Cracking Concussions: Part 2

Concussions really do make a lasting impact (pun totally intended) on an athlete’s long term function. In case you missed last week’s post about my own experience with concussion, check it out here.

In the event that you already caught Part 1 or just want to learn more about the impact of concussion, check out this blog honoring one of my first posts from this blog’s birthday, just in time (early this time!) for #throwbackthursday. Let’s face it, if I don’t post it today on Wednesday, I’m going to forget to post it. What are you doing to raise your or others’ awareness of concussion in your sport or your child’s sport?

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Concussion-Cartoon Photo credit: http://iphysioperth.com.au/news/sports-physiotherapy-for-common-athletics-injuries/

If you’re just picking up this post, you may have missed the story from Part 1 about my recent patient (Patient 1) who presented with a concussion. I discussed how without my recognition of his symptoms, he may have been misdiagnosed and/or mismanaged.

Mirror this case with another case of a high school athlete (Patient 2) I was treating at the exact same time of Patient 1. Patient 2 sustained a head injury when falling backward onto her head during a home plate collision during a softball game. Her father, a pediatric physician assistant, was on the scene and immediately recognized signs of a concussion. She was monitored and taken to a local emergency department. She followed up within a day or so with a pediatric primary care sports medicine physician, who recommended cognitive rest, a modified school schedule and program, and prompt referral to physical…

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Help! My kid is in pain! How do I talk about it with him or her? (Part 2)

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It is not fun for anyone when kids, ‘tweens, or teens have pain. In an age group whose sole responsibility is learning, play, and exploration, pain can really get in the way of these things sometimes.

My favorite line is “My kid (or my friend’s) ’tween/teen hurts! What does this mean and what do we do about it?

In case you missed Part 1 of this blog series, I outlined what it means and why kids have pain. Since you’re probably proactive like me (otherwise, why would you be reading this?), let’s move on to “what to do about it.”

First and foremost-it is essential to give kids the opportunity to describe pain in based on their established communication skills. As mentioned in Part 1, many kids simply agree with what adults tell them to say about pain, while others learn metaphors of describing pain that don’t agree with their age or experience level. Example: the 11 year old who states her knee pain is “bone on bone” feeling. She’s too young to be using that metaphor appropriately. Most confusingly–some kids are too young to understand metaphors or communicate about their pain at all.

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Keep it age-appropriate:

  • Very young kids (ages 0-3): Pay attention to body language, behavior, play activity, and body mechanics. It is less likely that kids in this age group will misinterpret pain or use it as “manipulation” to get something they want. They also will be less likely to discuss it in any detail with an adult. Use the FLACC pain scale to quantify your observations.

    this scale is commonly used in babies and toddlers who cannot communicate their feelings. It is also used in other older patients who may have conditions that challenge their ability to communicate with caregivers.

    This scale is commonly used in babies and toddlers who cannot communicate their feelings. It is also used in other older patients who may have conditions that challenge their ability to communicate with caregivers.

  • Preschool (3-5): if they are old enough to draw, have them draw how they feel. Use toys, dolls, or stuffed animals to have the child act out their feelings. Use the FLACC or FACES pain scale depending on their ability to communicate their feelings.

    This scale is appropriate for children who can communicate using pictures, usually up to about age 10.

    This scale is appropriate for children who can communicate using pictures, usually up to about age 10.

