Lesson 1 – Fueling Your Stroke, Buying and Burning Gas
Six 200’s descending on five minutes. Twenty-five 50’s on :58. Whatever your “favorite,” every set during every workout and dryland session requires energy.

Nutrients are the “chemicals” that supply the body with energy. Carbohydrate, protein and fat supply energy in the form of calories. These are your “Energy-Yielding Nutrients.” Vitamins, Minerals and Water don’t supply energy in the form of calories, but their presence is required in order for the body to access the energy provided by carbohydrate, protein and fat.

During exercise, the body gets its energy primarily from carbohydrate and fat. It likes to save protein for other things (building and repairing muscle tissue, hormones and red blood cells, and supporting the immune system). The only time the body uses protein as an energy source during exercise is when carbohydrate and fat are not present in sufficient quantities. This happens when the total caloric intake is too low over a period of months, and or the bout of exercise is so long that the body’s accessible sources of carbohydrate and protein become exhausted. Neither of these scenarios is desirable for swimmers.

Think about money. When you have lots of it, you don’t mind paying full price for things. But when money is scarce, or there is just too much you have to buy, you look for bargains. You’re not being cheap, just thrifty. Simplified to some extent, your body knows how to shop.

Now instead of dollars, think of your currency as oxygen. When swimming is “easy,” say during warm-up or your easiest sets, there is plenty of oxygen available to support the exercise. The body perceives itself as “rich” and doesn’t mind splurging on fat (1 gram of fat costs 9 oxygens). In fact, it automatically does so because it knows it might need carbohydrate at a later time.

When exercise is hard (we’re talking tough sets, definitely your hardest sets), oxygen is not plentiful. In fact, the body needs every bit it can get to support the exercise, but even that is often not enough, and the body is forced to derive energy in ways that do not require oxygen (i.e. anaerobic metabolism). In this situation, the body perceives itself as very “poor” and becomes very thrifty with its “purchase” if fuel. Since carbohydrate costs less than fat (1 gram of carbohydrate costs 4 oxygens), the body chooses to rely primarily on carbohydrate for its energy.

Keep in mind that this entire fuel burning process is never a case of “all or none.” In other words, the body is always using some combination of carbohydrate and fat, but the intensity of the exercise dictates which fuel source will be the dominant one. When swimmering is easiest, fat is the primary fuel source. When swimming is toughest, carbohydrate is the primary fuel source. When swimming is about 50% of maximum effort, carbohydrate and fat contribute about equally.

Let’s face it – the majority of workouts are hard. Above 50% for certain. If you consider the typical swim workout, it’s pretty safe to say that the primary fuel source for swimmers IS carbohydrate.

Lesson 2 – Eat Colorful Foods.
What are the first three foods that come to mind when we say “carbohydrate?”

1. Pasta
2. Rice
3. Bread

Each if these is excellent. But what do they have in common? They’re all white!

One of the most overlooked sources of carbohydrate is fruit. Yes, FRUIT. Fresh, canned, frozen, dried or juiced. No matter how you look at it, fruit is an excellent source of carbohydrate. Not only does fruit provide carbohydrate in the form of natural sugars (versus refined sugar), the bright colors of fruits indicate that they are also excellent sources of vitamins and minerals, including a sub-group called anti-oxidants.

You might recall that exercise is the stimulus that leads to training adaptations. And that adaptations to training occur ONLY is you give the body the right kinds of fuels during periods of rest.

Well, one of the side effects of exercise is the generation of “free radicals.” Free radicals are molecules that can actually cause damage to muscle tissue above and beyond the damage caused by exercise. The damage caused by exercise is normal. It serves as part of the stimulus for training adaptation to take place. But damage caused by free radicals is NOT a desired part of the training process. Damage caused by free radicals (aka “scavengers”) circulating in the bloodstream after workout can continue well into the recovery period. This is when the body is supposed to be adapting!

Anti-oxidants “absorb” free radicals, neutralizing their effect in the body before their damage to muscle tissue can amount to much. A diet consistently rich in fruits (and other colorful foods, such as VEGETABLES) is apt to keep the body consistently supplied with anti-oxidants, which will assist the body in keeping free radical formation to a minimum. This a good reason to eat lots of colorful foods during the recovery time between workouts.

Colorful foods include, but are not limited to

Apples, Strawberries, Blueberries, Bananas, Oranges, Kiwi, Watermelon, Raspberries, Grapes, Mango, Papaya, Apricots, Red peppers, Broccoli, Corn, Squash, Carrots, Peas, Green beans, Tomatoes

Colorful foods DO NOT include: Skittles, Jelly Beans, M&Ms, Mike&Ikes, Fruit Loops, etc.

