Osteo for swimmers

In the latter part of 2013, Eureka Osteo became a sponsor of the best swimming club in Ballarat, Ballarat Gold Swimming Club. They are a family based club with the bulk of the members kids and teenagers.

In my observations over the past few months when on the pool deck, there is a mix of swimmers' abilities and goals: national time swimmers who are training 6-10 sessions a week, right through to those swimming for fitness only and those who are just beginning to swim competition and beginning to push themselves like never before. The passion and commitment of the swimmers and coaching staff is superb and we are really thrilled to have commenced this relationship.

So we are going to a series over the coming months on common swimming injuries and what we can do to help treat them and avoid them. We will also discuss good technique as it vital in avoiding these injuries. Contributing factors to poor technique include: muscle imbalance, postural problems, joint instability or restriction of motion, fatigue and lack of strength. We will elaborate on these in our discussion of each of the injuries.

Of course we have to start the series with…

SHOULDER INJURIES

Not surprisingly, shoulder injuries are the most common of all amongst swimmers. Freestyle, butterfly, breaststroke and backstroke all present their own unique demands on the shoulders. They all require uninhibited range of motion in the glenohumeral joint (commonly called the shoulder joint) and the scapulothoracic joint (the shoulder blade region). These are remarkably dynamic joints and their anatomy allows for excellent range of movement in order to move our hands to wherever we want to reach to.

The less elastic joint structures (ligaments, joint capsule) in the glenohumeral joint are relatively loose and the “socket” part of the joint, the glenoid fossa is shallow (compare the hip joint) to enable this freedom of movement. Because of this, the muscles that make up the shoulder girdle are critical in giving the glenohumeral joint strength and stability.

A group of muscles called the rotator cuff are considered the most important in providing this strength and stability.  They are also the most prone to injury, particularly swimmers. These muscles perform the movements their name implies: rotate the humerus (upper arm). The humerus rotates both internally and externally. 

One of the keys to producing power in all swimming strokes is in the catching and pulling of the water with the upper limb and hand. The muscles that need strength and do gain strength in swimmers are those that internally rotate the arm. The larger of these muscles are pectoralis major on the chest and latissimus dorsi or the “lats”. The development of the lats is what gives swimmers their distinctive “v-shaped” backs. The other muscles that internally rotate the arm are teres major and subscapularis, both part of the rotator cuff. These internal rotators do so much work in swimmers and get very strong. They do however have a tendency to pull the humerus forward or anteriorly in the glenohumeral joint which can lead to altered joint mechanics, and due to the repetitive nature of swimming can lead to tendon problems (tendonopathy) caused by pinching or squeezing of the tendon (impingement). The tendon of the long head of biceps can also suffer from a tendonopathy.

Therefore, it is important for all swimmers who are training more then a few times a week to strengthen the muscles that externally rotate the arm in order to maintain good balance of the glenohumeral joint. These muscles are also part of the rotator cuff: teres minor and infraspinatus. The other muscle of the rotator cuff, supraspinatus, contributes a little to both internal and external rotation depending on which position the arm is in. Strengthening these muscles will give the shoulder more stability and they will be less prone to injury, especially under maximum effort and when fatigued.

Dry-land exercises are the simplest way to achieve strength in this group of muscles and can be done at home with a resistance band. Simple body-weight exercises like push-ups, chin-ups and plank are all excellent at building strength in the shoulder girdle and core as well. If coupled with a regular stretching program for the shoulders, swimmers can help minimise the risk of a shoulder injury.

Shoulder problems can also occur with over-training (particularly of the one stroke), sudden increases in intensity of training and one sided breathing. The way your hand enters the water can also cause strain at the shoulder: a thumb first entry is only possible with excessive internal rotation at the shoulder, so ensure that hand entry is with a flat hand with fingertips entering first. Avoiding the hand crossing the midline at the front of the stroke, which goes hand-in-hand with good symmetrical body roll in freestyle, will also help avoid excessive internal rotation. This creates greater ease of shoulder position and movement of the recovery arm high over the water with the elbow leading until the arm passes the shoulder.

Preventing shoulder injuries is a lot easier then rehabbing an injured shoulder and osteopaths are well-placed to assess your shoulder function and make recommendations for a strengthening and stretching program individualised for your needs. The benefits are not just injury prevention but also: increased power of the pull through the water, improved technique due to better muscular balance and range of movement, and importantly, increased praise from your coach because your form is better!

Should you injure your shoulder, osteopaths can also assess and diagnose your injury, help you through the acute phase of pain and loss of function, and advise how to best rehab the shoulder. Once the shoulder has improved, we also recommend an ongoing strength and stretch program to help avoid recurrence of the injury.