Friday, February 11, 2011

Do You Ever Get Shoulder Pain When Swimming?

Research says that as many as eight out of ten swimmers suffer from some level of shoulder pain or injury during their swimming careers. If you ever get shoulder pain before or after swimming, the very first thing to check is how your hand enters into the water.

A thumb first entry, with the palm facing outwards causes internal rotation of the shoulder and impingement of the joint. This action, repeated thousands of times in training, is the leading cause of shoulder injury in swimmers:


When we're swimming we are often unaware of how our hands enter into the water so ask a friend or coach to take a look at your hand entry on both sides, particularly as you get tired when bad habits creep in. You should be entering with a near horizontal hand, with the fingertips angled slightly down to spear smoothly into the water:



This is much safer way to enter the water for your shoulders and is also better swimming technique as it immediately puts you in the right position for a great catch phase.

If you have a thumb first entry it can be a hard habit to break and will take some persistence on your part. Here's two visualisations you can use to help you get this right in your stroke:

Visualisation 1: As your arm recovers over the top of the water, imagine you are holding a briefcase in your hand. It would be very awkward to turn that hand outwards whilst holding the briefcase so lightly carry it past your head with the palm facing inwards. (Thanks to Montreal based coach Charles Couturier for this tip!)

Visualisation 2: Imagine a small fish is swimming just in front of you and you are chasing it. As your hand enters into the water try and spear the fish with a nice horizontal hand, angling your hand and fingers down into the water.

In the 1970s a thumb first entry was taught together with an S-shaped pull to give a longer pull pathway, which was believed to be more powerful. Any advantage in propulsion has since been disproved and we now understand the outward sweep at the beginning of the S shape puts a large force on the shoulder in an awkward position. Since the 1990s all elite swimmers have been taught to enter with a flat hand and pull straight backwards - it carries a much lower injury risk and it's a faster and more efficient technique:


What are your experiences of shoulder pain or injury? Is it still causing you a problem or if you are cured, how did you go about about fixing it? Let us know in the comments section here.

Swim Smooth!

Relevant link: Our website page on shoulder injury.

29 comments:

Lyndal said...

This is exactly the problem that caused my shoulder injury a few years ago when training for the Rottnest Channel Swim. A video analysis session, with Paul Newsome at the Claremont Pool in Perth, put me on the right track. I couldn't believe how simple the problem of "thumb entry" was for him to identify and then how quickly I was able to eliminate the error. It took a bit of concentration for a couple of weeks but I've never looked back.

(I know this sounds like a bit of an advertisement - but it's totally unsolicited)

Thanks Paul!

Lyndal.

Anonymous said...

Great post. I always entered thumb first and experienced several rotator cuff injuries. The last to ok 8 months to heal. It would be great if you could go into arm movement on stroke recovery as I think this also contributed.

Charlie Noble said...

During my rather long and intensive training for a successful English Channel swim last year (12/13th Sept - 16hr 36mins), I suffered from severe shoulder pain in my left shoulder. The cause was in tw

As a right hander I assumed there was some link in my stroke balance which, having had a few people watch my stroke, seemed to be the case. My hip rotation was much weaker when I breathed to the left and my shoulder was making up the difference - ouch !

However, the main issue came to light when I went to see a very talented sports therapist. After looking at my upper torso for less than a minute, she was onto the problem.

The issue was being caused by a excess tightening in my pectorals which was pulling my shoulder in some odd angles as I took each stroke. My back muscles were trying to compensate but they were strung very tight and, as a result of the strain, were very knotted. In a nutshell, the long swims were starting to change my physiology quite significantly.

A few courses of (seriously painful !!!) sports massage as well as some pec stretches before and after training soon had the issue sorted. It was seriously painful, especially in the early stages. One especially effective treatment involved the therapist gripping the edge om my pec while my arm was against my body and then me having to put my arm above my head whilst she intensified the grip. Still brings water to my eyes thinking about it, but it did wonders for my swimming.

