A Series of Exercises for the Un-injured Athlete
Pain in the shoulder is common in swimmers.
Shoulder function is highly dependent on the
coordinated function of many muscle groups. These
include the muscles around the shoulder, those that
control the scapula or shoulder blade, muscles in
the upper and lower back, as well as abdominal and
pelvic muscles.
Since the shoulder is an inherently unstable
joint, muscle forces are critical for maintaining
stability, proper motion, and painless function. The
repetitive overhead activity of the swimming stroke
can result in fatigue of these muscles. This in turn
can lead to distinct changes in the function of the
shoulder, resulting in the pain that is commonly
known as �swimmer�s shoulder.�
One of the major factors causing shoulder pain is
overuse and subsequent fatigue of the rotator cuff
muscles, scapular muscles, and muscles of the upper
and lower back. Consequently, this fatigue can lead
to shoulder instability and predispose a swimmer to
shoulder pain. The risk of injury and pain is
especially true for swimmers who swim with poor
technique.
It is well-established that a comprehensive
program to develop strength, endurance, balance, and
flexibility of the muscles is the most important way
to prevent �swimmer�s shoulder". The exercises
described in this review were chosen to develop
these characteristics based on a sound knowledge of
the muscles that are most important for optimal
shoulder function.
The Exercises
These exercises were chosen and reviewed by a
panel of physicians, therapists, biomechanists,
trainers, and coaches from USA Swimming�s Sports
Medicine Society. These exercises have been proven
to be effective in improving shoulder function for
swimmers. These exercises address the three
important areas:
1) the rotator cuff,
2) the muscles that stabilize the shoulder blade,
and
3) the muscles of the low back, abdominal, and
pelvis that make up the �core� of the body � the
abdominal and lower back muscles.
It is important to note that these exercises should
only be performed by the uninjured athlete. Injured
athletes may need to modify the exercises in
duration and/ or range of motion depending on the
level of pain or impairment the athlete is
experiencing.
In doing these exercises, keep in mind that the
shoulder does not act by itself when you swim. You
use your back, trunk and even your legs to help
stabilize the body and help in the pulling movement.
You will use many of these same muscle groups as you
perform these exercises.
Also, these exercises should be performed AFTER
practice or several hours before you practice. DO
NOT do these exercises right before your workout
since you do not want to fatigue these muscles
before you swim.
Practical Tips
1) While it is beneficial to complete each of the
exercises presented in this review each week, it is
unlikely that the athlete will complete all of them
every day, due to the amount of time it would take.
If time is an issue, try the �Light Version� by
alternating days with the different groups of
exercises. For example, complete the three Rotator
Cuff exercises on Monday, the Shoulder Blade
Stabilizing exercises on Tuesday, the Core Strength
exercises on Wednesday and the Stretching exercises
on Thursday. Then start the cycle from the
beginning.
2) While it is best not to perform these exercises
before practice, we realize that for some programs
this may be the only time your group is together. If
this is the case, it will not hurt to complete the
exercises before the water workout, but realize that
in doing so the athlete may experience some degree
of fatigue in the targeted muscles during practice.
Primary Rotator Cuff Exercises
The first group of exercises we want to describe
is designed to strengthen the rotator cuff muscles
in the shoulder. The rotator cuff is made up of four
small muscles deep in your shoulder. When these
muscles contract they cause the shoulder to:
Rotate the arm away from the body.
This movement is called external
rotation.
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Rotate the arm towards the body.
This movement is called internal
rotation.
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Lift the arm away from the body.
This movement is called shoulder
abduction.
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Exercise #1 - External Rotation
Equipment:
To perform this exercise you will need a light to
moderate resistance Theraband or surgical tubing.
How do you determine what strength Theraband is
right for you? Pull on it and if it feels like the
resistance is too light � you probably have the
right level of resistance. You will be performing
many repetitions so a resistance that feels too easy
will probably be just right as you start to fatigue.
The
Movement: The External Rotation
exercise focuses on strengthening the
muscles that externally rotate the
shoulders. The muscles that perform this
motion usually are weak in swimmers. You are
going to strengthen both sides of your body
in this exercise.
