4 Reasons Swimming May Be Causing Your Shoulder Pain

I never used to enjoy swimming.  I would sink like an anchor whenever I tried and would be envious of other people I saw who floated effortless through the water.  Can some of you relate?

3 years ago, I began my journey into triathlon racing.  At first, I could barely swim a single length of 25m without being totally gassed!  Online information and videos helped me piece together an understanding of proper swim technique and slowly I got better and better.

But then I joined a Masters swim squad locally and after a few weeks of intense volume that I was not accustomed to, I got injured.  A shoulder injury to be precise.  Part of the reason of course was that I was not prepared to do 90-minute practices of over 3000m.  But as I delved more into swimming technique, I realized that my stroke was still flawed and the combination of poor technique and excessive volume were holding me back.

Here are the 4 freestyle stroke flaws that may be hurting your shoulder as well!

  1. Crossing the midline – I see this alot when I observe people during lane swimming at the community centre.  Imagine a line that cuts your body into equal left and right halves that extends from your head down to the feet.  As your arm recovers over the water and extends forward into the catch phase of the stroke, it should not cross the midline.  Instead, the arm should line up with your shoulder joint.  When you cross over, you place excessive stress on your shoulder joint and can create impingement pain.  If repeated hundreds of times while swimming laps, it will start to wear down on your rotator cuff tendons.  
  2. Thumb first vs fingertips first entry – This is also commonly seen in swimmer and makes Problem #1 above even worse.  A thumb-first entry results in excessive internal rotation of the shoulder further aggravating the impingement.  Conversely, focusing on a fingertip entry so that the hand enters in a more neutral shoulder position will greatly help prevent shoulder problems and set you up for a more effective catch and pull.   

    Nice finger tip entry!

  3. Pushing down on the water – Not only does pushing down with your extended arm result in a less effective pull through, it also puts a large stress on the shoulder joint.  It also has the effect of lifting your head and torso up while sinking your legs down thereby creating more drag in water.

    This swimmer has pressed her arm straight down to the bottom!

  4. Pulling through with a straight arm – Too much stress is placed on the shoulder joint when a straight arm is used to pull through the water.  While you might think that using a ‘bigger paddle’ will be more effective, it creates more stress on your tiny rotator cuff muscles.  Instead, a proper bent arm pull will engage larger muscles like your pecs and lats to help generate the pulling force.  You may see some Olympic sprinters very effectively pulling with straight arms but remember you are not an Olympian with freakish body genetics!  For the average Joe/Jane swimmer, sticking with safe biomechanics is a better idea.

If you have been having shoulder issues from swimming lately, then it is quite likely that there is something wrong with your stroke that is causing the problem.  Have someone watch you while you swim both above the water and below to give you some critical feedback.  If you can, a video recording is very instructive.  A GoPro camera or even some of the latest smartphones which are waterproof can be used.   When I developed my own shoulder pain from swimming it was extremely frustrating and took almost two months of minimal swimming and rehab.   As always, prevention is the best medicine!

Now that I’ve fixed my own stroke flaw (I was pulling with a straight arm), I am swimming pain free with greater efficiency and for longer distances.

Athletes understand athletes…until next time!

Dr. Keith




Pain Medication vs. Acupuncture for Sports Injuries

When it comes to sports injuries, I’ve been on both sides of the fence; being the injured athlete in pain and disabled and being the doctor/therapist treating the athlete.

It’s certainly no fun to be hurt.  And it’s also no fun to be sidelined from the sport you love because of pain and injury.  What do you do?

For many athletes, whether they are a professional, amateur or weekend warrior, the common response is to open up the cabinet and reach for the pain medication.  It could be the over-the counter variety like Tylenol, Advil, Aleve, etc, or it could be prescription type like Tylenol#3, Oxycontin or Percocet from your medical doctor.

Now I’m not saying it’s wrong to take pain medications…there is a time and place for these.  But I will say that they should not be relied on solely to help alleviate pain and restore the injured athlete.

This is where acupuncture can play a vital role in the treatment of athletic injuries.  Because acupuncture can not only relieve pain by desensitizing nerve endings and reducing swelling and inflammation but also stimulating your body’s healing mechanisms to repair damaged tissue.

What are the important differences between acupuncture therapy and pharmaceutical therapy?  Acupuncture works at the level of the injured tissue, the spinal cord level to block pain signals and the brain level to change the perception of pain.  Importantly, it starts by fixing the damage first and as the tissue heals, the pain naturally subsides.

This occurs because inserting an acupuncture needle in the area of an injury stimulates the immune system and blood circulation resulting in more oxygen, nutrients and immune repair cells delivered to the injury site.

In contrast, pain medications can block the pain signal at the spinal cord level or brain centres to quickly take away the sensation of pain, but the tissue damage is still waiting for the supply of nutrients and oxygen that is required for healing.

