Prevention of Shoulder Injury for Masters Swimmers by Jim Miller (2013)



[introduction, by Scott Bay]

Hi, my name is Scott Bay.  I’m the Coaches chair for the United States Masters Swimming, and I have the privilege of introducing Dr. Jim Miller, who is our speaker today.  He is a world-renowned expert in the fields of Sports Medicine and Sports Science.  We are fortunate that he’s also past-president of United States Masters Swimming.  He also is the recipient of our highest honor, the Ransom J. Arthur Award.  He is also a Coach of the Year from 1986, if I recall correctly.  And I am just thrilled that he agreed to do this for us; this is one of selections in the presentations that I love the most.  It is critical for us, as Masters coaches, to make sure that we take care of our athletes.  So without further ado, Dr. Jim Miller.


[Miller begins]

Thank you; thank you, Scott.  Well, first of all, thank you for being here.  (Everybody can hear, I assume?  Yes?)  We’re going to entertain a pretty interesting topic, in that we know that by-far the shoulder has the highest rate-of-injury of any of the joints, any of the parts of the human body, in all the Aquatic sports.  Accounting for, in some studies, up to 85% of athletes at some point during their careers will have a problem with their shoulder that requires them to have a minimum of a week to two weeks off.  In many cases, as you all know, it’s much longer than that.


So, in the theme of things, the best medicine in the world is preventative medicine.  So when I was appointed into the Sports Medicine committee for FINA, I took this directive to FINA.  They embraced it, having seen all their data from the World Championships in prior Olympic games.  Created a series of exercises, that we’re going to go-over with you, as to why and so forth and what they are, to avoid shoulder related injuries.  And that’s what we’re talking about today.


So it’s a delicate balance.  The Aquatic sports put a huge stress upon the human shoulder, as you all know.  Aquatic athletes’ range of motion is just obscene.  I mean, look at this: this girl’s shoulder right now is out of the joint.  It’s out; it’s floating above the shoulder joint right now.  And this is a routine move they do all the time in Synchro.  Obviously, we have all these support systems that we develop over years of training, and the problem and one of the things that we’ll be talking about today is how to engage that.  How do you engage those support systems, so the shoulder is not exposed to injury?


Application to the Aquatic sports is pretty simple.  If there is a definition of overuse, we’ve got it.  25-kilometer swimmer, so forth.  The longest swim I oversee internationally, is an 82-kilometer swim.  Talk about overuse:  Open Water Swimming.  That’s why I said extreme overuse is the case in Open Water.  Synchronized Swimming, overuse again.  High Diving is a new thing, that we’ll talk about just briefly, just so that you’re kind of informed about what’s going on in the Aquatic sport world.  Overuse in, of course, Water Polo, with the throwing motions, huge use of overuse problems.


So the math is pretty compelling.  It’s one reason that technique is so important; it’s one reason that places like ASCA and the coaches are so important.  Rotations.  You have 10,000-30,000 meters per day.  Now, this is for your elite, more elite-level swimmers; I understand the Masters don’t go this distance.  However, these guys are taking 30-35 strokes per length; you’ve Masters swimmers who are taking 60.  So I can take these numbers, drop them down to numbers that you guys actually see in your pool going on, and come out with this number of rotations for 3,000 meters, long course.  Okay?


So although you’ll sit there and kind of go, yeah, these guys are going 10,000 meters, when you take the efficiency issue that many of the Masters face, which as you know when you see somebody new showing up to your practice you go, ugh, not this again—yeah, we all see it,  every day; you’ll get into this number of rotations pretty quickly.


35 rotations or more for 50 meters?  How many Master swimmers do you know who has 35 rotations per 50 meters?  Not many.  (You do?  You have one?  We have one.)  But, in general, your newbies, your more inexperienced ones, a lot of the triathletes with their square stroke, have huge rotations leading-up to the math.  And that’s your number of rotations per week.  Wow.  Wow, can’t get much more than that.


So, in the other Aquatic sports, we have problems with diving, lifting, boosting.  But one of the issues we have in Masters is who in Masters Swimming is teaching diving?  Who’s teaching diving?  Impacts activity.  I’ll tell you, at Spring Nationals this year, I’ve served as coach-on-deck for the sprint lane, and I had not a dry-stitch on me at the end of this thing.  These guys cannot dive; they cannot dive.  And how much impact is that having on their shoulders, low back and other things.  Okay?