  • Elementary school age (6-10): Continue to use drawing and acting as needed. You can start to give suggestions of metaphors to describe the pain. Example: have the child stretch a non-painful body part & feel the sensation of “muscle stretch.” Ask them if the pain feels like that (stretch, pull sensation). Most children at this age know of bruises and cuts (dull, sharp), so you can ask them if it feels like that. Older elementary school kids have a better understanding of muscle soreness, so you can ask if the pain is reminiscent of how they feel after a hard day in PE when their legs may be tired (soreness, throbbing). It’s still important to let them use their own words. The FACES scale is most appropriate for this age group, even up to age 10.
  • Middle school (11-14): Believe it or not, ‘tweens and teens in this age group sometimes have the hardest time describing their pain. They are transitioning from “kid role” into more “teen & adult” roles, which often leads to confusion they don’t even know they’re experiencing. They are balancing the desire to please adults with the desire to gain independence, test limits and rules with adults. Anxiety normally increases with puberty, middle school social pressures, and a rapid developing brain and emotional regulation system. Plus kids are often rapidly growing while participating seriously in one or more sports. It’s a perfect storm—and all of these things often lead to increased pain, injuries, and problems in this age group. Be very gentle when communicating with ‘tweens and teens. The numeric pain rating scale is appropriate but it’s important to understand that kids in this age group may report pain differently depending on where they are emotionally, cognitively, hormonally, and socially.
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  • High school & College (14-22): You thought young kids and middle school were challenging to understand pain? Welcome to adolescence and early adulthood! While teens and young twentysomethings are much more capable of complex thought processes and may have more experience with pain, they still may not be very adept at processing on how to communicate their symptoms with someone else. We also strike a dichotomy where many adolescents continue to aim to please adults, while others want nothing to do with adults. You know that teen—the one who thinks they know way more than you because they took high school anatomy and are chemistry whizzes. Or you have the teen (usually girl) who is unable or afraid to appear knowledgeable about her body. See my blog on this very subject here. She’s in 7 AP classes and aced the SAT, but has spent so much time becoming book smart that she has developed zero body awareness. She literally cannot tell you what is wrong with her, just that “it hurts, and I don’t know why.” You can talk calculus with her with ease, but getting info from her about her body is like pulling teeth. The numeric pain rating scale is appropriate for this age group, but bear in mind you’ll also have the teen/young adult who swears the pain is a 10/10 while maintaining a smile and seeming relatively at ease. See what I mean about not being able to communicate or understand pain?
  • When in doubt, have them use an emoji, since this is becoming the new language of kids, 'tweens, and teens!

    When all else fails, have your child, ‘tween, or teen communicate with emojis since this is probably their new favorite language.

Keep your game face on

Do not—-I repeat—-do NOT project your own fear and feelings about your child’s or your friend’s child’s pain onto him or her. This may be the hardest part, because I know this is not easy on you, either. Keep calm, maintain your game face, be objective and matter of fact, and help him or her exercise his or her own independence. This doesn’t mean you should avoid showing compassion or caring. Let him or her know that you’re concerned and will do whatever it takes to help him or her through it. This also doesn’t mean it’s not ok to be worried. This is normal and natural for you! Worry and cry about it in the comfort of your own private space.

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Leave the doctoring to the doctors

Stop it with consulting Dr. Google or posting on facebook about it already. This only adds to overdramatizing something that may or may not be dramatic. Consult a medical professional!

Emergencies are emergencies and cannot wait

If it’s clearly deformed, the skin is open and bleeding/oozing, the child or teen cannot put weight on the body part, it appears infected, or your inner voice says “something just doesn’t seem right”-please consult urgent or emergency care! See more on this in Part 3 (coming soon!).

Sometimes there is just not a straightforward diagnosis

If it has been ongoing for a long time, the child or teen has had every test in the book, and there’s still no medical answer, consider the role of your child’s perception of the situation along with his or her emotional processing. It is exhausting and confusing for him or her to go through the rigmarole of myriad tests and physician visits. Cut your losses and consider consulting a functional/integrative medicine practitioner, pediatric pain psychologist, or physical therapist who specializes in chronic pain in kids and teens. Chances are, your child or teen is so burnt out on medical visits that he or she has now integrated a “sick” personality: seemingly more depressed, detached, disinterested in normal age activities, less successful at school and sports. He or she subconsciously realizes the attention they get from being “sick” or “broken” and this becomes part of who they are. Trust me on this one!

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Keep it kid and teen specific, no matter what age they are

Remember that kids, ‘tweens, teens and young adults process pain very differently than you do, as do their developing bodies. Not all adult treatments that may work for you are appropriate for them, even when you swear by them. Let a medical professional, particularly a physical therapist who specializes in pediatric and adolescent injuries, pain, and psychology, make the decision for you on who or what to consult to help your child. Just because Johnny is 18 does not mean he is ready for an adult practitioner. Honor and consider that as you navigate his care.

Let someone else play quarterback

Let a medical professional skilled in dealing with acute pain and ongoing/chronic issues sort through this one and manage all the specialists and/or therapists you may need to see. It’s hard enough to be a rock star parent and it can really wear on you to try and be the manager of your child’s or teen’s health. Let the professionals play “quarterback” to manage the child or teen’s case. Most importantly and often not discussed-consider speaking with a family therapist or life coach to help you cope. It is completely natural, normal, and expected for it to hurt or stress you when you have to put on your smile/game face when your child or teen is suffering. Don’t be a hero—get help for yourself too. There is no shame in doing so and it’ll really pay off in the long run!

