Restorative Swimming: Back from Shoulder Injury

By Terry Laughlin

Everything in life is a potential learning experience. In 1998, I fell off the roof of my house. I was fortunate not to be killed or crippled, but had severe injuries that required several months recovery. Swimming was part of my recovery process but I also learned a lot about how "restorative" swimming could benefit my "performance" swimming as well.

My article Swimming with Injury or Handicap in the last issue of Total Swim brought so much comment that I decided to follow up immediately by describing how I use TI-style swimming both for therapy and stroke improvement. Here I’ll focus on:

1) the therapeutic value of activating the injured area with gentle movement in pain-avoidance mode, and 2) the stroke-improvement value of activities that minimize load on your shoulder(s) while improving your balance, water awareness, etc.

Since my teens, my ankles have been frighteningly unstable. Stepping on a small crack, root or stone has often left me with a painful strain. Three times I’ve sprained an ankle badly enough to necessitate a trip to the emergency room. On the first two occasions at ages 14 and 15, doctors immobilized the injured ankle in a calf-high cast for several weeks. After removal, it took several more weeks for strength and range of motion to return to where they’d been prior to injury.

The third time, 20 years later, the emergency room physician told me to just wear tight-laced high-top basketball shoes for extra support, and gave me a pair of crutches with instructions to discard them as soon as I could put any weight on the ankle. I was stunned when this course of treatment resulted in more healing in a week’s time than I’d achieved in a month previously. This taught me that soft-tissue injury can often be healed more quickly through gentle activation than through immobilization.

After falling off the roof and shattering my left wrist, I wore a cast – and remained “dry” – for 10 weeks. When I returned to the pool, my left arm was useless for the first week or so because of severe limitations in range of motion and strength. Wearing fistgloves to avoid pressure on my fragile wrist I did exclusively balance drills at first, gradually introducing very delicate “switches” as my wrist gained strength. Over several weeks, I gradually increased the proportion of “dynamic” activity (switches and a bit of easy swimming) to “static” activity – balance and streamlining drills. It took about eight weeks to return to the level of swimming I’d been at previous to my fall. While I was slower, I was also noticeably more efficient, even with one arm still markedly weakened and unable to flex my wrist enough for an effective catch. The increased efficiency remained as my strength, fitness and speed returned – an unexpected legacy of the limitations imposed by injury. Unable to train as usual, the time devoted to practicing basic movements with great patience had a clear payoff.

Since my shoulder injury in September, I’ve had to exercise a similar degree of patience for an even lengthier period. For the first few weeks, I felt that the activation principle – gentle movement in ranges of motion that didn’t cause pain – would be enough to heal my undiagnosed injury. Though my shoulder was weak and tender, I continued swimming with modifications. I devoted more time to balance drills, swam more breaststroke than
usual, found that
whole- stroke butterfly was out, but I could do single-arm fly without pain. I could swim backstroke with little discomfort if I led recovery with the back of my hand, rather than my thumb. And freestyle was possible if I entered my hand closer to my head, at a steeper angle and took extra care to allow my shoulder to achieve a highly stable position before putting any pressure on my hand/forearm in the catch.

My shoulder still hurt in routine activities – like pouring tea or shifting gears in the car – but felt steadily better while swimming. When I finally consulted my doctor in late October he advised three weeks of complete rest to allow inflammation to reduce, and 600mg daily of ibuprofen. With the pool closing over Thanksgiving, three weeks turned into four, but when I resumed swimming in early December, the firmer catch produced by my pain-avoidance stroke modification remained. It took only one or two sessions to overcome a bit of “rust” in my coordination, but my practice performance reached an encouraging level quickly, though I had undoubtedly lost a good deal of my swimming fitness. [I’ve also done all of the following to aid in recovery – ice my shoulder for 20-25 minutes at least once a day with a bag of frozen veggies, had a cortisone injection from my orthopaedic surgeon, range of motion and strength exercises, complemented by yoga, pilates and stability ball exercise.]

And here’s a similar account from TI swimmer, John Garrett, in Northbridge New South Wales, Australia:

My right shoulder was injured in a bike fall a few years ago and never mended properly. This left me with less flexibility and sometimes discomfort or pain. Mostly I ignore it, but if it flares when swimming distance it can inhibit my stroke and certainly my enjoyment. I’ve learned to swim through it – not by gritting my teeth but by "purifying" my stroke.

In my case I feel pain as I extend my right arm. I overcome the pain and regain a good stroke within about 100 metres by not reaching with that arm but rather by letting the body roll, extend it forward, then hold the water as usual. I get the same degree of “reach” but without using or stressing the suspect muscles and rotator cuff. As a dividend, I feel improved balance when I do this so my "purified" stroke is reinforced.

As of Feb 1, I still have a weak and tender shoulder, but the one thing I’ve been able to do virtually pain-free is swim (still no whole-stroke butterfly though) and my swimming has improved steadily. I began getting a weekly deep-tissue massage three weeks ago – focused on back muscles that were compensating for my weak shoulder. Those massages, in combination with steadily increasing swimming – both volume and intensity – have led to dramatic improvement in my shoulder in recent weeks. In fact, it has seemed that the more aggressively I’ve swum, the better my shoulder feels.

It’s not exactly conventional treatment for a shoulder injury, but it does seem to point up the benefits of extra attention to stroking fluently. If you use an injured limb in a biomechanically sound way – and avoid movements that cause pain – it just might prove therapeutic.