After a month or so of treatment I could happily swim for 5-7 hrs without feeling it twinge, but when it did twinge I'd tread water for a bit and do some stretches (looking out for boats obviously).

When I actually did the swim I didn't feel it at all. It seems that the stroke correction, a real focus on even hip movement as well as the intensive (and regular) pummelling of my back and pecs had done the trick.

See my blog at www.channelswimcharlie.blogspot.com for more details

Anonymous said...

Thanks for the great post! I've been having trouble for about a week. I just skipped my Masters Swim practice for the first time because of it. I'm going to do a solo swim later today and I'll try some of the things you suggest.

Thanks again!

Sore guy in NY.

andresmuro said...

I used to experience shoulder pain. My biggest issue was to begin the pull as soon as my hand finished the catch phase. After lots of reading and research I figured that the actual pull starts once your forearm has dropped and created a definite angle with your arm (keeping shoulder high). This releases the shoulder from being under tension during the pull phase. You can see Grant Hackett doing this perfectly. In fact Grant Hacket has much better form than the little swim smooth character. http://www.youtube.com/watch?v=f6qIhkuzTx0

Andres

fpconbobo said...

I had a torn rotator cuff a few years ago, caused by using hand paddles. Found out too late they can cause too much stress on the joint. Took almost a year of no swimming and strengthening exercises to heal without surgery. I've never tried the new smaller paddles.

Mike A said...

I'm currently experiencing a little shoulder & neck pain. I don't do thumb-entry, but I think my issue may be more like what andresmuro mentions above. I've also become conscious of some shoulder tension during recovery - though whether this is cause or symptom (ie 'protection') I'm not yet sure. Will try and consciously relax that recovery shoulder on my next swim and see what happens.

h2oskier (Carl) said...

I have never experienced any shoulder pain, but after being out of competetive swimming for over 15 years and only swimming in lakes and rivers, I developed a thumb-first entry. When I started training for my first triathlon, my former high school swim coach was at the pool and commented on my technique. His tip was to make sure that I was bending the elbow in my recovery phase. I was keeping it pretty straight and carrying my hand up and over my body resulting in a thumb-first entry. When I focused on a bent-arm recovery, my hand naturally returned to entering the water fingertips first.

Anonymous said...

Thanks for the great advice ... do you have any tips top reduce lower back pain during long swims?

Mike H said...

I think another component is the position and status of your arms on recovery: I found that doing finger-tip drag ALL the time cured my shoulder pain. I was a flyer and tended to swing my arms wide with a straight elbow on every freestyle stroke. I have used finger-tip drag drills and carried it into my regular swims with great success. My only comment on flat hand entry is this tends to cause people to catch air and push it through the stroke! Swim on. Mike

Anonymous said...

Great post Paul, that's top advice on hand entry.

I had a shoulder operation about a year ago for impingement, and am now on my 4th steroid jab, - still with no real improvement. I haven't swam for over a year, and it's miserable!

It's hard to say what caused it, my bet is that it was down to a coach asking me to keep my lead arm higher in the water just before making the catch, - knuckles almost on the surface. My shoulder pain started immediately after that first drill session.

Having said that, Paul did spot a very slight thumb first hand entry when he saw some video footage, and if I ever get back in the water then I'll be making sure I correct it. Like Paul says, I was taught as a youngster that front crawl was "little finger out first, thumb in first.

Bottom line: if you have any shoulder pain then address it sraight away, it won't go away. And you might end up like me....
Harry

- Congrats on the Channel swim Charlie!

Sean Hillock said...

I noticed recent shoulder pain when increasing yardage too quickly as I was trying to improve my technique. I was crossing over with my left hand and not rolling my body enough to the right at the beginning of the pull. With the guidance from my coach, I was told to imagine my hands entering the water in a Y position to help exaggerate lateral entry and to concentrate on using the lats during the pull phase. Once these were corrected and I backed off the yardage for a bit, I have been pain free. I did experience some muscular pain in the area of the shoulder blade and lat as I changed technique, but this went away over time. I suppose that this was due to using the proper muscles with proper technique.

