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.

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Are Partial Squats Beneficial for Swimming Performance?

Before we get into squats I want to tell everyone about a cool feature of the Dryland for

Swimmers product. As you all know, knowledge and information continually grows. This one reason slowed me from creating Dryland for Swimmers. However, once I made the product, I realized it is possible to continually update and continue the flow of ideas of dryland and how it applies to swimming! We have started a Dryland for Swimmers Private Facebook group for everyone! This group continues the conversation, answers questions, and updates material on the ebook and video database. If you haven't already, purchase Dryland for Swimmers for all your information on dryland and continual updates! Thanks for reading!

Full or partial range squats? It seems the answer is obvious, if you can do a full squat, then why not fully squat? A full squat will activate more musculature, as you’ll go through the entire motion. However, is a full squat necessary for swimmers? As Tiago Barbosa points out, the knees only bend ~112 degrees during dolphin kicks, so do we need a full range of motion (~140 degrees of knee flexion) development during this motion? The knees bend ~90 degrees on a turn, so do you really need to go for the complete knee range of motion? Also, if you are truly mimicking a turn with your squats, should you do them on your toes?

Note: This is a partial squat, full depth squats can be done safely with minimizing pelvic motion. The bucket drill can help teach people pelvic motion.

Specificity of Range of Motion

If you frequent this website frequently, you've certainly heard of the principle of specificity (most recently referred to by Allan Phillips). The Specificity Principle simply states that training must go from highly general training to highly specific training. The principle of Specificity also implies that to become better at a particular exercise or skill, you must perform that exercise or skill. To be a good cyclist, you must cycle. The point to take away is that a runner should train by running and a swimmer should train by swimming.

Past research suggests the specificity of range of motion of strength training. Also, muscular size also adjusts to the range of motion for the exercise (Bloomquest 2013). It seems specificity is truly specific, as the body adapts to the specific ranges of motions trained.

Zatsiorsky (1995) hypothesized that partial lifts may improve power more than partial range of motion.

Clark (2011) notes:
“The terminal range of motion is loaded more optimally with a partial ROM lift than a full ROM lift because the full ROM lift is limited by the sticking point. Considering that many sports involve countermovements from knee and hip angles similar to those in a partial squat, has lead previous researchers to suggest that partial squats may improve athletic performance by increasing strength and explosiveness in the corresponding joint angles”.

Do Partial Squat Training Enhance Performance?

Bazyler (2014) had 18 recreationally trained college males (~20.8 years) perform 3 weeks of familiarization training, followed by a 3 week strength phase. After the 3 week strength phase a deload was performed. After the deload, another three week strength phase was applied. The subjects were split into two groups:

• Full range squat training 
• Full range squat training plus partial range of motion training (100 degrees knee angle to lockout position).

The training was performed 2 days per week.

Both groups had significant improvement in the full range of motion squat. Partial range of motion squat had significant improvements in both groups as well.

Isometric squat impulse showed a significant increase from pretraining in the partial training group for all time points with 90 and 120 degrees, but full range of motion only improved at 250 milliseconds with 120 degrees. The larger effect sizes for isometric squat impulse 120° (0.48) and impulse scaled with 120° (0.45–1.11) was present in the partial range of motion group.

Body composition was significantly lower in only the full range of motion group.

Adding partial range of motion training further enhances strength gains in previously trained subjects. However, this improvement may solely occur from the increase in training volume.

The greater increase in the isometric squat impulse may be more useful to swimmers, as swimmers don’t go into full knee flexion. For example, contact time for elite sprinters is ~90 milliseconds. At 90 milliseconds at 120 degrees knee flexion, the partial range of motion group was significantly greater. Elite swimmers have a "reaction time" from the block of 500 milliseconds, more specific to the rate of partial squats.

Will Partial Squats Help Swimmers?

We don't know. Unfortunately, this is the common result for many dryland applications with swimming, there are no clear cut answers. However, this study suggests partial range of motions squats improve peak impulse, which may translate to starts and turns or even quick dolphin kicks. However, the squat is much different motion than any of these actual tasks. If coaching, you must decide if you think squats or partial squats transfer to swimming, implement the training, then check the results.

References

1. Bazyler CD, Sato K, Wassinger CA, Lamont HS, Stone MH. The efficacy of incorporating partial squats in maximal strength training. J Strength Cond Res. 2014 Nov;28(11):3024-32. doi: 10.1519/JSC.0000000000000465.
2. Bloomquest K, Langberg H, Karlsen S, Madsgaard S, Boesen M, Raastad T. Effect of range of motion in heavy load squatting on muscle and tendon adaptations. Eur J Appl Physiol 113: 2133–2142, 2013.
3. Cotter JA, Chaudhari AM, Jamison ST, Devor ST.Knee Joint Kinetics in Relation to Commonly Prescribed Squat Loads and Depths. J Strength Cond Res. 2012 Oct 18. [Epub ahead of print]
4. Hartmann H, Wirth K, Klusemann M, Dalic J, Matuschek C, Schmidtbleicher D. Influence of squatting depth on jumping performance. J Strength Cond Res 26: 3243–3261, 2012.Clark RA, Humphries B, Hohmann E, Bryant AL. The influence of variable range of motion training on neuromuscular performance and control of external loads. J Strength Cond Res 25: 704–711, 2011.
5. Kivlan BR, Richard Clemente F, Martin RL, Martin HD. Function of the ligamentum teres during multi-planar movement of the hip joint. Knee Surg Sports Traumatol Arthrosc. 2012 Aug 11. 