Lesson 3 – Carb, Protein, Fat…How Much is Enough?

We talk a lot about the body using carbohydrate, protein and fat as it Energy-Yielding Nutrients, but the requirement from swimmer to swimmer varies. A swimmer’s energy requirements depend on several variables, including their age, gender, body weight (and possible composition) and level of training.

According to the American College of Sports Medicine, American Dietetic Association and Dietitians of Canada Joint Position Statement on Nutrition and Athletic Performance,

“Protein requirements are slightly increased in highly active people. Protein recommendations for endurance athletes are 1.2-1.4 g/kg body weight per day, whereas those for resistance and strength-trained athletes may be as high as 1.6-1.7 g/kg body weight per day. These recommended protein intakes can generally be met through diet alone, without the use of protein or amino acid supplements, if energy intake is adequate to maintain body weight.” (ACSM, ADA, Dietitians of Canada, 2000, p 2131)

The generally recommended daily intake of protein for swimmers in training is 1.4-1.8 g/kg of body weight. Typically this should account for 12-15% of total calories. For a 160 lb athlete, that equates to 102-131 g/day, which is 12-15% of a diet of 2,720-4,367 kcal/day.

Meeting this requirement typically ensures adequate dietary intake of all of the necessary amino acids. It is important, however, that high-quality protein products be selected. Sources include meats, dairy, beans, dried peas, milk, eggs, and grains. These sources provide a more complete mixture of the necessary amino acids and therefore have a higher “biological value” or protein efficiency score. If these protein needs can be met by selecting good dietary sources of protein on a daily basis, the amounts of amino acids required to achieve the effects observed in the studies mentioned above can easily be met as well. There is no evidence that ingesting protein in amounts far in excess of the recommended intake is beneficial to either protein balance or exercise performance. The primary role of protein, and therefore amino acids, is to synthesize structural proteins and TCA-cycle intermediates. Excess protein can be stored to some degree, but that which is not used for the aforementioned purpose is typically metabolized and excreted. Protein is generally not used for energy during exercise.

The American College of Sports Medicine, American Dietetic Association and Dietitians of Canada Joint Position Statement on Nutrition and Athletic Performance also states that:

“Carbohydrates are important to maintain blood-glucose levels during exercise and to replace muscle glycogen. Recommendations for athletes range from 6 to 10 g/kg body weight per day. The amount required depends upon the athlete’s total daily energy expenditure, type of sport performed, sex of the athlete, and environmental conditions.” (ACSM, ADA, Dietitians of Canada, 2000, p 2131)

The general recommendation is that carbohydrate intake should account for at least 60% of total caloric intake. In addition, long-supported research by Costill (1988) indicates that athletes training more than 2 hrs/day require a carbohydrate intake of 9-10 g/kg of body weight on a daily basis to prevent chronic depletion of carbohydrate stores.

Lesson 4 – Eat Early and Often to Recover Well.

Knowing how much carbohydrate, protein and fat to get in a day is good. But knowing when you should be getting those nutrients is even better. When it comes to optimal nutrition, timing really is everything.

In general, following these guidelines for incorporating carbohydrate, protein and fat into your day:

· Spread carbohydrate intake out over the course of the day (i.e. smaller meals and frequent snacks). This keeps blood sugar levels adequate and stable.

· Eat some carbohydrate before morning practice. Note: This can be in the form of juice.

· Eat carbohydrate in the form of a carb-electrolyte drink, such as Gatorade or Powerade, during workout IF workout is 90 minutes or longer. Gels are also acceptable.

· Eat carbohydrate and protein within the first 30 minutes after practice. This enables the body to replenish glycogen stores and repair muscle tissue. This is perhaps the most important time to eat!!!!

· Eat again (something substantial, like a real meal) before two hours post-practice has elapsed. This is critical to maximizing recovery!!!!

· Incorporate fat into the day at times that are not close to workout. Fat is necessary, but contributes little to the workout or immediate post-workout recovery period.

Part of the reason good nutrition is critical during recovery has to do with the fact that the body is extremely good at making the most of what it is given. Following exercise, the body is very sensitive to the hormone insulin. Insulin is that hormone that rises every time blood sugar rises. In other words, every time a swimmer eats carbohydrate, which causes blood sugar to rise, insulin goes up. Well, it’s insulin’s job to remove sugar from the bloodstream, and it does so by facilitating its storage as glycogen. Glycogen, the storage form for carbohydrate, is what the body taps into for fuel when exercise is very intense. This can happen quite a bit during a tough workout, which is why it’s important to see that glycogen is replenished before the next practice.

