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Swimming, Symmetry, Shoulder Pain & Science


Swimming is a intricate sport that places huge demands on the body for propelling through the water. The shoulders often suffer as a consequence of this, but, injury chiropractor, Dr. Alexander Jimenez asks, what are the implications of musculoskeletal shoulder asymmetry?

Overview

Swimming is a hugely popular game for both recreational and competitive functions. The nature of exercising against the water immunity provides a special setting compared to the field or court in all other sports. Likewise, most other sports utilize a dominant side, whereas in swimming that the repetitive, continuous motions require either side of your system to be coordinated and equally strong. This can place an accumulation of stress physically. The overhead actions of a swimming stroke may notably strain the shoulder joints and around 73% of swimmers will experience shoulder pain at any stage within their career(1).

Taking this advice on board, surprisingly, swimmers do not usually develop symmetrically with equal muscle power on each side. And in which there is muscle imbalance, they commonly compensate by using different muscles more than ordinary to guarantee the total force generated is the same(2). Swimming also does not provide that point of contact or source to hold on to enjoy most other sports have. Swimmers rely on their inbuilt strength throughout the body along with the entire kinetic chain to generate maximum force propulsion. Expertise and strategy are important facets to contribute to this, however if there's a natural muscle imbalance then this can further affect technique, however much technique instruction you provide.

Asymmetry is defined when there's a muscle imbalance between the left and right sides greater than 10%(two). This means that the muscles on one side are more powerful or more efficient compared to those on the opposite side. A recent study that screened nationwide- level hens found that 85% were asymmetrical(two). Asymmetry usually develops because of the shoulder or whole arm being used wrongly or too often. Excessive repetition with no adequate rest causes the muscles to exhaustion. This decreases muscle activity and induce generation, and eventually causes biomechanical abnormalities as the swimmer attempts to overcome these failing mechanisms(3). A third of those swimmers in the study that were discovered with asymmetry were also identified as having compensatory plans(2). Asymmetry can lead to:
  • further muscle imbalance;
  • compensatory movement strategies, such as using increased hand force;
  • muscle injury.
Every one of these can alter technique and thus performance execution. This might be the difference between finishing first and finishing second in competition.

Screening For Shoulder Asymmetry

Screening is the process of assessing a variety of characteristics that are significant with the game. This allows the identification of possible flaws and muscle imbalances. Strengthening applications to rectify such findings may provide optimum strength, functionality and prevention of injury.

Table 1 details the key screening tests for identifying asymmetry in shoulder power for swimming. This scale details if the athlete can move against gravity (tier 3), then resist your force (grade 4), and supply full strength to resist (grade 5).


Shoulder flexion is not listed here as a screening test as it's been found that it doesn't have any effect on shoulder asymmetry(2). This implies that many swimmers all have an equal stroke length. It seems to be the abduction, adduction and rotational components which become imbalanced and make the asymmetry of the shoulders.

Arm dominance and breathing side can also be often considered significant factors in procedure perfection; however studies have not found these to have any consequences on performance(two). For more technically precise ways to assess these functions with dynamometer, see the original research articles(1,2).

Even though these are significant testing purposes, it's just as important to look elsewhere when trying to identify potential weaknesses. The surrounding muscles like the latissimus dorsi should be considered.

Latissimus Dorsi Stiffness

The latissimus dorsi is your largest muscle of the trunk and is responsible for all pushing and pulling type activities. The repetitive character of swimming and thus overuse of the latissimus dorsi usually means that this muscle may be prone to stiffness.

Figure 2 shows the latissimus dorsi, which attaches to the mid spine at T7, the lower ribs and down to the pelvis at the iliac crest. It inserts into the top of the shoulder called the bicipital groove and also to the lower part of the shoulder blade. It inserts into the top of the shoulder called the bicipital groove and also to the lower part of the shoulder blade. It's these insertion points that allow the muscle to control shoulder blade motion.



A study that investigated the effects of latissimus dorsi stiffness on scapular movements among swimmers found that the muscle stiffness caused three significant problems with scapular mechanisms(1) (see Table 2).


Each of these issues alters the way the shoulder blade operates mechanically. This modified mechanics can then develop injuries as other structures become caught or pinched within the shoulder joint distances. These injuries will influence technique as the shoulder will slowly lose power and strength.

