Take Home Points for 10 Keys for Recovering from Swimming Shoulder Surgery
1) Concepts for rehabilitation after surgery are like any other shoulder injury, but a greater understanding of the specific procedure is required.
2) Aggressive training in non-surgical areas of the body is possible so long as the injured area is not placed at risk.
3) Rapid return to the water, even if the arm is not used, is the most important goal of the process.
Surgery is one of the worst fates for a swimmer. In many cases, surgery is avoidable, but that is a separate discussion (When to Have Surgery). For now, we’ll assume that surgery has happened and the next task is to make the best of a poor situation. Many swimmers make a successful return to the pool, due to advances in surgical techniques and rehabilitation strategies.
Yet many swimmers never make a full return to the water. One problem is that swimmers are often cleared from medical care, but not fully ready to withstand the rigors of swimming. In this post, we’ll deal with some unique features for post-surgical training, though many of the key points are like those mentioned previously in other return-to-swim posts.
For post-surgical training, know that the initial stages highly depend on the surgeon, surgery, and rehab staff (and note that many surgeons with a “hand of God complex” believe rehab and exercise are not needed after their surgery, yet that again is a separate topic…). Once cleared from the medical clinic, the coach and swimmer often lack formal guidance on safe and effective progression. Here are 9 keys for recovering from swimming shoulder surgery:
10 Keys for Recovering From Swimming Shoulder Surgery
1) Functional Assessment – Decrease of pain or the surgeon’s blessing are not the only factors in determining a swimmer’s preparedness for increased training loads. Instead, coaches must evaluate overall function to determine not only if the shoulder is prepared for increased training. Coaches must consider if the change in the shoulder has affected other areas of the body. Consider closed kinetic chain upper extremity testing as one simple technique to evaluate shoulder and full body function.
2) Grip Strength – Grip strength is a valuable quality to train under any circumstance. Following surgery it is a very safe measure of neural strength while minimally requiring shoulder movement or activation. Grip strength has also been correlated as a performance related biomarker and can help guide the transition toward performance training (Determinants of Masters Swimming Performance).
3) Core Strength – The evidence is mixed on the importance of core training (and realistically you could call EVERYTHING core training…or perhaps we should call it postural strength). Iif swim volume remains limited, addressing core strength can at least promote body awareness and increased activity in a transition to normal swim training.
4) Healthy Limb – Can be trained aggressively so long as pain is not a problem or it puts the injured limb at risk. In fact, there is evidence to suggest that “cross education” of the injured limb can occur when training the healthy limb.
5) Just Keep Swimming… Get back in the water as early as possible, so long as the surgeon gives approval that it won’t disrupt the integrity of the surgery area. You can begin by kicking with arms at side. Anything to preserve feel for the water. As we have said many times on this site, aquatic rehabilitation follows different rules than land rehabilitation since we aren’t naturally aquatic creatures (Swimming Science Return to Swim Program).
6) Nutrition/Sleep – Both are important for creating a healthy healing environment. This area can be difficult to prioritize these areas during busy times of work and school, but there is no excuse to be less than excellent if your swim practice time has been reduced (giving you upwards of 20 extra hours per week of free time for napping and meal prep!).
7) Mental Rehearsal – On that note, use the extra time to practice mentally. There is robust evidence that mental practice (motor imagery) can enhance physical performance. Though many swimmers don't make the time for motor imagery practice during peak training time (though the best in the world surely do), there is no excuse to skip this training if recovering from surgery (Motor Imagery Guide for Swimmers)!
8) Pain – Pain is also a brain aspect. Many swimmers run into trouble when they have been cleared by the surgeon as having been healed, yet confusion often emerges when pain persists, leading to ongoing frustration. We discussed this phenomenon in swimmers guide to pain. Structural healing is only one piece of the puzzle. Different types of motor imagery for pain management can also assist in this area (Swimmers Guide to Pain).
9) Stroke Biomechanics – Rehabilitation is an opportunity to make stroke changes, but you can also revisit whether prior stroke characteristics contributed to the damage. Additionally, you can address physical limitations that may have caused the biomechanical flaws, since rehab is an optimal time to make these corrections (Dryland and Stroke Biomechanics).
10) Dryland Training – Under careful supervision, heavy dryland and strength training is possible when recovering from swimming shoulder surgery. At the right facility, you can work on a plethora of lower body, core (see above), and contralateral exercises (see above). Single limb squats, single limb deadlifts, and many other exercises are possible with a bad wing.
Summary of 10 Keys for Recovering From Swimming Shoulder Surgery
Overall, the basic concepts for recovering from swimming shoulder surgery are the same for swimmer's shoulder. The key point for the coach is to understand that certain movements may be dangerous, but that overall physical conditioning can proceed close to normal so long as the injured site remains protected and pain free. For the clinician, understand that many options exist for a quick return to the water and a safe progression of land training that does not put the surgerized limb at risk. As with any injury, teamwork is vital to ensure a rapid and successful rehabilitation process.
Written by Allan Phillips is a certified strength and conditioning specialist (CSCS) and owner of Pike Athletics. He is also an ASCA Level II coach and USA Triathlon coach.