One of the things that we’re doing within FINA right now is we’ve put out an RPE [rating of perceived exertion] to do studies on low back, knees and other things.  So there’s other things coming to you also besides this.  But, the impact, in relation in… I would encourage you to really work with diving with your athletes that are going to be doing it in competition.


Technique is critical, absolutely critical.  The best answer I have to technique, is you’re here.  You are the elite level coaches, you’re going to be the informed ones coming out of here.  Take what you learn, put it in the pool, have it work.  One of your issues is: all the technique and all the things that you’re going to be learning here, how effective is it going to be for that athlete that’s always 15-20 minutes late, always misses your warm-up, always misses your instructional phases or heading into the distance sets.  Watch out for that athlete, obviously.


So, the good technique obviously pays off.  If you look at Michael’s [Phelps] fly over the years—over his Olympic Games, over his World Championships—and take pictures of him serially, you can see as he drops down in the pool, as he gets more efficient, as this recovery gets closer to the water and propels him forward, the faster he goes.  So technique was one of the things that allowed Michael to do the things he did.  And he and his coach worked hot-and-heavy on that.


Muscle balance is important to keep out of trouble.  Here’s a friend of Olivera’s: Gary Hall, Jr.  Is this muscle balanced?  Not at all.  The tendency, of course, with athletes in the Aquatic sports is to have this forward lean.  It’s not because they’re lazy; it’s not because of that.  It’s because the muscles in the back are out of balance with the muscles in the front; the tendency is to pull the athlete forward.


Don’t worry, I’m not going to make you physicians out of this, but you do need to understand the pieces of what we’re talking about with the shoulder.  They’re the static stabilizers, which are the bones.  And normally these are normal pictures.  The hitch is: the bones in Masters may have some arthritis, they may have some overuse injury sorts of problems over the years, there may be some bone spurs.  So a Masters’ x-ray may not look quite as clean as this, or the anatomy may not look quite as clean as that.


You also have the tendons which are static stabilizers.  And I’m going to talk a little bit about the tendons so you understand how they work, too.  Whether you know these names or not, doesn’t really matter; but, this is a fixed, stabilizing set of bones and tendons.


Dynamic stabilizing set, there’s two major groups in the shoulder.  There are the larger groups, which you see externally; and then of course, there are the intrinsic, small ones: the muscles of the rotator cuff.  There are four of them that go together to form that cuff—and don’t worry, I won’t ask you those.  All these combine to do what we call a force couple, which means that when they fire the job of this rotator cuff and of these muscles is to take that bony head of the arm and center it.  That’s what it does.


This is an interesting athlete.  She’s actually a model in Germany and is obviously an excellent Open Water swimmer, winning this particular race.  When I showed her this picture, she had no idea these muscles were back there.  Never had shoulder problems.


There are genetic factors that contribute.  Some of you have athletes come into your practice who have had shoulder problems, who have had unstable shoulders.  Multi-axial instability and so forth tend to be genetic factors.  Technique, technique, technique.  Key.  People can create their instabilities.


Core failure?  Person comes in, great, big gut hanging out, kind of sway backed; do they have any core muscles?  No.  Part of your job as a coach is to teach that.  You’ve got to find that and I’ll help you do that.


And then a sudden increase in training program.  All right.  Now, let’s define the word sudden.  If you guys are Age Group coaches, it means you go from going 5,000 a day to suddenly going 10,000 a day.  Or you go on Christmas vacation, you take them up to 15,000 a day.  You don’t have to do that with Masters: they just go on a business trip.  And then they come back to you a week or two later, starting in the same lane, doing the same workout they did two weeks ago, but they haven’t done anything.  Except gain 10 pounds on a cruise.  And suddenly, there’s a sudden change in a training program.


You have to be very careful with the athlete who tries to come back into the same lane they’ve been training in, have been training in for a long period of time.  Step them down, have them drop back a little bit, get that technique back, then move them up.  Everybody including their physician will thank you.


And then, of course, there’s the issue of trauma—the falling down, those sorts of things.  So trauma does occur; happens in Open Water, happens in mass starts.  Now this is a way that they start in World Championships, as well as Olympic Games.  And for 5K, 10K, 25Ks is a dive start.  I could have shown a picture of an Open Water start with 3,000 people running off the same beach at the same time, and that’s trauma, too.  Landing, obviously.