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.

Dryland for Swimmers

The Dryland for Swimmers ebook and video database is the most comprehensive dryland program and guide for swimmers. It includes a detailed dryland research analysis, club programming, and individual programming.

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Elite Swimmer Dolphin Kick Analysis

Take Home Points:

1. A qualitative, kinematic and hydrodynamic analysis of Thiago Pereira (Brazil, 2012 OG silver
   
   medalist at the 400IM) underwater kick in a flume.
2. In this trial, Thiago´s maximal knee and hip flexions were 112 and 148 degrees, respectively. The feet, knees, hip and shoulders vertical displacement were 0.49m, 040m, 0.16m and 0.21m;
3. His Strouhal number was 0.54-0.40 between 1.5 and 2.0m/s making him almost as efficient as some cetaceans (dolphins and whales).

Researchers and sport analysis must adhere to ethic guidelines. For instance, in most countries we are not allowed to disclose the identity of our subjects. Not so long ago, researchers would share what they have done only after the study being concluded. These days, we live in such fast-paced world that people are eager to share what they are up to. The temptation to post on social media pictures and videos of testing sessions and data collections is very high. In several countries, if one posts this kind of audio/video recording will be in troubles with the Institutional Review Board or Ethic Committee. If such posts involve underage participants, things will be nasty for the researchers. Can you image to be the parent or guardian of a swimmer that was invited to be part of a research, you authorized and a few days later pictures of your child in trunks or swimsuit are online and his/her identity is not protected? I guess the answer depends from which region of the world you are reading this post. In several countries a lawsuit would be filed against the researchers and the university. Other countries have more relaxed guidelines though.

It is not only the researchers that are sharing information on social media. Swimmers also do it on regular basis. It is a nice way to keep in touch with the fans. As long as they are adults, the ones posting the audio/video recordings and it is a public post, there are no ethical concerns. A few weeks ago, Thiago Pereira (Brazil) was generous enough to share a couple of videos over some testing sessions that took place in a flume in Tenerife (Spain). In one post we can watch him performing the underwater kick. Eventually this video became viral among the Brazilian and Portuguese swimming fraternity. It was shared by more than 2,400 people. Just a little bit of History: Brazil is a former Portuguese colony that is independent since 1822. Both countries share the same language (Portuguese) and have a common cultural heritage. 

We can perform a three-fold analysis of Thiago´s underwater kick: (i) qualitative analysis (as a coach would do); (ii) basic kinematics (as done on regular basis by sports analysts); (iii) hydrodynamics (carried out mainly but not exclusively by researchers).

Analysis of Thiago Pereira

• You may want to recap the main tips for a good underwater kick over here. You can also find
  
  some thoughts on the butterfly kick by Dana Vollmer (USA) and an analysis to her technique here.
• Thiago shows a nice body alignment (head´s in neutral position; arms fully extended; upper part of the body is streamlined for as much as possible)
• Wave motion (it seems to move all the way back to the feet; wave motion is not too wide so that would increase the drag force or impair the propulsion)
• Kicking (feet are in plantarflexion, i.e. tiptoes; seem to be pointing slightly inwards to increase the propulsive area; ankles are flexible enough; there is a quick change of direction from the upbeat to the downbeat and from the downbeat to the upbeat; he bent slightly the knees and hip to help the kicking; kick is short, fast and seems to have a good tempo).

 

Dolphin Kick Kinematics

• The kinematic analysis of the underwater kick involves mainly the assessment of joint angles and joint vertical displacements.  
• At least in this trial, Thiago´s maximal knee flexion was 112 degrees. Interestingly, in a sample of 19 international level swimmers Arellano (2002) reported an average angle of 113 degrees. His maximal hip flexion was 148 degrees.
•  The feet, knees, hip and shoulders vertical displacement were 0.49m, 0.40m, 0.16m, 0.21m, respectively. So, we can see that the extremities of the body have a higher vertical displacement.  Hence, wave motion moves all the way back (i.e. caudal direction). We can find in the literature a few papers reporting the same thing (e.g., Hochstein and Blickhan, 2011).

Dolphin Kick Hydrodynamics

• The questions that most of you will have right now are: “why should we perform the wave motion? What is the advantage?” and “Is it possible to measure it? To quantify it?”
• The wave motion (i.e. the vertical displacement of all major joints up and down as described earlier) will help to produce a vortex-wake. The same way fishes and cetaceans do it. When Thiago performs underwater kick the wake generated is very specific in the form of a sequence of vortices that alternate the direction of the rotation. While the feet moves one direction, creates a clockwise vortex, and then to the other, causing a counter-clockwise one (Arellano, 2002). Interestingly it was found that swimmers create this vortex in the front part of the body and then it will travel backwards (Mason et al., 1992) (Fig 1, bottom). Long story short: the vortex on the feet will produce thrust due to jet propulsion. That is why swimmers should perform the upbeat-downbeat and the downbeat-upbeat changes as fast as possible. A little bit of math: the circulation vortex increases with the angular speed and area. The induced velocity increases with the circulation vortex. Bottom line: if you are fast enough changing from up-down and down-up (i.e., short and fast kick) you increase the speed, likewise the circulation vortex and the induced velocity. Small and translating vortices are created in the end of the downbeat and no vortices at all are created in the end of the upbeat by poor swimmers (Arellano, 2002). Good swimmers created a big static vortex in the end of the downbeat and a small vortex in the end of the upbeat (Fig 1, top).

