficial short-term recovery effects of CWI.

6. Do you think the results would be different if you had differently trained athletes?

That is a very good question! The transferability of the results to a higher performance level in combination with the optimal scenarios for the application of cold water immersion as a recovery means in a practical setting does indeed require further research.

7. What do you think of different types of cryotherapy or contrast therapy?

Based on the available evidence, I think that cryotherapy seems to be very effective in decreasing pain. Further effects of cryotherapy on more frequently treated acute injuries have not been fully understood.

8. How about full body cryotherapy at extremely low temperatures (http://www.cryohealthcare.com/about-cryotherapy/)?

In this context, Poppendieck et al. (2013) published a very interesting meta-analytical review. The authors can show that the effect size of CWI was slightly higher than for cryogenic chambers. For cooling packs, average effects were negligible (see Poppendieck, W., Faude, O., Wegmann, M. & Meyer, T. (2013). Cooling and performance recovery of trained athletes: A meta-analytical review. International Journal of Sports Physiology and Performance, 8(3), 227-242.

9. A lot of swimmers are using CWI on a daily basis, do you think this is beneficial, harmful, or neutral for performance?

I don’t know. Many athletes use CWI as part of their daily routine, but any long-term effect on performance is not yet well understood. In this field, further research is needed.

10. What research or projects are you currently working on or should we look from you in the future?

My co-workers and I are currently conducting a cross-over training study involving CWI. The longitudinal study is scheduled to take one year.

Swimmer's Shoulder Return to Swimming Program

Take Home Points:
  1. When returning from any injury (in this case a shoulder injury), many training alterations are required.
  2. These are general outlines, please see a healthcare professional if you have shoulder pain and set an individual return to swimming outline.
  3. Don't rush your return to full swimming practice. Work on biomechanics, reduce pain, and elongate your swimming career!
The commonly used plans for returning a swimmer to the pool after a shoulder injury have many flaws. Swim coaches and health care professionals have vastly different views, both contributing to the problem. Swim coaches do not want their swimmers to miss any time from the pool as they feel any missed time will prevent progress. Health care professionals want swimmers to take weeks off from swimming to allow full recovery. The appropriate approach lies somewhere between these two options.

Yes!! He recovered from swimmer's shoulder!
A typical health care approach to recovery from a shoulder injury includes numerous “blank periods”. This is when a swimmer is not receiving care or swimming as they wait to be seen by the next professional. After these sessions, the health care professional expects the swimmer to return to the pool after their symptoms have alleviated, but often times don't necessarily stress their shoulder for the demands required in swimming. In their eyes, this is considered a successful treatment; unfortunately time away from the pool causes an athlete to lose “feel” which can only be acquired and maintained by spending time in the water.

This is the best-case scenario, but sometimes the symptoms never improve. Sometimes the swimmer will continue to swim with the pain. Other times, the symptoms may disappear and the swimmer will return to practice, hop in the pool, go full throttle, only to have the symptoms return. This reckless approach will likely cause a re-injury and add more “blank periods”. This is a sad, all too common case, for many age-group swimmers.

Many health care professionals don’t know how to safely return a swimmer to the pool with guidelines to benefit recovery. Applying continual, gradual swimming stress is essential to see if the swimmer’s shoulder pain is improving. Therefore, it is important to know their current pain level and have them progressively return to the pool. Tiers of limitations can be used to gauge improvement, yet maintain neural feel. Knowing an athlete's current level of pain will help in monitoring whether or not their symptoms are improving, as it is unlikely for the athlete to go from 8/10 to 0/10 pain after a few sessions with the rehabilitation specialist, especially if these symptoms are long-standing. Helping them progress with milder and fewer symptoms allows the swimmer to see progress, keep their sanity, and stay positive as they return to the pool.

After working with thousands of swimmers, I began piecing together simple tricks to speed recovery while maintaining “feel”, thereby preparing the athlete for a full return to practice.

Follow these guidelines closely to ensure shoulder recovery, while maintaining “feel” and strength in the water.

