Wednesday, April 16, 2014

Healthiest Swimming technique for shoulder?



Swimming Technique and Injury
High Elbow vs. Low in Recovery Phase, What is Right?!




WHAT IS THE PROPER WAY TO REACH FORWARD IN THE WATER!?  HOW DO I PROTECT MY SHOULDER??  Recently, my focus has been on swimming technique and biomechanics of the shoulders and torso during the freestyle stroke.  It seems that many coaches, professionals, and colleagues have different viewpoints on how to perform the freestyle with not enough clarification to sway me one way or the other.  Do we have a high elbow, or do you throw the arm and keep the hand higher?  I need to figure out how to help my clients be safe, build strength the right way, and not exacerbate a problem and cause bigger issues down the road.  I also don’t want cause an overuse injury in the future. Working in rehab has made me scared about destroying my body now and regretting it later…

While working at the physical therapy clinic.... I have learned a lot about shoulders and their mechanics.  One thing being that the shoulder’s resting position is 30 degrees of abduction in the scapular plane.  Too much adduction and internal rotation as well as repetitive overhead motions can irritate the bicep tendon.  The Other problems in the shoulder, the Supraspinatus can become impinged under the AC joint.  Weakness in the shoulder along with overuse and injury can lead to other tendonitis, osteoarthritis, shoulder instability, etc.   Doesn’t this sound lovely?





I have been swimming in the pool and developed Bilateral Bicep Tendonitis!!  It leads to referral pain on the back of my arm, freestyle hurts, and I am “swimming” around trying to diagnose what about my form and training led to this problem.  Reaching behind me hurts, overhead action, we need to solve this. 

Problems I have with my stroke...  So I have been told my multiple people that as I finish my recovery and enter the water I cross my midline a lot.  Also, if my thumb was going into the water first I was creating a lot of internal rotation.  Torso rotation also has a lot to do with this.  If I was not rotating my body enough, my arm was traveled behind me causing the humerus to travel forward in the GH socket and create an impingement.  Before this, I had major trigger points in my shoulder and an injury to my rotator cuff muscles from a job where I had to twist open a valve to change a filter.  I believe the combination to all of these aspects, plus a lot of vigorous swimming and repetitive motion of the freestyle led to my shoulders giving out.   

So, in the mean time, I am putting together drills to go back to the basics and really slow down and teach myself form. One aspect of the stroke I am really picking apart is  how I perform the recovery phase, of the stroke.  Some people have told me to keep a high elbow while others will teach that throwing the arm and keeping the elbow lower than the hand is the way to go. 

High Elbow or low elbow? I have come across multiple key points that help build the defense of each technique.  Keeping a high elbow can help utilize more of the lats and upper back and take more stress off the deltoids and rotator cuff.  A straight arm though, generates more velocity and helps carry you through the stroke more.   This does put more stress on the shoulder though and puts more emphasis on the deltoids.  So, maybe both strokes aren’t considered right and wrong?  Maybe we just need to choose when to use them to out benefit almost like interval training, or changing where your butt is on your bike seat to use more hamstrings versus quads. 





I recently read a paper written by Theodore J. Becker Ph.D., R.P.T., A.T.e who titled his paper “The 'Coaches Guide to Bicipital Tendonitis”  His paper gave me an overview of how the shoulder functions during different aspects of swimming. 

Let’s look at the freestyle stroke and what happens to the muscles on your arm.  When your hand enters the water during the initial catch, your hands downward position (supination) followed by the immediate high elbow pull puts the bicep tendon in a vulnerable position. It presses almost out of the groove!  The bicep plays huge roles in the pull phase as it flexes the elbow, horizontally adducts the arm, and supinates the hand.  So…now I understand why I have bicep tendonitis. The bicep ligament is very closely related with the supraspinatus and Deltoid, which is probably why a deltoid and SS taping felt so good to my shoulder and I continue to find trigger points in them.    

So the conclusion!  Found and theorized on Triradar.com.  If you think about it, the straight arm method is going to give you more velocity and brings the momentum out of the pull phase into the recovery.  It is great over the short term, but uses more of the deltoid and rotator cuff and doesn't allow for more support from others.  The bent arm technique allows you to use your traps, lats, deltoid,  and moreover recruits more muscle groups to put less tension on the deltoid.  Sooooo......In the mean time, I am sleeping without a pillow, trying to keep my shoulders back and down, icing constantly, and am going to get better soon!  My therapist told me today, David...try not to analyze this so much.  you are looking for the answer so bad that you are giving yourself 20 things to think about when you go swim instead of trusting your instinct, listening to how your body wants to move, and just swimming!  I am going to try that next week and just go with the flow.  