John H. said...

I was getting very tired shoulders after long swims but no pain development yet. My coach noticed that my arm position during the glide (prior to the catch phase) was high in the water. He told me that puts an impingment on the shoulder and can eventually lead to injury. He had me drop my hand/arm slightly below my shoulder during the glide. I am now able to do long distance workouts without my shoulders getting tired and hopefully reducing my chance of injury.

Jukka Valkonen said...

Great topic! I was one of those 70s swimmers, and in 2002, I began my retraining. For me it was easier to over correct initially with a ring and pinky finger entry. Now I visualize soft hand entry as if I am putting on surgical gloves made from rice paper. I try and have the least artifact possible, or "quiet hands". Moreover, I do allot of functional training of the shoulders and back to ensure proper stabilization and strength of the muscles. Please note, functional training is NOT traditional weight training, and thus should only be executed under the supervision of a subject expert in this area. Kayaking and freestyle have many similarities including rotator cuff injuries. While kayaking can be a great cross-sport for swimming, it also can pose the same risks if technique and functional stabilization needs are not addressed.
Best,

Anonymous said...

i agree with the flat hands but am not so sure about the "S" stroke comment. Watch this clip of Phelps: http://www.youtube.com/watch?v=SuRLkXB2IBE
Just don't exaggerate it...

Anonymous said...

I was still doing the old-school thumb-first entry when I got back into swimming mid last year after having been forced to stop swimming 15 years ago due to rotator cuff syndrome in my right shoulder. Within a couple of weeks of restarting swimming last year the old problem had reappeared and several weeks of physio didn't help (immediate recurrence on the first freestyle length). But acupuncture helped from the first treatment. I then started swimming again whilst avoiding thumb-first entry and have had no recurrence of the shoulder problem with regular distance training over 4 months since then. Fantastic. Thanks for the accurate and useful info swimsmooth.

Keating said...

Hold the back page! the S shape is not recommended anymore? I've just been doing it for the last year, I have some shoulder pain but not too much. Should I change to a straight pull back?

Paul said...

Thank you all for your comments, I will try and address your questions and feedback below as this is indeed a very interesting and important consideration for your swimming.

@ Lyndal:

Very pleased to hear that the tips worked well for you Lyndal and helped clear up your ongoing shoulder issue.

@ Anonymous # 1

You are quite right - the recovery phase of the freestyle stroke can also be a contributory factor to shoulder pain. As mentioned in Visualisation # 1 from the original post:

Visualisation 1: As your arm recovers over the top of the water, imagine you are holding a briefcase in your hand. It would be very awkward to turn that hand outwards whilst holding the briefcase so lightly carry it past your head with the palm facing inwards. (Thanks to Montreal based coach Charles Couturier for this tip!)

...other things to watch out for are over-extending or "flicking" at the end of the push-phase immediately prior to the hand exiting the water as this can also lead to a poor recovery pathway being created over the top of the water.

What we have to remember is that good body roll plays an important part in how well your hands clear the surface of the water during the recovery phase and so too does flexibility as well. Some swimmers (we call them SMOOTH) tend to swim with a beautiful-looking high elbow recovery stroke with good body rotation, other swimmers (we call them SWINGERS) tend to swim with a straighter arm recovery and a higher stroke rate which can be more suited to rougher open water swimming conditions. Personally this is how I swim as the majority of the racing I now do is in the rough open water. Still, we have to be careful not to carelessly throw the arm over the top of the water as many SWINGERS can inadvertently then cross over at the front of the stroke if this action is not controlled. This often leads to issues at the back of the shoulder from essentially repeatedly over-stretching this muscle group.

TBC...

Paul said...

@ Charlie Noble

Brilliant stuff Charlie - I'm doing the Channel myself this year on the 5th September so I will be sure to check out your site for some useful information.

