We are thrilled that after about a year of production and development, the ISCA Education Program has officially launched!
The program is available online internationally and features evidence-based curriculum developed by sport scientists specifically for swim coaches. Our modern education portal is easy to navigate and secure, with transcript tracking and interactive course content.
ISCA Certification is available for coaches that are ISCA members and also complete the six core science-based courses (Biomechanics 101 & 102, Physiology 101 & 102, and Sport Psychology 101 & 102). The science behind swimming is something that all coaches need to understand to be effective and successful–and we look forward to providing this crucial piece of education to coaches around the world.
Fundamental shoulder strengthening exercises for competitive swimmers
Written by Behnam Liaghat, recognized specialist by the International Federation of Sports Physical Therapy, based in Denmark at the University of Southern Denmark. Email: firstname.lastname@example.org
Following my recent blog about identifying joint hypermobility in swimmers, in this blog I will go through some of the top shoulder exercises for the competitive or elite swimmer to develop fundamental strength and neuromuscular control of the rotator cuff and scapular stabilizers.
In our recent research about young competitive swimmers with joint hypermobility (Liaghat et al., 2018), we found that swimmers with inherent shoulder joint hypermobility displayed reduced internal rotation strength and a tendency to poor activation of the scapular muscles. Another interesting finding was that swimmers with joint hypermobility not only display reduced absolute internal rotation strength, but these swimmers are weaker through the entire range of shoulder rotation. The suggested dry-land exercises in this blog can be designed to be beneficial for both hypermobile and non-hypermobile swimmers with few adjustments in range of motion, i.e. by increasing shoulder rotation to be as close as possible to the individual end range.
What are the benefits?
The four exercises specifically aim at improving shoulder retraction (refers to moving the scapula towards the spine), internal rotation and external rotations strength. To avoid injuries, it is important to target muscles on both sides of the shoulder to achieve a balanced intermuscular function. This is the rationale for including exercises for both internal and external rotation movements. Adequate strength in these movements has, besides injury prevention purposes, a positive effect on swimming stroke performance.
Some general guidelines for these exercises include performing them without producing any pain or discomfort and slowly through the entire range (approximately 6-8 seconds per repetition) to engage all important muscles. As there are no golden standard number of repetitions, you may want your swimmers to start with 3 x 30 seconds for the first 2-4 weeks and then move on to 3 x 8-12 repetitions with heavier resistance. Depending on the load applied and experienced level of muscle soreness, the exercises can be performed 3-5 times weekly. Make sure your swimmers breathe in a relaxed manner and engage the whole kinetic chain in all exercises.
When introducing these exercises to your swimmers, be certain that they can control the shoulder so excessive movement of the tip of the shoulder in either upward (towards the ear), backward or forward directions is avoided. In principle, reducing resistance and/or decreasing the range of movement may be applied to increase quality of shoulder control.
Active release of muscles before you start
Before instructing swimmers in performing these exercises, it is recommended to do some active release of the posterior rotator cuff muscles by standing against a wall with the arms perpendicular to the trunk and putting a pressure to the mid-point of the scapula with a lacrosse ball to target the infraspinatus area (Fig. 1). From here the swimmer can simply roll on the ball and add a shoulder external and internal rotation movement for up to two minutes to release tight and sore muscles (Fig. 2 A-C). The active self-release can be performed in supine for adding more pressure.
Now let us move on to the top dry-land exercises for fundamental shoulder strength
Exercise 1: Prone 1-arm diagonal lift
Either lie on the floor or on a gym ball supporting with your feet and one arm. Apply resistance with an elastic band. Slightly retract and depress your shoulder before lifting your arm with a 45 degrees angle away from the trunk´s midline. While lifting the arm, a maximum external rotation is performed in the arm so the thumb points towards the ceiling.
Level down by lifting the arm perpendicular to the trunk’s midline.
Level up by adding a back extension in the movement or lifting the opposite leg.
Exercise 2: Supine internal rotation 1
Either lie on the floor or on a gym ball supporting with your feet. Apply resistance with an elastic band. Slightly retract and depress your shoulder before turning one arm at a time internally as far as possible without losing shoulder control (e.g. protracting the shoulder towards the ceiling).
Level up by adding oscillation (fast movements back and forth) through the movement.
