Below is the injury case study written by my coach, Mike Finch, head coach of W Ross Macdonald Swim Club in Brantford. For someone that has been dealing with unnecessary injuries for over a year now it was a perfect time to share my story. Enjoy!
A Rehab Case Study by Mike Finch
Athlete: Tyson MacDonald – 18
Note: I want to thank Tyson for allowing me to write this “case study”. Our hope is that other athletes facing the same situation will have a better idea of how to both avoid or manage a swimming injury. Tyson’s comments are included in blue.
Swimming injuries do not have to be an inevitable part of our sport. Training and competing in constant pain is a path out of the sport rather than being a toughness “merit badge”. “Swim through it” (tendon, back and joint pain) at your own risk!
Background: Tyson joined WRMS in September of 2014. During the 2014 LC season he trained and competed with an increasing amount of pain. His meet swimming was hard to watch; he was turning in very slow performances, and clearly in a great deal of pain after each swim.
Tyson’s rehab process has taken the majority of the 2014-15 season. It has been expensive to the Ontario Health Care System in terms of 2 MRIs and consultations with several specialists. Many trips to Steve Hill at Kings Cross Physio in Brampton have also been expensive for the family. It’s likely that Tyson’s injuries were completely preventable as they were almost certainly due to over-training, poor stroke technique, muscle imbalance and a general weakness in his back.
Note: It’s important to note that Tyson has been meticulous in following all of the directions he has been given – he has also been very patient which hasn’t been easy – he just wants to train and race! Its likely that many attempts at rehabbing a swimming injury fail based on a lack of patience and or focus on the part of the injured athlete..
MRIs: The results of his first MRI were inconclusive so a second “Contrasting MRI” was ordered. The results appeared to indicate a Shoulder Joint Tear (Glenoid Labrum Tear) Surgery is often recommended in these cases.
Physio: Tyson’s physio has covered three major areas:
- Tendonitis Treatments: The initial priority was treatment of Tyson’s fairly advanced tendonitis.
- Dryland: Tyson was given a number of very basic exercises designed to begin building back stability and strength – the approach at Kings Cross is different as they do not start with all sorts of Rotator Cuff Exercises.
- Development and control of “holding muscles”: Once the tendonitis was no longer a factor in terms of pain, the work at Kings Cross shifted to teaching Tyson how to hold his shoulder in a stabilized position.
- Tyson was given a number of dry land exercises that gave him control of the muscle groups that hold his shoulder in a healthy position.
- We moved Tyson into the clinic’s SwimEx (flume) starting with shoulder positioning against a current (out of the SwimEx), followed by the same shoulder positioning while swimming.
- The outcome of this section of Physio was to give Tyson awareness and control over shoulder position as well as the muscular endurance required to hold his shoulder in position over increasing amounts of swimming volume.
- General Strength Development: Tyson as always been an extremely focused and dedicated swimmer but he had some major strength deficits that certainly contributed to his injuries. He is currently heading into Kings Cross every 3 to 4 weeks for strength program updates. We take technical video of each session at Kings Cross so that Tyson can go back to check exercise technique. Tyson continues to be completely focused on exactly following the exercise prescriptions from Kings Cross.
Progression in the pool:
- September – November:
- Technical Analysis: Underwater video revealed a number of technical errors that had very clearly contributed to his injuries. We knew what technical errors need correction but Tyson kept any swimming to an absolute minimum; initially well under 500 yards/day.
- Technical Work: Regular use of our underwater video systems (used every minute of every practice) allowed Tyson to make the required technical changes.
- Training: Almost 100% of Tyson’s early season training was done “hands back – snorkel kicking with and without fins” We swam, Tyson kicked. Absolutely no swim training until Tyson had made the required technical changes – and then – only as much pain free swimming as he could do…..we always stopped before he was experiencing any pain – it was a very conservative approach –
Tyson: “Watching my teammates swim and race personal best times in practice or in a meet was challenging, but kicking for many practices in the first couple of months of the season only improved my poor kicking and allowed me to discover new leg muscles that I did not know existed. I also gained the rewarding role of coaching my junior teammates at a couple early season meets as well taking meet video and giving immediate feedback on technique to my teammates.”
