Can "Therapeutic" Swimming also Improve your Stroke Efficiency?

By Terry Laughlin

Have I possibly come up with a new protocol for rehabilitation – one that’s especially suited for a TI Swimmer with a habit of swimming mindfully and with a spirit of exploration? I hope so, but that’s not the only benefit of my rehab-swimming. I’ve also been intent – as always – on finding ways to use my pool time to improve my efficiency and to work on subtle problems in my swimming and drilling. As it happens, rehab-swimming is ideal for that as well.

Here's another progress report on my recovery from shoulder surgery on Feb 15. As you may recall from previous articles, I injured myself Sept 30 while lifting weights. Though I was lifting moderate weight and using careful form, I felt something in my right shoulder give way on the 11th rep in a set of 12 bench presses. I instantly felt extreme pain and disabling weakness in that shoulder. Stubbornly I continued with the workout – though avoiding movements that caused pain.

I continued swimming over the next few weeks, with significant pain and limitation, focusing mainly on gentle range-of-motion activities, hoping that light activation would have some therapeutic effect, but my shoulder continued to hurt in virtually all activities, so three weeks after the injury I consulted my family physician. He diagnosed a torn labrum and instructed me to stop swimming and lifting, and to begin taking ibuprofen three times a day to reduce inflammation. After three weeks I resumed swimming, but slowly and carefully, again in pain-avoidance, hopefully-therapeutic mode.

I gradually increased my capacity for swimming freestyle, by using a steep and deep entry close to my head and taking the briefest moment to put my arm in a stable position before stroking. Long story short, I continued to gain strength and speed progressing to the point where in late January, I was swimming as fast as I ever had. But everything else I did with my right arm – like flipping a light switch – hurt. I finally got an approval for an MRI from the HMO but it was inconclusive. However given the lack of improvement in normal arm function, my orthopedist agreed to “scope” me, which he did on February 15.

The last 10 days I swam and lifted weights regularly, hoping to have my shoulder as strong as possible going into surgery, in the expectation that I’d recover more quickly. I even went to the gym for a weight lifting session on my way to the hospital for my surgery, as I understood that the stronger my shoulder was before surgery, the faster I might recover, and I had my heart set on being ready for my first scheduled open water race – a 5K at Mashpee Pond, Cape Cod, June 25th.

Two days after surgery I had an appointment with the surgeon who delivered disappointing news. When he got a clear look inside my shoulder with the scope, he saw a complete tear of the rotator cuff. He stapled the muscle back to the bone, but told me I wasn’t to begin swimming for three months – in other words until May 15, just six weeks prior to the Mashpee race. It wasn’t looking too good for being back in the swim for the 2005 open water season.

Still, even with my arm in a sling for three weeks, I immediately began working to maintain some measure of fitness – and avoid weight gain – by visiting the gym five days a week. I did stationary cycling, fast walking on an inclined treadmill, stair climber and elliptical trainer, for 60 to 90 minutes each time. I also did lower body weight training.

“Swimming” in Secret
When the sling came off, I began Physical Therapy. But, on March 29th, in secret violation of doctor’s orders, I took my first swim – 300 yards of single arm drills, with fins and with my right arm at my side. I continued that for a week. In PT, I’d begun to do some gentle arm extensions in a supine position (laying on my back) so I began to experiment with the same movement while kicking in Sweet Spot. Extending my arm with the support of the water felt quite therapeutic, so I added Skating practice, in a nose down position. I experienced no post-practice soreness from practicing TI balance drills, and in fact could sense that I was making greater gains in Physical Therapy once I did.

Encouraged by this, within a few sessions I added Under Switch drills, wearing fins as an extra precaution to lessen load on my shoulder. Under Switch had the effect of moving my arm in two directions – extending it then drawing it down to my side, but with exceeding gentleness. I continued to increase my time in the water, soon reaching an hour. In early April, while leading a workshop in NYC I found myself needing to demonstrate Zipper Skate and Zipper Switch to my students, which involved rotating my elbow over my shoulder for the first time. To my great pleasure, that felt fine, so the following week I added that to my repertoire and several days later did Overswitches for the first time. All that remained was to shift from “yoga breathing” to rhythmic breathing and I’d be swimming, which I began on April 11, five weeks sooner than my surgeon’s instructions.

