on the Shoulders of Swimmers — Boatloads of Advice

I started experiencing shoulder pain in the fall of 2010, and just assumed it was due to stroke mechanics. (You can read more about my personal experience, including my surgery and post-op complications HERE.) When, by August 2011, the pain had gotten significantly worse, I sent out an email requesting advice from my local open water swimming community, the CIBBOWS.

On Mon, Aug 8, 2011 at 11:31 AM, I wrote:

Help please!

There is something wrong with my stroke. It works well for about 3 hours, and then my left shoulder starts hurting. After a long swim in which I have kept swimming with that pain for yet more hours (for example: 6 hour Malta swim, the Kingdom 10 mile, the Swim Across Long Island sound- 25K two-person relay), my left arm goes dead– zero strength in it. Super painful, and I have to use my right arm to lift my left arm up and around. This lasts for a few days, then I get the strength back.

Please advise if you can. I’m looking for:

1.) Favorite places to get stroke fine-tuning advice (with video analysis?)
2.) a sports medicine doc who really knows swimming and swimmers issues
3.) physical therapist who really knows swimming and swimmers issues
4.) a sports massage person who knows swimming… etc.

The problem with advice on something like a bum shoulder is that it is easy to feel like you have access to way too much of it. If I thought asking a bunch of open water swimmers would narrow the results, I was wrong. I received an enormous number of helpful replies suggesting therapies, doctors, and stroke mechanics from the CIBBOWS. Of course, with the internet, I also had access to endless articles and blog posts on swimming-related shoulder issues.

Below, I have collected much of the advice on shoulders that I received from fellow swimmers, as well as some of the advice that I found. As you will see, there are lots of ways to think about and approach the same problem. (For my eventual approach, see THIS POST)

A Selection of Advice found:

Developing World Class Open Water Swim Mechanics – LAVA Magazine  LINK

Excerpt: “Much of the confusion athletes feel with regards to swim mechanics is born from pool-trained swimmers or coaches, which focus on a longer glide phase and lower stroke count. Open water swimming in choppy waters requires a strong back end of the stroke, with a follow-through that pushes beyond the hips. Athletes who have a long glide phase in their stroke tend to be slowed by open water chop while in this portion of the stroke, being re-propelled with each pull phase. Unfortunately, a long glide phase typically results in a slow turnover and, therefore, fewer pull phases per minute. This means fewer opportunities for forward motion because of not being re-propelled through the water. Because of this, open-water swims require a higher turnover than their pool-based counterparts.”

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Avoiding Shoulder Swimming Injuries – Advice from Active.com LINK

Excerpt: “One good thing about shoulder injuries is that they force us to slow down, and give us a chance to work on drills and stroke technique while we get back to health.”

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How to Avoid and Fix Swimming Shoulder Injury – Advice from SwimSmooth.com LINK

Excerpt: “…four simple tips will ensure you avoid developing a shoulder injury from your swimming…”

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Evan Morrison suggests backstroke to “unwind” the shoulder in his blog, FreshwaterSwimmer LINK

 Excerpt: “…backstroke is a natural recovery motion for freestyle. While similar muscles are engaged in the two strokes, they’re moving in opposite directions. After a hard freestyle effort, backstroke helps you almost literally “unwind” your shoulders.”

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Acknowledging The Pain – One Perspective from The Daily News of Open Water Swimming LINK
Jen Schumacher on the idea that pain is not real

Excerpt: “…pain is simply the mind trying to trick the body to slow down or stop. If you can just acknowledge the pain and recognize that it is not real, it will eventually go away, thus reaffirming the original notion that pain is not real.”

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Swimming Biomechanics and Injury Prevention – an article from The Physician and Sportsmedicine LINK

Excerpt: “Shoulder injuries are common in swimmers of all ages and abilities. Advances
in the understanding of biomechanics help identify and correct stroke flaws to prevent
shoulder injury.”

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A Selection of Advice Offered:

(In response to my email sent to the CIBBOWS Google Group in August. If you would like your name removed from, or added to your advice, please let me know)

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Hi Caitlin,

Sorry to hear that you are experiencing discomfort from long swims. I suffer myself occasionally though probably not the same thing…. I have a tendency toward tendonitis in my right bicep, and a few spots near my right elbow. The effect is loss of grip in my right hand, and painful. I have learned to move things around while swimming…. focusing on loading specific muscles and relaxing others in both my arms and legs while trying to maintain my stroke rate and speed. It takes practice, and its hard to know if you are being effective unless you are experiencing pain in a certain area.

