Aswimmer’s stroke technique may be altered to reduce the likelihood or severity of a potential impingement between the rotator cuff and the coracoacromial arch and an episode of SS (Bak & Fauno, 1997; Baum, 1994; Chang, 2002; Costill, Maglischo, & Richardson, 1992; Johnson, Gauvin, & Fredericson, 2003; Koehler & Thorson, 1996; Loosli & Quick, 1996; Maglischo, 2003; Mayo Clinic, 2000; Pollard & Croker, 1999; Reuter & Wright, 1996; Tuffey, 2000; Weisenthal, 2001). These changes could include several elements, from head position through hand-pull pattern. Specific modifications or technique methods that can reduce the chance of impingement include:
- Encourage adequate body-roll of the trunk, shoulder through hip (45° to 100° from the long axis in both directions), while swimming (Costill, Maglischo, & Richardson, 1992; Johnson, Gauvin, & Fredericson, 2003; Mayo Clinic, 2000; Tuffey, 2000).
- Ensure that swimmers are breathing to both sides in order to facilitate a greater degree of body-roll to both sides (Bak & Fauno, 1997; Costill, Maglischo, & Richardson, 1992; Johnson, Gauvin, & Fredericson, 2003; Mayo Clinic, 2000; Tuffey, 2000).
- Rotate the hips and shoulders as with the arm pull to allow a freer range of shoulder motion, allowing the elbow to stay lower or closer to the water during the recovery phase but still keeping the hand lower than the elbow (Baum, 1994; Koehler & Thorson, 1996; Mayo Clinic, 2000).
- Teach a hand entry and pull pattern that stays outside the midline of the long axis (Johnson, Gauvin, & Fredericson, 2003; Koehler & Thorson, 1996; Mayo Clinic, 2000; Weisenthal, 2001).
- Teach a fingertip or little-finger-first hand entry, as opposed to a thumb first entry (Johnson, Gauvin, & Fredericson, 2003; Weisenthal, 2001).
- Encourage a technique of eyes-down swimming or a neutral head-position, looking at the bottom of the pool instead of the wall ahead of the swimmer (Johnson, Gauvin, & Fredericson, 2003; Tuffey, 2000).
- Encourage a hand-exit at or slightly behind the beltline (Johnson, Gauvin, & Fredericson, 2003; Pollard & Croker, 1999; Weisenthal, 2001).
- Promote establishing a finger-tip down, high-elbow hand position before rearward force is applied to the water; move to a catch position first, then perform the push (Maglischo, 2003; Mayo Clinic, 2000; Weisenthal, 2001).