What you mention there about the pectoral muscles being quite tight is quite a common occurrence often brought on simply by a lot of "slouched over the keyboard office work" - just look at me now...that's exactly what I'm doing! Shoulders back and chest forward - proud posture and attention to pectoral flexibility is key...can you tell my wife is a physiotherapist??

@ Anonymous # 2 (Sore guy in NY)

Sorry to hear that - how did your session go by yourself after trying some of these pointers? Obviously this is not an exhaustive list of why someone would run into problems with their shoulder, but it is always a starting point.

@ andresmuro

What you are seeing here with Grant Hackett is what is commonly referred to as "EVF" or Early Vertical Forearm. Grant's position is very extreme with the elbow very close to the surface of the water as he bends it to press back on the water. Normally I'd suggest that a super-high elbow catch and pull through like Grant Hackett's is a bit too extreme for most of us (due to the lack of flexibility and rotator cuff / scapular stability and control that he has), but the bending of the elbow as you do start to pull through is certainly important as it takes the load away from the shoulders and places more emphasis on the larger / stronger pectorals (chest) and latissimus dorsi (upper back) muscle groups.

@ fpconbobo

Yes, we have to be careful with the use of large hand paddles especially if your stroke is a little "suspect" before using them as you'll simply be performing a poor catch under additional load which is not good for the shoulder. I like the Finis Freestyler paddles for this reason as they are designed like an arrow-head and so unstable on your hand that if you enter into the water incorrectly like we discussed on this Blog, they simply fall off - so they're actively encouraging you to improve your stroke when using them rather than getting away with practicing potentially poor form under load.

Paul said...

@ Mike A

Again Mike, please let us know how you get on after you've tried a little of this.

@ h2oskier

Some great advice from your coach there Carl and something which only direct 1-2-1 coaching will ever give you. Nice work!

@ Anonymous # 3

If your hand enters into the water at the front of your shoulder and crosses the midline extending forward in front of your head (very, very common) this will lead to the hips snaking from side to side (and also a pronounced lateral scissor kick in most cases which causes drag) and may be the source of your lower back pain. Try and get someone to film you from a bird's eye view looking down at your stroke from above (even from a viewing gallery above the pool) and you'll immediately see if this is the case. Easily improved upon by ensuring the middle finger of each hand extends straight forward in front of the same shoulder and not across the midline.

@ Mike H

As mentioned to Anonymous # 1 (above) different swimmers swim with different recovery pathways, so if you are now swimming with a very high elbow and it's helping improve your shoulder woes, then this is great. Question, are you just swimming in a pool?

On the flat hand entry point - just to clarify...the hand still wants to be piercing the water as finger-tips before wrist and wrist before elbow which will negate the "bubble effect" of which you talk, but more importantly set you up for a better catch too rather than slicing through the water with the thumb-first.

Paul said...

@ Anonymous # 4

Some sage advice there - thanks for sharing. As mentioned to andresmuro (above) about the visualisation of Grant Hackett's catch - this sounds like what you were maybe being encouraged to try, i.e. a super-high elbow catch and pull through or an "extreme EVF" as we refer to it on the site. If you have amazing flexibility (and at the same time great stability in the rotator cuff and scapular region) then you might be able to support an elite-level catch like Grant Hackett, but if not, over-emphasising this position may well have been what led to your shoulder issues.

Next time you get into the pool, obviously try the thumb-first entry tip, but also look at spearing into the water fractionally deeper too - so long as your finger-tips stay below the level of the wrist and wrist below the level of the elbow when viewed from a perfect underwater side view, you'll still be setting yourself up for a great catch, albeit starting that catch just a little deeper in the water than some of the elite swimmers you see on TV. This still allows you to get into an EVF position, just not an extreme EVF position. Many people have asked us why we don't show Mr Smooth with what we would view an extreme EVF position, and this is exactly why - we know the likes of Grant Hackett wouldn't use Mr Smooth as a model to study off (why would he - he's BRILLIANT already!), but we know aspiring swimmers and age group triathletes would do, and knowing that most of us don't have this supreme level of flexibility and control in the shoulder region, we wouldn't want you to be practicing something that puts your shoulders at a potential risk. We delve into this quite deeply in our new Swim Smooth Catch Masterclass DVD for your interest.