Exercise 3: Supine internal rotation 2
Description: Either lie on the floor or on a gym ball supporting with your feet. Apply resistance with dumbbells. Slightly retract and depress your shoulder before slowly turning one arm at a time externally in cranial direction and then back to vertical position in the underarm without losing shoulder control (e.g. avoid pushing the shoulder towards the ceiling).
Level up by adding more load and increasing range of external rotation.
Exercise 4: Prone external rotation
Lie on a gym ball supporting with your feet and one arm. Apply resistance with a dumbbell. Slightly retract and depress your shoulder before externally rotation your arm with the upper arm perpendicular to the trunk.
Level up by adding more load and increasing range of external rotation.
Every swimming coach should be familiar with these top shoulder exercises and include them in some content as part of the dry-land routines for injury prevention and for enhancing swimming stroke performance.
A special thanks to the Danish swimmers Matilde Lerche Schrøder and Line Virkelyst Johansen for giving their photo consents.
Liaghat, B., Juul-Kristensen, B., Frydendal, T., Marie Larsen, C., Søgaard, K., & Ilkka Tapio Salo, A. (2018). Competitive swimmers with hypermobility have strength and fatigue deficits in shoulder medial rotation. Journal of Electromyography & Kinesiology, 39, 1-7. DOI: 10.1016/j.jelekin.2018.01.003
Written by Behnam Liaghat, recognized specialist by the International Federation of Sports Physical Therapy, based in Denmark at the University of Southern Denmark.
With hypermobility, it is really a balance for the swimmer between taking advantage of the condition by reducing drag and avoiding excessive motion that may potentially damage the joint. I propose that you may easily acquire the knowledge to test many of your swimmers for generalized joint hypermobility, including shoulder hypermobility, within 1-2 minutes.
In our recent research study on young competitive swimmers, the main findings were that healthy swimmers with hypermobility in the shoulder had a decreased strength and a larger fatigue development. In addition, more experimental data indicated a poorer stability of the shoulder blade. As a swimming coach, you can prescribe exercises to target these deficits and help your swimmers take advantage of their joint hypermobility. Generalized joint hypermobility is evaluated with the 9-point Beighton scale, which requires the performance of five maneuvers, four passive bilateral and one active unilateral performance:
Passive dorsiflexion and hyperextension of the fifth MCP joint beyond 90°
Passive apposition of the thumb to the flexor aspect of the forearm
Hyperextension of the elbow beyond 10°
hyperextension of the knee beyond 10°
Active forward flexion of the trunk with the knees fully extended so that the palms of the hands rest flat on the floor
Each positive test scores one point, with cut-off values of more than 5/9 being indicative of the presence of generalized joint hypermobility. These cut-off values may vary, and some authors suggest lower cut-off values (e.g. 4/9) for males.
Since the shoulder is not represented in the Beighton scale, you may use a shoulder external rotation (positive score more than 90°) with the upper arm in neutral along the side of the body.
In case further investigation is required of the musculoskeletal condition of the swimmer or in case the swimmer experiences pain, please refer to a sports physiotherapist, who can perform additional tests and examination.
For more detail on this topic, please read the freely available research paper by Liaghat et al. (2018): “Competitive swimmers with hypermobility have strength and fatigue deficits in shoulder medial rotation”. https://authors.elsevier.com/a/1WU8g3kurobLDS
Research on swimming is broad and essential for the evolution of the sport. The level of swimming related scientific research is very advanced, as is the level of coaching. However, as both fields are very demanding, their connection, in terms of knowledge and experience diffusion, is difficult.
In-depth reading of scientific papers is needed for a thorough interpretation of their results. However, this is usually time consuming and difficult for non-accustomed readers. The short display (shorter than their abstract) of interesting articles in a simple manner, without meddling, for someone to figure out if an article is helpful (and then go on with full-text reading), is our main intention. Additionally, useful notes from the coaching practice that are based on testing will be posted. The purpose is to assist swimming coaches and relevant sport scientists to keep up with the swimming research progress.
So sswimt comes to accelerate the dissemination of information and updates on swimming testing and research with a focus on physiology, biochemistry, metabolism, nutrition and training! Our goal is to set off the abundant information provided by eminent sports scientists and swimming coaches, thanks to whom swimming is evolving constantly. Hope you will enjoy it! More interesting things are on the way…
This episode of the Swimming Science Podcast features Jenni Brozena.