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Have resources nearby to help them understand and cope with their bodies

Stay tuned for a future post on helpful books and websites for all youth injuries, conditions, and pains. See Part 1 for examples of 2 books that are appropriate for parents of kids of all ages and middle school age and up. Some other helpful titles are Look Inside Your Body (Louie Stowell/Usborne books) , Magic School Bus: Inside Your Body (Joanna Cole), Understanding Myself (Mary C Lamia, Ph.D.), Sammy’s Physical Therapy Adventure (Michael Fink, PT, DPT), and the Be the Boss of Your Body Series (Be the Boss of Your Pain, Be the Boss of Your Stress, Be Fit, Be Strong Be You (Rebecca Kajander CPNP, MPH and Timothy Culbert, MD)

be fit be strong

Now that you know exactly how to communicate with your child or teen about his or her pain, you’re ready to take the steps to get him or her the right care depending on what is the problem. See Part 3 to understand the problem and determine where best to seek the appropriate care.

Disclaimer:

In an effort to conserve each person’s personal experience and beliefs about how to care for and deal with pain, I offer a bit of advice from the pediatric & adolescent healthcare provider’s perspective. It should be noted that I am not a parent nor do I fully understand all of the complexities and intricacies that go on in each family. Ultimately, how you discuss pain and teach your children and teens to deal with pain is a matter of choice and fully depends on each situation you encounter.

6 Reasons Why the Diaphragm may be the Coolest Muscle in the Body

What if I told you that there is a muscle in your body that is key to giving you good posture and participates in weight lifting between 17,000 and 25,000 times per day? What if I told you it does this without you even knowing it? What muscle do you think that is? Hint: it’s not a heart muscle.
Stumped yet? Check out this great blog by my colleague Jessica Reale to find out the answer. Young athletes of all ages and backgrounds need to learn from a young age the importance of this muscle.

Jessica Reale, PT, DPT, WCS

I have a small confession to make– I love the study of human anatomy. Always have. It was studying human anatomy and physiology that made me shift my undergraduate degree at Gordon College away from “Biology” and into “Movement Science” (which has now become “Kinesiology”… Who would have known that years later, “Movement Science” would have been the coolest name for a major ever? Am I right fellow PTs?). The human body is fascinating and incredible. So, it should come as no shock to you that I have favorite muscles. In PT school, my favorite muscles were the ones with the most fun names… like the Gemelli brothers (who are small hip external rotators) or Sartorius (a thigh muscle…best, if sung to the tune of “Notorious“). Of course, you know that now the pelvic floor muscle group ranks pretty high on that list…but the diaphragm, well… it just takes…

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The Road to TED Talk-ing

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After watching my Duke Blue Devils conquer the ACC Women’s Swimming Championship at Georgia Tech this weekend, I spent the better part of my weekend devouring some great TED talks. Not only were the messages by Shirzad Chamine and Brene Brown inspiring and refreshing, but they also gave me the opportunity to reflect on my own recent public speaking experiences.

Two weeks ago, I had the honor and privilege to do what I consider two of the most humbling experiences of my professional life: speak with and in front of colleagues at the American Physical Therapy Association’s (APTA) Combined Sections Meeting. In keeping with the fact that it occurred the same week as the Super Bowl-we’ll  basically equate this to the Super Bowl of all PT nerd-dom, complete with fanfare, its own hashtag, an exhibit hall with plenty of games and freebies, and plenty of evening parties. Just imagine 10-15,000 of your best nerdy PT friends all descending on one giant convention center in snowy, frigid Indianapolis (seriously, whose idea was that?). It was a geek fest- but a very inspiring geek fest at that. And some may argue it offered some great people watching and fashion critiques. Apparently the token wardrobe for PTs is still believed to be khakis and polos, if you were wondering (there is an entire Twitter conversation about that).

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They even decorated the stairs with nerdy PT-isms

I found out last summer that I would be speaking, so there was plenty of time to prepare. Like the athlete that I am, I spent weeks training, rehearsing, polishing, and preparing my presentations so that I could get up there and deliver the presentations in true TED talk style. I read a book, watched tons of TED talks, and ran the talks by several colleagues and students. I selected outfits that would convey my personality. People: I wore HEELS for crying out loud. I spent hours in the convention center’s “practice room” making sure that the computer and projector were compatible and that all of my photos and videos shone through to convey my visual message. An audiovisual snafu was a worst nightmare for this overprepared, overachieving, nerdy PT.

