I wrote this article for www.triathlonmagazine.ca

‘Shoulder prehabilitation’ means strengthening the shoulder’s resistance to injury – thus PRE-rehabilitation.  These shoulder strength exercises prepare the shoulder muscles that are the most vulnerable to injury from everyday swimming repetitive movement.  Strengthening these muscles improves your posture and body alignment.  For swimmers, and triathletes by extension, the most common injuries occur in shoulder rotators so these are the muscles we are focused on.

Matt Rose is a physiotherapist with Broadmead Orthopedic Physiotherapy in Victoria BC, and a former national team swimmer.   With experience at an elite level in swimming, Matt created a prehab program that targets and addresses the potential areas of weakness that will leave swimmers susceptible to repetitive strain injuries in the rotator cuff and bicep tendon.  Prehabilitation focuses on strengthening supporting muscles to facilitate proper biomechanics in movement and avoid needing rehabilitation.

In swimming constant rotation of the shoulder joint puts stress on the muscles of the rotator cuff.  The rotator cuff is comprised of four small muscles: the supraspinatus, infraspinatus, teres minor and subscapularis.

Focused work on these muscles is more effective for maintaining shoulder health than heavier weights for the larger prime mover muscles in the shoulders, as the limitation for most triathletes is not brute strength but rather correct motor patterns and flexibility.

[embedyt] http://www.youtube.com/watch?v=IuVLkPbABYI[/embedyt]

The proper movement pattern for the shoulder is to first control the shoulder blade, then control the shoulder, then put torque on the system.  If this pattern is broken, bad things can happen.

The only equipment required is either rubber tubing or resistance bands.  Attach one end of the tubing to a door or fixed object so that the band will be at approximately waist height.

“Y’s and “T’s”

Y’s and T’s are shoulder blade stabilizing exercises.   A stable shoulder blade is very important as it is the platform for the rotator cuff to work from.  “Think about doing a push-up on a bosu as opposed to on the flat ground- you are a lot stronger on the stable floor.”

Matt advises all athletes to focus on preventing the shoulders from shrugging up to the ears:
“Athletes should lock the shoulders gently down and back- about 90% down and 10% back.” This lock should happen with each repeat followed by an “unlock” of the blades to program the proper pattern.

Take an end of the rubber band in each hand and step backward until the band becomes tense, now assume the “Y” position from the YMCA dance.  Keeping your body upright and your abs tensed, gently add tension to the band by pulling the shoulders down and back and the hands backwards another 6 inches, then return to starting position.  For the next repetition, pull your arms out into a “T” at your sides and return to the starting position and repeat.  This exercise is meant to strengthen between the shoulder blades so focus on using these muscles rather than your arms to complete the exercises and ensure your shoulders stay down away from your ears during the exercise.  Start with 12 repetitions.

Rows

Begin the exercise locking the shoulder blades down and back.  The key is to not allow any movement in the shoulder blade when rowing with the arm.  While holding the tubing or pulley in one hand, you will first lock your shoulder blade. While maintaining the lock, pull the arm back until the elbows is bent to 90 degrees and return forward to the starting position, followed by unlocking the blade (relax between each rep).  The shoulder blade moves to position before the arm pulls back and remains locked when the arm returns forward.

Internal and external rotation

With each rep of internal and external rotation you will lock the shoulder blade (before) and unlock it (after) just as you did with the rows.    With the elbow locked in at your side and bent to 90 degrees, you will stand perpendicular to the anchor point with shoulders.  The motion is to lock the blade down and back, pull the arm the furthest from the anchor point away from the body for external rotation.  Pull the tubing directly away from your body keeping your elbow anchored to your waist.  The motion is like a gate opening and closing.    Continue the motion for one minute and work towards two minutes per side.   Use the opposite hand to the working arm to feel that the shoulder blade is remaining stable while rotating the shoulder.

Still standing perpendicular the anchor point, grasp the tubing in the hand closest to the anchor point.  Take one lateral step away from the anchor point to put resistance on the band.  With the elbow held close to the body, rotate the arm away from the anchor point towards the body then return to the starting point for internal rotation. Remember to lock and unlock the blade with each rep. Start with one minute, work towards two minutes per side of each direction.

Matt has this to offer on internal and external rotations:  “I would say to take about 3 seconds going each direction with the internal and external rotations, slow is better for control even if the arms move fast while you swim.  Also keep in a pain free range of motion.  If it hurts, make sure your shoulder blades are locked down, if it still hurts make it a smaller range of motion, and if it still hurts- stop.”

Push up Plus

There are a variety of names for the exercise but in essence you begin in plank position or the start of a pushup position.  Keeping elbows locked straight raise up as high as possible and lower down slowly in between your shoulder blades, all without bending the arms.  Moving the hand position around can make this exercise more or less challenging.  For instance, try staggering the arms forward and back or make them wider apart.  The most important cue is to keep the shoulders down away from the ears and the arms straight for this exercise.  Start with 20 repetitions.

Training the correct movement pattern is the key to prehab exercises.  Focusing most of the attention on the quality of the movement and less on the quantity or training load of the work is very important.

Matt noted that, “Most shoulder injuries occur after a long break or during a build in volume (steeper the build the more likely to injure).  So during the off season and during build ups in training programs- these exercises are key.”