Terry Laughlin is an excellent stroke mechanic and has an endless pool with mirrors and video at his residence in New Paltz. I also frequent an Active Release Therapist in New Paltz… Dr David Ness. Painful but effective body work.

Sorry that I don’t know any folks in Bklyn. Hope this info is useful to you.

David Barra

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I’d look first at over-reach on entry which would cause your left arm to hit the water at full, or nearly-full extension with the result that your shoulder is experiencing high lever forces at a moment when it’s in a highly unstable position. Another likely cause is poor balance which would result in your pressing down with hand and forearm rather than back. Several correctives that ought to relieve the pain and put you back on the road to healing — and improve your stroke efficiency:

1) A ‘Mail Slot’ (or Silent) entry and a very patient – and very gentle — catch.
2) Make sure your hands are always relaxed – never tense or stiff.
3)  From the moment your hand enters the water until it exits, it should be angled down.
4)  Avoid turning palm out on recovery or entry. Keep your hand neutral — happens naturally if it’s relaxed.
5) Never use a pull buoy, paddles, or kickboard.  All put pressure on the shoulder.
6) Finally, a far more economical option than the four you cited, and one I feel confident would greatly improve your distance swimming, would be to begin working through the process illustrated on this self-help DVD.

I’ve had an unstable left shoulder, due to rotator cuff tear suffered in an auto accident, since 1997. I’ve trained for and swum multiple marathons with only rare and minor occurrences of shoulder irritation since, that I can always resolve in a few days. Good balance and sound mechanics are the best assurance of a healthy shoulder.

Swim Well. Live Well.
Terry Laughlin

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I had surgery a long time ago – one on each shoulder, but it was a different problem – bone spurs within the shoulder joint, which they cleaned out (along with some bursa and even a vestigial tendon!)

It worked well, although i always have to nurse my shoulders along (chill them after every swim, and sometimes back off for a day or two), but they’ve held up on swims up to 14+ hours.

Recovery, however, took longer than I expected — it really took a year after each surgery for the shoulders to come up to strength — and I think you have to be ready for a longer recovery than they tell you, because their definition of ‘recovery’ and yours may vary!

The surgeons were Dr David Altchek at Special Surgery, who is the Mets team surgeon, but he may be too big a cheese…he was already allocating a lot of his work then, so he may be up on MT Olympus – you want someone who is accessible, no?

And William Levine at Columbia Presbyterian, who was very good – I think he may be the head of the department now.

Again, this was probably 10 or more years ago, so this info is not the latest and greatest, but the best way to find out is to go see the doctor and see how you feel about them – are they knowledgable, concerned and conservative?

I think a lot of people deal with rotator issues by strengthening (I had to do that after the surgeries), which is always the best place to start…but if they diagnose a real issue that requires surgery, then all the strengthening in the world will probably not help. But I guess that’s why you need someone good to diagnose – Levine was very good and I would not hesitate to recommend him based on my experience, with the caveat that it was quite a while ago.

Best,

Mo

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You really need to get an expert evaluation from someone who understands what you do.  When my shoulder flared up, I visited a doctor who made a quick 5 minute evaluation, and I got the impression that with the least evidence he is ready to put people thru surgery.  At my age doctors assume that you are over the hill  and treatment is just a way of making you comfortable while you are winding down.  He had no clue what open water swimming was.

So I started emailing swimmers who might know a doctor who worked on swimmers.  In no time I got the same name coming up: Dr. Jonathan Glashow.  He is associated with Mt. Sinai hospital and works on athletes’ shoulders.  Year after year he is profiled as one of the best doctors for shoulder surgery in the country.  My wife consulted with him as did Suzanne. No surgery required.  Dr. Glashow had a good idea what was bothering me but sent me for an MRI just to confirm his findings.  I had a torn labrum (left shoulder – breathing side) and a couple of bone spurs.  It was no time to be modest.  I informed him of my swimming workouts and swimming events repeatedly just to make sure he “got it”   — even though he did get it.  I was looking for a repair that would put me back at full strength in the water.