The American College of Sports Medicine, American Dietetic Association and Dietitians of Canada Joint Position Statement on Nutrition and Athletic Performance states that:

“After exercise, the dietary goal is to provide adequate energy and carbohydrates to replace muscle glycogen and to ensure rapid recovery. If an athlete is glycogen-depleted after exercise, a carbohydrate intake of 1.5 g/kg body weight during the first 30 min and again every 2h for 4 to 6h will be adequate to replace glycogen stores. Protein consumed after exercise will provide amino acids for the building and repair of muscle tissue. Therefore, athletes should consume a mixed meal providing carbohydrates, protein, and fat soon after a strenuous competition or training session.” (ACSM, ADA, Dietitians of Canada, 2000, p 2131)

In addition, research (van Loon et al, 2000) has implicated immediate post-exercise carbohydrate ingestion (1.2 g/kg/hr for 5 hrs) in the enhancement of glycogen re-synthesis.

Lesson 7 – Drink Early and Often.

There are 2 reasons to drink fluids: (1) to stay hydrated, and (2) to provide the body with fuel.

During Workout – Regardless of age or length of workout, all swimmers need fluids during practice to stay hydrated. Easily accomplished with a couple of sips from the water bottle every 15-20 minutes. As swimmers progress, workouts get longer and tougher. It’s well established that exercise beyond 90 minutes benefits from a supplemental fuel source. The sports drink can provide it. But we still have hydration to think about. Drinks that are too strong, or “concentrated,” can provide the fuel but also inhibit fluid absorption and often lead to cramping.

Years of research tells us that drinks that are 6-8% carbohydrate by weight provide the perfect balance. Enough carbohydrate to provide a fuel source during long exercise, but not so much that will inhibit fluid absorption. A couple of sips every 15-20 minutes keeps the body fueled, helps prevent unnecessary tissue breakdown, and maintains hydration. Today, only Gatorade and Powerade meet the 6-8% criteria. Most other drinks are too strong to be effective during workout.

After Workout – Water is an excellent choice to replenish fluids after practice. It’s always wise to drink at least one cup. But after a tough workout, replenishing fuel stores is equally important. Competitive swimmers need a little over 1 gram of carbohydrate for every kilogram they weigh (lbs/2.2) each hour after workout. And they need it within the first hour.

Oftentimes, a sports drink that is easily digested and quickly absorbed, such as Gatorade or Powerade can provide a convenient way to get some of this fuel within the first 20 minutes. Accelerade, a newer drink on the market may also do the trick. Endurox, perhaps, but beware of the high protein drinks, as they often forgo the carbohydrate, and carbohydrate is what you are trying to replenish within that first hour after workout. A little protein won’t hurt, in fact a little bit of protein may actually help by supporting tissue repair and re-building processes. But too much protein, especially when it comes in place of carbohydrate, may actually be detrimental to the post-workout recovery process.

**Remember…

1. Carbohydrate is the primary fuel source during tough workouts. Protein is used as a fuel source during exercise only when carbohydrate and fat are not present is sufficient quantities. This can happen during long/tough workouts when the body uses much of its stored carbohydrate, and it must find an additional source. If an additional carbohydrate source (ex. Gatorade, Powerade) is not supplied, the body taps into stored protein, aka your muscles. This is why we drink carbohydrate-electrolyte solutions during workout…to spare muscle protein. And this is also why it is important to replace carbohydrate stores lost during a workout…so you start the next workout with a full tank of gas!

2. Following exercise, the body is very sensitive to the hormone insulin. Insulin is that hormone that rises every time blood sugar rises. In other words, every time a swimmer eats carbohydrate, which causes blood sugar to rise, insulin goes up. Well, it’s insulin’s job to remove sugar from the bloodstream, and it does so by facilitating its storage as glycogen. Glycogen, the storage form for carbohydrate, is what the body taps into for fuel when exercise is very intense. This can happen quite a bit during a tough workout, which is why it’s important to see that glycogen is replenished before the next practice.

During the Day – Staying hydrated during the day is just as critical as hydrating during and after workouts. Most swimmers can do this by incorporating a variety of fluids into their daily diet. Water, fruit juice, milk, soups, etc, etc. Water is always an excellent choice, but other drinks, including sports drinks (defined as 6-8% carbohydrate by weight) are okay too. Just remember that variety is the key to a healthy diet. If you use a sports drink during and after practice, it may be better to drink water and juice during the day to stay hydrated. Juices are often healthier than sports drinks in that their sugars are natural. Always keep in mind that juices and sports drinks contribute to total caloric intake.