This is something of interest—just to kind of bring you up on the world of Aquatic sports—there’s now a sixth aquatic sport in FINA, it’s called High Diving.  It’s [from] 27 meters for men and 18 meters for women.  Underneath we have a full ICU ambulance, we have a boat; we have divers underneath all equipped with cameras so they can identify body parts if they become dislodged.  So this is trauma.  So there are now six aquatic sports, not just five.


This is kind of an interesting picture.  If you notice, this athlete’s pretty high.  He actually shot this goal and won it.  Why is he so high?  If you notice, there’s an athlete under there.  Obviously, trauma.  You’ll have some of your athletes that are crossing between sports, too.  And then the micro-trauma we’ve already talked about.


Stretching.  Masters tend to get tight.  They sit at their computers all day, they sit down, they watch movies, they do things; but they don’t stretch, they don’t move, they don’t do stuff.  But, there’s a tendency that all stretches, including a lot of the old stretches, are all good and that’s just not true.  You have to ask a critical question whenever you’re instituting a stretching program: what are you stretching?  You want to stretch muscle; you do not want to stretch tendons, you do not want to stretch your stabilizers.


To show you an example (if you can see that), every single one of these stretches is bad—really bad.  Whenever I’m with the U.S. team I say, “Whatever you saw Michael Phelps do on the block, do not ever do any of it.  It’s all bad.  Works for Michael, only.”  Her shoulder’s out of place right now.  That’s her humeral head out of the joint; completely out.  She feels fine, there’s no pain; that’s how loose it is.  You can see she’s actually stretching some of her stabilizers.  Good muscle tone, all the definition’s good.  Stretching anterior parts of the rotator cuff; stretching posterior parts of the rotator cuff.  You can see actually the humeral head popping up to past her chin.  Big smile on her face; no pain.  It’s out of joint.


So, stretching you have to be careful.  What are you stretching?  Make sure the stretches you do are good ones.  There’s lots of resources on the USA Swimming website; some of the resources also link to the U.S. Masters’ website.  But you can look at those stretches and see what your athletes should and should not be doing.  A lot of the things you’re used to, I’m afraid, are things they should not be doing.


This is the project I was telling you about.  And the way it’s organized—and we’ll actually go through this and show you the exercises right now—is we’re going to start with core.  Now, core is basically from my shoulders down to my pelvis; that’s your core.  That is your power source.  That’s where you get the oomph in your stroke; that’s where you create the power.  It comes from core.  It doesn’t come from the shoulder, doesn’t come from anything else; it comes from core.


How you translate that to the arm is by way of this bone called scapula, or shoulder blade, that is the linking agent.  Okay?  Pretty important.  And then finally, this is what you’re familiar with, this is the shoulder itself, this is the thing that you see everybody having operations on.  That’s the final core.


So what we are going to do is we’re going to talk to you about core first, the part that allows you to translate the power from here to here, and then eventual we’ll talk about rotator cuff.  But you want to do your exercises, you want to teach your exercises, in that sequence.  Very important.  The tendency is that everybody leaps to their shoulder exercises and ignores these other parts.  If the shoulder can be as strong as it wants to be to be, but if the energy source, power source and the linking agent’s not there, it won’t work.


Now afraid you don’t have audio on this, but this is a shoulder video that you can find online.  You can google “FINA Shoulder Video”, and it pops right up.  You can go on the FINA website and find it also.


The first part of it is a description of a lot of the things we talked about.  It shows the anatomy of the shoulder, kind of draws in those tendons and so forth (which you’ll see in just a moment).  You can see how these shoulders, how these muscles are firing—very critical.  Look at the stabilities, look at the other things that are required; a lot of the things we just saw.  (So sorry we don’t have the audio portion of this.)  But we’ll go through these exercises one at a time so you’ll understand what you’re teaching your athletes.


So in looking at the shoulder itself, and we’ll look at how is the shoulder produced.  This is a frontal view of the shoulder.  This talks about the bone here called the humeral head; the shoulder blade, the scapula; talks about the other issues.  And the space itself is called the glenoid fossa.  Now the glenoid fossa is not one of the things that actually it sits in; it kind of is like a golf ball on a tee: it’s like it’s sitting on it.  These are the stabilizing ligaments and tendons that we talked about, that they’re showing you, and where they come from.


These are the four short muscles that go into forming the rotator cuff and where they come from.  And you’ll notice how long some of these are and it’s one of the reasons that they are set up for injury.  Just with the length of some of those tendons and how they have to course to make this cuff.  It shows the size of the glenoid fossa, as you can see.  Obviously, it’s not like a hip joint where the ball is actually in the joint.