Have the athlete in crook lying with their back flat against the bed. Ask them to lift their arms over their head. If there is latissimus dorsi stiffness they'll struggle to fully stretch the arms overhead, and/or their spine will lift up away from the mattress.

For a more accurate and technical evaluation method refer to this analysis by Illinois University(1).

Power Exercises For Fat Loss

The added resistance that the water provides requires strengthening exercises to be carried out in similar motions to replicate the coils. This may improve the specificity and ensure the correct muscles have been targeted. Key exercises for scapular strengthening that carry over ideally for swimming are shown below.

1. Breaststroke

This is all about the scapular setting. The shoulder blades are activated as the arm extends forwards, then pull backwards just like the swimming stroke(10).

2. Swimming

The athlete raises their opposite arm and leg up while maintaining the shoulder blades in the neutral position. The opposite side is then performed(10).

3. Low row

Using a resistance band tied to a door handle in front, the athlete pulls the band backwards past their hip and slowly returns to the start position.

4. Front crawl simulation

This exercise involves having a resistance band from one hand around the back of the body and held in the other hand (like wearing a jacket). The affected arm is then taken through a front crawl stroke while pulling the resistance band tightly. The shoulder blades should be kept in neutral throughout and avoid the desire to throw the shoulder forwards.

Summary

  • Asymmetry is a difference in muscle balance between the right and left sides and can lead to weakness, poor technique, compensatory strategies, and injury.
  • Swimmers are susceptible to asymmetry due to the repetitive use of the shoulders. Specific screening tests can be performed to identify where weaknesses lie. Shoulder abduction, adduction, and rotations are the main culprits because of their repetitive use within every stroke.
  • Treatment consists of strengthening and stabilizing the scapular muscles over a period of weeks, and making the exercises powerful to replicate the force required to battle through the water.

References:
1. Phys Ther in Sport. 2013; 14:50-53.
2. Phys Ther in Sport. 2013; http://dx.doi.org/ 10.1016/j.ptsp.2013.02.002
3. Rehab Res and Practice. 2012; ID:853037; 1-9.
4. McKesson Healthcare Solutions. 2004. www.mckesson.co.uk
5. Phys Ther in Sport. 2004; 3:109-124.
6. Musculoskeletal assessment. 2000. 2nd Ed; 150-156.
7. Clinical Sports Med. 2006. 3rd Ed; .246-247.
8. http://www.shoulderdoc.co.uk/article.asp?article=1381
9. http://www.youtube.com/watch?v=AcPZEtWP1x4 (2013).
10. APPI Pilates Matwork Handouts manual.2012. www.ausphysio.com

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Professional Scope of Practice * The information on this blog site is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Blog Information & Scope Discussions Welcome to El Paso's Premier Wellness and Injury Care Clinic & wellness blog, where Dr. Alex Jimenez, DC, FNP-C, a board-certified Family Practice Nurse Practitioner (FNP-BC) and Chiropractor (DC), presents insights on how our team is dedicated to holistic healing and personalized care. Our practice aligns with evidence-based treatment protocols inspired by integrative medicine principles, similar to those found on dralexjimenez.com, focusing on restoring health naturally for patients of all ages. Our areas of chiropractic practice include Wellness and nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, severe sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Functional Medicine Treatments, and in-scope care protocols. Our information scope is limited to Chiropractic, musculoskeletal, physical medicine, wellness, contributing etiological viscerosomatic disturbances within clinical presentations, associated somatovisceral reflex clinical dynamics, subluxation complexes, sensitive health issues, and/or functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and has identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies that are available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how they may assist in a particular care plan or treatment protocol; therefore, to discuss the subject matter above further, please feel free to ask Dr. Alex Jimenez, DC, APRN, FNP-BC, or contact us at 915-850-0900. We are here to help you and your family. Blessings Dr. Alex Jimenez DC, MSACP, APRN, FNP-BC*, CCST, IFMCP*, CFMP*, ATN* email: coach@elpasofunctionalmedicine.com Licensed as a Doctor of Chiropractic (DC) in Texas & New Mexico* Texas DC License # TX5807 New Mexico DC License # NM-DC2182 Licensed as a Registered Nurse (RN*) in Texas & Multistate  Texas RN License # 1191402  Compact Status: Multi-State License: Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP*, IFMCP*, ATN*, CCST