@ Sean Hillock

Yes of course Sean, a sudden ramp up in your yardage together with a poor hand entry is recipe for disaster - well done on making the successful modifications to your stroke with the help of your coach!

@ John H

Exactly John! Just as mentioned to Anonymous # 4 above - this is exactly the right thing to do in your case. Well done!

Hope this helps everyone and thanks for all contributing to this Blog comment section!

Cheers!

Paul

Paul Newsome

Head Coach - www.swimsmooth.com

Paul said...

@ Juka Valkonen

Lovely analogies Juka - thanks for sharing!

@ Anonymous # 5

Again, a brilliant observation - "just don't exaggerate it" - undoubtedly there will be some curvature to your catch and pull through pathway...the key being to let this happen naturally and focus on establishing a good feel for the water and then putting your energy into pressing back (not too hard though) rather than side to side.

Like many things the concept of an S-Pull shape has been taken way too literally for many, many swimmers and if combined with an exaggerated thumb-first entry, with respect to shoulder issues, you *could* be asking for trouble.

@ Anonymous # 6

Always happy to help! ;-)

@ Keating

Please check this: http://swimsmooth.com/catch.html

...and this:

http://swimsmooth.com/injury.php

Hope that helps!

Rudolf said...

Yeah, i have had this twice so far, but i noticed it maybe triggered by extensively long hours on the pc leaning on the table to heavily without really noticing until sleep or the next day at the pool.

I want to forward another something that refers more to a short note in the previous newsletter though;
Push up's where mentioned to improve muscle strength in the belly area.
Just around this time i came across a new (or newer) study that found out push up's do not really much to strengthen the abs or belly muscles but instead another exercise that looks almost like it's no exercise at all - until you try it!

This is what i made of it:
Lay flat down on your belly, you probably want to do this on a couch, bed or soft exercies mat rather than on hard stone grounds.
You go on your elbows and lift your body slightly up into thin air and hold it there, that's it.
The study suggested to lift the lower body with your toes, foot in a 90° position to your legs, but since we swimmers need to stretch our ankles i also stretch my feet out as if i was swimming.

The lift over ground is not very high, no need to go up or down, just hold the position and bread in and out deeply, you notice within 10 seconds why this works wonders on your abs / belly muscles, and if you can hold it for a minute my congrats, keep on holding, we'll visit some day...

It's the perfect anti-pc-bellyexercise.

Ermie Robinson said...

Paul corrected this fault in my swimming and have had no problems since. However, after having shoulder surgery a few years ago and doing the rehab, I find that continued use of an elastic band for resistance exercises to maintain strength in the muscles around the shoulder is also very helpful.

Anonymous said...

I have been taught to swim thumb first entry. 20 years later, i forgotten it and start swimming instinctively. Surprisingly, fingertip becomes the habit. from there, i try to swim thumb first entry because all gold medalist i knew swim that way!

Ian Hamilton said...

Hi john,after a lifetime of swimming and no serious shoulder injuries,im a bit perplexed with my tennis elbow,although not caused directly by swimming{more on that on my blog}it does seem agravated swimming,any thoughts?Hammo

Guangxun Ma said...

Thank you!

I suffered quite a bit pain on my shoulders without knowing any reason for a while.

Typically it take me a week to recover from this kind of pain by taking a slower pace. After knowing "thumb entry" is one of the causes for shoulder pain, I intended to correct it and so far no pains occures on my shoulder again for 2 weeks....I am back to my routine and am very happy for it. ..Thanks ...Guangxun

Anonymous said...

if you are doing high-elbow catch, you can't avoid internal rotation of your should. and if you don't stretch your shoulder and side muscles such as lats and trapezes, the internal ratation will hurt your shoulder hard.

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