I should emphasize that I wasn’t doing anything reckless in this process. I knew that the surgeon’s definition of “swimming” was likely of “human swimming” – ungainly arm-churning that would indeed endanger a vulnerable joint. The “swimming” I’d been doing for three weeks closely mirrored the activities I was doing in PT, but with the therapeutic addition of water support and resistance, done with care to avoid pressure on the joint. When I began doing whole-stroke swimming, I wore fins shifting most of the propulsive load to my legs. I simply used the stroke as way of exploring and extending my range of motion, avoiding any pressure on the stroke back. Last week I did get carried away on a couple of 500-yard repeats and stroked/swam more aggressively then I planned. After those practices I not only didn’t feel any pain, my shoulder felt great.

Accelerating Recovery
Meanwhile, back at PT, my therapist was marveling each week at how rapidly strength and range of motion was improving in my surgically-repaired shoulder. When I shared my little secret with him, rather than a scolding, he congratulated me on finding a way to use my favorite activity to accelerate recovery and said he’d never had a patient who came back as quickly from a complete cuff tear as I had. Today I had an appointment with the surgeon and let him know of my “creative non-compliance” with post-surgical protocol. He approvingly said that whatever I'd done had obviously worked.

Have I possibly come up with a new protocol for rehabilitation – one that’s especially suited for a TI Swimmer with a habit of swimming mindfully and with a spirit of exploration? I hope so, but that’s not the only benefit of my rehab-swimming. I’ve also been intent – as always – on finding ways to use my pool time to improve my efficiency and to work on subtle problems in my swimming and drilling. As it happens, rehab-swimming is ideal for that as well.

By far, the largest number of inquiries we receive by email, and on the Discussion Forums, relate to breathing. Breathing is Issue #1 for a large number of our students – specifically how to transition smoothly from the Sweet Spot “yoga breathing” we practice in Switching drills to the rhythmic “bite of air” breathing we use in whole-stroke. During the week in which I was doing only side-balance kicking with an extended arm, I focused intently on practicing "Skating with a bite" rather than going to Sweet Spot, guided by three focal points suggested by TI-Australia Coach Maree Weir on the Discussion Forums: (1) Relax into the water as you roll to breathe, (2) Lead the rotation to your breath by having your chin follow your shoulder, and (3) Let a natural breathing rhythm guide your Skating practice breathing rhythm.

For a solid week of practice I worked on all three focal points, with a goal of better understanding how to guide novice students. I learned enough from intense focus on a very basic skill that I advised all the TI Coaches to improve their own teaching abilities with similar practice. As I added Switch drills to my repertoire I continued to work on fitting in seamless “bite of air” breaths, rather than rotating to Sweet Spot for “yoga breaths.” Within a couple of months I expect to release a downloadable video clip illustrating this TI practice refinement.

Since transitioning to whole-stroke swimming, I’ve focused on three small challenges in my own stroke: (1) a tendency to cross over the midline when pulling, (2) difficulty in integrating a steady 6-beat kick with my stroke, and (3) a slight loss of grip in my right hand anchor when I take a left-side breath – when swimming with a 6-beat kick.

When might I use a 6-beat kick? Infrequently at best – probably not at all in open-water swimming. But I do like to shift to steadier kick when doing 25- or 50-yard sprints in pool training because it does help me swim faster for short distances. And I enjoy tackling all manner of puzzles in my stroke, even those with limited application to my racing – simply because it concentrates my attention and strengthens my “problem-solving muscles.” And the last few weeks have reinforced my recognition that the slow, gentle movements that are best for rehab, are also ideal for tightly focused examination of subtle stroking problems such as I’ve described.