Completely relaxed and confident, I walked into presentation 1, plugged in my computer for one final test, and it popped up beautifully onto the screen. I was speaking among 10 other experts in sports medicine. I was 7th in line to speak, covering a case study of a young female athlete swimmer (does it get anymore exciting for me!?). I sat listening to my colleagues share their stories, eagerly awaiting my turn to take the podium. It was finally my turn. I thought in my best Kevin McAlister homage “This is it, don’t get scared now,” proudly took the stage, and plugged in my computer.

Womp womp.

As Murphy’s Law would have it, all of those hours of preparation and practice came to a screeching halt. The A-V connection wasn’t working. What!? I’d practiced and tested it a minimum of 23495 times on this very projector! Why wasn’t it working? I had approximately 1 minute to get it sorted out before they told me to get off the stage and let the next speaker go. That 1 minute went pretty quickly and unsuccessfully, and off I went, sheepishly back into the audience.

Now, this could have been a total game changer. First time on a big stage and my computer malfunctions. The whole world can now seemingly assume that I wasn’t prepared. But…but..I practiced!! I swear! And I even bought the special Mac adapter! A charitable stranger offered up his PC computer and I spent 20 minutes transferring files, videos, and completely rewriting my talk. Apparently presentations written on a Mac don’t always transfer perfectly to a PC (Insert elitist Apple statement here). I finished everything just in the nick of time and retook the stage.

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Talk 1: The Long Term Effects of Slipped Capital Femoral Epiphysis (SCFE) in Young Female Swimmer, part of the Sports Section’s Complicated Patient Session

By this time, I was going last. Nearly half the room had emptied as people left early to catch lunch. It wasn’t what I had envisioned. But I charged on. To my surprise, I was even more relaxed this time around. I thought, I suppose it can’t get any worse… The projector worked, I didn’t even need to consult my notes, and I delivered the message with ease and grace—even inserting a little humor here and there. After the talk, I had some wonderful conversations with PTs and PT students who were so thankful for a talk about swimmers-a topic that is rarely covered in a sports medicine world heavily focused on more traditional sports.

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Thanks to the faithful who stuck around to see me dressed in a Missy Franklin costume!

First talk down. Snafus aside, I was pretty proud of myself. Now that I had ripped off the proverbial Band-aid, I was more than ready for the 2nd talk the next day.

For the next presentation, I was speaking with 2 of my most valued mentors and colleagues-Blair Green & Julie Wiebe. See this post and this post and this website to learn more about Blair. See this blog and website featured in my Blogroll to learn more about Julie W. Needless to say-they are both rock star PTs that I really admire, so it was a honor to stand up and speak with them.

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Here I am in Talk #2. Credit to Julie Wiebe for the awesome slide. Credit to Jen Miller for the photo.

I was up first. I joked that they were hazing me and made me go first and explain all the “sciency” concepts because I was the baby of the group. For the record-It is NOT easy to speak continuously for an hour! Talk #1 was only 9 minutes. This one took me 65 (apologies to Julie W for being long-winded…I blame the bad video connection!) The good part about having to teach a big group science concepts is I also got to exercise my inner 3rd grade teacher-meets-kids Pilates instructor. Getting a room of 100+ people on their feet and making them wiggle and do some silly things really does give an air of feeling powerful (or maybe that’s just what I’m telling myself).

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Audience on their feet, following directions. What fun!

We had a pretty awesome message to share, if I do say so myself. The presentation, Building the Female Athlete from the Inside Out, conveyed the most current ways to build and fashion a female athlete’s movement performance after injury or impairment. We took a multifaceted approach, covering three unique cases. I discussed a young female athlete (my wheelhouse!), Blair shared about a post-partum runner (her true love), and Julie W anchored the relay by taking on the beast of the CrossFit/High Impact athlete (seriously, she is the only person I know who can talk publicly about that hot topic and not get tomatoes thrown at her).

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Here I am with the Female Athlete Dream Team: Blair Green & Julie Wiebe. Fully representing The Georgia Bulldogs and Duke Blue Devils in our color scheme.