Return to Swimming Freestyle Biomechanics

Proper technique for injury prevention is essential. I’m sure not all of the readers will agree with these biomechanical corrections for swimming propulsive reasons. However, I recommend them because they will put less stress on the shoulder joint and muscles, the primary correction for those with shoulder pain. During freestyle, ~75% of the “most pain” occurs during the first half of the pull and ~18% of pain occurs during the first half of the recovery (Pink 2000).

The most common biomechanical causes of shoulder pain in swimmers are:

Crossing Over

Crossing over occurs when the swimmer initiates their catch and brings their arm across their body. When the arm crosses the body, it closes the space on the anterior shoulder. The anterior shoulder contains the supraspinatus, the most commonly injured rotator cuff muscles.

Solution: The most common reason for this error is a lack of emphasis on biomechanics. Most swimmers can prevent a crossover catch with concentration and appropriate cuing from their coach.

If the swimmer lacks shoulder blade stability, this may be causing them to cross their arm across their body on the catch. Stabilize the shoulder during the initial catch by performing the compact position. In the compact position, it is nearly impossible to cross over and impinge the anterior rotator cuff muscles.

Thumb-First Entry

If an athlete enters with his or her thumb, the whole hand can enter through a smaller hole, decreasing drag. However, many athletes achieve a thumbs-first entry through shoulder internal rotation. This orientation can stress the anterior structures of the shoulder and increase the risk for shoulder impingement.

Luckily, the thumb first entry can be achieved with no movement at the shoulder. Instead, instruct your athletes to use forearm pronation (rotating the forearm inwards) instead of shoulder internal rotation to get their thumbs to enter first, decreasing the amount of drag on the entry.

Solution: Either instruct your swimmers to enter finger tipss first or thumb first with only forearm pronation, a difficult but beneficial difference. Consider performing finger tip drag drills or hesitation drills just prior to entry to perfect the entry.

Head-Up Swimming

If an athlete swims with a head-up position, this will lead to the athlete curling their neck upwards, putting many shoulder and neck muscles in improper positions. Many masters swimmers and some age-group swimmers still use this head position, impairing their strength and putting their shoulder muscles at risk for injury.

Solution: Focus on swimming with your head down, try looking at the bottom of the pool or only slightly in forward. Invest in a snorkel and practice having the swimmer have the water line just above their hair line.

Armpit Breathing

Every coach knows the armpit breather. This indentured swimmer has difficulties controlling and timing their neck rotation. These swimmers will often look back when they breathe or breathe late. This can irritate the shoulder by stretching and putting the shoulder muscles at the wrong muscle length.

Solution: Instruct the swimmer to initiate their breath just prior to their arm on the same side exiting the water. For example, if you are breathing to your right, initiate your breath just prior to your right arm exiting the water. Also, focus on a rapid inhale and exhale, allowing the head to return to the water rapidly. Performing six kick rotational drills with the swimmer’s arms at their side can help the swimmer learn how far and in what direction to turn their head.

Overtaking or Catch-Up

Although the catch-up stroke is commonly performed, this position of elongated shoulder flexion
aides to approximately 70% of shoulder impingements [likely primary impingements] (Yanai 1966). Extended time in this stretched out position minimizes the subacromial space and increases rubbing of the rotator cuff muscles, a major injury risk.

An example of a "catch-up" stroke.
Solution: Have the swimmer enter their hand at a ~45 degree angle, with their hand traveling down, instead of parallel to the floor of the pool.

Wide Catch

A wide catch typically embodies vigorous and excessive shoulder abduction while internally rotating the humerus increases shoulder stress (Yani 1966).

Solution: Instruct adduction of the humerus during the initial catch, ensuring the hand is not moving outside the body line.


Other Strokes Biomechanics

This is mainly a piece regarding freestyle, but here are some quick tips for other strokes. If you are interested in more detailed biomechanical adjustments for other strokes, please comment below.

Backstroke

Swim with a wider stroke, like you have your arm around your friend's back, not underneath your body.

Breaststroke

Outsweep with your hands flat or parallel to the bottom of the pool. Do not rotate your arms inward during the catch, having your thumbs face the bottom of the pool.