Start by cutting the Theraband and tying it
into a loop. The loop should be big enough
so that your hands are 6-8 inches apart when
your elbows are at your sides and your
forearms are parallel to the floor.
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Stand up straight with good posture. Do not
hunch your shoulders forward. Lift your
sternum and your chest towards the ceiling
to help set your shoulder blades in the
proper position. |
Your elbows should be at your sides and
should be bent 90 degrees so your forearms
are parallel to the floor and your thumbs
are pointing towards the sky. Perform the
exercise by trying to rotate your hands away
from your body like you are pulling taffy
apart. The figures to the left show the
correct start and finish positions. |
Focus on squeezing your shoulder blades
together before you start this exercise.
Feel this squeeze through the ENTIRE
exercise. If you do not focus on squeezing
the shoulder blades you will be exercising
the wrong muscles. |
You should take about two seconds to complete each
repetition � 1 second as the muscles contract and
you externally rotate the shoulders. Then take 1
second as you return to the starting position. Count
1-and-2-and, 1-and-2-and as you perform the exercise
to get the correct timing.
You should perform 3 sets of this exercise, resting
30 seconds between each set. Each set should end
after 2 minutes or when you are no longer able to
maintain correct form. It is time to end the set if:
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the shoulders start to roll forward,
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you use you upper body or wrists to help the
motion or,
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you are unable to keep your shoulder blades
squeezed together.
It is okay if you are only able to complete a few
repetitions at first, but strive for completing 3
sets of 2 minutes. When you can do this, move up to
a higher resistance Theraband.
Exercise #2 � Full Can Scaption/ Full Can Straight
Arm Lifts
Equipment:
You do not need equipment to perform this exercise,
but as you get stronger, you can use some very light
weights. You can make your own weights by filling
two small water bottles with sand.
The
Movement: The Full Can Scaption Exercise gets
its name because performing it is like lifting a can
without spilling its contents. The exercise
strengthens the part of your rotator cuff that lifts
the arm. Start this exercise using no weight. As you
progress and get stronger you can use very light
weights with this exercise, but even the strongest
athletes should not lift more than 5 extra pounds.
Stand upright with your feet shoulder width
apart and do not allow the shoulders to
slump forward. Lift your chest towards the
ceiling to help set the shoulder blades in
the proper position. Focus on pinching your
shoulder blades together and you should feel
tension in these muscles for the entire
exercise. The figures to the left show the
proper posture and starting position.
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Raise your arms so that they extend straight
out to your sides. Move your hands forward
about 1-2 feet so they are now slightly
ahead of your shoulders to get in the proper
exercise position. This will actually allow
you to perform the movement in the same
plane of the shoulder blade. Keep your
thumbs turned up so they are facing the sky.
(See figures to the right). |
Lower your hands to your side and then lift
them up again so your hands end up level
with the top of your head (See the figures
showing the start and finish positions for
the exercise to the left).
Maintain a steady cadence � Take 1 second to
lift your hands to head level and one second
to lower the hands back to your sides. As
you raise and lower your hands, count slowly
1-up-2-up, 1-down-2-down� Remember to keep
your hands and arms ahead of your shoulders
and keep your shoulder blades together. |
Continue this exercise for 2 minutes or until you
are unable to lift your arms while keeping your
shoulder blades pinched together. Perform 3 sets in
this way taking 30 seconds rest between each set.
Exercise #3 - Ball on the Wall
Equipment:
One tennis ball or light medicine ball.
The
Movement: The Ball on the Wall exercise is
designed to strengthen the muscles that stabilize
the shoulder blas� (scapula) as well as those that
internally and externally rotate the shoulder. You
will need a tennis ball or a light medicine ball to
perform this exercise.
Facing the wall, stand
up straight with one arm extended in from of you so
that your palm almost touches the wall. Keeping the
elbow straight, �pin� the ball between your hand and
the wall. Pinch your shoulder blades together and
feel that contraction through the entire exercise.
Roll the ball in small circles in a
counter-clockwise motion for 15 seconds.
Each circle should take about 1 second to
complete. Without stopping, switch
directions and make small circles in a
clockwise direction.
Control the cadence so that you make one
circle each second. Continue this exercise,
switching between making clockwise and
counter-clockwise circles, until you become
fatigued, or 2 minutes, which ever comes
first.
