Ask the Swim Doctor: 2006
"Ask the Swim Doctor" is a popular column written by Dr.
Paul Hutinger. This column appears regularly in the Florida LMSC quarterly
newsletter, which is the recipient of the 1998 USMS Newsletter of the Year
Question: What can I do to keep training when I have persistent pain in my shoulder?
Answer: You can verify rotator cuff injury by testing as follows: stand, arm against your side; bend forearm at 90; resist a force on your hand, inward and outward. A weakness in movement will indicate rotator cuff injury.
The most important muscles for the swimmer and the most overused, involve the rotator cuff. These are a group of muscles and tendons that help hold the head of the humerus (upper arm bone) in the shallow socket in the scapula (shoulder blade). There are no strong ligaments to do the job.
The tendons of the rotator cuff pass under the bony arch of the acromion (outer tip of the shoulder). The muscles and tendons can get pinched under the acromion arch, especially with poor stroke mechanics. Other swimming injuries can occur from overwork and old injuries to the shoulder and arm.
The rotator cuff is primarily four muscles (subscapularis, infraspinatus, supraspinatus, and teres minor) and their tendons. It stabilizes the upper arm in the shoulder socket and allows a great range of motion. Rotator cuff pain is caused by an "impingement syndrome". This is because exertion or overuse causes a compression of tendons by the shoulder bone, resulting in tears and/or inflammation. Bursa are fluid-filled sacs that protect muscles and tendons from irritation by the bone. A shoulder problem of tendinitis or bursitis may be a result.
1. Use ice before and after practice. Invest in a commercial fabric bag, cold compress, that is reusable, to keep in the freezer. Check your local drug store.
2. Change the strokes you use in training or competition. At LCM Nationals one year, I had to change from my usual fly and IM events, to the three breast strokes.
3. Use fins or zoomers for all your swim training and do more kicking. A national record holder used this approach over ten years ago. Unable to do any training because of neck and shoulder problems, she implemented fin training for the entire season. She made the switch to regular swimming several weeks before Nationals and swam some of her best times. Use more kicking--do sets of repeats and time them. Heart rates of 150-160 (depends upon your age) or at the anaerobic threshold and VO2 race speed, for your age, should be part of your kick training.
4. Use stretching and flexibility exercises to keep your range of motion.
5. Strengthen the rotator cuff with special exercises for the muscles involved. Since the rotator cuff muscles are small, you only need to use 2# to 5# weights. The emphasis should be on a high number of repeats, such as 3 sets of 25 repeats.
6. Use aspirin, ibuprofen, or naproxen as an anti-inflamatory.
7. IF THE PAIN PERSISTS, SEE YOUR PHYSICIAN. HE MAY REFER YOU TO AN RPT. EXTREME PROBLEMS MAY NEED SURGERY, AS A LAST RESORT.
Question: I saw you swim at the St Pete meet. How are you able to swim backstroke with both arms, yet use only your right arm for your fly and free events?
Answer: That's a very good question, which I have been asked, many times.
What would you do in swimming if your left arm dislocated when you extend it forward? This is what happened to me, one year ago, as I did a standard two arm pushoff. To avoid this excruciating pain, I swim fly, free and breast with my right arm, left arm at side. I also keep my damaged left arm at my side on forward and back starts and pushoffs. I have to time my turns perfectly, so I always turn with my right arm.
In my August, 2005 column, I mentioned that I would have to swim all strokes with one arm. Getting a shoulder replacement isn¹t in the near future, as it wouldn¹t give my the mobility and strength I would need to be competitive. Since then, I have been able to modify my backstroke, so I am able to use both arms. It puts me in a different position, and I can only use my left arm for a one-half stroke.
With my doctorate in Exercise Physiology from Indiana U, including swim and stroke analysis from Doc Counsilman, I wanted to convert my previous World record technique into at the least, competitive swims in the 80-84 age group.
One factor was my older brother, who had polio, which affected his left arm. I remembered how he would swing his arm when he wanted to raise it above his head. Could I do that in the pool while swimming backstroke?
I thought about the mechanics of trunk rotation while throwing and converted that to swimming, specifically, to the recovery phase of backstroke. The critical timing of the hip rotation before the hand reaches the end of the stroke, increases force in the backstroke pull.
I combined these principles to help recover my left arm on backstroke without causing a painful dislocation.
Through the years, I had developed good body rotation. Now, I needed to time it correctly and control the recovery with my rotation. I worked on this with fins, so I could more easily rotate my hips and body to the opposite side and put my left arm through the stroke pattern when it hits the water the the top of the recovery. The catch and push part of the stroke was then below the critical level (shoulder). The rotation of the upper torso and then the pelvis, compete my modified backstroke pattern.
The experts recommend a 45 degree rotation with a thumb-out recovery.
My rotation is closer to 75 degrees and a little finger-out recovery. This allows me to "throw my arm" for a more efficient arm swing.
My two-arm backstroke is a challenge, and for now, my innovative mechanics are working. The one-arm IM and fly are a lot slower than the National record times I did with both arms.
As swimmers age, they will be faced with more injuries and must find a way to adapt to remain in Masters swimming. It could happen to you. Do the best you can with what you have.
QUESTION: I recently read that if you swim 25's, and longer, in practice without breathing, you can increase your endurance. Is this dangerous in any way?
ANSWER: In St Louis, MO, in the early 1940's, we had a competition that included swimming ten different events during a four-week period. This was similar to the current decathlon, with logarithm tables to determine points scored. One of the events was an underwater swim for time. It was limited to 50 yards, due to the risks of prolonged breath holding underwater. Even then, coaches and most swimmers knew of the danger of underwater breath holding for long underwater swims.
Hypoxic (low oxygen) training, developed by legendary coach Doc Counsilman, chair of my Doctorate dissertation, does have significant value for your workouts. It can help swimmers learn to keep their stroke smooth and strong in the face of apprehension and mental adversity.
The theory is that hypoxic training can increase the ability of the muscles to work better when oxygen levels are low, such as at the end of a 200 meter race. It is also believed that reducing the number of breaths per lap will increase the swimmer's speed, because changing the body position to take a breath tends to increase drag.
The problem is, you can pass out underwater. Your breathing is on automatic, and as your carbon dioxide reaches a certain level, you take a breath. You can override this mechanism in holding your breath, but a very high carbon dioxide level causes you to pass out and automatically start breathing. If you are underwater, death can occur. The unconscious swimmer has no symptoms or warning. Even competitive swimmers working on underwater techniques (hypoxic breathing) for back, breast or free may suffer a blackout. During hypoxic sets (5, 7 or 9 stroke breathing, no breathers, lung busters, etc), the coach must be aware of the dangers and alert the swimmers. If you are a self-coached swimmer, inform the life guard, and tell him to watch in case you pass out under water.
There was an incident in a Florida pool, about ten years ago, that ended in death. The life guard knew the swimmer was working on breath holding, but wasn't aware that he could pass out underwater.
I have a further warning if you use hyperventilation (many rapid
breaths) before holding your breath (on starts or hypoxic swims). This also reduces carbon-dioxide levels and you may be more prone to blacking out underwater.
Hypoxic training can be an important part of training; however, it must be done under very close supervision by coaches or life guards. Lung capacity diminishes with age, so Masters swimmers should be watched even more carefully, especially those over 70.
The Florida Mavericks will be hosting the One Hour Postal in January 2007. I have written this article to help you set realistic goals for your total time and suggestions for your training. One Hour Postal Training Hints
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