Of course, this presentation was not without its blessing from Sir Murphy and his law. While I had carefully ensured no encore performance of the computer issues I had in talk #1 (of course I had!), it turns out there were more issues to be had. This happened in the form of the presentation completely shutting down in the middle of Blair’s portion. <Cue potential panic attack>. Good news—turns out we could give the presentation in our sleep and she carried on and handled it like a champ while I scrambled to help her fix the problem.

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#nerdclub president takes the podium. Who cares if the presentation shuts down in the middle? No biggie.

Overall in that talk, we had our share of issues and imperfections. There was certainly a laundry list of things to improve upon in the future. Despite those things, the outpouring of support and gratitude following our presentation was humbling. We were tweeted, retweeted, facebooked, Pinned, emailed…the list goes on. As far as social media goes, we were definitely feeling the PT nerd love.

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I’ve sat in many talks tweeting stuff the presenter says. Now I’m the one being tweeted. #whoa #humility #carefulwhatyousay

But perhaps the most rewarding feedback we received was at the conclusion of the presentation. As the last presentation on the last day, we were afraid nobody would stick around for our talk. On the contrary, we had a room full of engaged attendees. As we entertained questions from the audience, one attendee stood up from the front row and said nothing, but just began clapping. She turned to the audience and continued to clap, offering up her own personal standing ovation. I was thinking to myself wow, this attendee is quite enthusiastic. Not to mention she has some guts to stand and do that. She then turned to us and said “Ladies, you NAILED it.”

 

Then she identified herself. It was Mary Massery.

 

For those of you who aren’t PTs—this would be akin to having Coach K stand up and applaud you as you gave a talk to the entire NCAA on new and innovative approaches to coaching men’s college basketball. Yes, of course I’m going to use a Duke basketball reference after that win over UNC this week.

We were starstruck, to say the least. For Blair and I, both of our jaws immediately hit the floor. According to Blair, this was like being thanked at the Oscars. Julie W knew her previously but it was clear that was very meaningful to her as well. When I was in PT school, I was told by multiple professors that if you ever had the opportunity to learn from Mary Massery-you do it without hesitation.

To add vulnerability to humility—I had even quoted her twice within the presentation, not knowing she was sitting on the front row. This, ladies and gentlemen, is exactly why we are always taught to check and double check references before quoting someone! My 5th grade and high school journalism teachers would be so proud.

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Giving credit where it is due!

Mary happened to escape the room before I had a chance to thank her and shake her hand. Good news is she’s coming to Atlanta later this year and I will get to do that AND learn from her, as recommended to me when I was a novice PT. She did send an email to us later commending us on our effort. It’s not quite a hand shake, but my jaw may or may not have hit the floor again.

Overall, it was a wonderful experience. Among my many reflections, here are a few pearls I picked up along the entire journey:

  1. Like in any sport or activity-you can prepare, rehearse, perfect, and polish to the nth degree-and things will still go wrong. The key? Learning to roll with it and breathe through it. You’ve got this.
  2. Humility, vulnerability, and grace go a long way. It’s not about YOU in sharing your message. It’s about the people with whom you share it. It’s more important to establish a connection with them in order to get the message across than to worry over the details of the actual message. People only retain 10-20% of what you say. So it’s not about what you say-it’s why and how you say it. Be yourself, add some humor and fun—and people will really engage with you. This makes it a lot more fun as the presenter, too.
  3. I say this all the time—but teaching is not a teaching experience. It is a learning experience for the teacher.
  4. Blogging is a fantastic platform for sharing passions and messages. It’s even more fun when you are given an actual voice on an actual platform, and you get to wear heels to do it. Thank you Blair for letting me raid your shoe closet.
  5. The unconditional support, compassion, and reinforcement I received from people who barely knew me was so humbling and validating. It has been amazing to receive messages and emails from people who just want to network and share their stories with me. What an incredible profession to be a part of.
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Duke alums in PT gathering! Some of my favorite PTs in the world in this photo!

I’m thankful for the opportunity to have shared my stories and passions with so many people. I can only hope that even just one person has been able to integrate some of those concepts into their daily practice.  I gained new inspiration not only for this blog, but reinforced and reinvigorated my curiosity and passion for so many things related to the care of young athletes. As I come down from the CSM high-or hangover as I’ve called it-there is plenty to integrate into my practice. Lots of new connections, friends, and knowledge. I haven’t even started to reflect on all the cool things I learned at the conference in all the classes I took (another post for another day). Stay tuned!