• To quantify the efficiency of the wave motion we can compute the Strouhal number (St). In fluid mechanics St is defined as a “dimensionless number describing oscillating flow mechanisms” or “the ratio between unsteady and steady motion”. For the layman I would say that it is the ratio of tip-toe speed to body speed and enables us to monitor the optimal creation of thrust associated with jet and vortices. So, the lower the St (i.e. less jet needed for a given same speed) the better.
• We can benchmark Thiago Pereira against other national and international level swimmers (Arellano 2002; von Loebbecke 2009 et al., 2009; Hochstein and Blickhan, 2011) and even against other animals such as cetacean (i.e., dolphins and whales) (Rohr and Fish, 2004). As expected, human swimmers were outperformed by their cetacean counterparts (fig 2). Overall the international level swimmers are better than the national counterparts.
• I am not completely sure of the flow speed in Thiago´s trial. I got values between 1.7 and 2.2m/s over several attempts, but most of them at 2.0m/s (mode=2.0m/s). So my guess is that the trial was performed at around 2.0m/s. Anyway, I estimated his Strouhal number for a range of speed between 1.5 and 2.0m/s. Each red dot is his trial at different hypothetical speeds. As speed increases his Strouhal number decreases. He is clearly better than the swimmers reported in the literature. What is surprising is that at higher speeds he reaches values similar to some cetaceans. He is within the range of values often reported for dolphins and whales, i.e., between 0.2 and 0.4 (Taylor et al., 2003).
• Short question for a short answer: “Why is the Strouhal number lower in cetaceans than humans?” Cetaeans have many vertebrae leading up to the end of the tail, which allow them to pass a much smoother wave. Humans have a very limited number of joints. So the increase of displacement along the length of the body is not smooth. Humans also have smaller propulsive areas and a few muscle-skeletal constrains. Elite swimmers, as Thiago are not cetaceans albeit are more flexible, have more strength and larger surface areas than poor swimmers.
• How can one improve the Strouhal number (i.e. the wave motion efficiency during underwater kicking)? To start, the body speed must be the same or higher. Anything that would you make impair the forward speed, not good at all. So make sure that the forward speed is the same or increases. After that, improve the kicking tempo (i.e. less time to perform the kick) and decrease the kicking amplitude (i.e. less vertical displacement). Follow-up question: how can one improve kicking tempo and amplitude? There are several ways, I´ll cover only two key-factors: strength and conditioning and technique. The swimmer must build-up strength power (e.g., to improve the kicking tempo) and enhance the kicking technique (e.g. decrease the joints range of motions, notably the knee flexion and therefore the kicking amplitude).

References

1. Arellano, R., Pardillo, S., & Gavilán, A. (2002). Underwater undulatory swimming: Kinematic characteristics, vortex generation and application during the start, turn and swimming strokes. In Proceedings of the XXth International Symposium on Biomechanics in Sports, Universidad de Granada
2. Hochstein, S., & Blickhan, R. (2011). Vortex re-capturing and kinematics in human underwater undulatory swimming. Human movement science, 30(5), 998-1007
3. Loebbecke, A. V., Mittal, R., Fish, F., & Mark, R. (2009). A comparison of the kinematics of the dolphin kick in humans and cetaceans. Human Movement Science, 28(1), 99-112
4. Rohr, J. J., & Fish, F. E. (2004). Strouhal numbers and optimization of swimming by odontocete cetaceans. Journal of Experimental Biology, 207(10), 1633-1642
5. Taylor, G. K., Nudds, R. L., & Thomas, A. L. (2003). Flying and swimming animals cruise at a Strouhal number tuned for high power efficiency. Nature, 425(6959), 707-711

By Tiago M. Barbosa PhD degree recipient in Sport Sciences and faculty at the Nanyang Technological University, Singapore.

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A Swimmer's Guide to Pain

Take Home Points:

1. How coaches talk to athletes about injuries may have an impact on return-to-sport timelines
2. Coaches and parents should have a basic understanding of pain science to best communicate with swimmers
3. Fear of movement can be crippling setting off a vicious cycle of pain and disability

• I have a vertebra out of place
• My back is out of alignment
• My knees are bone-on-bone so I can’t do breaststroke

All of the above are common ways to describe typical injuries around the pool. And while there are often grains of truth in such statements, a narrow focus on the structural elements of injury inevitably ignores the psychosocial components in pain. This is one area where coaches and parents can play a key role in talking to injured swimmers and reinforcing what contemporary medical professionals understand about pain science.

Now, the purpose of this is not to dismiss the role of structure in causing pain. In fact, the extreme statement of “pain is all in your brain” is equally counterproductive to injury healing in athletes. Yes, certain pathologies are likely to induce pain, particularly when lesions occur in particular nervous system structures. However, what is unfortunate is that a misunderstanding of pain can thwart even the most carefully planned treatment and exercise regime.