Butterfly

Initiate the catch earlier, do not press the chest down with the arms remaining elevated, see this piece by Dr. Rod Havrulik

Swimmer's Shoulder Return to Swimming Program

Once swimming biomechanics are improved (via coaching, drills, underwater video, and/or concentration), it is necessary to have guidelines for return. Here are the nuts and bolts for returning to swimming in no time.

No more than 3

Knowing the pain level of a swimmer is important for determining when the swimmer should return to the pool. A pain scale of 0 to 10 is commonly used, with 0 representing no pain and 10 representing unrelenting pain. For discussion of shoulder pain, we will assume that the swimmer has at least a level of 1/10 pain. The typical presentation of shoulder pain is a swimmer with pain only during swimming. Their pain level is typically 0/10 at rest. However, once they start swimming, it is likely their pain level will steadily increase. The 'No more than 3' rule allows a swimmer to maintain their “feel” for the water, until the pain level reaches a 3/10.

It is unrealistic to expect any swimmer with a history of shoulder pain to jump in the pool and have
0/10 pain. The 'no more than 3' rule allows the swimmer to swim until they reach a 3/10 pain level. This rule is based on the belief that 0/10, 1/10, or 2/10 pain is not causing more injury or inflammation. However, if a 3/10 pain level is reached, it assumes more irritation, damage, and inflammation will ensue. When the pain reaches 3/10, the first pain plateau, changes to the swimming routine need to be made. Once a 3/10 pain level occurs, it is best to rest and allow the shoulder irritation to dissipate. This is accomplished by having the athlete kick on their back with fins, eliminating arm movements and stress to the shoulder (with streamline unless this prevents resolution of the 3/10 pain level. If pain persists in streamline, move to the arms next to the body). Hopefully a swimmer’s pain will not reach between a 4/10 and 7/10 while in the pool, because they will have stopped at the 3/10 level and proceeded with directions on how to adjust their practice routine.

If you have a shoulder injury, be excited for fin kicking!
If the swimmer has a 3/10 or greater pain at rest, it is best to have them stay out of the water, it is likely the cause is inflammation or sympathetic pain. If this is the case, it is recommended to see a health care professional for treatment and further evaluation.

This approach is effective when the athlete is seeing a health care professional on a regular basis and their symptoms are continually improving. If the symptoms are not improving with a rehabilitative specialist, either find a new one or consider taking a break from doing the activity which causes the symptoms (likely stroking). As much as I realize maintaining “feel” is important, keeping a swimmer’s shoulder away from the knife of surgery is even more important.

Solution: Have the swimmer swim the typical workout until their symptoms reach 3/10. Once a 3/10 occurs, have them kick on their back with their arms at their side or in streamline (if their symptoms don't increase with streamline) with fins when their symptoms reach 3/10. This allows them to stay in the water and keep “feel” while minimizing shoulder stress. Moreover, most swimmers can do main sets and intervals with fins, keeping them involved in practice and their face in the water. If they have 3/10 symptoms prior to practice, discontinue for the day and have them seek treatment for inflammation or sympathetic pain.

No Kickboards

Kickboards are recommended if someone has shoulder pain. Most cases of shoulder pain occur due to repeated overhead motions, leading to musculoskeletal pain. Holding a kickboard for a stagnant period is locking the arm in an overhead position and irritating the shoulder repeatedly (Pollard 2001). Moreover, athletes commonly push their shoulders down on the board, leading to overpressure on the joint, a hazardous move.

Kickboards will perpetuate the pain and is easily replaced with the swimmer kicking on their back. In fact, to prevent this dangerous position and prevent re-injury, I will have swimmers kick without a board for an extended period after the symptoms resolve (approximately one month).

Solution: Kick on your back in streamline if symptoms are less than 3/10; if symptoms are greater than 3/10, have them kick on their side or with their arms next to their side.

No Paddles

This is a tough one for some programs, but paddles place higher stress on the shoulder by allowing the swimmer to grab more water (Pollard 2001). This obvious statement supports the fact that moving more water requires more arm strength and use of shoulder muscles. Even with perfect technique, paddles will increase shoulder stress, which is bad for shoulder pain. Removing paddles will give the shoulder time to recover, getting them back to paddles sooner.