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Emory DPT Classmates. Love these guys!

 

Swimmer’s Shoulder: Best Friends and Mortal Enemies

Athletes of all ages and backgrounds thrive on efficient movement, maximizing results with as little energy as possible. In swimming, inefficiency can lead to many injuries, especially shoulder pain. Meet a swimmer’s best friends and mortal enemies. It’s often the enemies—those that pretend they’re friends—who cause the most trouble. ­­

BEST FRIENDS

KISS Principle and the 3 Bs

When it comes to swimming efficiency, we need to establish two simple truths for keeping it simple, swimmer (KISS):

Truth 1: Swimming is not all about the arms. You may have lats (“swimmer muscles”) of steel, but they do more than propel the body in water. They interconnect with the core and are sewn into your glutes. The arm bone is connected to the leg bone after all! But that doesn’t mean it has to do all of the work. Truth 2: Swimming is all about the 3 Bs: balance, buoyancy and breathing. But how do you make those your best friends? Read on to find out how to use them to help your arms and swimming efficiency, specifically in the freestyle (front crawl) stroke.

Be strong and carry a big kick

“I am not a strong kicker” and “I hate kick sets“ are common quotes from swimmers with shoulder pain. We may love-to-hate kicking, so let’s make it more digestible with a metaphor. Imagine you have a beautiful boat that you use each week. You’re thrilled until one day—BAM! The boat starts to slow down and feel sluggish each time you take it out. You take impeccable care of your boat, so you’re baffled. You take the boat to a mechanic, who asks how you drive it. You proudly present two paddles that you hand-carved. He smiles and points at the boat’s motor. “This is a motor boat,” he says. “Have you been paddling it all along?” You answer, “Yes! I don’t want to pay for gas and put in the time to service the engine!”

Friends don’t let friends overlook the importance of having a strong motor in the water. Using your “paddles” to do all of the work is not only inefficient, but it will slow you down and worse—potentially injure you. Dragging your motor along is added weight for your arms to pull. Use that weight to your advantage! Find a precisely balanced use of that motor coupled with good body rotation (twist), balance, and buoyancy so that you won’t have sore “paddles.” Want to know more? See this article about efficient freestyle kick in swimmers and triathletes.

Do the twist

There is no one-size-fits-all answer to swim posture and balance, but here are a few guiding principles:

  • Head position: Head position and shoulder pain are related. Poor head posture begets a sluggish hip position and vice versa, leading to a sluggish motor. Gaze through the top of your goggles instead of tilting your head up. Keep the water line at mid-forehead or cap line.
  • Pelvis and hip motion and rotation: drives the kick, which in turn drives the body, then the arms. This requires glute and hamstring strength and flexible hips.
  • Upper back: follows the pelvic and motor motion. You need flexibility and strength into twisting motions in the upper/mid back, shoulder blades, abs, and low back.
  • Knees and ankles: neither held too rigid nor floppy. Kick from the hip, not the knees or ankles.

Utilize your own personal floatation devices

If you don’t breathe well, your motor and 3 Bs will suffer. Swim lessons begin with bubble blowing and floating for a reason: to teach use of the most buoyant part of the body—the lungs—to stay afloat. Diaphragmatic breathing keeps your core engaged with your arms and delivers oxygen to your muscles. And be an equal opportunity breather! Breathe bilaterally to keep the work balanced on each arm/leg.

Swim toys: the good guys

  • Swimmer’s snorkel: Ditch the nose plug. The swimmer’s snorkel may help you with the 3 Bs. It keeps your head and body in line while working on your body rotation and kick. Sure, you won’t breathe to both sides or compete with it, but it does help you sync your inhales and exhales with your strokes. That’s a step toward 3 B success and a best friend for swimming life!

    Photo credit: swimswam.com

    Photo credit: swimswam.com

  • Swim fins: Not only will they help you practice your Little Mermaid impression, but swim fins will also help you run over everyone at practice. While they are no replacement for establishing an efficient motor and 3 Bs on your own, they do boost kicking and, in exchange, take a load off of your arms. Word of caution: if your ankles are stiff, they can cause shin pain.

