Hackett's shoulder surgery

: >From reading the accounts in the Aussie papers, I surmise that Hackett
: had a typical, garden variety impingement-type rotator cuff tendon
: injury. He intends to return to high volume training at an early time,
: which may be a mistake, as his big problem will be recovering from the
: pre-existing damage to the tendon (as opposed to recovery from the
: surgery itself, which won't take too long). The problem is that the
: blood supply to the superior rotator cuff is very poor, and, as in the
: case of a diabetic foot ulcer, healing takes a very long time. If he
: pushes too much/too soon, he'll jeopardize his chances of being in top
: shape for the World Championships in 2007.

It's been a year now since my rotator cuff surgery and I am still in pain
from time to time. It doesn't hurt while I swim, but it usually does that
evening and the next day. And I'm not in the World Championships, by a long
shot!

Pat in TX

Hi Pat, I've thought/wondered about you and your sore shoulder. My
older kid just had arthroscopic surgery on her right shoulder. She'd
had her left shoulder "done" at age 14 and had no more problems, but
has had off and on debilitating pain on the right (we have a familial
"Type II" acromion which produces more than the average amount of
impingement and really needs to be surgically modified to make it
compatible with the demands of serious swimming). Owing to the
advances in technology, this time we got a DVD of the whole procedure.
I've got the kid's permission to post it on my swimming website as a
somewhat unique "swimming video." I hope to do so soon, as it is
instructive -- both to illustrate the precise nature of the damage in
typical rotator cuff swimming shoulder and also what the orthopedic
surgeon does to correct the underlying problem.

- Larry W

: Hi Pat, I've thought/wondered about you and your sore shoulder. My
: older kid just had arthroscopic surgery on her right shoulder. She'd
: had her left shoulder "done" at age 14 and had no more problems, but
: has had off and on debilitating pain on the right (we have a familial
: "Type II" acromion which produces more than the average amount of
: impingement and really needs to be surgically modified to make it
: compatible with the demands of serious swimming). Owing to the
: advances in technology, this time we got a DVD of the whole procedure.
: I've got the kid's permission to post it on my swimming website as a
: somewhat unique "swimming video." I hope to do so soon, as it is
: instructive -- both to illustrate the precise nature of the damage in
: typical rotator cuff swimming shoulder and also what the orthopedic
: surgeon does to correct the underlying problem.
:
: - Larry W

I appreciate your interest. I was diagnosed with "chronic impingement
syndrome" after the MRI. I had a full-thickness tear of the rotator cuff
anteriorly and a small tear of the labrum anteriorly. The report says he did
a "generous subacromial decompression", removed soft tissue from the
underside of the acromion with acromioplasty as well as shaving off the torn
portion of the labrum. And, he cut the coracoacromial ligament. Add to that
some arthrotomy, suture anchors reattaching the edge of the rotator cuff,
and Ethibond, and that was that!

Of course, that was my left shoulder and in the back of my mind is concern
over the right shoulder! I have had knee and ankle operations from playing
soccer, and they were minor compared to this shoulder rehabilitation. I had
the operation in November and was finally allowed back into the pool in
June. I am concentrating on having my fingers entering the water so that the
thumb does not enter first. I am under the impression that rotating the
hand so that the thumb enters first tends to close off the shoulder space a
bit more. Maybe you could tell me if I am wrong about that....

Pat in TX

Quoted message said:

Quoted message said:

I am under the impression that rotating the

hand so that the thumb enters first tends to close off the shoulder
space a
bit more. Maybe you could tell me if I am wrong about that.... <<

You are correct. 75% of all impingement occurs during recovery and
entry.

What you want to do is to feather your recovering hand immediately
after it exits the water to begin recovery. The idea is to recover
with your thumb facing upwards, rather than downwards. Then you want
to enter thumb up/pinky first (or, at a minimum, with a flat hand).
Under no circumstances to you want to recover with the back of your
hand facing your ear (thumb down recovery) or enter thumb down.

In the clip below, the swimmer in the bottom lane is doing it wrong and
the swimmer in the next to the bottom lane (Auburn's Adrienne Binder;
third fastest all time 1650) is doing it right.

I refer to the "feather" recovery as the Birmingham Feather, after the
Australian swim coach (Paul Birmingham) who invented it (while coaching
at the Golden West Swim Club, here in Huntington Beach, CA, 5 years
ago).

The clip below must be accessed using the Explorer browser (Mozilla
won't work) and Windows Media Player.

Note particularly the LEFT HAND position during recovery of the two
swimmers (bottom swimmer no good; swimmer above bottom swimmer good).

http://weisenthal.org/swimming/Birmingham_Feather_Binder.wmv

- Larry W

: What you want to do is to feather your recovering hand immediately
: after it exits the water to begin recovery. The idea is to recover
: with your thumb facing upwards, rather than downwards. Then you want
: to enter thumb up/pinky first (or, at a minimum, with a flat hand).
: Under no circumstances to you want to recover with the back of your
: hand facing your ear (thumb down recovery) or enter thumb down.
: - Larry W

I have been changing the attitude of my hands after they exit the water so
that the thumb faces upward. The entry has been a bit tricky, because I seem
to revert to entering the water with all the fingers at the same time--and
maybe that isn't all bad (?). I have noticed tiredness in my triceps while
practicing these things. However, my big eye-opener was when I started to
apply these principles to the backstroke. I realized I had been turning my
hand so that the thumb was nearest my ear when the hand entered the water
and my pinky fingers were entering the water first.

I have been working on changing that entry so that at least the back of my
hand is entering the water. This has proved to be difficult for me to
sustain. And, I am feeling tiredness in the muscles of my lower arm. I am
sure that's not a bad thing--the muscles will cope over time.

Do you have any advice for the backstroke?

Pat in TX
: