Chiropractic and swimmer’s neck
I was never a great swimmer. In fact, I had a fear of water most likely related to the archaic teaching methods back in the 70’s which essentially involved pushing you when you least expected it.
Whenever I had to swim for school purposes, I recall struggling to find a smooth breathing rhythm. As a result, my stamina was not good.
Furthermore, my style was unorthodox. I would thrust my head upwards and forwards and then bring it around the left (never the right) before diving it back under the water again.
Suffice to say my neck suffered and I soon gave up.
Hi, this Dr. Andrew Arnold from Back In Motion Cranbourne.
I want to talk about my swimming journey and how I overcame ‘swimmers’ neck.
About 5 years ago I decided to improve my swimming. I joined my local swimming venue and started laps. At first it was the same old problem. My technique sucked and my neck was in pain. In fact, my entire left neck and shoulder complex was in constant spasm and pain.
As a Chiropractor, the first thing I did was look at the research, the best available evidence.
“Most injuries and complaints encountered in swimming athletes occur because of repetitive microtrauma or overuse, with many injuries originating from faulty technique and poor swimming biomechanics.”  The neck is subjected to sustained and repetitive movements and this can lead to overuse injury. The mechanism is thought to be related to the increased flexibility in the neck and shoulders from multiple lap swimming. For example, is a swimmer takes 5000 strokes per session and they breathe every 3 strokes then the swimmer would be turning their head 1667 times to breath per session. What’s interesting is that this is complicated with unilateral neck rotation such as in my case and that creates significant muscle imbalances over time. .
Furthermore, deviating the head from the axis of rotation i.e., looking or breathing forward repetitively can cause unnecessary neck problems due to the neck adopting an extended and rotated position, which is known to stress the neck, again as in my case.  The resultant overuse of a hyperextended cervical spine can predispose the athlete to cervicogenic based headaches. [3,4].
It is thought neck over-rotation loads cervical spine ligaments and muscles, which encourages asymmetrical development. The face emerges from the water into an air pocket at the bottom of the bow wave, which is created by the head pushing through the water in the same manner as a boat. Due to the protection of the bow wave, swimmers only need minimal rotation of the head to obtain a breath . Poor body rotation results in over-rotation of the neck to breathe. If the body is well rotated along its long axis, then there is no requirement for the neck to over-rotate.
I definitely had poor body roll and as result this was contributing to a habit of breathing unilaterally.
One study “showed increased left cervical rotation in left unilateral breathers after training.”  This would imply less cervical rotation to the right. Such muscular imbalance was possibly aggravated by forward head carriage, as the axis of rotation changes resulting in greater body and cervical side bend and extension to compensate for lost rotation range of motion  Conversely, breathing to the “bad” side may not rotate the body enough potentially contributing to over-rotation of the neck.
So, the research supports bilateral breathing.
My next step was to watch other swimmers, the squad guys. I sat on the side at my local pool and watched the squad team do lap after lap. I got on YOUTUBE and watched the Olympians. My focus was freestyle and after a while I began understanding what my school swim teachers failed to teach me.
- Bilateral breathing
- Body rotation
I made a pact to swim 3x per week every week no matter what and my goal was 40x25m with only one break. That was 5 years ago. At first it was clumsy. I needed to re-learn how to swim, to breath both sides, body roll and to apply a correct arm movement. It is clear unilateral breathing caused what is known as ‘swimmers’ neck’. This is when your sterno-cliedo-mastoid muscles on one side is repeatedly twisted and shortened causing it to cramp and subluxate-fixate-sprain the upper cervical spinal joints where most of the neck motion is afforded. 
One lap at a time, slow it down and focus on technique. This is what I kept telling myself.
Of course, like any habit I just kept wanting to turn left so my next step was use a technique called ‘tapping’.
Tapping or EFT (emotional freedom techniques) is used to re-program the brain for all sorts of reasons, from phobias to addictions, from trauma recovery to improving sport performance.  At the end of each lap, I stopped and tapped* engraining my new-found technique in my neurology. It was working.
After 3 weeks bilateral breathing was getting easier. I was on my way to reaching my goal.
My next challenge was equipment. I needed the right gear to support my new practice.
- Resistance band exercises.
- Hand paddles - speedo
- Thigh spacer floatation device.