You know you are fatigued if you can not
keep your shoulder blades squeezed together,
if you hunch your shoulders, or if you can
not hold the ball against the wall. Perform
3 sets, but do not go longer than 2 minutes
for each set.
Repeat this procedure for the other arm.
Primary Shoulder Blade Stabilizing Exercises
The second group of exercises, the Shoulder
Blade Stabilizers, is designed to strengthen
the muscles that control how your shoulder
blades move. These muscles are found in the
middle of your upper back and along your
sides. When these muscles contract, they
cause your shoulder blades to rotate or
slide across your back. They work in
coordination with the rotator cuff muscles
to control the movement of the shoulder. If
these muscles are weak, you can put too much
stress on the rotator cuff when you swim.
Exercise #4 � Theraband Rowing
Equipment:
One moderate resistance Theraband.
The
Movement: Theraband rowing
strengthens the muscles that hold your
shoulder blades in place. These muscles are
important in helping your shoulder joint to
move when you swim.
First, make a loop with the
Theraband and tie the ends together.
The loop should be about 2 feet
long. Attach the loop to a doorknob
or some other stationary object that
will not move when you pull on the
Theraband. Sit on a bench or at the
edge of a chair. Position the chair
so that when your arms are extended
in front of you the Theraband is
just taut. |
Sit with an upright posture, and
lift the chest to help set the
shoulder blades in the proper
position. Do not hunch the upper
back or shoulders.
Pull your hands toward your body.
Keep your elbows in and pull your
hands to a point between your belly
button and your rib cage. Make sure
you lead the pull with your elbows.
Your palms should be facing upward
when you pull towards your chest.
See the figure below for proper
start, middle and finish positions. |
Remember to focus on squeezing the shoulder
blades together with each row and
maintaining this contraction for the entire
exercise.
Maintain a comfortable cadence, completing 1
complete repetition every 2 seconds. Count
to yourself 1-and-2-and, 1-and-2-and taking
one second for the contraction and 1 second
as you return to the starting position.
Perform 3 sets of this exercise. Each set
should end when you become fatigued or reach
2 minutes of exercise. Take 30 seconds rest
between sets and strive for completing 3
sets of 2 minutes each. Like the other
exercises, fatigue is indicated when your
posture slumps, or you cannot keep your
shoulder blades pinched together.
Exercise #5 � Hitch Hiker
Equipment: No equipment is needed for
this exercise, but as you get stronger, you
can use some very light weights. You can
make your own weights by filling two small
water bottles with sand. These should weigh
less than 2 pounds, even for the strongest
swimmers.
The
Movement: The Hitch Hiker exercise
strengthens the muscles that control your
shoulder blades as well as your rotator cuff
muscles. You can exercise both sides of body
at the same time, or choose to do one arm at
a time.
Lay on your stomach on the floor. Relax your
head and keep it in line with your spine.
Put your arms straight out to your sides
with your thumbs pointing to the ceiling (It
looks like you are hitch-hiking).
While squeezing your shoulder blades
together, lift your hands up off the floor
and move them slightly towards your head.
Use both arms at the same time. You should
end up in a position that looks like a �Y�
at the end of the exercise. Hold this
position for 1-2 seconds and then relax to
the starting position. Repeat.
Try to perform this exercise for 2 minutes.
If you cannot continue the exercise for 2
minutes, that�s okay. When you become
fatigued and can no longer maintain your
form, rest for 30 seconds. Perform your
second and third sets the same way.
If you reach the point where you can
complete 3 sets of 2 minutes, perform the
exercise while holding some small weights
(less than 2 pounds) in your hands.
Remember, you can make your own weights by
filling small water bottles with sand, and
you can also perform this exercise with one
arm at a time.
Exercise #6 � Push Ups with a Plus
Equipment: None.
The
Movement: This push up exercise
strengthens your chest muscles like a normal
push up, but there is an added motion at the
end that strengthens one of the muscles that
stabilizes your shoulder blades. There is a
progression to this exercise, which means
you will first perform the exercise against
a wall while standing. As you get more
advanced you can do this exercise while on
your knees and then finally in a traditional
push-up position.
To start this exercise, stand at
arms length away from a flat wall.