Solution: Discontinue pulling until symptoms have fully resolved for at least one month. 

Bottom Hand

When coming off a flip turn, the swimmer should initiate their pull with their bottom hand. This is biomechically advantageous to rapidly rotate and spiral the athlete to the surface. Unfortunately, this powerful stroke is always performed by the same arm as swimmers are robotic. For athletes with shoulder pain, it is necessary to give the overworked shoulder a break. In almost all overuse injuries the bottom hand off the turn is the injured shoulder.

Solution: Reverse your rotations off the wall and start your stroke with your opposite arm. This will feel like writing with your opposite hand, but will distribute shoulder stress and allow adequate shoulder healing. Another option is starting your stroke with your top hand.

Proper Pacing

During times of stress, the body adapts. At the end of a race, the body adapts to finish. Unfortunately, these adaptations are often inefficient and hazardous. At the end of a 100-m race (when the swimmers slowed ~7.7%), their biomechanics shifted from using more adduction to more shoulder internal rotation. This adaptation will increase shoulder stress and risk of injury.

Solution: Attempt to even split your races and sets during practice. This minimizes the amount of time undergoing poor, injurious biomechanics.

Snorkel

Recent research suggests that swimmers with shoulder pain have higher neck muscle activation during overhead movement outside of the pool. It is hypothesized, that if the neck muscles are overactive on land, then in the water they must be even more active. Neck rotation and breathing uses the neck muscles and can feed into the increased neck muscle activation. Using a snorkel will minimize head rotation and neck muscle activation.

Solution: Consider using a snorkel during workouts if your symptoms persists.


Return to Swimming Yardage

Knowing how much yardage to begin with is difficult. I often suggest starting with 1,000 yards of breast and freestyle. Once again, if pain increases past a 3/10, I suggest kicking on your back with fins until it returns to a 0-1/10. After this, I suggest adding 500 - 1,000 yards every 3 days with a maximum of 1/10 pain. Once you're able to swim 3,000 yards, I suggest adding butterfly and backstroke (ideally on separate days, to know which is the irritant). 

Example 6 Week Return to Swimming Program

Below is an example 6 week return to swimming program, she swam once a day, six times per week, for the entire six weeks. The swimmer also did not perform any meets during this six weeks. 

The swimmer had infraspinatus tendinits initially and she received 2x/week of physical therapy for the entire 6 weeks. 

DayYardageStrokesHighest Pain LevelNotes
11000Free3
21000Free2
31000Free1
41000Free1
51000Free1
62000Free2
72000Free, Breast5Performed 1,700, then kicked 300.
81750Free, Breast2
92000Free1
102000Free1
112000Free, Breast0
122500Free, Breast0
133000Free0
143000Free, Breast, Back0
154000Free, Breast, Fly7Performed 3000, then pain during fly. Kicked last 1000.
164000Free, Breast, Back3
174000Free, Breast, Back3
184000Free, Breast, Back2
194000Free, Breast, Back1
204000Free, Breast, Back1
214000Free, Breast, Back1
225000Free, Breast, Back0
235000Free, Breast, Back0
245000Free, Breast, Back0
255800All Strokes4Performed 4800, pain during fly. Kicked last 1000.
266000All Strokes2
276000All Strokes2
286000All Strokes2
296000All Strokes1
306000All Strokes1
316000All Strokes1
327000All Strokes1
337200All Strokes0
347400All Strokes0
356900All Strokes1
367100All Strokes0
377200All Strokes0
387400All Strokes0

As you see, there were days when the pain exceeded 3/10. This is expected as recovery from an injury isn't linear. Nonetheless, sticking with a plan, which emphasizes rehabilitation (ideally with skilled physical therapy), progressive addition of swimming volume and strokes, and biomechanical adjustments can enhance the recovery a swimmer's shoulder. Ensure all these for a quick and long-lasting swimmer's shoulder recovery and be a life-long swimmer (#fist pump)!