One of the things about the shoulder which is pretty unique, as you saw [Ryan] Lochte and some of these others go through their activities, is this instability of the shoulder actually creates the range of motion of the shoulder.  That’s the reason you have such better range of motion of the shoulder than you do a hip or anything else that’s more encased.  So it does offer mechanical advantage in the water to have that inherent instability of the joint itself.


I’m going to emphasize the fact that the exercises we’re going to be teaching you are ones that to prevent problems, not ones that treat problems.



Core exercises

So we’re going to start with core, like we talked about.  We’ll go through four exercises in core—there’ll be four in each one.  I have my demonstrators up front, and they’ll be showing you also.


This is called a side plank raise, which you’ll see on the screen.  Then we’re actually going to pause for a moment and let the demonstrators actually show you this.  They’re going to be showing you this straight line, that she’s doing.  Very important.  If you can’t hold that because of strength or problems that you physically may have, you can actually go down on the hip and then just raise it up some to emphasize it.  This is the more difficult of the forms with the shoulder with the arm held up, and we’ll show you that in just a moment.  We’ll go with it that way.


All right, so they’re going to show you the side-plank.  First the more basic, which Terry Sue is showing you right here.  And Katherine will show you the more advanced, with the arm held up in the air.  Okay?  Very important, those differences.  Obviously start with the basic.


If you find an athlete that has more strength on one side than on the other side, obviously you want to get the side symmetrically strong.  This is not like a pitcher in a major league game, this is not like the tennis player; we have a symmetrical sport here, so having that symmetry is critical.


The second of the core exercises is called dead bug.  Which they’ll show you.  Where they’re lying down.  And there’s two different formats of that.  One is the basic, which Terry Sue will show you, with her hands behind her, and then she’s just going to do a very slow type flutter kick.  And then Katherine will show you the more advanced version of that, where she’s actually alternating and again firing more of her core by engaging the upper part of her body also.  That’s core exercise number two.  The advanced version was what Katherine just showed you.


A slide, side-plank raise is, one where the core is engaged at all times.  Go ahead.  And that’s where she’s actually raising her hips up.  And then if you want to make it more advanced, the arm up in the air puts a little bit more force to it.


[audience member]:  Does the foot placement actually affect it?


[Miller]:  Absolutely, because you want that alignment.  And we’ll talk more.


[member]:  No, I mean, just, that both of their feet are different; I mean, one’s got the stack and one doesn’t.


[Miller]:  You can do it either way.  This adds stability to you, okay.  Doesn’t affect the core.  Now, does she have her feet widely spread?   No.


[audience member]:  The other provides more balance.


[Miller]:  And that shows the motion itself.


Number three is a chair pelvic tilt, which we’ll show you in just a moment.  I’ll show you those pictures.  This is where one of them will use a ball, one will use a chair.  And they’re basically going to do some short sit-ups, where they’ll take their hands, put them together.  Go to one side, then come back; go to the middle, then come back; then go to the other side, then come back.  Shoulders just come off the surface; there’s no reason to do a full sit up, per se.


[audience member]:  What does this exercise do?


[Miller]:  It’s a pelvic tilt exercise.  Helps engage the lower part of the pelvis, part of the core process.  Links in the pelvis into this whole process.


Any questions about core exercises?  Those are your four.




[audience member]:  How many times and for how long for each?


[Miller]:  To begin with?  Not many.  In other words, if you can do 10 of these, holding form.  And holding form is critical.  It’s one reason I’m going to refer to that FINA video, which this wouldn’t hold on to, it’s all there.  But from is critical and you have to do it correctly.  So if you can do 8 correctly, fine.  It’s better than doing 16 with 8 of them being done incorrectly.


What you want to be doing, is you want to be building them up so that you’re doing like 20, in good form.  But the key here is you want to be doing these things routinely.  It’s not just Saturday morning at 8:32.  It’s routinely you have to be doing this stuff.




[audience member]:  Yeah, just two questions.  First, what are some of the common form errors you see?  And one of the other things that happens—and I’m going to speak for our entire gender for just a moment—is guys who normally get proficient in something, we tend to like rush through it real quick.  So is there a tempo, or is it better one way than the other: to do it slowly, quickly?