  

Monday, February 17, 2014

NYU Treatment of Multisport and Endurance Athletes Course.

NYU School of Medicine Approach to Treating The Multisport and Endurance Athlete
Across Age, Gender, and Injury


I'm registered and ready to go to this course!  This is going to be a great time as I'm excited to learn more about how to help others and myself.

I think the best part of this lecture will be learning about the injuries that are associated with long endurance type events.  I believe that many people train and compete like they are invincible, and then when they sustain an injury they don't understand why it takes so long to overcome, or they ignore it which then worsens the problem.  There are many risks associated with multisport events and learning how to go about training for them properly as well as nourishing yourself, protecting yourself, and discussing different perspectives is important.  

I will include a blog post in the future about my time there and I cant wait to share the information with my clients and with you all!



Friday, February 14, 2014

Body Aches and Pains

Body Aches and Pains
Where are they coming from? 
How to help combat what Society has thrown at you and 
hoy my lectures from traveling to a couple companies can help!



Exercise and Stretching!  It's as simple as that.  The last couple of months I have traveled to different companies including Trident in New Milford, CT, Odyssey Logistics in Danbury CT, and soon Kimberly Clark in New Milford, CT to discuss how simple it can be to reduce chronic pain with stretching and exercise.  Also, people don't know what pain is or where it's coming from!  Or, they don't realize what type of pain it is and are too stubborn to deal with it.  Men are famous for this, as their mentality is "I'm tough, I can deal with it," and a week later they are incapacitated.  



When I traveled to these companies and spoke to the employees, I explained to them how sitting at a desk, constantly being on the phone or texting, or repetitive movements can cause these postural problems!  I think seeing these pictures and the lecture slides made them realize they know certain people who look like this!  Or, they might be susceptible to these problems with the certain type of work they perform at their company.  



Did you know that for every inch that your head moves forward its an extra TEN pounds of pressure on your neck, shoulders, back and spine?  That's a lot of force to be putting on the nerves in the back of your spine.  You will find that your upper back will stiffen, leading to less range of motion of your arms, your neck will be sore along with your arms and hands, and soon you will be an old lady or man that looks like a hunch back.  



Like I said before, people don't understand what pain is, and therefore don't know how to treat it.  I put this slide together to show people that a trigger point, or as people would call it a knot, in your neck can lead to pain traveling up and around your ear to the front of your head!  The "X" is where the knot is and the blue is where pain can travel.  Moral of the story, people think they are having a migrane and take a bunch of advil when in reality it is a knot in their neck from a postural problem, and until they correct the way they are holding themselves up it's not going to change.  I also had a slide of how back pain can really be caused by tightness in the front of the hip from sitting too long! Until you fix the problem in the front of the leg, your back pain isn't going to get any better even with ice and advil.




When you are hungry what do you do?  YOU EAT!  When you are thirsty what do you do?  YOU DRINK!  When your body hurts what do you do?  MOST people lay down, don't move, and take pills.  This is you body asking for help as it wants to move and to be stretched out!  Simple stretches like these can cure headaches, chest pain, etc.  Some people go to the ER thinking that they are having a heart attack and it's really a tight Pec muscle that is causing the pain.  Think you have Carpal Tunnel?  Scroll back up and see the referral pain patterns from the pec minor in the slide above



 

Here I am at Odyssey Logistics in Danbury CT showing employees how simple hip strengthening exercises can be and how low impact they are on your knees.  This is a simple cure for many ailments which can be easy and fun to do with a partner.


What was nice about this company is they gave their employees 2 different time slots to come to the lecture.  They could either come at 12 or at 1 depending on their work load.  I spoke with about 20 employees that day and even though that was a small fraction of the company, I hope word will travel and more will be informed about these topics. 




Wednesday, February 5, 2014

Swim Intervals and Techniques

Swim Interval Training and Techniques
Workouts in the pool to improve your aerobic endurance


Here it is!  Canterbury Pool!  My home turf.  I loved going there for highschool and Its nice to be here to train for my future events.  The pool was remodeled a couple of years ago and is quite a site.  At the shallow end it is 7' feet deep and 12' at the other.  Our swim team has been doing great this year and with aquatic director Sarah Bednar and coach John Jurkowski, my swimming has gone to a new level

I was so tired!  The first day, I didn't realize that swimming took so much energy out of you!  That was until I realized that swimming is all about form and finding your balance in the water.  Not until John started us on drills with arms straight out and leaning on your sternum and kicking from the hips did I understand this. Then, he would tell me to stop taking my head out of the water so much to breathe during freestyle and to try to keep one goggle under.  My stroke improved, but I began drinking a lot of pool water...not purposefully.  