Hand entry

It’s easy to get caught up on hand entry (pun intended). It’s important, but not everything. Hand entry is akin to a runner’s foot strike: both are dependent on body position. This has less to do with your arms and more to do with—you guessed it—kicking and the 3 Bs. With these in check, the hand should enter fingertips first, just wider than the shoulder. Too wide or too narrow likely means there’s under- or over-rotation in the hips and torso, respectively. This can lead to technique issues and stress the shoulder.

Training terrain

This is mainly applicable for triathletes and open water swimmers, though pool swimmers can benefit from this part, too. Just as trail runners need to train off road and road cyclists need to train on the road, swimmers need to train in their competition “terrain.” Accessibility, weather and water temperature pose a challenge here. For open water races, train where you can’t see in front of you. Vision affects the 3 Bs, so practice lifting your head too look for race buoys, support crew, and other competitors. Just remember keeping your head up too long will affect your 3 Bs and motor. If a current or waves are involved, train in choppy water. Wear your wetsuit before race day to ensure fit, comfort, and no change in your 3 Bs.

MORTAL ENEMIES

Improper FITT

That’s not a spelling error, and I’m not referring to swimsuit fit. That’s training Frequency, Intensity, Type, and Time. Too much or too little of each can be problematic. Periodic muscle soreness is normal, but should taper with experience and improved technique. Increase training distance or duration by no more than 10-20 percent per week and vary your strokes to allow for this gradual change. Having stroke variety (e.g. breastroke or backstroke) in the back of your Speedo can be handy if you need to change your position or speed in a race.

Swim toys: the bad guys

  • Kick boards: Kicking is essential to healthy shoulders, but kicking with that 12-inch piece of foam is not. It puts the shoulder in the “impingement” position, pinching your rotator cuff and other structures against your scapula. That’s PT-speak for “ouch.” Kicking with no board helps master the 3 Bs. Kick on your side with one arm up or on your back or stomach with both arms down.
  • Hand Paddles: These are a privilege, not a right. Added resistance is great for building shoulder strength and to the swimmer who paddles the motorboat. Remember what I said about the arms? It’s not about them! Unless you have no pain, a good kick and the 3 Bs, just don’t even go there.
  • Pull buoys: Why would you take away your motor especially when your shoulder hurts?

Poor ergonomics in other activities

What you do out of the pool is just as important as in the pool. Poor cycling and running posture can beat up a shoulder. That goes for workplace, school, and car ergonomics, too. Habits accumulate quickly and can catch up to you when you least expect them.

IN SUMMARY:


Now that you’re armed with a checklist, you’re ready to dive in and make lots of new best friends. But if you find you’re having trouble with them, don’t wait until you’re in pain to ask for help. Sports physical therapy is not just for when you’re broken. We can identify factors that may put you at risk for injury not only in swimming, but in other activities too. Video stroke analysis can be key to help identify and correct errors that may strain a shoulder.

Movement is medicine for low back pain

 

Just ran across this great whiteboard video from an NPR post about low back pain. It’s a video by a Canadian primary care physician. It’s the best patient-friendly explanation I’ve seen of low back pain, what to know, and what to do about it.

While low back pain in the young athlete is not always the same as in adults and there are other kid- and teen-specific diagnoses AND PT treatments to consider, I still find this video very helpful for all ages. Though there are some very rare reasons they may have it, kids and teens almost never have problems like neurogenic claudication due to spinal column narrowing mentioned in the video. Discogenic pain is also more rare in kids and teens..

Given that low back pain is one of my favorite conditions to treat, particularly in the young athlete, I’d say this video hit the nail on the head for the most part. I love the physiotherapy, manual therapy, and Pilates shout-outs in the video.  It’s important before beginning something like Pilates or yoga that you start slowly and ensure that your instructor is familiar with how to help people with injuries. In addition, if you are a kid or a teen, it’s important that the instructor is skilled in working with children and adolescents as there are special precautions that must be made in Pilates and yoga due to differences present in the growing spine vs. the adult spine. Typically what I do, as a Pilates instructor and PT, is teach kids the right movements they would need to know for Pilates, then find them the right Pilates instructor or class.

You can skip the ad at the beginning, but I also love the Neurac and WebPT advertisements at the start of the video. Between Pilates, Neurac, and WebPT, I use all of these things in my daily practice (in full disclosure: nobody paid me to say that).

The best 3 lines:

“Motion is lotion”

“A physiotherapist can probably help you with all of these things” 

“Movement is medicine.”

Enjoy!