For the purpose of this article, a sports drink is defined as a 6-8% carbohydrate-electrolyte solution. Do NOT include “energy drinks,” such as Red Bull, 180o, Sobe, etc. These dietary supplements fall into the Yellow Light category of the Dietary Supplements Health & Contamination Risk Chart. (pdf file…requires AdobeAcrobat)

Shoulder Injury Prevention

Presented by USA Swimming and the Network Task Force on Injury Prevention. (April 2002)

Introduction by Scott Rodeo, MD // Chair of the USA Swimming Sports Medicine/Science Committee and Team Physician for the NFL’s NY Giants

A series of exercises for the UN-injured athlete.

Pain in the shoulder is common in swimmers. Shoulder function is highly dependent on the coordinated function of many muscle groups. These include the muscles around the shoulder, those that control the scapula or shoulder blade, muscles in the upper and lower back, as well as abdominal and pelvic muscles.

Since the shoulder is an inherently unstable joint, muscle forces are critical for maintaining stability, proper motion, and painless function. The repetitive overhead activity of the swimming stroke can result in fatigue of these muscles. This in turn can lead to distinct changes in the function of the shoulder, resulting in the pain that is commonly known as “swimmer’s shoulder”.

One of the major factors causing shoulder pain is overuse and subsequent fatigue of the rotator cuff muscles, scapular muscles, and muscles of the upper and lower back. Consequently, this fatigue can lead to shoulder instability and predispose a swimmer to shoulder pain. The risk of injury and pain is especially true for swimmers who swim with poor technique.

It is well-established that a comprehensive program to develop strength, endurance, balance, and flexibility of the muscles is the most important way to prevent “swimmer’s shoulder”. The exercises described in this review were chosen to develop these characteristics based on a sound knowledge of the muscles that are most important for optimal shoulder function.

THE EXERCISES
These exercises were chosen and reviewed by a panel of physicians, therapists, biomechanists, trainers, and coaches from USA Swimming’s Sports Medicine Society. These exercises have been proven to be effective in improving shoulder function for swimmers. These exercises address the three important areas:

1) the rotator cuff,

2) the muscles that stabilize the shoulder blade, and

3) the muscles of the low back, abdominal, and pelvis that make up the “core” of the body – the abdominal and lower back muscles.

It is important to note that these exercises should only be performed by the uninjured athlete. Injured athletes may need to modify the exercises in duration and/ or range of motion depending on the level of pain or impairment the athlete is experiencing.

In doing these exercises, keep in mind that the shoulder does not act by itself when you swim. You use your back, trunk and even your legs to help stabilize the body and help in the pulling movement. You will use many of these same muscle groups as you perform these exercises. Also, these exercises should be performed AFTER practice or several hours before you practice. DO NOT do these exercises right before your workout since you do not want to fatigue these muscles before you swim.

Practical Tips

While it is beneficial to complete each of the exercises presented in this review each week, it is unlikely that the athlete will complete all of them every day, due to the amount of time it would take. If time is an issue, try the “Light Version” by alternating days with the different groups of exercises. For example, complete the three Rotator Cuff exercises on Monday, the Shoulder Blade Stabilizing exercises on Tuesday, the Core Strength exercises on Wednesday and the Stretching exercises on Thursday. Then start the cycle from the beginning.
While it is best not to perform these exercises before practice, we realize that for some programs this may be the only time your group is together. If this is the case, it will not hurt to complete the exercises before the water workout, but realize that in doing so the athlete may experience some degree of fatigue in the targeted muscles during practice.
Primary Rotator Cuff Exercises

The first group of exercises we want to describe is designed to strengthen the rotator cuff muscles in the shoulder. The rotator cuff is made up of four small muscles deep in your shoulder. When these muscles contract they cause the shoulder to:

Rotate the arm away from the body. This movement is called external rotation.

Rotate the arm towards the body. This movement is called internal rotation.

Lift the arm away from the body. This movement is called shoulder abduction.

Exercise #1 – External Rotation

Equipment: To perform this exercise you will need a light to moderate resistance Theraband or surgical tubing. How do you determine what strength Theraband is right for you? Pull on it and if it feels like the resistance is too light – you probably have the right level of resistance. You will be performing many repetitions so a resistance that feels too easy will probably be just right as you start to fatigue.

The Movement: The External Rotation exercise focuses on strengthening the muscles that externally rotate the shoulders. The muscles that perform this motion usually are weak in swimmers. You are going to strengthen both sides of your body in this exercise.