References:

  1. Yanai, T., & Hay, J. G. (1966). The mechanics of shoulder impingement in front-crawl swimming. Medicine and Science in Exercise and Sports, 28(5), Supplement abstract 1092.
  2. Suito H, Ikegami Y, Nunome H, Sano S, Shinkai H, Tsujimoto N. The effect of fatigue on the underwater arm stroke motion in the 100-m front crawl. J Appl Biomech. 2008 Nov;24(4):316-24.
  3. Pollard B. The prevalence of shoulder pain in elite level British swimmers and the effects of training technique. British Swimming Coaches and Teachers Association; 2001.
  4. Spigelman T, Sciascia A, Uhl T. Return to swimming protocol for competitive swimmers: a post-operative case study and fundamentals. Int J Sports Phys Ther. 2014 Oct;9(5):712-25.

The COR Swimmer's Shoulder System E-book and video database starts with a comprehensive e-book that guides you through Mullen's four-phase system. This book details everything about the shoulder, why swimmers are at risk for shoulder pain, to which training frequency option you should choose to exactly how you can make effective program modifications if you don't have specific equipment at your disposal.


A video database gives you video access to more than 40 exercise videos, so you'll never have to worry about how to execute a correct movement again! It'll be like G. John Mullen is there with you, teaching you how to perform the entire program in person! This great resource for coaches and swimmers is valued at $370, but is yours for only $59.99!

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.

Us Old Swimmers...

This was an article submitted to Swimming Science. Although it lacks scientific literature or
references, it's anecdotes provide an necessary look into the possible long-term effects of the sport. Although the writer is just one person, so is Michael Phelps. Although opposing ends, Phelps and the writer are just one, uncommon result, with the author having a more likely result than Phelps.

 Coaches, parents, and swimmers remember exercise is a life-long journey. For some, you'll have great success during adolescents and teenage years, but always question...will this add up when I'm older? Coaches, realize you can help swimmers in the short- and long-term, just ensure safe programs and healthy environments for long term success. 


I have added some editor notes, which are indicated with brackets, enjoy!

Take it Laura

Warning to all coaches and swimmers,

Bodies break down. It may take only a few years, but when the former swimming athlete is progressing into middle age his/her body will scream out for pain relief. When doctors tell you, “swim, itʼs a non impact, great exercise" or  "It's good for you”, watch out.

Some of you know know that swimming is probably the last thing you should do, as the mere thought sends pain throughout the body. If you feel as though a nice easy thousand yards would be the right ticket for your swirling mind, then you realize the agony of pushing off of the walls and twisting your neck turns you into a blithering pain ridden fool and stops you.

Hear me out.

This is my story of the body versus mind and whatʼs become of a relatively honed body.

I was never a top ranked swimmer. I was among the thousands of girls who had very few athletic opportunities in the 1950ʼs-60ʼs. My father, who ran swimming pools throughout New Jersey, private country clubs, public pools and taught swimming at Seton Hall University introduced me to swimming at birth. He taught me and many others, and he introduced the “swimming meet” to the clubs. One day after I suffered a bad asthma attack my doctor told said. “Get her on a swim team. The humid water and breathing rhythm will help with the asthma. And it did. I remember the first day, at age 7, like it was yesterday [there is some conflicting research on asthma and swimming, despite the common physician recommendation].

Boylan Street Pool in Newark, 50 meters x 25 ydʼs. It was BIG! Lots of girls swam up and down the pool. The coach, “K”, greeted me and said, “You stay in the outside lane, and if you need to hold on there is the wall”....

“Are you kidding me!”

Thus began the years of up and back....

In those days, we didnʼt have weight training per say. We had K. Under Kʼs leadership we did pull ups from the pool to the deck. She filled buckets with cement and attached them to a rope and spindle, which we curled up and slowly let down, and we dragged each other on our pulling lengths. She used cut off broom handles for sticks to keep our hands out in front swimming freestyle. She had us meet at a local university in the “off” season to run the track, throw discuses and shot puts, and hop over hurdles. K was an Olympian runner! She yelled, she screamed and we did lots and lots of miles. K taught form in stokes. We did starts and turns for what seemed forever. We never thought we were wearing out our joints. No one did. Until...