Quite simply, the feeling of pain is driven by the body’s perception of threat. We know that

perception is key, not merely structural damage, as many studies have shown that pain-free subjects can have structural damage in similar rates to painful subjects, particularly for repetitive use conditions (trauma is a different story…). We have discussed this point previously in several posts including for:

• Shoulders
• Knees
• Low Back

Recently, Finan (2013) compared knee osteoarthritis patients classified into “high” and “low” severity. Somewhat surprisingly, those with high severity damage experienced less pain than those with low severity damage, as those with less damage were actually found to have more pain! There are several reasons why this may be the case, but the take home point is that damage is not automatically linked to pain. As such, coaches and parents must not mislead swimmers with a narrow focus on the injury and instead shift the focus to more productive areas such as function, mobility, and progression.

So why do some swimmers feel pain and others don’t, despite similar structural makeup (damage or lack of damage)? One explanation is that everyone has different sensitivities. Each swimmer’s sensitivity is driven by a myriad of factors such as previous injury, personality, training load, stroke biomechanics, among other factors. As pain scientist David Butler wrote to one patient suffering shin splints,

“Even a few years after an injury the brain holds memories of serious injuries and can react over time – almost trying to heal it again so it puts in a bit of useful swelling there which can irritate things. It gets a bit compounded when treatments don’t work or make sense and you start to worry - worry can make can make things more sensitive too. But this is all good – it will go.”

Conclusion

Many swimmers (and patients in general) are more comfortable with discrete explanations of structure. Unfortunately, a misunderstanding of the psychosocial elements of pain can often prolong the rehabilitation process as swimmers, coaches, and parents obsess about the structural elements of injury with laser focus! This commonly results in perpetuation of injury, creating a vicious cycle in which the swimmer is unable to successfully progress through rehab, despite best practices being employed via treatment and exercise. Ultimately, a proper understanding of pain can help guide swimmers back to function if injury strikes.

If you are looking for more information on pain and injury at the shoulder, consider purchasing the Swimmer's Shoulder System.

References

1. Finan PH1, Buenaver LF, Bounds SC, Hussain S, Park RJ, Haque UJ, Campbell CM, Haythornthwaite JA, Edwards RR, Smith MT Discordance between pain and radiographic severity in knee osteoarthritis: findings from quantitative sensory testing of central sensitization. Arthritis Rheum. 2013 Feb;65(2):363-72. doi: 10.1002/art.34646.

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. Allan is a co-author of the Troubleshooting System and was selected by Dr. Mullen as an assistant editor of the Swimming Science Research Review. He is currently pursuing a Doctorate in Physical Therapy at US Army-Baylor University.

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Weekly Round-Up

Each week we aggregate recent swimming journals and blog posts relating to

swimming biomechanics, physiology, nutrition, psychology, etc. If you wish to add, please add an article in the comments section.

Journal Round-up 

1. Wearable inertial sensors in swimming motion analysis: a systematic review.

Blog Round-up

1. Can Short Swimmers Compete at the Highest Levels?
2. Shawn Simonson Discusses Resistance Training for Incoming College Swimmers
3. 6 Reasons Anterior Core Stability Exercises Are Essential
4. Does Greater Force Production Equal Faster Swimming?
5. Is Beet Juice Really a Performance-Enhancing “Drug”? Digging In…
6. Swimmer's Shoulder Return to Swimming Program
7. Top 5 Swim Meet Fears (And How to Get Over Them)
8. The 5 Most Embarrassing Swimming Problems
9. Lap Swimmers Guide of Conduct
10. 7 Common Excuses for Not Swimming and How to Beat Them
11. 4 Reasons to Quit W-Sitting, Including Breaststroker’s Knee

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Shawn Simonson Discusses Resistance Training for Incoming College Swimmers

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

credentials, experience, etc.).
My name is Shawn R. Simonson and I'm a National Strength and Conditioning Association (NSCA) Certified Strength and Conditioning Coach (CSCS), American College of Sports Medicine (ACSM), Health Fitness Specialist (HFS), and Ed.D. from the University of Northern Colorado. I started in Exercise Physiology as a middle school science teacher and coach. I have worked as a personal trainer, police fitness instructor, health educator, and owned my own gym. I have eleven years in academia teaching and conducting research. I am currently in my 8th year at Boise State University.

2. You recently published an article which surveyed college strength coaches. How many strength coaches were surveyed?
The survey was sent to 195 collegiate strength and conditioning coaches. The survey was completed by 57 (29%). This is a low rate of return, but is within reason for on-line surveys.

3. What did your study look at?
We asked strength and conditioning coaches to share with us their perception of the preparedness of incoming college freshmen athletes for the rigors of strength and conditioning in training for their respective sports. The survey was specifically designed to find areas in which pre-college programs could help athletes improve and asked open-ended questions that allowed coaches to respond with any information they felt appropriate. Coaches’ responses were grouped into themes.

4. What were the results of your study?
Incoming college freshmen athletes lack lower extremity strength, overall flexibility, and core strength, as well as proper Olympic lifting technique. Athletes also lack mental toughness (grit) to endure collegiate sport strength and conditioning. In addition knowledge of correct nutrition and recovery principles is limited. From the manuscript:

Table 2. Thematic Analysis Regarding Areas of Improvement(3)

Major Themes	%
Olympic Lifting Technique	36.8
Core/Lower Extremities Strength	33.3
Flexibility/Mobility	22.8
Mental Toughness	22.8
Knowledge of Exercise Technique/Recovery	22.8
Work Capacity	19.3
Minor Themes
Running/Jumping Form	5.3
Knowledge of Periodization	3.5

Note: 50th Percentile was 18.4%. Any theme greater than the 50th percentile was considered a major theme while any themes less than the 50th percentile was considered a minor theme.