Start by cutting the Theraband and tying it into a loop. The loop should be big enough so that your hands are 6-8 inches apart when your elbows are at your sides and your forearms are parallel to the floor.

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Stand up straight with good posture. Do not hunch your shoulders forward. Lift your sternum and your chest towards the ceiling to help set your shoulder blades in the proper position.

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Your elbows should be at your sides and should be bent 90 degrees so your forearms are parallel to the floor and your thumbs are pointing towards the sky. Perform the exercise by trying to rotate your hands away from your body like you are pulling taffy apart. The figures to the left show the correct start and finish positions.

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Focus on squeezing your shoulder blades together before you start this exercise. Feel this squeeze through the ENTIRE exercise. If you do not focus on squeezing the shoulder blades you will be exercising the wrong muscles.

You should take about two seconds to complete each repetition – 1 second as the muscles contract and you externally rotate the shoulders. Then take 1 second as you return to the starting position. Count 1-and-2-and, 1-and-2-and as you perform the exercise to get the correct timing.

You should perform 3 sets of this exercise, resting 30 seconds between each set. Each set should end after 2 minutes or when you are no longer able to maintain correct form. It is time to end the set if:

the shoulders start to roll forward,
you use you upper body or wrists to help the motion or,
you are unable to keep your shoulder blades squeezed together.
It is okay if you are only able to complete a few repetitions at first, but strive for completing 3 sets of 2 minutes. When you can do this, move up to a higher resistance Theraband.

Exercise #2 – Full Can Scaption/ Full Can Straight Arm Lifts

Equipment: You do not need equipment to perform this exercise, but as you get stronger, you can use some very light weights. You can make your own weights by filling two small water bottles with sand.

The Movement: The Full Can Scaption Exercise gets its name because performing it is like lifting a can without spilling its contents. The exercise strengthens the part of your rotator cuff that lifts the arm. Start this exercise using no weight. As you progress and get stronger you can use very light weights with this exercise, but even the strongest athletes should not lift more than 5 extra pounds.

Stand upright with your feet shoulder width apart and do not allow the shoulders to slump forward. Lift your chest towards the ceiling to help set the shoulder blades in the proper position. Focus on pinching your shoulder blades together and you should feel tension in these muscles for the entire exercise. The figures to the left show the proper posture and starting position.

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Raise your arms so that they extend straight out to your sides. Move your hands forward about 1-2 feet so they are now slightly ahead of your shoulders to get in the proper exercise position. This will actually allow you to perform the movement in the same plane of the shoulder blade. Keep your thumbs turned up so they are facing the sky. (See figures to the right).

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Lower your hands to your side and then lift them up again so your hands end up level with the top of your head (See the figures showing the start and finish positions for the exercise to the left).

Maintain a steady cadence – Take 1 second to lift your hands to head level and one second to lower the hands back to your sides. As you raise and lower your hands, count slowly 1-up-2-up, 1-down-2-down… Remember to keep your hands and arms ahead of your shoulders and keep your shoulder blades together.

Continue this exercise for 2 minutes or until you are unable to lift your arms while keeping your shoulder blades pinched together. Perform 3 sets in this way taking 30 seconds rest between each set.

Exercise #3 – Ball on the Wall

Equipment: One tennis ball or light medicine ball.

The Movement: The Ball on the Wall exercise is designed to strengthen the muscles that stabilize the shoulder blasé (scapula) as well as those that internally and externally rotate the shoulder. You will need a tennis ball or a light medicine ball to perform this exercise.

Facing the wall, stand up straight with one arm extended in from of you so that your palm almost touches the wall. Keeping the elbow straight, “pin” the ball between your hand and the wall. Pinch your shoulder blades together and feel that contraction through the entire exercise.

Roll the ball in small circles in a counter-clockwise motion for 15 seconds. Each circle should take about 1 second to complete. Without stopping, switch directions and make small circles in a clockwise direction.

Control the cadence so that you make one circle each second. Continue this exercise, switching between making clockwise and counter-clockwise circles, until you become fatigued, or 2 minutes, which ever comes first.

You know you are fatigued if you can not keep your shoulder blades squeezed together, if you hunch your shoulders, or if you can not hold the ball against the wall. Perform 3 sets, but do not go longer than 2 minutes for each set.

Repeat this procedure for the other arm.

Primary Shoulder Blade Stabilizing Exercises

The second group of exercises, the Shoulder Blade Stabilizers, is designed to strengthen the muscles that control how your shoulder blades move. These muscles are found in the middle of your upper back and along your sides. When these muscles contract, they cause your shoulder blades to rotate or slide across your back. They work in coordination with the rotator cuff muscles to control the movement of the shoulder. If these muscles are weak, you can put too much stress on the rotator cuff when you swim.

