Jul 2014 26

Case study - the competitive swimmer

By: Dave Wheeler

As the 3rd day of the 2014 Commonwealth Games opens in Glasgow this morning, the swimming medal board for the home nations is looking really strong:

Scotland is in 2nd place behind Australia, with 3 golds and 5 in total.

England is in 3rd place with 2 golds and 11 in total.




Just like cycling after London 2012, it looks like swimming is set for a bump in popularity, so it seems appropriate in today's blog to look at a real-life example of a competition swimmer who's been for treatment with me recently.


Butterfly stroke

Butterfly is a notriously strenuous stroke - physically demanding both in terms of cardiovascular workout and punishing on the muscles of the shoulder.


pic by arztsamui @ freedigitalphotos.net


Think about the action of the shoulder: it's like windmilling your arms through the water. Technically its called circumduction.

The shoulder is taking the force the arms pushing against the water, raising the body and then propelling the body forward as the arms come into line with the body. Next, as the arms start to come upwards behind the body, they have to overcome the water above.

At every stage of the stroke, the arms act as long levers putting huge forces into the shoulder joint, and continually working on all of the muscles surrounding it.

Because the arm movement involved in butterfly stroke is circumduction, which is a combination of every possible movement at the shoulder joint, it really is every single muscle that's being used. And every muscle is being used under force.


The swimmer

Natalie (not her real name) is competing in the ASA National Championships in Sheffield in just under 2 weeks.

She came to see me a week ago with pain under the edge of her shoulder blade which got worse when she swam; she was worried she wouldn't be able to compete in the upcoming championships.

The particular muscle that was causing her problems is called the serratus anterior - it's the muscle that sits on the outside of the upper chest, always well developed on Marvel superheroes.

Serratus anterior attaches to the upper 8 or 9 ribs then runs along the side of the torso up underneath the shoulder blade (or scapula) attaching to the underside of the edge of the shoulder blade closest to the spine.

If serratus anterior gets tight, then it pulls on the inside edge of the the shoulder blade, levering the shoulder blade tighter against the back wall of the ribs. Normally, this can be a good thing unless the muscle gets too tight - known as hypertonic

Muscles become hypertonic through overuse. With butterfly stroke and the huge forces being placed on the shoulder, overuse is easy, so a hypertonic serratus anterior (as well as all the other muscles of the shoulder) is pretty much a given.


pic by arztsamui @ freedigitalphotos.net


Treating Natalie

Because Natalie had left it quite late before coming to see me (she was REALLY sore), it wasn't just her serratus anterior that had become really tight: all of the other muscles all round the shoulder joint had also become hypertonic, partly because they were trying to compensate for the serratus anterior that wasn't functioning properly, and partly because even when not swimming, she'd been holding her shoulder in a tensed position to protect it.

Natalie's teres minor seemed to bear the brunt of her muscle tension (to find your teres minor grab the muscle right up in the back of your armpit and move your arm inwards across your body, you should feel a slight tensing of the muscle).

In preparing Natalie for her competion I saw her twice, one week apart.

All of the muscles of the shoulder complex had to be treated using a combination of deep tissue massage, soft tissue release, connective tissue massage, muscle energy technique and neuromuscular technique. All of which sounds complicated but boils down to a bunch of sports massage and remedial soft tissue techniques.

Fortunately, after sessions, Natalie's serratus anterior and the other muscles around her shoulder were a lot less painful, and tretched enough to let her compete.


pic by Salvatore Vuono @ freedigitalphotos.net


As ever, if you think I can help, give me a call.