Jenni Brozena is the President and Owner of Aqueous, a healthcare education and human performance company specific to the aquatic athlete. The company’s cross-disciplinary approach brings exercise physiologists, physical therapists, athletic training, sports medicine doctors, athletes, and parents together to understand the body/water connection. The evidence-based approach is centered on the deliberate treatment of the unique needs of the aquatic athlete. She also currently serves as the Director of Aquatic Performance at Kinetic Physical Therapy where she and physical therapists utilize video analysis to build a deliberate treatment plan and return to sport goals for aquatic athletes. Her research has been accepted at the Biomechanics and Medicine in Swimming Symposium and the 3D Analysis of Human Movement Symposium. Her current research interests include neuromuscular core control during the body roll and utilizing video analysis as a patient outcome measure in the health care setting.
Thanks for joining me for this episode. I know the conversation broke up a few times and I apologize, I’m still very new with this! If you have any tips, suggestions, or comments about this episode, please be sure to leave them in the comment section below.
If you enjoyed this episode, please share it using the social media buttons you see at the bottom of the post.
Shoulder pain is almost universal in swimming, and like most endurance sports, overuse injuries are commonly encountered (commonly called swimmers shoulder). The difference between routine soreness associated with sports can be had to distinguish from the pain of injuries. Usually, soreness in the shoulder is relatively mild and associated with training. It improves with time or the occasional anti-inflammatory medication. In general, shoulder pain that is progressively worsening, unresponsive to conservative treatments (over the counter medications, ice, etc) or causing significant functional limitations should be evaluated by your team orthopedic surgeon. Additionally, any shoulder dislocation should be seen managed by an orthopedic surgeon.
All doctor visits will be different, but most follow a similar pattern. Your orthopedic surgeon will take your history, where you explain your shoulder problems and perform a physical examination of your shoulder. X-rays will usually be obtained, and these show valuable information. Many causes of shoulder pain (including those not associated with swimming) can be identified on x-rays – for example bone spurs, arthritis, avascular necrosis, tumors, or infections. Depending on the information from your visit, sometimes an MRI or an MRI Arthrogram (where a radiologist injects contrast into the shoulder to show more information) may be ordered to help with your diagnosis. This can show more detail on soft tissue injuries, such as rotator cuff tears, tendonitis, labral tears, or biceps injuries.
Controversy exists around “Swimmers Shoulder” and what exactly causes it. It is associated with training volume and is thought to be due to the miles accumulated during a career. Depending on the exact cause, a treatment program will be discussed. Fortunately, most of the injuries associated with swimming improve with out surgery. A short period of rest, with anti inflammation medication, and physical therapy can help with much of the pain. Physical therapy can be extremely helpful to retrain the muscles around the shoulder and the shoulder blade to make you more stable and decrease pain. Occasionally, cortisone injections can be useful for tendonitis or inflammation that does not respond. For some injuries, shoulder surgery may be recommended to get you back to optimal performance and relieve your pain. Your orthopedic surgeon can help make recommendations based on your individual case.
Written by Lucas Wymore. Dr. Wymore is an orthopedic surgeon specializing in sports medicine. He attended Notre Dame for college where he swam for the Irish. He went to medical school at Texas A&M University, completed my orthopedic residency at the University of North Carolina at Chapel Hill and a sports medicine fellowship with the San Diego Sports Medicine and Arthroscopy fellowship. He became interested in sports medicine while in high school. He loved sports, and because of swimming, he had a desire to remain involved in the sport and work with athletes as a career.
1. Please introduce yourself to the readers (how you started in the profession, education, credentials, experience, etc.).
My name is Lucas Wymore, and I am an orthopedic surgeon specializing in sports medicine. I attended Notre Dame for college where I swam for the Irish. I went to medical school at Texas A&M University, completed my orthopedic residency at the University of North Carolina at Chapel Hill and a sports medicine fellowship with the San Diego Sports Medicine and Arthroscopy fellowship. I became interested in sports medicine while in high school. I loved sports, and because of swimming, I had a desire to remain involved in the sport and work with athletes as a career.
2. You recently published an article on subject active swimmer responses based on their shoulder. What do we know about the accuracy of subjective responses ?
We know with any survey study, there are some inherent limitations. Recall bias can change people’s responses due to memory of past events. Some athletes may wish to underreport their symptoms if they fear that they may lose playing time. In order to decrease this bias, our study was to be completed based on shoulder symptoms at the present time, in an effort to minimize recall bias. Privacy was assured so that athletes would be more comfortable answering as truthfully as possible.