Exercise #4 – Theraband Rowing

Equipment: One moderate resistance Theraband.

The Movement: Theraband rowing strengthens the muscles that hold your shoulder blades in place. These muscles are important in helping your shoulder joint to move when you swim.

First, make a loop with the Theraband and tie the ends together. The loop should be about 2 feet long. Attach the loop to a doorknob or some other stationary object that will not move when you pull on the Theraband. Sit on a bench or at the edge of a chair. Position the chair so that when your arms are extended in front of you the Theraband is just taut.

Sit with an upright posture, and lift the chest to help set the shoulder blades in the proper position. Do not hunch the upper back or shoulders.

Pull your hands toward your body. Keep your elbows in and pull your hands to a point between your belly button and your rib cage. Make sure you lead the pull with your elbows. Your palms should be facing upward when you pull towards your chest. See the figure below for proper start, middle and finish positions.

Remember to focus on squeezing the shoulder blades together with each row and maintaining this contraction for the entire exercise.

Maintain a comfortable cadence, completing 1 complete repetition every 2 seconds. Count to yourself 1-and-2-and, 1-and-2-and taking one second for the contraction and 1 second as you return to the starting position. Perform 3 sets of this exercise. Each set should end when you become fatigued or reach 2 minutes of exercise. Take 30 seconds rest between sets and strive for completing 3 sets of 2 minutes each. Like the other exercises, fatigue is indicated when your posture slumps, or you cannot keep your shoulder blades pinched together.

Exercise #5 – Hitch Hiker

Equipment: No equipment is needed for this exercise, but as you get stronger, you can use some very light weights. You can make your own weights by filling two small water bottles with sand. These should weigh less than 2 pounds, even for the strongest swimmers.

The Movement: The Hitch Hiker exercise strengthens the muscles that control your shoulder blades as well as your rotator cuff muscles. You can exercise both sides of body at the same time, or choose to do one arm at a time.

Lay on your stomach on the floor. Relax your head and keep it in line with your spine. Put your arms straight out to your sides with your thumbs pointing to the ceiling (It looks like you are hitch-hiking).

While squeezing your shoulder blades together, lift your hands up off the floor and move them slightly towards your head. Use both arms at the same time. You should end up in a position that looks like a “Y” at the end of the exercise. Hold this position for 1-2 seconds and then relax to the starting position. Repeat.

Try to perform this exercise for 2 minutes. If you cannot continue the exercise for 2 minutes, that’s okay. When you become fatigued and can no longer maintain your form, rest for 30 seconds. Perform your second and third sets the same way.

If you reach the point where you can complete 3 sets of 2 minutes, perform the exercise while holding some small weights (less than 2 pounds) in your hands. Remember, you can make your own weights by filling small water bottles with sand, and you can also perform this exercise with one arm at a time.

Exercise #6 – Push Ups with a Plus

Equipment: None.

The Movement: This push up exercise strengthens your chest muscles like a normal push up, but there is an added motion at the end that strengthens one of the muscles that stabilizes your shoulder blades. There is a progression to this exercise, which means you will first perform the exercise against a wall while standing. As you get more advanced you can do this exercise while on your knees and then finally in a traditional push-up position.

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To start this exercise, stand at arms length away from a flat wall. When you stand up straight your palms should touch the wall. The hands should be shoulder-width, or slightly wider than shoulder-width, apart.

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Allow your chest to move towards the wall, as you would into a normal push up position. Once you are in the “down position” push away from the wall. It is important to do this slowly so your hands never lose contact with the wall.

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When you reach the normal ending position for a push up you want to keep going. This is where the extra action comes in. Continue pushing so that your shoulders rotate forward a bit. It should feel like the center of your back is farther away from the wall than your shoulders, as if you are raising your back like an angry cat. This is the extra motion that strengthens the stabilizers of your shoulder blade.

Hold this position for 2 seconds and repeat the action. Continue each set until you fatigue and start to lose form or until you reach 2 minutes, which ever comes first. Complete 3 sets, resting 30 seconds between each set.

As you become stronger, perform the same exercise when kneeling on the floor.

And eventually you will be able to perform normal push-ups with the extra motion.

Primary Core Strength Development

The third series of exercises focuses on developing strength in your abdominal and lower back muscles. These are some of the core muscles of your body. The muscles in the core of your body are essential for helping you maintain balance in the water when you swim. Balance is one of the most important skills you can develop. With weak abdominal and lower back muscles you will not be able to achieve a sufficient level of balance using your core. If you are like most swimmers, you will then try to achieve balance by changing your arm position or your stroke pattern. This places added stress on the shoulder and can lead to shoulder problems. There are many abdominal and lower back exercises you can do to strengthen these muscles. We will show you two of these exercises.

