swimmerSwimmers are some of my favorite patients.  They present their own set of unique challenges.  The repetition on the upper extremities is like no other, not to mention the breathing.  Swimmers will often times breathe in through their mouth, and out through their nose.  In many cases they will only breathe to one side and then hold their breath while their head is down instead of keeping a steady stream of air blowing out.  Finally they are usually in a prone or face down position which puts them in a state of extension or increased lordosis.lordosis1These are just a few of the things that swimmers face when trying to stay healthy and avoid things like shoulder and back injuries.

Even if my swimmers aren’t in pain, it’s good to stay ahead of any potential injuries and keep them pain-free and functional.  Breathing is one of the places I like to start with my swimmers.  I don’t necessarily mean their technique in the pool either.  It is important to keep the diaphragm in a good position.  The diaphragm diaphragm  is usually overlooked in these situations.  I like this picture of the diaphragm because it shows that the right side is higher than the left side (it sits on top of the liver on that right side).

We are asymmetrical by design and every time we breathe we can have muscles that work too hard, and others that don’t work hard enough, what I like to call a muscle imbalance. These muscle imbalances and asymmetries can start to put strain on tissue and lead to pain.  If the diaphragm is not in a good position then you won’t ever be able to correct these asymmetries and imbalances.  With every breath you might have back muscles, or neck muscles that are turning on, or trying to help you breath, when they shouldn’t be turning on.  Now imagine going through swim practice like this!  The amazing thing is that most people go through life with these imbalances, and they aren’t even a bad thing, until we get stuck in that position.

That’s one of the reasons why I like to look at the diaphragm.  It can influence rib cage position, which then impacts how the scapula sits on the ribs, which affects the positioning and movement of the shoulder.  Sometimes people think I’m crazy when I start talking about the importance of the diaphragm when they come in with a shoulder problem for example.  If you start to work the shoulder (glenohumeral joint) with exercise or manual therapy, or start to go after a scapula (shoulder blade) without looking at the diaphragm and rib position first, you won’t have a solid base to work from.  It’s like trying to build a house on a sandy beach hurricane-sandy-collapse-home  instead of building a house on a solid foundation.  You can usually see some pretty dramatic results once you start looking at the body as a whole,  get those ribs in a good position, which allows your scapula to be positioned correctly so that your shoulder can move the way it’s supposed to move.  I see this in the general population on a regular basis; the difference with a swimmer is that they move that shoulder much more than your average Joe, so it becomes imperative to have the proper position.