Swim Practice 2/4/14
by John Jurkowski
1) Warm up 4 100's

2) 4 rounds of 2x25, 1x50, 2x25 
1st round with 10,20,10 rest
2nd round 15,25,15
3rd round 20, 30, 20
4th round 25, 35, 25

3) 4x25 Rest is how long it took you to do 25 yards
    3x50 Rest is how long it took you to do 50 yards
    2x75 Rest is how long it took you to do 75 yards
    1x100 Rest is how long it took you to do 100 yards
    2x75 "
    3x50 "

    4x25 "

We ALWAYS start in the pool with drills, so I believe working on those before you go into training is important.  Doing a couple drills of side swimming or "belly to the wall" is important.  You learn to lean on your armpit and not let your extended arm sink down.  Trying to keep it extended and up is key.  


By swimming on your side and twisting through the water you use less energy and will be able to go farther, faster!  It allows you to use your Lat muscles more, improvement in range of motion of the shoulder, and also allows you to use the upper arm to throw your momentum forward so your not just using your Lats to pull.  You want to twist from the point right above your belly button.  This torpedo motions allows you to travel faster through the water with less resistance. Look at the drill above in the picture and try it out before you start the intervals.  


This picture demonstrates how a forward head position and pushing down on your sternum allows your back legs to come up.  

Wahoo Speed and Cadence Sensor

Wahoo Speed and Cadence Sensor
Fitting it to my Specialized Roubaix



You know that feeling of getting a new toy and being so excited to set it up and try it out!? I can't explain to you how pumped I was to hook up my new sensor and be able to track speed, cadence, and distance with my new Wahoo Sensor.  I opened up the package, looked at the pieces, and then went to set it up.  IT DIDNT FIT!

Because my Specialized Roubaix has Chain Stays that have a big curvature inwards, any way I set this up the Cadence or the speed wouldn't work.  Either would be too far away and this led to me playing around with my friend Rick to get it to fit.  We tried moving it to the front of the chain stays and then to the back.  We tried flipping the speed sensor upside down but only the cadence worked.  It was a lot of playing around but Rick then had a great idea.  



 This is the cadence sensor that goes around the crank arms.  You have to take the pedal off and then fit the robber around the crank.  We found that it was too far away from the sensor, and as we tipped the sensor forward to get it closer to the crank, the speed sensor which is an "L" design located at the back of the unit, would hit the spokes on my tire!  This part of the unit is adjustable with an allen wrench and we found that it needed to be tightened in order for the speed sensor to start registering.



This was the solution!  TA DA!!!  We used two extra zip ties and instead of putting it around the crank we simply put it against it.  Not so much of an aerodynamic design, but it worked!  Also, the piece to the right that looks like it curves around and down the backside of the chain stay, that was the other problem piece. We ended up using a different magnet that did not come with the kit that was skinner and meant to be fitted on the flat spokes.



So now...the sensor works great!  I can't begin to explain how awesome it is to see my stats on my iphone while I am working out on my bike trainer at home.  My Heart rate, speed, distance, cadence is all listed and at the end of my work outs I get an Ave and a Max of all my stats.  This was a time trial I did for testing.  If I was outside the GPS would have worked as well.  The reason I bought this sensor was so I could use it with my iphone while on the road along with gps.  Just getting accustomed to the roads and routes around my house, It's nice to have a route planed out and directions just like GPS in your car.  

Time Trial Testing

Time Trials
Training using a Time Trial as a Base Measure for Fitness

Fabian Cancellara

It SEEMS like a good idea…let me hop onto my bike and pedal as fast as I can with as much power for 30 minutes…  After, you are pouring sweat and wondering how you will find the motivation to do it again in another 4 weeks. 

The theory behind this is to test your body’s ability to maintain a set speed for a set distance in a great amount of time. 

If it only was as easy as it sounds….

This can be the biggest challenge for an athlete because your head needs to be in the right space, you need to feel physically able to do your best, and in the end you want to show improvement. 