Exercise #7 – Dead Bug

Equipment: None.

The Movement: The Dead Bug exercise strengthens your abdominal muscles and gets its name because if you do it correctly you will look like a bug that is flipped over on its back waving its legs in the air.

Lay on the floor and put your hands under your tailbone.

Tighten up your lower abdominal muscles by trying to pull your belly-button in towards your spine. This will help you avoid excessive arching in your lower back. It is important to keep your back FLAT on the floor at all times.

Lift your legs off the floor and perform a light “flutter kick.” Continue this movement for 2 minutes or until you can no longer keep your lower back flat. See the figures below for proper positioning.

When you master this technique, you can remove your hands from under your tailbone and perform a flutter kicking like movement with your straight arms.

This form of the exercise (using the arms) is more difficult. You must make sure you do not allow the lower back to arch very much to avoid injury and work the appropriate muscles.

Exercise #8 – Quadruped

Equipment: None.

The Movement: It’s called the Quadruped exercise because initially you resemble an animal walking on all fours. When performing this exercise you will strengthen muscles in the lower back and abdominal region and foster strength development between the two sides of your body.

Start this exercise with your hands and knees on the floor. Get into a “table-top” position by flattening out your back.
There should not be an arch in your back, nor should there be a dip. This will require tightening up your abdominal and lower back muscles. Think about pulling your belly-button in towards your spine.

Once you’ve achieved the proper starting posture, simultaneously lift your left arm and right leg – straightening them out so they are parallel to the floor. Hold in this position for a second making sure you maintain a flat back.

Slowly bring the hand and knee back to the floor. Repeat the action lifting the right arm and left leg.

Alternate in this fashion for 2 minutes or until you become fatigued. You are fatigued if you cannot lift the arm or leg parallel to the floor or if you are not able to maintain your flat back posture. Perform 3 sets with 30 seconds rest between each set.

As you become more experienced, try performing the exercise while closing your eyes. This will force you to use your postural muscles to a greater level while developing balance and stability.

Stretching
We have talked a lot about strengthening muscles so far. However, stretching is also important to make certain you can use your newfound strength.

Strengthening + Stretching = Function.

By combining the strengthening and stretching exercises, you will help reduce the likelihood of shoulder injury when you swim.

Exercise #9 – Hamstrings Stretch

Equipment: Towel

The Movement: The Hamstrings Stretch engages the group muscles in the back of your thigh. These muscles, the hamstrings, help you bend your knee and also are involved in straightening out your hip. They have a lot of control over the position of your pelvis and therefore impact your body position and balance in the water. You are much better able to control your balance in the water if your hamstrings are loose. This exercise is designed to help you stretch these muscles.

Lay flat on your back on the floor.

Keeping the leg that is not going to be stretched flat on the floor, loop the towel around the ball of your foot. Gently straighten your leg, and pull it towards your body. Do not lock your knee. A slight bend in the knee is necessary for safety reasons, but it should not be bent a lot.
Keep your pelvis on the floor and do not rotate you body to help you get your leg closer to your torso. Pull until you feel a moderate stretch in the back of your thigh and hold that position for 30 seconds.

Perform the stretch 2 times on each leg. You should not feel pain in this stretch or in any stretch. If you feel pain stop the stretch immediately.

Exercise #10 – Upper Back Stretch

Equipment: None.

The Movement: The Upper Back Stretch targets the trapezius (tra-peez-ee-us) muscle, which connects your neck and your middle back to your shoulder blades. Good flexibility is needed in this muscle in order for the shoulder blades to move normally. This exercise is designed to stretch the upper part of the trapezius muscle since it tends to get tight in swimmers, and a tight muscle may contribute to shoulder pain.

Stand up straight and push the palms of your hands together in front of your chest.

Push your hands straight away from your body while continuing to squeeze your palms together. Try to keep your shoulders from moving upward towards your ears by pushing straight away from the body. Continue to push your hands away from your body until you feel a moderate stretch in your upper back and between your shoulder blades. See the front, side and back views of the stretch below.

Hold this position for 30 seconds and repeat after a 15-second rest. Be sure to breathe (do not hold your breath!) as you perform this exercise.

Exercise #11 – Neck Stretch

Equipment: None.

The Movement: The Neck Stretch is another way to stretch the muscles of your upper back. This stretch targets the upper trapezius muscle.