[Miller]:  The big thing, I think the key word is throwing.  You don’t want to throw the body into position.  So, you’ll notice that what she’s doing is she’s not actually, she’s not throwing herself up to the side.  Okay?  How often do you see that in the gym?  All the time.  I mean, that’s just momentum, that’s not building core at all.  Plus it’s not teaching you a link.  So, very important question.


Now, can they control it?  Yes.  Speed, does it matter?  For this purpose it actually doesn’t.  We’re not talking about creating a fast-twitch versus slow-twitch.  Now when we get to the rotator cuff itself, that changes a little bit—and I’ll address that.




[audience member]:  Yeah, we’re routinely asked, is this something you build up to almost on a daily basis?


[Miller]:  I would say that if you’re doing your strength training—and you should be doing that three days a week, okay, as an off-set to improving the strokes in the pool and the benefits to the pool itself—then this would be part of that.  Now I have some people who have limited time—I would be probably one of those—and I have them doing lifting every day: one day they do upper body, next day they do the lower body.  And they can do that in about 15-20 minutes, and then they incorporate different ones of these on different days.  But you have to work it in to what’s your schedule.  Before practice, after practice does not matter.




[audience member]:  I’m sorry, but ideally you want to get at least three times a week?


[Miller]:  Yes.  Absolutely.  But, to answer this question over here, let’s say that all you can do is six of them: that’s okay, do them four days a week.  Build it up more quickly, keep that form, do it more often; but critical: form, form, form.




[audience member]:  Just something real quick.  He had asked about more problems.  One thing I’ve seen is people that have a severe upper cross syndrome is they can’t put all that weight on their shoulder without the shoulder collapsing.  So if they can’t keep the scapula stabilized, I’ll have them do it at an elevated angle so they’re not supporting so much body weight.  I find that that works pretty well.


[Miller]:  Okay, his point, is the issue is, could you decrease the amount of force that is necessary to do the exercises by having the exercise being done slightly at an elevation with the upper body, so that gravity is actually helping some of these motions as opposed to opposing it.  The answer is absolutely.  So an incline will help that some.  Have to make sure your incline’s stable, though.  A lot of sit-up planks would not necessarily be stable for what we just showed.


[audience member]:  On the video does it show for each exercise how long?


[Miller]:  Yes.  The video shows, for each exercise, how long and so forth.



Link exercises

Next piece, very important, is the link; that’s the shoulder blade or scapula.  If you don’t have the link, you can’t produce the stroke.


So scapula exercise number one is called a scapular push-up.  And what a scapular push up is, is a push-up, not like you’re thinking of—of this old fashioned kind of I’m going to put my chest on the floor—but what she’s going to be doing is squeezing the shoulder blades together so you can see the straps of this bathing suit coming together into one line.  So she’s actually moving.


Now the scapula is a very different joint from anything else in the human body; it’s a gliding joint.  So this, this bone, the shoulder blade, actually glides over the rib cage—that’s how it works.  So it’s a gliding joint.  So what she’s doing here, is she’s gliding those scapula together and squeezing them together, developing these muscles here, which will help this fire.  If the scapula weakens, then the athlete will naturally go to the shoulder itself to produce their stroke and then you’re going to get in trouble.


So I’m going to show you the first of the scapular exercises called the scapular push up.  So you can see where she’s squeezing these together.  So, if I put my fingers between her shoulder blades (relax it), you can see that hyper-mobility as she brings those in and squeezes that out.  Okay?  Got it?  And squeezes.


Now, Terry Sue is a pretty interesting athlete. Try to do the same thing.  Can’t squeeze nearly as hard.  Terry Sue is in the top-3 in the world in 200 fly and in 1,500, and she doesn’t have scapular stabilization nearly as much as what you saw in Katherine.  So it’s something we’re working on with her—she’s a project in development.  But we really need to get that in her, and you can see the difference between two athletes.  Although, speed wise, don’t challenge her to anything: she’ll kick your butt. So.  That’s something we have to work with her, but Katherine shows it just incredibly.


Second one, it’s called hitchhiker.  And you should have a nice mat here.  The best we could do here at the Marriott was to have nice towels.  But we gave them two nice towels so, that they’re not completely….


So the arms are out to the side, thumbs are up, they just literally raise them straight up.  Now, watch your athletes: don’t let them bring them forward and raise them, don’t let them bring them backward and raise them.  You want them to go straight up, that way you’re engaging scapula as opposed to muscles in lower back and other parts.  You don’t want them firing rotator cuff to produce this exercise.