The danger then is for athletes to use pain meds or even worse, steroid injections, to suppress the pain.  They then return too quickly to training and competition and the tissue damage becomes more severe.  The athlete is lulled into a false sense of belief that he is ‘ok’ when he truly is not and soon an acute injury become a chronic one that puts him/her out of action for an even longer period of time.

Who would’ve thought that these little needles could do so much?

Dr. Keith


Laser Therapy for the Treatment of Sports Injuries

It’s a new year and a good time to get off to a new start by tackling some of your nagging, chronic sports injuries!

Assuming you weren’t just flopping, we can help take care of your sport injuries!

2013 also marks my 10th year of clinical practice in Richmond Hill and during this time I’ve had the pleasure of treating weekend warriors, exercise enthusiasts and amateur athletes with things like:

  • ACL tears
  • Mensicus injuries
  • Rotator cuff tendonitis
  • Muscle contusions
  • Achilles tendonitis
  • Plantar fasciitis
  • Tennis elbow
  • Sprained ankles
  • Patellar tendonitis
  • ITB syndrome
  • and more!

It’s been exciting to help all these active folks get back to enjoying what they love and competing successfully again.  The most successful outcomes have always been when we’ve worked as a TEAM and each doing our parts to get the injury under control and the healing going in the right direction.

My main tools of therapy have always been a combination of BIOFLEX laser therapy, Graston technique, myofascial release, acupuncture and rehabilitative exercise.  They work so well together because they address 3 key issues in injury management:

  1. resolution of inflammation and pain
  2. promotion of tissue regeneration
  3. remodelling and strengthening of injured tissues

Laser therapy and acupuncture work to affect #1 and #2 while soft tissue techniques like Graston technique, ART or myofascial release and rehab exercises affect #3.

The following are some clinical case studies on the use of BIOFLEX laser therapy at the Meditech clinic for various sports injuries:

Case 1

Diagnosis: Partial tear of the right hamstring muscle origin with an associated extensive hematoma

History: The patient is a 52 year old male golfer who injured his right hamstring muscle while forcefully rotating in the course of a golf swing.  The result – a tear accompanied by hematoma that continued to expand rapidly with accompanying tenderness, edema and complete loss of function of the extremity.  The pain was severe even at rest and the patient had difficulty sleeping, along with inability to engage in any meaningful physical activities.

Result: Following the administration of four laser therapy treatments over the course of seven days, there was a dramatic resolution of the hematoma along with the edema, tenderness and pain.  The patient was able to walk without difficulty and resume normal weight bearing activities.

Case 2

Diagnosis: Full thickness tear of the right supraspinatus tendon

History: The patient injured his right shoulder during a sudden movement utilizing the extremity at the gym.

Imaging results: An ultrasound study prior to the administration of laser therapy revealed a full thickness tear of the anterior and mid-fibres of the supraspinatus muscle at its junction with the tendon.  The defect measured 24 x 15 x 9 mm.

Result: After the administration of 13 laser therapy sessions over the course of two months, a follow-up ultrasound study indicated that the tear had diminished to less than 50% of its original dimension, measuring 10 x 4 mm.  The patient received 5 additional treatments and a second ultrasound study subsequently demonstrated that the rotator cuff injury was no longer visible.  It should be noted that the patient was asymptomatic and had a normal range of motion of the shoulder at this point despite having continued to perform normal activities throughout the course of treatment.

Case 3

Diagnosis: Bilateral synovitis of the knees along with tears in both medial menisci and the right lateral meniscus

History: The patient is a 16 year old male elite soccer player who presented with pain in both knees.  Symptoms had been present in the left knee for approximately 1 year and the right for several months.  The was no history of any significant knee injury.  The patient was unable to continue playing soccer; moreover symptoms precluded even minimal physical weight bearing activities.  The left knee lacked 15 degress of extension and the right 10 degrees.  Tenderness was noted over the medial and patellar compartments bilaterally.  No instability was noted.

Imaging results: An MRI of the right knee prior to his initial presentation revealed a horizontal tear of the body and anterior horn of the medial meniscus, with an adjacent parameniscal cyst measuring 2.7 cm x 4 mm.  In addition, there was a horizontal upper-surface tear at the anterior horn of the lateral meniscus.  A joint effusion was also reported.  The MRI of the left knee indicated a lower-surface tear at the anterior horn of the medial mensicus with an adjacent parameniscal cyst measuring 2.5 cm x 5 mm.  Similar to the right, a joint effusion was present.

Result: The patient was treated 5 times over the course of 6 days and re-examination revealed marked improvement characterized by reduced edema, decreased tenderness and a normal range of motion.  For geographical reasons, the patient was instructed in the use of a Home Bioflex System to continue treatment on alternate days at home.  The patient was able to resume training and competition within 2 months after the initial examination and continued to be asymptomatic.  Re-assessment demonstrated a normal range of motion, no existing tenderness or abnormalities.  A follow-up MRI of both knees 9 months after his initial examination indicated significant reduction in the extent of all meniscal tears and in the size of the associated cysts.  This patient had been offered a full soccer scholarship to a major US university and was able to accept the offer, as the knees were normal on clinical examination and he was completely functional.