- Good ear plugs – speedo, Doc’s pro-plugs
- Good google – speedo, vista.
- Paddle board.
I started developing chronic swimmers’ ear which led to ear infections and tinnitus. After professional ear cleaning and medically prescribed drops a patient at my practice suggested ‘doc’s pro-plugs’. I haven’t looked back. These comfortably plug my ears without pushing wax deep inside. I have also found speedo’s ear plugs just as effective.
TIP: apply a small amount of Vaseline to the plug to help avoid skin irritation and keep the water out.
Next was eye wear. Most goggles are just too small. The skin around our eyes is very thin and sensitive and some rubbers can irritate this. I started using a larger goggle called ‘Vista’. Seals beautifully and instantly and comfortably.
TIP: Apply a little Vaseline to the inside lens, use a towel to wipe. Helps prevent fogging up so you can keep your eye on the blue line)
At this point I was starting to knock over 10 or so laps without a break, but not reaching 40 which was my goal.
Again, I looked to the internet and noticed swimmers using hand paddles. These not only provide momentum in the water, but they also help keep your technique in form not to mention building endurance.
Other equipment I recommend include a thigh floatation spacer. This helps you focus on upper body strength and helps keep your entire body on top of the water. Conversely, a paddle board helps you focus on your leg kicking. The added addition of flippers will also help your lower limb endurance.
A swim caps for a great for glide thru the water and the proper swim attire of course. It is worth investing in decent togs. You don’t want baggy, saggy, floppy, clingy bathers, trust me!
So, with the right kit right and the proper technique I was on my way to my goal, 40 x 25m laps with one break.
Let’s fast forward to today.
I now swim 80x25 (or 50M if available) without breaking or breaking a sweat. My record is 4km non-stop using paddles. I bilaterally breath effortlessly and easily and just love it. It’s a meditation for me.
My next challenge is 5km in 90 minutes.
I incorporate a high-level interval (HIT) approach, i.e., fast, and slow laps and add some breaststroke.
I also weight train, specifically using swim technique targeted resistance band exercises, but that’s for another article. Remember, swimming is non-weight bearing and therefore does little to help build bone strength. Specific swim gym techniques are a great adjunct, and necessary.
TIP: Make sure you use an anti-chlorine shampoo in the shower room afterwards. Helps keep your hair and skin healthy.
Good luck with your swimming journey and remember, always breath both sides.
*Head points, mainly temples, above the eyes, above and below the mouth.
About the author
Dr Andrew Arnold is senior Chiropractor and Director, Back In Motion, Cranbourne.
 Pollard H, Fernandez M, Spinal Musculoskeletal Injuries Associated with Swimming: A Discussion of Technique, Australas Chiropr Osteopathy. 2004 Nov; 12(2): 72–80.
PMCID: PMC2051327, PMID: 17987215
 Wong A, The Effects of Training on Cervical Range of Motion between Unilateral Breathers and Bilateral Breathers in Collegiate Swimmers during Freestyle Swimming, PHYSICAL THERAPY SCHOLARLY PROJECTS, University of North Dakota, 1997, Scholarly Project, Master of Physical Therapy (MPT)
 Sjaastad O. Cervicogenic headache: the controversial headache. Clin Neurol Neurosurg 1992; 94Suppl:S147-9. 24.
 Bogduk N. The Anatomical Basis for Cervicogenic Headache. J Manipul Physiol Therapeut 1992; 15(1):67-70.
 Chek P. Stabilisation for Propulsion: Abdominal training for Swimming. The Official Magazine of the Strength and Conditioning Association 1996; 4(3):18-21.
 Guth EH. A Comparison of Cervical Rotation in Age-Matched Adolescent Competitive Swimmers and healthy Males. J Orthop Sport Phys Ther 1995; 21(1):21-7
 Ferrell MC. The spine in swimming. Clin Sport Med 1999; 18(2):389- 93.
 Church D, The Effect of EFT (Emotional Freedom Techniques) on Athletic Performance: A Randomized Controlled Blind Trial, The Open Sports Sciences Journal, 2009, 2: 94-99, Foundation for Epigenetic Medicine, 1490 Mark West Springs Rd, Santa Rosa CA 95404, USA, Electronic publication date 31/12/2009, [DOI: 10.2174/1875399X00902010094]