During surgery, while cleaning up the labrum and removing the bone spurs, Dr. Glashow noticed a conflict with my bicep tendon with other tendons.  So he cut it and screwed it into a different place.  He wouldn’t have done this with someone going back to a normal life with minimal exercise.  He knew that as soon as I recovered I would once again be swimming, testing the shoulder’s limits.

Following surgery, I had physical therapy and training at NY SportsMed.  I couldn’t lift my arm for two months.  I swam with one arm and fins.  Surgery was in June 2009 and I resumed workouts in November.

Be prepared that if you need to go thru therapy, it will be months of therapy, but, ironically, I found this whole experience to be a big plus.  I learned much about body mechanics which I then applied to swimming.  I have reinvented my stroke.  Once again, I incessantly talked to the therapist and trainer about swimming.  I made sure they knew that I wasn’t there just to recover from surgery, I was going to the Olympics (I lied about that. They didn’t believe me but I think they got the point).  I continued my therapy for a year and increased my training time from 20 minutes to an hour. Very much worth it.  My first open water swim was Liberty Island  in June, followed by Brooklyn Bridge and last Saturday a 5K in Coney Island.  No problems.

Some shoulder problems just cannot be attributed to stroke technique. Muscles sometimes just do not perform as they should–or are being asked to over-perform. PT becomes the only solution. From what you described you are doing some extreme distances that may require some well thought out dryland preparation/rehab.

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The Body Needs Rest

“Rest the arm”

Three straight hours of doing just about anything is a strain. Even when properly conditioned. Some of our weaker, worn, and injured areas can be pushed just too far.

We need rest much more than most of us are willing to give ourselves.

An MRI is probably what the right doctor will eventually recommend – it cannot hurt your arm (unless you have metal or some other condition – which they will provide you with a pre-MRI checklist)

As a swimmer of your caliber the MRI will be like a quick workout, (just count strokes, and you will love it).

The doctor and his team than can see what is wrong and more accurately and safely narrow down your options and personal situation. Most of the times they have recommend to me to eventually start building up the areas around the effective area to help is even further along.

In addition, a great book to see is a “Body Atlas” this will give you a fantastic visual idea of what is going on beneath the skin. The better atlases will have several drawing of the same area: Muscle Groups, bones, nerves, tendons, veins, arteries, and such.

All the Best

Robert

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Hi Caitlin,

I’ve had problems with my left shoulder and swimming for years. They flared up last year so I went to a clinic. They did an x-ray which showed nothing in particular. They prescribed an NSAID, and got me started on a simple set of rotator-cuff exercises… Oct and Nov last year I replaced a lot of sets…with kicking. That basically did it: it took a couple of months before I was basically pain free. I still do the exercises (probably not as religiously as I should).

One of the coaches here …said he had pretty much the same thing when he was swimming in college, and had a very boring time of it kicking and kicking and kicking. He also said I had a little problem with crossover. You might have John or someone check out your stroke.

Every body and every pain is different, so you should probably go have it checked out.

Cheers,

Tony

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Careful not to let your entry cross over too far to center.  Causes you to pull outward unnecessarily. Entry should be at shoulderwidth, which may feel way wide or strange :) Let your entry dive deeper. If your hand starts the pull near the surface, the next motion would be to push straight down, which is hard on the shoulder and provides no propulsion.

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… my shoulder pain has been lessened by Alexander lessons and gyrotonics, both of which work to teach you to engage the body in the motion of the shoulder so the poor rotator cuff isn’t doing so much work. there is an alexander teacher who specializes in swimming based on the Shaw Method? I haven’t done it. might be helpful.

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see Dr Robert DiStefano! he’s the best shoulder guy in ny, no kidding.  a chiropractor, ART (active release therapy) specialist and athlete.  he’s expensive and worth it.  tell him I sent you.  “another long distance swimmer from Kathy”. he got me around the MIMS solo.

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…stop swimming for more than 3 hours?! :)

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Feel free to add your thoughts to the conversation. I believe that since everyone’s situation is unique, it is unlikely that there is one answer to any problem. However, having access to a wide range of advice is very helpful. It can be daunting to sort through advice, especially when some of it contradicts. What do you do when one authority is telling you to use a shallow catch, and another is saying to dig deep? Why not try them both and find what works for you.