3. What did you choose the KJOC and did you consider any other subjective questionnaires ?
The KJOC score was selected because it is validated for overhead athletes. It is specific for function and performance in the athlete, which will pick up differences that may be missed in other scores. Many studies have used this questionnaire for a variety of shoulder and elbow research in athletes. There are other shoulder scores in the orthopedic literature, but these focus on activities of daily living. For example, the Disabilities of Arm, Shoulder, and Hand (DASH) ask questions including difficulty with preparing meals or washing one’s hair because of shoulder pain. In many athletes, they may have a debilitating shoulder problem and are completely disabled for sport, but can still have a nearly perfect DASH score. The KJOC score evaluates function and performance specifically for athletes to find these differences.
4 . What exactly did your study look at and why is this a point of interest ?
Our study was designed to define a baseline KJOC score for active swimmers. We wanted to take a group of swimmers that were actively competing in the sport at a high level, and determine a numerical value for their shoulder function. This had been done previously with baseball pitchers. Our goal was to provide similar data to the swimming community that can be useful for comparison both with future research and clinical evaluation.
5. What were the results of your study ?
The study showed that swimmers had a surprisingly low baseline KJOC score. The mean score for all participating athletes was 79.0 out of a possible 100. For swimmers competing without shoulder trouble, the mean score was 84.4, those with shoulder trouble was 53.9. We found swimmers competing for 11 years or longer had a significantly lower score than those swimming for 10 years or less, 72.0 vs 86.4, respectively. We have no other swimming data like this for comparison. However, other studies looking at baseball pitchers show a baseline score of 94.8 (Kraeutler et al, Journal of Shoulder Elbow Surgery, 2013.) That study concluded that scores for healthy pitchers should be greater than 90. Our study showed a baseline score less than 80.
6. What were the practical implications for coaches and swimmers from your study ?
This data can be useful when evaluating swimmers with complaints of swim shoulder pain. The survey is very simple to use and can be completed in under 5 minutes. Physicians and athletic trainers can now compare their athlete’s score to our baseline scores to help guide treatment.
7. Do you think the results would be different if you had older, elite or untrained swimmers?
Yes, I think the results would have been different. We focused only on NCAA swimmers, which gives a consistent age and skill level. Older studies show that youth or age group swimmers have less incidence of swim shoulder pain than older swimmers. Most research shows that the more elite swimmers have a higher incidence of shoulder trouble. I think that generalizing our results to all swimmers- competitive or recreational, youth or masters, is difficult and should be done with caution.
8. There has recently been research on perceptions of swim shoulder pain in swimmers (mainly by Hibberd), what are your views on the perception of swim shoulder pain in the sport of swimming?
Dr. Hibberd has published some excellent research in swimming. Her recent article on perception of swim shoulder pain gives a scientific insight to the culture of the sport. I think that in swimming, shoulder pain is considered part of the sport in ways not seen in other overhead athletes. Pitchers are shut down if they develop shoulder pain. Swimmers tend to accept it as normal. I think our data shows this. Athletes who define themselves as competing without shoulder trouble have an average score of 84.4- still lower than what is considered the cutoff for a healthy pitcher.
9. I’m often asked, especially in maturing young swimmers, how can you tell the difference between pain and soreness, how do you respond to that question?
It can definitely be difficult to define. In general, I think of soreness as the body’s physiological response to intense athletic activity. It is generally milder discomfort, resolves on its own, and should not interfere with sport. Pain from injury tends to be more severe and consistent in location and nature. Pain that forces alteration in technique, or causes a noticeable decline in performance in both training and competition is more concerning.
10. There has been more of a shift towards high intensity swimming training with a lower volume, do you feel this training approach reduces shoulder stress ?
I think that the “swimmers shoulder” is a cumulative effect of the miles on the shoulders. Swimming is still an inexact science- both with training and medicine. I think that less miles reduces shoulder stress. The true test will be if it improves performance as well as decreases shoulder problems.
11. If a swimmer has pain in their shoulder, what course of action do you suggest?
I would first recommend a short period of rest (3 days rest to minimize deconditioning,) ice, and anti inflammatory medications. Then a gradual return into the pool, with a focus on warm up. Pain that was persistent and more debilitating warrants work up with a careful exam of the shoulder, X-rays, and possibly an MRI if there was concern for a soft tissue structural problem, such as a tear of the labrum or rotator cuff.