5. What were the practical implications for coaches and swimmers from your study?
High school strength and conditioning coaches, personal trainers, and club sport coaches should consider obtaining certifications within the field of strength and conditioning (i.e., CSCS, USAW). These certification indicate that the coach is qualified to develop and implement safe sport training regimens that will take into account biological maturity, athlete experience, evidence-based program design, and appropriate progressions. Parents also need to become educated and understand the importance of hiring only suitably certified strength and conditioning professionals to train their children. Just because a potential strength and conditioning coach or personal trainer was a successful competitor sports does not indicate that they have the education and knowledge to design and properly progress a strength and conditioning program for high school athletes. Failure to employ certified individuals with the requisite knowledge not only puts athlete health at risk, but also creates a disadvantage when beginning collegiate sport training and competition.

Certified high school strength and conditioning coaches/trainers should 1) focus on teaching proper technique in the basic multi-joint movements and Olympic lifts. 2) Increase power via appropriate plyometric exercises and sprinting and agility form drills to improve movement economy. 3) Ensure a complete and proper mobility/flexibility component. 4) Include mental training to enhance mental toughness (grit), and 5) Educate athletes regarding evidence-based nutrition and recovery principles.
 
6. Did you ask the strength coaches specifically about sports they worked with or what which sports were the least prepared?
We did not.

7. Do you think it is appropriate for a swim coach to implement resistance training at their club for high school athletes or is a strength and conditioning specialist preferred?
Based on what we found in the survey, we encourage club and high school teams to hire Certified Strength and Conditioning Specialists rather than implementing their own programs.

8. If a swim coach is leading their high school kids strength program, what education do you recommend they have for safety and preparing the athletes?
High school strength and conditioning coaches, personal trainers, and club sport coaches should obtain certifications within the field of strength and conditioning (i.e., CSCS, USAW). These certification indicate that the coach is qualified to develop and implement safe sport training regimens that will take into account biological maturity, athlete experience, evidence-based program design, and appropriate progressions.

9. What is the ideal athlete to coach ratio in the weight room?
“The National Strength and Conditioning Association recommends staff-to-athlete ratios based on the age and experience of the athletes participating in the training program. For middle school strength and conditioning programs, a 1:10 staff-to-athlete ratio should not be exceeded. Secondary school strength and conditioning programs should not exceed a 1:15 staff-to-athlete ratio. Strength and conditioning programs for athletes older than the secondary level should not exceed a 1:20 staff-to athlete ratio. It is recommended that no facility exceed a staff-to-athlete ratio of greater than 1:50(1).” (2) page 84.

10. What are some things coaches can work on to have their swimmers ready for college strength training?
1) Focus on teaching proper technique in the basic multi-joint movements and Olympic lifts. While many swimmers do not think much about Olympic lifting, the clean and snatch are specific to getting off the starting block and wall quickly and with power. In addition, start with the basic movements before moving on to multi-planar movements and more advanced conditioning programs.
2) Increase power via appropriate plyometric exercises and sprinting form drills to improve movement economy. This is important for both sprinters and distance swimmers as it will help with coming off the block and wall as well as reduce fatigue and delay the loss of movement economy that accompanies fatigue. Proper mechanics and movement economy also reduce the potential for overuse injuries – the most common injuries in swimming.
3) Ensure a complete and proper mobility/flexibility component – especially in the hips and low back.
4) Include mental training to enhance mental toughness (grit). This will help athletes overcome adversity and better tolerate the grind of intense and/or long conditioning sessions.
5) Educate athletes regarding evidence-based nutrition and recovery principles. Do not pay attention to the fads and commercials. What does the science say?

11. What research or projects are you currently working on or should we look from you in the future?
We are currently working on a follow-up assessment protocol for this recent study to measure the accuracy of the strength and conditioning coaches’ perceptions that will include sport-specific information. We hope to collect data from a wide variety of programs and sports.
We also continue to work on the use of Olympic weight training to improve sport performance.

References:

1. Greenwood M and Greenwood L. Facility organization and risk management, in: Essentials of Strength Training and Conditioning. TR Baechle, RW Earle, eds. Champaign, IL: Human Kinetics, 2008, pp 543-568.
2. Simonson SR, Moffit JT, and Lawson J. What is the impact of NCAA policy 11.7.2.1.1 weight of strength coach (Football Bowl Subdivision) limits on strength and conditioning as a profession? Strengt Cond J 36: 82-87, 2014.
3. Wade SM, Pope ZC, and Simonson SR. How prepared are college freshmen athletes for the rigors of college strength and conditioning? A survey of college strength and conditioning coaches. J Strength Cond Res 28: 2746-2753, 2014.

If you're looking for more information about dryland for swimmers, consider purchasing dryland for swimmers. Although this doesn't substitute a certification for strength and conditioning, it helps bridge the gap between swimming and weight training. 

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Does Greater Force Production Equal Faster Swimming?

Measuring force in the water is difficult, let alone the contribution of force in swimming success.