Stand up straight and do not roll or hunch the shoulders. Place one arm in the small of your back. The elbow should be bent so that the forearm is parallel to the floor. Press your arm into the small of your back to provide some stability for the movement, but you do not have to “grab on” to anything.

Place the other hand on the top of your head. Gently guide your head towards your shoulder, bending it to the side until you feel a moderate stretch on the opposite side of your neck. Remember, bring your head to your shoulder and do not raise the shoulder to meet the head.

Hold this position for 30 seconds. Rest 15 seconds, then repeat.

You can also stretch a different part of the muscle by looking at the armpit of the pulling arm.

Try both to stretch as much of the muscle as possible.

Perform the same stretch on the other side of your body.

Swimmer’s ear symptoms are usually mild at the onset of swimmer’s ear, but they may get worse if the infection isn’t treated or spreads.
First signs and symptoms
 Itching in ear canal
 Slight redness of skin in ear canal
 Mild discomfort
 Some drainage of odorless fluid
Moderate disease progression
 Redness of skin
 Excessive fluid drainage
 Discharge of pus
 Pain that worsens on moving your outer ear (pinna, or auricle) or pushing on the little “bump” (tragus) in front of your ear
 Feeling of fullness in your ear
 Decreased or muffled hearing
Severe disease progression
 Severe pain
 Swelling in your ear or lymph nodes in your neck
 Redness or swelling of outer ear
 Scaly or flaking skin of outer ear
Treatments and drugs
By Mayo Clinic staff
The goal of treatment is to stop the infection and allow your ear canal to heal.
Cleaning
Your doctor will use a suction device or ear curette to clean away any discharge, clumps of earwax, flaky skin and any other debris. Cleaning is necessary to help medications get to the infected areas of the skin.
Medications
Your doctor may prescribe eardrops that have some combination of the following ingredients, depending on the type and seriousness of the infection:
 Acidic solution to replicate your ear’s normally acidic, antibacterial environment
 Steroid to reduce inflammation
 Antibiotic to fight the bacterial infection
 Antifungal medication to fight a fungal infection
Ask your doctor about the best method for taking the medication. Some ideas that may help include the following:
 To reduce discomfort of relatively cold drops in your ear, you can warm the eardrop solution by holding the bottle in your hand for a few minutes to bring it closer to your body temperature.
 If possible, have someone else put the drops in your ear.
 Lie down on your side with the infected ear up to help the medication travel to the site of the infection in your ear canal.
 Put a cotton ball in the “pocket” of your outer ear to absorb any excess fluid after you sit or stand up.
 If your ear canal is blocked by inflammation or excess discharge, your doctor may insert a wick that helps transport the medication into the ear canal.
If the infection is more advanced or doesn’t respond to treatment with eardrops, your doctor may prescribe oral antibiotics.
Other treatments
You will need to keep your ear dry and avoid any irritation of the ear while you’re treating swimmer’s ear.
 Don’t swim or scuba dive.
 Avoid flying.
 Don’t wear an earplug or hearing aid before pain or discharge has stopped.
 Avoid getting water in your ear canal when bathing. Use a cotton ball coated with petroleum jelly to protect your ear during baths.
Prevention
By Mayo Clinic staff
Follow these tips to avoid swimmer’s ear:
 Keep your ears dry. Dry your ears thoroughly after exposure to moisture from swimming or bathing. Dry only your outer ear slowly and gently with a soft towel or cloth. Tip your head to the side to help water drain from your ear canal. You can dry your ears with a blow-dryer if you put it on the lowest setting and hold it at least a foot (0.3 meter) away from the ear.
 At-home preventive treatment. If you know you don’t have a punctured eardrum, you can use a homemade preventive eardrop before and after swimming. A mixture of 1 part white vinegar and 1 part rubbing alcohol may help prevent the growth of bacteria and fungi that can cause swimmer’s ear. Pour 1 teaspoon (5 milliliters) of the solution into each ear and let it drain back out. Similar over-the-counter solutions may be available at your drugstore.
 Swim wisely. Avoid swimming in polluted water.
 Avoid putting foreign objects in your ear. Never attempt to dig out excess or hardened earwax with items such as a cotton swab, paper clip or hairpin. Using these items can pack material deeper into your ear canal, irritate the thin skin inside your ear or scratch the skin.
 Protect your ears. Avoid substances that may irritate your ears, such as hair sprays and hair dyes. Or put cotton balls in your ears when applying these products.
 Use caution after ear infection or surgery. If you’ve recently had an ear infection or ear surgery, talk to your doctor before you swim.