First 10-15 minutes
I spent some time on my trainer warming up and spending short intervals at my time trial pace.  With the help of my Sufferfest video, an online database of training videos that includes a time trial, I spent some time above a 90 cadence to get used to moving at that speed and then recovered to then work on form.  I practiced pulling up on the pedal as well as pushing. The instruction on my laptop screen told me to pretend I was scraping mud off the bottom of my feet. after 5 minutes of a light warm up at 4/10 intensity I was ready to go!

Ready…Set….GO!!!
I think the key is here to not let it all out on the road in your first minute, because after the first 10 minutes you will be left wondering when it will be over.  Eminem’s song Cinderella Man and Not Afraid really help me get pumped for the next couple of minutes.  The screen instructed a cadence of 90 with an effort of 7.5/10.  As I tried to match some of the top riders in the world like Fabian Cancellara, I realized their cadence was sitting up around 100+.   As the riders took corners, I backed off and took advantage of the little rest, then practiced accelerating out and back onto the straight away.  

Analyze!
In the beginning of my last season I had my Lactate Threshold tested at 154.  I was way above this the whole time trial and I could feel it…mentally and physically.  My new Wahoo speed and cadence sensor gave me my stats in terms of how far a biked, my average HR, speed, cadence, and highs and lows. 



I'd Love to see my HR go down next time.  Since my LT is 154, staying up in this range for a longer race will be impossible to maintain. 

So for training, I need to work around my LT in order to build up my aerobic endurance.  A great Interval workout I saw at http://www.training4cyclists.com/ was 3x(3+3) at your LT or VO2 max.  
This means, 3 sets of 3 min at your high intensity with 3 min of recovery.  Recovery periods can be played with, recovery intensity can be altered...and how much time at your intensity can be modified depending on where you are in your training program.  

How important is recovery!?  very important.  After swim practice my swim coach will always make us swim a slow 200 yards as it helps your body absorb the lactate, slowing the heart rate properly, and also during a race, you might be pedaling hard and half way through the course...you won't be able to just stop right?!  



Sunday, January 26, 2014

Speed work and Endurance Part 1

Speed work and Endurance Part 1
How speed work can help in therapeutic settings and in the gym
  
http://3.bp.blogspot.com/-dugGx1F-L9w/T-KvazLpboI/AAAAAAAAA0g/Ns1r4ntNK_Y/s1600/Speed_Work_Training_Kezar_Track_Marathon.jpg




I believe a very hard part of being an endurance athlete is learning how to train for high bouts of speed and intense work and then being able to recover but keep at a time trial speed.  For example, being on the bike and pedaling as HARD as you can, but after the 30 seconds is over, being able to continue at a very good steady state.  Training your body to excel at these high speeds is important if you plan on doing well in competition. 

Ok, so we have 2 types of muscle fibers, fast twitch and slow twitch.  No, these aren’t the muscles that make you twitch when you see your mother’s dance moves on a Saturday night, or really AGGRESSIVE PDA that you can’t get away from.  These muscle fibers help during long-term exercise and fast movements.  If we never practice in the gym how to recruit these fibers, then we will lose the ability to recruit them in competition or in common life situations. 

I work with someone who has Parkinson’s, and in order to prevent falls I have started some speed with him on an agility ladder. First, it’s different from anything he has ever done and not typical of therapy so he loves it.  Second, if he is on a curb on the side of the road and trips, he will be able to move his leg quickly out to the side to prevent the fall from practicing different directions on the ladder. 

NOW, FOR THE TRAINING!

1.)  Dry Land Training, Hurricane Training!

Using the Speed ladder for quick movements in multiple directions is great.  What I love about it is that it uses ankle mobility and prepares them for stress in multiple angles which is important for the run section of the triathlon.  Here is how I like to use the ladder. 

All performed 1 after the other with no rest, then 45 seconds of rest after the first complete set.
3 sets of 45 seconds on the ladder in multiple positions
3 sets of 12-15 Pull Ups
3 sets of 12-15 Kettle Bell squat overhead press

            This same technique can be used with sprinting.  Sprinting for 30 seconds up and down a track or sprinting in place with resistance using a large band are some other options. 

All performed 1 after the other with no rest, then 45 seconds of rest after the first complete set.
3 sets of sprinting for 30 seconds with resistance band in place
3 sets of 12-15 deadlifts
3 sets of 30 seconds of rotational movements for abdominals



My other favorite explosive movements are side jumps with a resisted band around the hips and the other end fixed to a solid point, since we don’t want any accidents.  In studies, vertical leap was tested in athletes who performed box jumps and forward movements versus athletes who mixed this together with lateral movements.  The results showed that lateral movements provided more progress in vertical leap rather than the group that exercised in one plane.