Before we can address if force production equals faster swimming, we must review how force is calculated in swimming research. Must of this piece is taken from Sacilotto (2014), if you are interested in reading more.

Unfortunately, only a limited number of reviews identify resisted, or drag forces, in swimming.

The drag force is the force component parallel to and in the same direction as the relative fluid force. Drag force D is calculated by: Df = 1/2CDrv2A, Cd is the drag coefficient, and r is the density of fluid, v is the velocity of the object and a is the frontal surface area of the object. 

The resistive forces the swimmer interacts with in the water are form, wave, and frictional drag. These are influenced by the swimmer's velocity, boundary layer, shape, size, and the frontal surface area. In swimming, the resistive forces are termed the active and passive drag. 

• Active drag is the water resistance associated with the dynamic swimming motion.
• Passive drag is the water resistance that a human body experiences in a fixed or unchanging posture.

Komogorov (1992) determined active drag varies between individuals and seems to related to swim technique and anthropometry. For swimming, drag can be active or passive. However, we will only discuss active drag.

Active Drag and Swim Performance

The two most commonly identified factors for swimming speed are propulsion and drag. The ability to reduce the active drag encountered allows propulsive forces to be efficiently applied, increasing swimming velocities. Elite swimmers are more able to reduce active drag than nonelite swimmers (Kolmogorov 1992). This efficiency allows elite swimmers to minimize wasted kinetic energy. 

However, Hollander (1985) did not find a significant correlation in active drag and swim velocity at a constant velocity. 

Mechanical Power Output in Swimming

Some suggest swimming performance is defined by the relationship between the useful mechanical power output, active drag, the hydrodynamic force coefficient (drag coefficient) and the maximal free swim velocity. The mechanical power is the power delivered to overcome drag. Swimming power is evaluated as the product of swimming drag (D) and velocity (v):

P= Dv

The ratio between the useful power and the wasted kinetic energy is defined as the propelling efficiency of a swimmer: 

hP = Pd/PO

hP is the propelling efficiency and Pd is the useful power.

Techniques of Drag Assessment

Measurements of active and passive drag have been attempted through the years. However, there is much controversy on the techniques. The energetics approach, numerical solutions and experimental techniques have been developed and use to estimate or measure drag forces in swimming.

Energetics Approach

The energetics approach is also coined theoretical calculations, investigates the relationship between

energy costs of swimming, the velocity, and the overall mechanical efficiency of the swimmer and the body drag. This is used for deciphering the mechanical power output of a swimmer during free swimming. This approach tows a swimmer at a given pace, which is maintained by a towing carriage with known additional weights to provide assistance/resistance. The maximal oxygen consumption is then recorded. The body drag is determined by adding (or subtracting) extra loads to (or from) swimmers moving at a known speed. The extra drag was measured and related to the swimmer's energy expenditure to calculate the drag and swimmer's mechanical efficiency. 

Di Prampero (1974) identified a linear relationship between drag and maximal oxygen consumption at constant swim velocities, which led to this technique of determining drag as a function of VO2net. Clarys stated “extrapolated the linear regression between VO2net and the added propulsion and added drag to VO2net = 0.” At a constant mean velocity, the mean propulsive force exerted by the swimmer will be equal and opposite to the active drag produced.

Similar values of active drag were found when comparing propelling efficiency values as a percentage. In this studies the drag values were similar, but the authors assumed propelling efficiency did not change where active drag was calculated. It is likely propelling efficiency will change, even at a constant speed, when external loads are applied, as is this case in this approach. Also, small changes in VO2net values due to small deviations in propelling efficiency will be amplified by the extrapolations that are a basis for these studies. Van de Vaart believes this form of testing overestimates active drag. Also, a snorkel is used to measure VO2net, altering the frontal surface area which likely modifies the active drag.

Numerical Simulations

These models use the computational modeling of the water flow surround the swimming to determine

the resistive forces. This is typically through computational fluid dynamics (CFD). CFD solves the analyses problems using fluid flow by means of computer-based simulations. It creates a 3D model of a swimmer and simulates their movement patterns. CFD simulations eliminates within-subject variability, allowing the same input you always have the same output. Bixler (2007) studied the water flow and drag force characteristics on a human, a CFD, and a mannequin. Although the study only assessed passive drag, the results were positive, as the submerged human body had similar passive drag. For CFD to become a readily available method of resisted force assessment, basic kinematic measures during free swimming need to be collected, like the ability to collect instantaneous swim velocity, or knowing where the center of gravity is while a swimmer is swimming. A further limitation is that CFD simulations require a lot of computer time and knowledge of the process, making it difficult for coaches and scientist.

Experimental Techniques

Experimental techniques attempt to accurately determine the resistive forces encountered by a swimmer. This often uses the measuring active drag system (MAD-system), and the indirect techniques of collecting active drag values, the pertubation method (VPM), and the assisted towing method (ATM).

Measuring active drag system 

Hallander (1986) developed this system which measures the drag force generated by a swimmer, which enables the calculation of the propulsive force production during the trial. The assumption is made that the mean propulsive force would be equal to the mean active drag values when the swim velocity is constant.

The MAD-system, requires the swimmer to push off from fixed pads underneath the water. Originally this technique different but constant velocities. The swimmer's legs were restricted by a small buoy. The depths of the pads were able to be adjusted for the swimmer’s height as well as the distance between pads. For each trial, the registered output signal of the force transducer was transmitted telemetrically to determine mean force. The average propulsive force was calculated by integration from the force registrations at a constant swim velocity. The swim velocity was determined from the sample frequency and the pad distance (between the second and final pad).