Now, I have participated in many sports since then. I played basketball for the CYO, tennis when allowed at the clubs, and many pick up games of whatever was playing in the streets and parks of Maplewood, so my cross training was all on my own. I have sprained my ankles many times, broke a nose from an angry bat wielding brother, and flown off many a bike. But when, in the midst of a awesome beach volleyball game, I swung my arm to spike a shot, it stuck there....

Uhoh!

I tried to just go with it for months, I finally saw a doctor, who is a well known specialist in Boston who says, “Where you a swimmer?” [personally, this is a bold prediction by any physician, but whether it is from swimming or another overhead sport, there is a common shoulder presentation.]

Ah yes.

Hmmm swimmersʼ shoulder, he diagnosed! He knew from the tests that I had over used my shoulders from swimming, not from all the other sports. We scheduled the operation to clean out the shoulder of calcium deposits, bone chips and shave down the acomion to give rotation some room. He removed the bursa sack sewed me up I was good to go, until the next shoulder gave out.

He did the other side. Same procedure. The explanation for all this was “When you were swimming, those years, you didnʼt do the correct exercises to pull your shoulders back. You needed to do back strengthening exercises. Overall, youʼll be fine. You can swim, but use fins to eliminate the pressure on your shoulders while swimming laps." He then asked, "How are your knees?” Really! “Pretty good”.

Perhaps I spoke too soon, ten years later I had my left knee meniscus trimmed. This was the second time a doctor said to me, “Were you a swimmer?”
“Yes.”
“Bet it was breast stroke.”
“Yes!”

He then told me I could swim if I didnʼt push hard off the walls [as a Physical Therapist, I'd be more worries about twisting the knee or large knee flexion].

All was going well until I turned sixty, and all hell broke loose in my body. I donʼt know if hormones are to blame, but doing workouts to stay in some kind of shape to avoid the dreaded weight gain, caused injuries that I couldnʼt shake. First a torn hamstring, then a strained Achilles tendon, and now a massive amount of arthritis in my right knee [all uncommon injuries in swimming. When asked Laura reports golfing, weight lifting, and officiating during this time period.]. Now the right knee!

So I see my knee guy and he sends me to his top surgeon and he says to me, “you were a swimmer right, bet a breaststroker!”

Ahh come on guys.

So, they canʼt give me anymore shots into it, cortisone or synvisc, or use any other delay tactic. Walking is wicked painful bone on bone and the wonder how I even can walk and when I'll soon need a total knee replacement.

I am throwing this out there because we need research to pass on to the new generations of swimmers. We need data from all us olʼ folks who swam and swam for preventing short and long term effects of swimming. I am a big believer in doing multiple sports. Overuse is hurting out bodies. Some of the techniques and equipment being used by coaches with their swimmers is hurting them. I officiate meets and watch young children walking around with ice packs wrapped on their bodies.

This is not good.

Knowledge and science is available. We need to pass it on. Parents and coaches need to develop their athletes without causing injuries.

Written by Laura Menza Wanco. Born and raised in New Jersey. She swam with the Watchung Lake
Swim Club an AAU team under the coaching of Catherine D Meyer, long time AAU Coach and Official with the US Olympic Committee. Laura coached summer club teams, was a lifeguard, and swim instructor in summer clubs. She started along with a group of former swimmers the Women's Swim Team at Seton Hall University in 1968 after a year of swimming with the men's team.

She started the Women's Basketball Team at Seton Hall University in 1971, from the Intramural teams. Coached Tennis at Summit High School, Mens and Women. Coached High School Swimming Team at Columbia High School.


She moved to Cape Cod, MA. where she started a team in the local health club and became an official. She has 
 officiated local, sectional, and state tournaments, swimming and diving and officiated at the NCAA Womens D1 championships.

Does Low Back Pain Resolve Itself?

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

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

Does Low Back Pain Resolve Itself?

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

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

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

Why is it Different?

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

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

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

Practical Implications

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

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

For more examples, consider purchasing Dryland for Swimmers.

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