When you stand up straight your
palms should touch the wall. The
hands should be shoulder-width, or
slightly wider than shoulder-width,
apart. |
Allow your chest to move towards the
wall, as you would into a normal
push up position. Once you are in
the �down position� push away from
the wall. It is important to do this
slowly so your hands never lose
contact with the wall. |
When you reach the normal ending position
for a push up you want to keep going. This
is where the extra action comes in. Continue
pushing so that your shoulders rotate
forward a bit. It should feel like the
center of your back is farther away from the
wall than your shoulders, as if you are
raising your back like an angry cat. This is
the extra motion that strengthens the
stabilizers of your shoulder blade.
Hold this position for 2 seconds and repeat
the action. Continue each set until you
fatigue and start to lose form or until you
reach 2 minutes, which ever comes first.
Complete 3 sets, resting 30 seconds between
each set.
As you become stronger, perform the same
exercise when kneeling on the floor.
And eventually you will be able to perform
normal push-ups with the extra motion.
Primary Core Strength Development
The third series of exercises focuses on
developing strength in your abdominal and
lower back muscles. These are some of the
core muscles of your body. The muscles
in the core of your body are essential for
helping you maintain balance in the water
when you swim. Balance is one of the most
important skills you can develop. With weak
abdominal and lower back muscles you will
not be able to achieve a sufficient level of
balance using your core. If you are like
most swimmers, you will then try to achieve
balance by changing your arm position or
your stroke pattern. This places added
stress on the shoulder and can lead to
shoulder problems. There are many abdominal
and lower back exercises you can do to
strengthen these muscles. We will show you
two of these exercises.
Exercise #7 � Dead Bug
Equipment: None.
The
Movement: The Dead Bug exercise
strengthens your abdominal muscles and gets
its name because if you do it correctly you
will look like a bug that is flipped over on
its back waving its legs in the air.
Lay
on the floor and put your hands
under your tailbone. |
Tighten up your lower abdominal
muscles by trying to pull your
belly-button in towards your spine.
This will help you avoid excessive
arching in your lower back. It is
important to keep your back FLAT on
the floor at all times. |
Lift your legs off the floor and perform a
light �flutter kick.� Continue this movement
for 2 minutes or until you can no longer
keep your lower back flat. See the figures
below for proper positioning.
When you master this technique, you can
remove your hands from under your tailbone
and perform a flutter kicking like movement
with your straight arms.
This form of the exercise (using the arms)
is more difficult. You must make sure you do
not allow the lower back to arch very much
to avoid injury and work the appropriate
muscles.
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Exercise #8 � Quadruped
Equipment:
None.
The
Movement: It�s called the Quadruped exercise
because initially you resemble an animal walking on
all fours. When performing this exercise you will
strengthen muscles in the lower back and abdominal
region and foster strength development between the
two sides of your body.
Start
this exercise with your hands and knees on
the floor. Get into a �table-top� position
by flattening out your back. |
There should not be an arch in your back, nor should
there be a dip. This will require tightening up your
abdominal and lower back muscles. Think about
pulling your belly-button in towards your spine.
Once you�ve achieved the proper starting posture,
simultaneously lift your left arm and right leg �
straightening them out so they are parallel to the
floor. Hold in this position for a second making
sure you maintain a flat back.
Slowly bring the hand and knee back to the floor.
Repeat the action lifting the right arm and left
leg.
Alternate in this fashion for 2 minutes or until you
become fatigued. You are fatigued if you cannot lift
the arm or leg parallel to the floor or if you are
not able to maintain your flat back posture. Perform
3 sets with 30 seconds rest between each set.
As you become more experienced, try performing the
exercise while closing your eyes. This will force
you to use your postural muscles to a greater level
while developing balance and stability.
Stretching
We have talked a lot about strengthening muscles so
far. However, stretching is also important to make
certain you can use your newfound strength.
Strengthening + Stretching = Function.
By combining the strengthening and stretching
exercises, you will help reduce the likelihood of
shoulder injury when you swim.
Exercise #9 - Hamstrings Stretch
Equipment:
Towel
The
Movement: The Hamstrings Stretch engages the
group muscles in the back of your thigh. These
muscles, the hamstrings, help you bend your knee and
also are involved in straightening out your hip.