Now, in this one—to answer a question that this lady asked earlier—how long do you hold it?  And you’d like to do it so that you can hold it 10-15 seconds and then let it down.  You have to remember our sport, remember those rotations and the numbers?  Our sport is very demanding as far as the numbers of rotations and how long the training sessions go.  We’re trying to reduce the fatigability of these strokes; trying to create that situation so that this muscle can actually sustain the stroke.


Now, none of us hold our hands up in the air for 15 seconds waiting for our arm to go forward, so it’s not like that.  But you want to be able to hold this in good position.  Remember straight out from the body; not forward, not backward.




[audience member]:  On the scapular push-up, you really should do it horizontally, not vertically?


[Miller]:  Yes.  Well, she did it [standing] so you could see her back.  She was just doing that way so you could see it.  Thank you for that clarification.  So his question was do you actually do it in a push up position.  Yes, not in a sitting position.


This answers your questions about repetitions: about 20 repetitions, 3-6 sets.  Remember you’re trying to sustain a sport that has thousands and thousands of rotations per week.


Scapula exercise number three is called an isolated shrug.  Now we don’t have the weight bench here, but we’re going to show this on a chair.  And basically what she’s going to do is, she’s going to take this weight in her hand—now this is something we’re working on with her right now, is we’re trying to build the scapula.  And she’s actually going to just shrug this backward.  See this thing glide?  She’s going to glide my hand back.


Now, resist the temptation of yanking this up, we can all do that.  This is a scapular exercise, okay?  Katherine, want to try the same thing?


[audience member]:  How heavy should the weight be?


[Miller]:  Form; form is the critical part, okay.  See the rotation as that shoulder blade glides over the torso.


So the question is: how heavy should the weight be?  It depends upon technique, depends upon your form.  Form, form, form: critical part.  So if you start with 5 pounds, great.  If you go to 10, fine.  I had a full shoulder reconstruction last year—not related to Swimming—and I’m up to 60 right now.  Got it?  That’s scapular exercise number three.


Scapular exercise number four is called the swimmer.  You can do this on the ball, you can do this on a chair.  (Each one of you is going to show that a little differently.  Yep, you can pretend.)  You can actually grab some tennis balls and just do this, too.  And what they’re going to be doing is: they’re starting out at a neutral position with arms just parallel to the surface, to the floor.  And then they’re going to bring the ball behind them, and then they’re going to bring it back to their starting position, then they’re going to bring it between their legs, together, and then in starting position.


Now, without telling them this, both of them went into absolutely perfect body positioning stabilizing their core.  So, right now, everything is all lined up on both of them—really well done.  That’s where they want to go.  They both went to there quite nicely.


So, four positions.  Starting out arms here, they raise it behind them, they raise it back up, they go back to the middle, raise it back up.  Not throwing it—anybody can throw their arms back there—but controlling it.  Most of you in your gyms will have weighted balls; you can hold cans of soup.  I mean, whatever you want to hold is fine, to get those muscles to fire in sequence.  They do need some resistance to actually cause that to occur.


All right, those are the four scapular exercises.  Any questions about any of those four?




[audience member]:  That last one, when you bring it back, it said please try little raises.  When you’re back here.


[Miller]:  You can; yeah.  Her point is: one of the more advanced forms is once you get back there, you’ll go ahead, fire that shoulder blade.  And she’s not firing this from her shoulder.  The problem with this you want to make sure that you don’t throw it again.  Same thing.


[member]:  That might be a little… you may want to add that once you get the correct position and form.


[Miller]:  Right.  Right.  And that’s in your video, too.


Any other questions about scapula?


[audience member]:  What is this one called?


[Miller]:  It’s called the swimmer.


A lot of people, when they go into the gym, will talk about rotator cuffs, they may talk to you about core, they may teach you all those things; it is unusual that somebody will teach you how to link them.  This is critical.  You can have a six-pack of abs on you, you can have shoulders out to here, but if you can’t translate the power source to the power production, it’s all lost.  This is the key that links those.  You have to have this.


You yourself will know that when you’re swimming distances, you’ll start feeling yourself weaken.  Many times what’s happened is your shoulder blade has disengaged.  And therefore, you can’t take this rotation as you go through the water and translate it into power.




[audience member]:  Remember when you said she had a smile on her face, she doesn’t know.


[Miller]:  She doesn’t know her shoulder is out of place.


[member]:  Was it so stretched out so it doesn’t hurt her anymore?


[Miller]:  Right.


[member]:  So, she thinks she has good flexibility?


