The column of Live, Love Laugh Compete
Part III: Dryland training and Injuries in swimming: what do the medical experts think?
By Sara DiPaolo,
Photo Michael Lyn
Summary: a coherent, progressive dryland program can and should be designed and implemented that begins with strengthening the often overlooked, generally weaker supporting muscles. Such a program would contain built-in accommodations for swimmers who are physically weaker, less motivated, injured, or less talented, while simultaneously providing an environment that also allows elite level swimmers to succeed. In reality, the dryland progression could and should look similar to the in-pool progression of a normal training cycle, which begins with baseline endurance work and progresses to more targeted, pace and race specific training.
In Part I we saw the diverse strength/dryland training approaches used by the top teams ranging from Gainesville to Tallahassee to Jacksonville.
In Part II we heard from Colin Woodmansee, an expert in training endurance athletes, about the importance of incorporating attention to form, exercise progression, and baseline strengthening of the smaller supporting muscles.
Today in Part III we will enjoy the insights of a decorated panel of medical professionals:
Dr. Andrew Rocca, President, The Orthopaedic Institute, Gainesville, FL; former collegiate swimmer and current father of swimmers.
Dr. Sara Filmalter, Family and Sports Medicine physician at Mayo Clinic Florida, with a special interest in endurance athletes; age-group triathlete training for her first Ironman.
Dr. Nata Salvatori PT, DPT, OCS, FAAOMPT, a clinician and educator who serves as faculty and mentor to the Brooks/UNF Orthopaedic Residency and Orthopedic Manual Therapy Fellowship at Brooks Rehab Centers.
- Besides shoulders, what are the major injuries you see in swimmers?
The doctors agree that shoulder injuries account for the vast majority of swimming related problems, with both Dr. Filmalter and Dr. Rocca stating that shoulders compose 90% of all swimming injuries.
Shoulder injuries are probably the most discussed, and feared, injury, and, as Dr. Rocca describes in section two are actually fairly predictable in how they occur – which should suggest that coaches and athletes can be proactive in preventing them rather than waiting to address them after they occur.
As my twelve year old niece can attest to, a growing percentage of injuries seem to be occurring in the lower back. “The advent of the Berkoff blast in 1988 really has led to a big uptrend in these injuries,” Dr. Rocca said. “Underwater dolphin kicks, especially in the kids that are ‘good’ at it, puts added stress on the lower back.” Back injuries include hyperextension disk injuries and spondylolysis (stress fractures) and are most commonly seen in butterflyers, swimmers who repetitively kick extensively underwater (especially those who are extremely flexible and hyperextend), and kids with poor core strength.
The doctors also pointed to medial knee pain in breaststrokers, groin injuries to hip flexors, and ankle injuries as three other common areas of injury in swimmers. Ankle issues such as peroneal/Achilles/extensor tendonitis, peroneal tendon subluxation (my kids can actually write a book on that one, sadly…), and trigonum (posterior ankle) impingement can arise when the stress placed upon the ankle by extensive kicking (and exacerbated by fin usage) overpowers the swimmer’s ankle strength.
Summary: Shoulders, lower back, hips, knees and ankles are the primary injury locales for swimmers, which should not surprise anyone. Each of those areas endures a lot of torque and repetitive movement and is very susceptible to muscle imbalance/fatigue created issues that lead to injury.
- Have you noticed an increase in injuries related to dryland training, and, if so, is there any particular kind of training or reason for that increase (i.e. poor technique, the training is ill-suited for already overtaxed shoulders etc.):
The doctors unanimously agreed that poor technique (both in the pool and in the dryland room) and failure to strengthen supporting muscles while focusing on the larger/stronger muscles both contribute to dryland related injuries.
“Poor technique in athletes that are already susceptible amplifies the problems,” Dr. Rocca asserted. “The primary factor for shoulder problems is the imbalance between strong external muscles (deltoid, latissimus, trapezius) and relatively weaker deep structures (rotator cuff).” As Dr. Rocca explains, once the weaker supporting muscles become fatigued, the imbalance begins to alter shoulder mechanics, and a vicious cycle ensues. “The stronger external muscles amplify the damage to the weakened rotator cuff,” noted Dr. Rocca. This creates a cycle of deterioration that starts with tendonitis and ends with rotator cuff or labral tears.
Dr. Salvatori concurred, and emphasized that strength training needs to be progressive to allow for body adaptations, performed with the correct mechanics, and properly supervised. “We have noticed an increase in injuries with some of the new training methods,” explained Dr. Salvatori. “There are more gains to be made if the muscle group to be trained is the one to be actually used in a swimming event.”
One element to avoid in strength training for swimmers, Dr. Filmalter emphasized, is adding stress to already heavily taxed areas of a swimmer’s body. “Dryland overhead shoulder exercises should generally be avoided due to the increased risk for shoulder impingement,” asserted Dr. Filmalter. “There is also an increased risk for lower back pain and injury during compound exercises if they are completed with poor form.”
Summary: The doctors agree that proper technique, avoiding exercises that focus on already fatigued major muscles, and emphasizing a progressive plan that strengthens the supporting muscles are essential elements of a dryland program.
- Do you think a dryland program that focuses more on the core and supportive muscles would help limit or eliminate overuse injuries or dryland related injuries?
Dr. Salvatori summed up the responses when she said “Focusing on supportive musculature is fundamental for a successful outcome, just like establishing a good foundation is important when building a house.” Dryland training is actually an essential tool in developing swimmers, according to Dr. Filmalter. “ (The training should be) focused on strengthening both the core and supportive musculature to prevent poor technique that places undue stress (on already fatigued areas of the body),” she explained.
Dr. Rocca agreed, but also pointed out a fact that coaches, especially of larger teams, know all too well – the challenge of creating a program that accommodates a wide variety of goals, abilities, and limitations. “The difficulty comes in developing elite athletes,” explained Dr. Rocca. “In working with a team a coach must strike a balance between minimizing injuries, but at the same time pushing athletes to their maximum potential.” Rocca pointed out that the development of the core provides an element of protection to an athlete in almost any sport, but that “development of strong ballistic muscles is going to be beneficial to the athlete who is able to tolerate the training.”
Summary: A dryland program should start with an emphasis on core and supportive muscle strengthening but be flexible enough to accommodate the stronger, more motivated, elite level athletes in the development and enhancement of large muscle strength as well.
So, what is the upshot of all of this? Let’s put it in simple points:
- Swimmers need strong supporting muscles as well as strong primary muscles. The swimmer with the strongest delts in the world will only go as far as the muscles of the rotator cuff will take him.
- A step-wise progression that increases the strength of the supporting muscles in order to increase the strength of the major muscles will enable a swimmer to maintain proper technique longer, which will in turn reduce the death spiral caused by fatigue and muscle imbalances.
- Coaches can incorporate these exercises into their regular strength training plan in a way that allows elite/highly motivated athletes to advance while enabling a more limited athlete to have success as well. (I can personally attest that, in the first year I worked with Colin, I don’t think I duplicated an exercise… there are THAT many different ways to work these muscles!)
- Ensuring the coach and swimmer understand the reason for the exercise as well as what constitutes proper technique is imperative to the progression.
- Strengthening the supporting muscles before injury looks a lot like the progression used in physical therapy after an injury. Logic suggests doing the exercises as a prophylactic rather than a treatment would be beneficial to the swimmer and the program.
Up next: Colin Woodmansee demonstrates and discusses some simple and basic exercises that swimmers and endurance athletes can do to begin the supporting-muscle strengthening program.
A goal is a dream with a deadline.
Florida Swim Network