Toussaint (2011) represents the calculation for drag as Da=Kv2, where Da represents total active drag, K is the constant (incorporating the density, coefficient of drag, and frontal surface area), and v equals swimming speed. 

Although this technique has been used extensively, it has much criticism. For one, it limits the swimmer's natural stroke mechanics, and it can only be used at a constant velocity. Also, this technique should only be compared against itself or if a swim velocity is the same between techniques. It also uses pads and doesn't allow the swimmer to be in contact with the water. This may alter the normal hand trajectories. Having the pads requires more coordination to constant the pads and may slow down effort. Also, the use of a pull buoy alters swimming biomechanics.

Velocity Perturbation Method 

The VPM method is based on the assumption that a swimmer is capable of producing an equal amount of useful mechanical power output and that the simmer will swim at a constant velocity. This technique is seen as a progression from the energetics approach in estimating active drag, without the use of maximal oxygen consumption. In the VPM, a swimmer must produce two equal maximal efforts. This is typically used over 25 m, but has been used in other distances. The first swim is freely, without any attachments, and the second is swum with a hydrodynamic body attached to the swimmer, creating extra resistance. The maximal mean velocity when swimming with the hydrodynamic body was compared with the maximal mean free swimming velocity, which along with the a known addition resistance is used to calculate active free drag for free swimming:

DA=Dbvbv2/v3-v3b

Db is the additional resistance from the pertubation buoy and vb and v are the swimming velocities with and without the hydrodynamic body. 

This method is frequently criticized, as it is an indirect measurement of active drag, and may overestimate active drag. It is also assumed participants use the same velocity level. This is difficult due to the added device and it is found that the maximal error due to stroke cycle fluctuations is around 6 - 8%. The other error is that it is difficult for non-elite swimmers to swim with this added device. 

To allow different skill levels, different hydrodynamic bodies were developed. However, no matter the size, a hydrodynamic body will still alter swimming skill. Xin-Feng (2007) created an apparatus which stayed in a steady position and minimizes the floating movement of the hydrodynamic body. During Xin-Feng's study they measured the variation in tension of the tread when the gliding block was moved by the swimmer. The results revealed that the tension of the thread fluctuates, revealing the additional resistance does not have a constant value as assumed. 

Despite the limitations of the VPM, there are benefits. For one, the VPM method is easily set-up at a pool, allowing coaches and athletes use. It also doesn't need adaptations for different strokes.

Assisted Towing Method

The assisted towing method (ATM) technique is essentially the reverse of the VPM method, by assisting, instead of resisting the swimmer. The ATM is also based on the equal power assumption and the constant velocity assumptions. However, as outlined by Xin-Feng (2007), a swimmer will not be swimming at a constant velocity at any point throughout a maximal effort due to the intrastroke fluctuations in the swimming. Such fluctuations are a result of the intrastroke forces that are generated during a natural arm cycle. kicking also leads to fluctuations. 

Mason (2011) compared constant active drag values with fluctuating active drag values. During these trials, the mean velocity maximal free swims (individual swimming without any attachments) and the mean velocity of the towed swims (towed from the hip using the dynamometer) are used to calculate for drag with respect to the drag force required to tow the swimmer. This helped create the VPM equation:

Da=Fbv2v1^2/v2^3 - v1^3

Fb is the force required to tow the athlete at the increased speed as measured from the force platform, v2 is the increased tow velocity, and v1 is the maximal free swimming velocity. Similar to the VPM approach, when using this system with a constant velocity, the dynamometer is set to 5% faster than the swimmer's mean maximum free swim velocity with a high force selection to allow for a near constant tow. To allow the swimmer's intrastroke fluctuations, the force setting on the dynamoeter is reduced and the velocity setting is increased to 120% of the swimmer's maximum free swim velocity. Along with these changes in set force and velocity settings, a paramter on the towing dynamometer is

altered so that when the force setting is reached it will fluctuate the tow velocity to maintain that force setting, therefore allowing the intrastroke fluctuations. The force setting used is a predetermined fraction of the swimmer’s passive drag tow (streamlined tow at the swimmer’s maximal free swim velocity) and is different for every individual swimmer. Despite the increase in the velocity, setting the mean tow velocity will still equal between 5% and 10% greater than the swimmer’s maximal mean free swim velocity; however, when calculated, the velocity profile will demonstrate the intrastroke fluctuations. The results from the fluctuating trials seem to demonstrate a smoother drag profile, more repeatable results, more resembling free swimming characteristics. The ATM allowing a fluctuating tow velocity in active drag estimation, is still in its infancy. However, the results shown thus far are positive in being able to decipher exactly what affects performance during free swimming. When towing with a constant velocity it has been assumed that drag was equal but opposite in direction to propulsion. However, when utilizing a tow allowing for instrastroke fluctuations, this can't be true. A recent study using ATM attempted to calculate a swimmer's propulsive profile, net force, and acceleration curves while allowing intrastroke velocity fluctuations:

P=d/dt (mv)-DA

P is propulsion, m is the passive drag force of the swimmers (as a substitute for the mass of a swimmer), v is the velocity profile, and Da is the active drag. 