12. What research or projects are you currently working on or should we look from you in the future?
I would like to design a study that determines prevention strategies to decrease shoulder problems in swimmers. In our study, the question “How difficult is it to get loose or warm up before practice?” had the lowest score, a mean of 6.4 out of 10. I think that investigating warm up is an area that may help the athletes decrease shoulder problems.
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The NCAA has The NCAA has sanctioned championship events in the men’s swimming and diving since 1937 and women’s swimming and diving since 1982. Over the 2013-2014 academic year, 9,630 men and 12,333 women participated in NCAA swimming and diving. Unfortunately, the rate of injuries is not well documented in the sport. This study assessed the injury rates within the sport of swimming and diving. This study collected data from nine varsity swimming programs.
Men’s Swimming and Diving
Overall, there were 149 injuries reported in the college men’s swimming and diving. Of these, 133 were swimming injuries and 25 were diving injuries. Most of the injuries occurred during the regular season 61.7%. Most were non-severe injuries, as 77.2% did not require time off, while 2.7% required surgery. The injury rate was 1.54/1000 athletic exposures.
Women’s Swimming and Diving
A total of 208 injuries were reported for college women’s swimming and diving. Of these, 171 occurred in swimmers and 37 in divers. Like the men, most occurred during practice during the regular season. The severity of the injuries were similar to the men, with only 1.9% requiring surgery. The injury rate for women was 1.71/1000 athletic exposures.
There was no trend for the men’s swimming and diving injuries, while the women had a reduced injury rate in the 2012/2013 – 2013/2014 season.
The most injured site was the shoulder in men’s swimming (34.7%), men’s diving (32.0%) and women’s swimming (31.3%). The trunk/low back had the largest injury rate in women’s diving (37.8%). Of the injuries, the majority were strains.
Classification of Injuries
The majority of the injuries were classified as overuse. Overall, these injury rates are encouraging, as previous research suggests higher injury rates within the sport. However, the culture of swimming likely under reports injuries, as many swimmers believe shoulder pain is “normal”. In fact, a recent study by Dr. Lucas Wymore reports active swimmers without an injury have a lower subjective functional score than injured baseball players. Clearly, further education and a shift in culture is necessary for further decreasing the rate of shoulder and low back injuries, the two most common sites of injury in swimming.
Improving shoulder strength is a frequent goal of injury prevention and rehabilitation, often termed stability. Stability suggests balance and proportional strength around the joint exists. Shoulder joint stability is a result of passive and dynamic components. The bone geometry, relative intra-articular pressure, glenohumeral labrum and capsuloligamentous structures are the passive components. The dynamic components are those which contract around the joint, often the muscles and tendons. Both passive and dynamic structures provide proprioceptive (joint position) for the joint. Proprioception is an essential aspect of sports, as it is a main component of body awareness. Studies on throwing athletes have found a poor sense of position on the throwing side and a correlation with instability. Despite the importance of proprioception, the effects of strength training on proprioception is not well researched.
Strength Training on Shoulder Proprioception
Salles (2014) split 90 male undergraduate students into three groups:
Performed exercises at the same intensity
Performed exercises at different intensities
Performed no upper body exercise
The exercises were performed for 8 weeks and included bench press, lat pull down, shoulder press, and seated row. Before and after the training, a joint positioning test was performed on each arm.
Strength Training on Shoulder Proprioception Results
Nine subjects did not finish the study due to a lack of time. Before the study, there was no difference between groups. However, after the training group 1 had a less absolute error than group 2 during the joint position test. Group 2 also had greater improvements in sense of position than the control group.
Strength Training Improves Shoulder Proprioception
Overall, strength training appears beneficial for improving joint positional sense and a constant exercise intensity (8-9 RM) appears better than a varying intensity (8-9 RM and 12-13 RM). However, the effects of strength training during sport must also be studied, as fatigue and overtraining may influence these findings. Also, the effects of strength training and proprioception in those with shoulder injury, particularly swimmer’s shoulder, is an important research topic.
Nonetheless, it seems shoulder strengthening with a lower volume and constant intensity is most beneficial for improving shoulder proprioception. Therefore, consider adding shoulder strengthening for your return to swimming program and swimmer’s shoulder prevention programs.
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.
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