[Miller]:  Right.  We’re working on decreasing her flexibility.  She’s an internationally-ranked breaststroker and distance freestyler, and I also happened to be married to her; so she’s under a very disciplined program to decrease her flexibility.  But she goes into those positions just like, sure I can do this.  It’s amazing.


[member]:  Why doesn’t it hurt?


[Miller]:  It’s so stretched out there’s no pain.  (She’s used to it.)  I mean, she grew up in the world, (stand up for me, don’t worry, I don’t do it to you) where people took these and they… remember all this stuff?  All that jazz?  Woo!


In fact, scary.  You see that happen now.  I was on the pool deck working Barcelona World Championships.  I saw one of the USA coaches doing that, and I went, “Excuse me.  I know I’m not the team physician here for the United States; I do represent FINA, stop that.”  And he did.  And then he asked the other guys, who is that?  Who just told me that?


[member]:  It’s just confusing because she’s world-class, she’s going really fast, it doesn’t hurt her.


[Miller]:  Well, the question is: applied range of motion.  Is there any stroke that you know of where it’s important on the recovery for your right arm to go over the left side of your body?  No.  In fact, that destabilizes you.  And as we make her more stable, what’s going to happen to her?  She’s going to get faster.


[member]:  She won’t have the ability to cross over?


[Miller]:  We don’t want it.  We’re trying to stabilize the shoulder not destabilize it.


[member]:  But it feels good to be flexible.


[Miller]:  It feels good to be flexible.  And you have to teach some stretches… once again, I’d go on the website, so the question is… it feels good to be stretchy, it does.  But what are you stretching?  Remember that slide: what are you stretching?


So there’s exercises you can do.  One of them you’ll see on the websites is where you’ll actually stand next to a door jamb, put your arm against the door jamb and just step forward.  Now I’m stretching the pectoralis groups; I’m not stretching rotator cuff.  So stretching muscle is the key; you don’t want to stretch tendon.  You don’t want to destabilize the athlete.



Rotar cuff exercises

All right, rotator cuff.  These are the little guys.  These are the ones that tend to get tired.  These are the ones that allow you to apply the force in the core and all the pieces we talked about to the water.  Because of their size, they tend to be overwhelmed by the mass.  And therefore, they tend to fatigue first.  And this is where standing on the pool deck as swim coaches, you have to understand there are several strokes involved in butterfly.  There’s butterfly and there’s butter-struggle; when they convert one to the other, stop doing it—that’s crazy stuff.


Ball on the wall is a simple exercise.  It doesn’t matter the type of ball.  As your athlete gets better and better, you can actually put some weight to the ball so that they’re actually having to apply more force.  But they go up and they go down.  The key thing is they’re standing perpendicular to the wall.  Don’t let them slump into the wall or stretch behind; it’s got to be straight on.  They can go up and down, they can go side to side.  They just roll it on the wall.


[audience member]:  This is rotator cuff?


[Miller]:  This is rotator cuff; it teaches rotator cuff sequencing of firing in different positions.  Easy to do.  Again, as the athlete gets more progressed, if they want a weighted ball.  So Terry Sue is holding a five-pound, weighted ball, right now—that she’s doing.  And you know one of her keys is she’s very strong in core, she’s very strong in her rotator cuff; we’ve got to work on scapula.  Because she has no trouble with five pounds at all.




[audience member]:  You only want this, like you said, perpendicular; you’re not going forward, only sideways?


[Miller]:  Nope.  Just sideways.


[member]:  How far sideways?


[Miller]:  Uh, to where the wall is.  I mean, you don’t want to go forward, you don’t want to go backwards.  You want to be side on.


Now, the gentleman in the back asked an interesting question: could you do these in other positions?  And the answer is, could you?  Yes.  Do you get maximum benefit from it as much as you do in this position?  No.


We want four exercises for each.  If I can get the Age Group coaches in this hotel today to have each one of their 9 year-olds doing 1 of these, each one of their 10 year-olds doing 2 of these, each one of their 11 year-olds doing 3 of each one of these; get it up to four.  You do all of these, it’ll take you about five minutes or so.  The more innuendos, the more variances, the more things that I add to it or change to it; the less likely I am to get a reproducible product, I’m afraid.  So I want to keep this simple.


There’s lots more exercises out there.  When I developed this… remember, this was released on the opening day of the Olympic Games to 208 federations.  So, I want it so where they can do it in Mobile, Alabama or they can do it in Kenya.  With equipment, not with equipment.  With basic stuff.  We don’t want to make this difficult for folks to do.