Although ATM is promising, validation is needed. Although a small sample, a recent study revealed very good reliability value for within-subject mean active drag values (interclass correlation of 0.91, at a confidence limit of 95% and a likely range of 0.58 and 0.98). Future studies must investigate into whether the velocity/force profiles obtained during this technique mimic real stroke mechanics. However, until accurate measurements of basic kinematics while a swimmer is submerged in water, research with the method is under scrutiny. Also, the use of this system for other strokes is not well established due to the intracyclic variations between strokes.

So Does Great Force Production Equal Faster Swimming?

The simple answer is no. Elite male sprinters have a peak force of 50 – 80 pounds and on average 20

– 31 pounds of resultant force (Havrulik 2013). Compare this to the ~800 pounds of force created by Olympic track sprinters. Another way to look at it, if simply increasing force resulted in faster swimming, then the strokes with the highest force production (fly and breast), would be the fastest (Morouço 2011). 

Instead, it seems variation in force production plays a larger role in swimming speed. This isn't to say, if you improve your swimming force production, then you won't be a better swimmer, as you may improve your force production as you decrease your variation in force production. 

Also, we must consider the timing and displacement of force. Sometimes, a swimmer will create force, but in a wasted manner, ie when their hand is not facing perpendicular to their body or as their arm is out of the water. This is a wasted increase in force production.

Overall, a careless increase in force production doesn't necessarily increase swimming velocity. However, increasing force production in a vacuum will increase swimming velocity.

Now the question is how can you improve this force production with altering the rest of their biomechanics...

Reference:

1. Mason B, Sacilotto G, Menzies T. Estimation of active drag using an assisted tow of higher than max swim velocity that allows fluctuating velocity and varying tow force. Paper presented at: 29th International Society of Biomechanics in Sports; July, 2011; Porto, Portugal.
2. Bixler B, Pease D, Fairhurst F. The accuracy of computational fluid dynamics analysis of the passive drag of a male swimmer. Sports Biomech. 2007 Jan;6(1):81-98.
3. Xin-Feng W, Lian-Ze W, We-Xing Y, De-Jian J, Xiong S. A new device for estimating active drag in swimming at maximal velocity. J Sports Sci. 2007;25(4):375–379.
4. Toussaint HM, Roos PE, Kolmogorov S. The determination of drag in front crawl swimming. J Biomech. 2004;37(11):1655–1663.
5. Sacilotto GB, Ball N, Mason BR. A biomechanical review of the techniques used to estimate or measure resistive forces inswimming. J Appl Biomech. 2014 Feb;30(1):119-27. doi: 10.1123/jab.2013-0046.
6. Hollander AP, De Groot G, Van Ingen Schenau GJ, et al. Measurement of active drag during front crawl arm stroke swimming. J Sports Sci. 1986;4:21–30.
7. Di Prampero PE, Pendergast DR, Wilson DW, Rennie DW. Energetics of swimming in man. J Appl Physiol. 1974;37(1):1.
8. Kolmogorov SV, Duplishcheva OA. Active drag, useful mechanical power output and hydrodynamic force coefficient in different swimming strokes at maximal velocity. J Biomech. 1992;25(3):311–318.
9. Toussaint HM, Beelen A, Rodenburg A, Sargeant AJ, de Groot G, Hollander AP, van Ingen Schenau GJ. Propelling efficiency of front-crawl swimming. J Appl Physiol (1985). 1988 Dec;65(6):2506-12.
10. Havruilk, R. Personal Communications. San Jose CA. September 2013.
11. Morouço P, Keskinen KL, Vilas-Boas JP, Fernandes RJ. Relationship between tethered forces and the four swimming techniques performance. J Appl Biomech. 2011 May;27(2):161-9.

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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. 

Day	Yardage	Strokes	Highest Pain Level	Notes
1	1000	Free	3
2	1000	Free	2
3	1000	Free	1
4	1000	Free	1
5	1000	Free	1
6	2000	Free	2
7	2000	Free, Breast	5	Performed 1,700, then kicked 300.
8	1750	Free, Breast	2
9	2000	Free	1
10	2000	Free	1
11	2000	Free, Breast	0
12	2500	Free, Breast	0
13	3000	Free	0
14	3000	Free, Breast, Back	0
15	4000	Free, Breast, Fly	7	Performed 3000, then pain during fly. Kicked last 1000.
16	4000	Free, Breast, Back	3
17	4000	Free, Breast, Back	3
18	4000	Free, Breast, Back	2
19	4000	Free, Breast, Back	1
20	4000	Free, Breast, Back	1
21	4000	Free, Breast, Back	1
22	5000	Free, Breast, Back	0
23	5000	Free, Breast, Back	0
24	5000	Free, Breast, Back	0
25	5800	All Strokes	4	Performed 4800, pain during fly. Kicked last 1000.
26	6000	All Strokes	2
27	6000	All Strokes	2
28	6000	All Strokes	2
29	6000	All Strokes	1
30	6000	All Strokes	1
31	6000	All Strokes	1
32	7000	All Strokes	1
33	7200	All Strokes	0
34	7400	All Strokes	0
35	6900	All Strokes	1
36	7100	All Strokes	0
37	7200	All Strokes	0
38	7400	All Strokes	0

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.

COR Swimmer's Shoulder System

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.

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