They have a lot of control over the position of your
pelvis and therefore impact your body position and
balance in the water. You are much better able to
control your balance in the water if your hamstrings
are loose. This exercise is designed to help you
stretch these muscles.
Lay flat on your back on the floor.
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Keeping the leg that is not going to be stretched
flat on the floor, loop the towel around the ball of
your foot. Gently straighten your leg, and pull it
towards your body. Do not lock your knee. A slight
bend in the knee is necessary for safety reasons,
but it should not be bent a lot.
Keep your pelvis on the floor and do not
rotate you body to help you get your leg
closer to your torso. Pull until you feel a
moderate stretch in the back of your thigh
and hold that position for 30 seconds.
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Perform the stretch 2 times on each leg. You should
not feel pain in this stretch or in any stretch. If
you feel pain stop the stretch immediately.
Exercise #10 � Upper Back Stretch
Equipment:
None.
The
Movement: The Upper Back Stretch targets the
trapezius (tra-peez-ee-us) muscle, which connects
your neck and your middle back to your shoulder
blades. Good flexibility is needed in this muscle in
order for the shoulder blades to move normally. This
exercise is designed to stretch the upper part of
the trapezius muscle since it tends to get tight in
swimmers, and a tight muscle may contribute to
shoulder pain.
Stand
up straight and push the palms of your hands
together in front of your chest. |
Push your hands straight away from your body while
continuing to squeeze your palms together. Try to
keep your shoulders from moving upward towards your
ears by pushing straight away from the body.
Continue to push your hands away from your body
until you feel a moderate stretch in your upper back
and between your shoulder blades. See the front,
side and back views of the stretch below.
Hold this position for 30 seconds and repeat after a
15-second rest. Be sure to breathe (do not hold your
breath!) as you perform this exercise.
Exercise #11 � Neck Stretch
Equipment:
None.
The
Movement: The Neck Stretch is another way to
stretch the muscles of your upper back. This stretch
targets the upper trapezius muscle.
Stand up
straight and do not roll or hunch the
shoulders. Place one arm in the small of
your back. The elbow should be bent so that
the forearm is parallel to the floor. Press
your arm into the small of your back to
provide some stability for the movement, but
you do not have to �grab on� to anything. |
Place the
other hand on the top of your head. Gently
guide your head towards your shoulder,
bending it to the side until you feel a
moderate stretch on the opposite side of
your neck. Remember, bring your head to your
shoulder and do not raise the shoulder to
meet the head. |
Hold this position for 30 seconds. Rest 15 seconds,
then repeat.
You can also
stretch a different part of the muscle by
looking at the armpit of the pulling arm.
Try both to
stretch as much of the muscle as possible.
Perform the
same stretch on the other side of your body. |
Conclusion
We hope that you
will find time to incorporate the exercises
described above into your training routine.
If you have
difficulty performing a specific exercise or if you
have pain while doing an exercise, it is best to
stop that exercise and seek advice and an evaluation
from a medical professional who has expertise in
this area. The
USA
Swimming web site
lists medical practitioners in your area who have
experience with shoulder problems in swimmers; this
list is available under the
Sports Medicine
section of the web site. You may also
directly contact
USA Swimming for further information on referrals.
Good luck!
Acknowledgements
USA Swimming would
like to thank the following professionals for their
contributions to this program:
Scott Rodeo, MD |
Murray Stephens |
Chair |
Vice President |
USA Swimming Sports Medicine Committee |
USA Swimming Technical Committees |
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Mahlon Bradley, MD |
Rick Eagleston, PT, ATC |
George Edelman, PT |
Paul �Strib� Ellison, MD |
Julie Gorman, PT |
Scott Heinlein, PT |
Margaret Hunt, ATC |
Rick Laing, PT |
Jim Johnson, MD |
Mike Leahy, Chiropractor |
Joe Noel, PT |
Scott Riewald, PhD |
Ed Ryan, ATC |
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Disclaimer: USA Swimming is not
responsible for the misuse of information published
in this review that could result in injury. No
member of USA Swimming should pursue any of the
exercises discussed in this review without the
direct and immediate supervision of a qualified
professional. |