- December to April
- Technical Work: Every practice – making sure that he was seeing the exact stroke pattern that would allow him to swim pain free. Backstroke and Breaststroke were added to the technical work. Always with an emphasis on shoulder positioning, swimming with a long neck…keeping the strokes long and relaxed.
- Swim Training: Swimming volume and intensity increased over the period – the over-riding rules were listen to your body and be conservative.
- Kicking: Tyson was and is responsible for monitoring his training and moves to kicking as an intuitive switch from swimming. If he can’t hold his shoulders in position, a swim set is over…so he’s swimming with a high level of self-awareness.
Tyson: “Diving into my first meet near the end of November I knew I could not afford to anything ‘amazing’ or race to ‘aggressive’ – instead I dove in for an easy 50 free, still pulling an impressive time and felt easy, pain free, and relaxed. This was the exact expectation for my first race of the season.”
- May to Current:
- Technical Work: Continues at every practice
- Dryland: As prescribed by Kings Cross
- Swim Training: The progression continues – increased volume and intensity – never any fly swimming – but increasing amounts of back and breast work with the majority of his swim training being freestyle based.
- Kicking: As needed.
- Meet Swimming: Tyson has been building out from 50s to 400M – he has absolutely no interest in continuing compete at 800 and 1500M. His times have improved at every competition….
Tyson: “Every time I dive into the water there is noticeable improvement, whether it is time, technique, under water, or faster reaction off the blocks. ‘Constant improvement’ is noticeable in my daily training and racing which helps to keep the confidence levels high and drive to continue to improve. Now that I have a few months of solid racing under my belt I am confident with my new technique in my strokes, being able to just race and not be concerned about my shoulder, and most importantly having ‘fun’ something many swimmers refuse to do.”
End Notes:
- Tyson has been able to train Pain Free since November – he has often experienced muscle soreness but absolutely no pain which would indicate injury onset.
- Tyson knows his limits – everything is improving but it’s at a manageable pace.
- Re. Tyson’s MRI Results: Tyson clearly experienced some level of shoulder tear but Steve Hill’s advice was that if Tyson could race and train “pain free” surgery was probably not necessary. All of the time and effort needed to teach Tyson how to control his shoulder position has allowed him to avoid a surgical correction.
- We continue to feel that a majority of career ending or damaging injuries are completely preventable. Tyson’s injuries almost certainly resulted from poor technique, an inadequate dry land program, poor posture, over training and trying to continue racing through an existing injury.
- Swimmers need a physical assessment each year the goal of which it to identify potential problem areas before they create an injury.
- Proper Technique is easy to teach and easily maintained – but swimmers need to see what they are doing on a regular/daily basis.
- Swimmers need to understand their limits – pushing into neural fatigue is a perfect way to “tough your way into an injury”.
- Dry land programs need to focus on developing muscle balance and muscular endurance in “the holding muscle groups”
- Racing injured makes absolutely no sense as it just leads to a longer or more serious injury!
Tyson: “Technical training, body awareness, and patients will all remain part of my training methods for the rest of my career to ensure my shoulder stays ‘healthy’ and no further damage is done. I know I’ll never swim an 800 or 1500 free again as well butterfly or I.M. and I am totally fine with that. This injury has allowed me to look outside the box and train in a new way that I thought would never work.”
- Expectations for Tyson’s University Swimming
- Tyson appears to be fully recovered – having corrected all of the issues that we think contributed to his injuries.
- As long as Tyson continues to listen to his body he should remain un-injured over the course of his University and Summer swimming.
- Tyson should get back to Personal best times in free events 50 – 400, and at all distances for Breast and Back.
Tyson: “Working with WRMS, the many doctors/specialist, and most importantly Steve Hill has been a career saver! Without these people working together and being on the same page nothing gets accomplished. The key to coming back healthy from an injury and STAYING healthy is doing the little things daily, proper warm up/activation, following the training plan accordingly, let your coach know asap when something doesn’t feel right. The worst thing to do is rush back into training/racing and think lifetime bests will come. Instead baby steps and returning to reality are key in order to come back healthier and stronger.”