[audience member]:  Is there an age too young to be doing this then?


[Miller]:  No.  Question was, is there an age this is too young to do, and the answer is no.


However, let me answer that a little bit differently: Is there a mental age to do this correctly? Yes.  You have to have the maturity to pay attention to technique.  So if you’re lying there with a five pound weight, doing hitchhiker, just throwing your arms up in the air; then, you’re actually working against the process.  Which is one of the problems with some of the members of the U.S. National Team is they don’t have this age to go with these yet.  But, technique is just key.


And it’s one reason why, when you have the younger coaches with the younger kids—older kids also—you never want to say do your shoulder exercises and walk off the deck.  You’ve got to be standing right there.  Because they’ll mess it up every time.  But, great question.


Second of the rotator cuff is something that we actually learned from the water polo world; it’s called shake it up.  Everybody, of course, shows up with their water bottle in place.  And what you want to do is you want to be straight on and she’s just going to shake.  Okay?  You can put more water, less water in there; you can do all those different things to change the weight in there.  This is not a heavy weighted exercise.  But you just want to rock it.  Okay?  And the reason for this being so important is this teaches the rotator cuff to stabilize the humeral head quickly.  It teaches that immediate quick firing.


I was standing with one of the other physicians from the U.S. National Team in Manchester, England.  We, for some reason—I’m not really sure why we did this—we went to a Water Polo training session.  And they put this up and we both stared at each other and went whoa, this is awesome.  Water bottle, some water, and you’ve got yourself an exercise.  Easy.


But, very easy to do, but teaches this thing to fire quickly.  And it’s not slow firing, this is fast.  It’s amazing after about 90 seconds, you’re going to feel like your arm’s falling off.  This is harder than it looks.


Third exercise: internal and external rotation.  Couple things that we’re going to be doing….  Now, the reason for the towel is to keep engendered in her that she needs to keep this elbow locked to her side.  So she’s going to be doing an inward rotation, right now, but she keeps that elbow in.  If I want to make it a little harder, I just step over here.  So, pretty easy to change the amount of resistance you have.  She’s then going to actually turn, and she’s going to go the other way.  She wants both rotations.


You’re going to find in all of your athletes that they’re not symmetrical.  If they have a weak side, you have a symmetrical sport here, so if their left arm’s weaker or the right arm is weaker, spend your time on the weak side.  Don’t build-up the rotations just on the strong side.  So don’t take somebody and have them well their right arm’s stronger, so we’re going to do 8 rotations, the left arm’s weaker so we’ll just do 4.  No.  You keep the rotations at the low number for the weak side and the strong side.


Same thing.  All right, then the other side.  Good.  Okay.


Questions?  That’s the next of the rotator cuff exercises, number three.


Number four is drop and catch.  This is something that Aquatic athletes are awful at.  Hand-eye coordination, what’s that?  So basically what they’re going to do is she’s going to be firing, and again this teaches rotator cuff to fire quickly.


It teaches the speed of firing rotator cuff.  Once again.  Same exercise; they’re both doing it a little bit differently, but they’re both firing that cuff quickly.


Any questions about rotator cuff exercises?




[audience member]:  Since Swimming is an internally rotated sport mostly, is it better to focus on external rotation exercises to offset that?


[Miller]:  I think it depends on the balance of your athlete; it depends on how off-balance your athlete is.  If you look at it, normally what you’re going to see is that they’re off because they’re weak left-to-right or right-to-left, and they’re compensating.


So your athlete that frequently has one arm that’s too far out, the other one’s crossing over, is that a balance issue in the water?  Which Matt Kredich talked about balance in the water.  Or is it an issue having to do with strength, left-side to right-side?  Can be either.  But good question.


Other questions?  I’d like to thank ASCA for having us.  Hopefully you have found this out to be a meaningful exercise for you.  I would encourage you to go to the video site on the FINA website.  Or if you want to, just google “FINA Shoulder Exercises” and it pops right up and fires.


I know FINA wanted to charge for all of this, so people would have to pay to get on to it; and I said I wouldn’t develop it if they did.  So, it’s free to all of you and that’s the way it should be.  As will knee be, as will low back be—they fully bought it.  Now that we have about 50,000 viewers, they are fully engaged; they get it now.


Other questions?  Very good.  I appreciate your attention.  Thank you very much.



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