The public is becoming increasingly aware of the availability of laser therapy for sports injuries.  Professional athletes and teams from the NHL, MLB, NFL, NBA, etc have been using laser in their locker rooms for years now.  After all, these athletes get paid big dollars to perform…not sit on the sidelines.  The same technology used for these elite individuals is also available to you and I have had the pleasure of being able to use it here at Meridian Wellness for the past 8 years.

If you have any questions as to whether laser therapy can help your condition or sports injury, give us a call or come in for a free 15 min consultation with me.

Happy New Year and Wishing You An Injury-Free 2013!

Dr. Keith


Laser Therapy Vs. Other Therapies

Ever since I started using laser therapy in my practice 8 years ago, my old ultrasound and electric stim machine has been progressively sitting more and more by the wayside.  In fact, for the last 4 years, I haven’t even turned the old device on….it just sits by the wall of one of my treatment rooms collecting dust and every now and then a patient will say: “What’s that machine for?”

Comparatively speaking, I haven’t found ultrasound or electric stim anywhere near as effective as laser therapy for pain and muscle, joint or nerve injuries.  That’s not to say laser therapy is 100% full proof because nothing is.  But I will say that I consistently get great results with laser on a wide variety of patient conditions.

Below is a great summary chart that compares the use of laser and other common therapies used in chiropractic, physiotherapy and massage clinics.

Laser therapy can be used to treat so many different effects, can treat so many different things and has so few precautions which makes it an ideal therapeutic tool.

If you are in Richmond Hill, Aurora, King City or Newmarket and haven’t tried laser therapy for your pain or injury, maybe it’s time to give us a call and see how we can help!

Dr. Keith

Chiropractic ‘Self-Defense’ Tips for Your Shoulders

As mentioned last week, “An ounce of prevention is worth a pound of cure.”  Continuing with my blog series on ‘Self-Defense Tips’ for different parts of the body, this week’s post deals with your shoulders.

All the joints in your body represent a trade-off between stability and mobility.  In the shoulder, it is clear that mobility is the primary characteristic.  Humans can move the shoulder easily in every direction.  This movement is achieve through a beautiful engineering design which involves 18 muscles and 3 bones.  But the price we have to pay for this freedom of movement is instability.  In fact, of all the joints in the body, the shoulder has the greatest risk of dislocation.  It is the intricate weave of connective tissue and muscle around the shoulder, that helps this joint glide and rotate without falling out of the socket!

You may have heard of the rotator cuff…a group of four muscles and tendons that surround your shoulder joint that are critical to the multidirectional movement and stability of the shoulder.  The large majority of shoulder injuries are either directly to the rotator cuff or are caused secondarily by a poorly functioning rotator cuff.  Tears to the cuff are common during extreme activity.  In middle age, rotator cuff injuries are mostly due to wear and tear of repetitive motion.  If you have a major tear, it will need to be surgically repaired.  Otherwise, tears can be rehabilitated with passive therapies like low intensity laser in combination with addressing muscle dysfunctions in the neck, upper back, chest and shoulder areas.

The following are your key Self-Defense Tips for Shoulder Health:

  1. Have your posture checked.  Gradual rotator cuff damage occurs if you have bad posture because the slouched position that many people have actually reduces the clearance for one of the tendons in rotator cuff.  This causes the tendon to be repeatedly irritated with various shoulder movements.
  2. Avoid doing too much overhead activities.  Anything that requires you to reach above your head alot will cause repetitive stress injury to the rotator cuff.  Things like volleyball, baseball, tennis are sports that commonly cause shoulder problems.  Occupations like electricians, drywallers, carpenters, etc. which require alot of daily overhead work also are at great risk for injury.  They key is to vary your activities as much as possible.  And make sure you stretch and strengthen related muscles to counteract the negative effects of overhead work.
  3. Avoid sleeping with your arm overhead…this is like combining the bad effects of #1 and #2.
  4. For any strenuous activity, keep your arms as close to your body as possible.  The further outstretched your arm is from your body, the greater the instabiliy of the joint and the greater likelihood of injury.
  5. Avoid barbell bench presses and shoulder presses when working out at the gym.  The solid bar limits the natural movement of the shoulder compared to dumbbells.  Plus, the classic press exercises all put your shoulder joint in the most dangerous and harmful position.  There are better exercises that will help prevent shoulder injury while still allowing you to get a good workout!
  6. If you regularly carry any sort of bag (purse, briefcase, backpack, etc.), make a conscious effort to switch shoulders periodically.  Most people have a regular habit of carrying bags only on their dominant side.  Over the long term, you will develop muscle imbalances that will eventually result in pain and injury to the shoulder as well as neck and back.

If you need preventative or rehabilitative treatment for shoulder pain, we are here to help in Richmond Hill!