Home 2009 February (Page 3)

Back Squatting with a Posterior Labral Tear?

Q:  I'm a baseball pitcher who was diagnosed with a posterior labral tear.  Since I was young and the doctor didn't feel that the tear was too extensive, he recommended physical therapy and not surgery.  I'm still training the rest of my body hard, but am finding that I can't back squat because it causes pain in the shoulder.  Any idea why and what I can do to work around this? A: It isn't surprising at all, given the typical SLAP injury mechanism in overhead throwing athletes.  If there is posterior cuff tightness (and possibly capsule tightness, depending on who you ask), the humeral head will translate upward in that abducted/externally rotated position.  In other words, the extreme cocking position and back squat bar position readily provoke labral problems once they are in place. The apprehension test is often used to check for issues like this, as they are commonly associated with anterior instability.  Not surprisingly, it's a test that involves maximal external rotation to provoke pain:

apprehension-test

The relocation aspect of the test involves the clinician pushing the humeral head posteriorly to relieve pain.  If that relocation relieves pain, the test is positive, and you're dealing with someone who has anterior instability.  So, you can see why back squatting can irritate a shoulder with a posterior labrum problem: it may be the associated anterior instability, the labrum itself, or a combination of those two factors (and others!). On a related note, most pitchers report that when they feel their SLAP lesion occur on a specific pitch, it takes place right as they transition from maximal external rotation to forward acceleration.  This is where the peel-back mechanism (via the biceps tendon on the labrum) is most prominent.  That's one more knock against back squatting overhead athletes. If you're interested in reading further, Mike Reinold has some excellent information on SLAP lesions in overhead throwing athletes in two great blog posts: Top 5 Things You Need to Know about a Superior Labral Tear Clinical Examination of Superior Labral Tears The solutions are pretty simple: work with front squats, single-leg work (dumbbells or front squat grip), and deadlift variations. If you have access to specialty bars like the giant cambered bar and/or safety squat bar, feel free to incorporate work with them.

And, alongside that, work in a solid rehabilitation program that focuses not only on the glenohumeral joint, but also scapular stability and thoracic spine mobility. Sign-up Today for our FREE Baseball Newsletter and Receive a Copy of the Exact Stretches used by Cressey Performance Pitchers after they Throw!

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What Really Constitutes Functional Balance Training?

Just a few days ago, a friend of mine passed along the link for a Reuters article reporting on a study that found that a 12-week Tai Chi intervention did not reduce the risk of falls in the elderly. This might be surprising to some, as one would think that any sort of physical activity would benefit untrained elderly individuals.  However, I wasn't surprised at the results at all, given all the research I'd done to prepare for The Truth About Unstable Surface Training.  And, I wasn't surprised at all when I realized that this had significant parallels to how we train balancing proficiency in athletes. It's important to understand first and foremost that balance and proprioception (and, therefore, stability at a certain point in time) are skill-specific.  In particular, one must appreciate that static balance - which is typical of Tai Chi - is markedly difference from dynamic balance, which we encounter all the time in everyday life and in the world of athletics. For proof, one mustn't look any further than when Drowatzky and Zuccato (1966) found little carryover from static to dynamic balance (1).  Tsigilis et al. confirmed this finding 35 years later (2). And, it's one reason why I feel so strongly that we have to qualify our unstable surface training (UST) recommendations.  UST necessitates a significant amount of static balance that may not transfer to sporting movements, which typically are more dependent on dynamic balancing proficiency.

From my e-book on the subject, "Previous research has demonstrated that scores on static balance tests are not useful information when attempting to predict inversion ankle injuries in soccer players (3). This lack of correlation implies that methods to improve static balance may not be effective training approaches to prevent injuries in dynamic sporting contexts - especially when dealing with athletes with no recent history of lower extremity injury." Now, we know that we can't train complete specificity 100% of the time.  Otherwise, in the elderly, we'd be trying to simulate every kind of fall that is possible.  And, in a football player, for instance, we'd be trying to simulate every kind of tackle a running back could possibly encounter.  So, what do we do?  Once again, we look to the research! In a study by Bruhn et al., a high-intensity strength training group actually outperformed the unstable surface training (static balance training) group on measures of static balance (4).  In other words, one group trained static balance, and the other didn't - and the one who didn't train static balance directly actually improved the most overall.  Maybe muscle cross-sectional area played into it?  Maybe it occurred because of increased stabilization via enhanced intra- and intermuscular coordination that would allow for more rapid and effective force production (strength and rate of force development)?  Maybe true specificity isn't as important as we thought?

Click here to purchase The Truth About Unstable Surface Training.

References 1. DROWATZKY, J.N., AND F.C. ZUCCATO. Interrelationships between selected measures of static and dynamic balance. Res. Q. 38:(3) 509-510. 1966. 2. TSIGILIS, N., E. ZACHOPOULOU, T. MAVRIDIS. Evaluation of the specificity of selected dynamic balance tests. Percept Mot Skills. 92(3 Pt 1):827-33. 2001. 3. KONRADSEN, L. Factors Contributing to Chronic Ankle Instability: Kinesthesia and Joint Position Sense. J Athl Train. 37(4):381-385. 2002. 4. BRUHN, S., N. KULLMANN, AND A. GOLLHOFER. The effects of a sensorimotor training and a strength training on postural stabilisation, maximum isometric contraction and jump performance. Int J Sports Med. 25(1):56-60. 2004. Sign-up Today for our FREE Newsletter and receive a deadlift technique tutorial!
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Plyometrics and Unstable Surface Training

Two weeks ago, I made it clear that a lot of folks were missing the boat with respect to baseball strength and conditioning by insisting that "plyos are all you need." And, last week, I discussed how strength and reactive ability have interacted in some successful players in professional baseball, and how those qualities should dictate how an athlete trains. This week, though, I'm going to throw you for a little loop and tell you that the static-spring continuum means absolutely NOTHING for a lot of athletes.  Why? You must first understand that each stretch-shortening cycle (SSC) activity involves three distinct phases: 1. eccentric (deceleration, preloading) 2. amortization (isometric, pause) 3. concentric (propulsion) phases. As I discussed in great detail in The Truth About Unstable Surface Training, Komi (2003) outlined three fundamental conditions required for an effective SSC action (1): 1. "a well-timed preactivation of the muscles before the eccentric phase" [we need our muscles to be ready to go to decelerate] 2. "a short and fast eccentric phase" [deceleration has to occur quickly, as the faster the rate of stretch, the more energy the musculotendon complex stores] 3. "immediate transition (short delay) between stretch and shortening (concentric) phases." [if we spend too much time paused at the bottom, the stored energy is lost as heat instead of being used for subsequent force production] So, what I'm really saying is that if you don't have a decent foundation of strength, training reactive ability - or even considering where you stand on the static-spring continuum - is a waste of time.  Weak athletes need to have the strength (and rate of force development, for that matter) to decelerate with control in order to allow for fast eccentric and amoritization phases to occur. I'd estimate that 60% of the young athletes who walk through my door on their first day to train are nowhere near strong enough to derive considerable benefit from "classic" plyos.  Sure, they need to learn deceleration and landing mechanics and pick up some sprinting techniques, but the true progress comes from the resistance training they do. Now, let's apply this to baseball, a sport where good strength and conditioning is still yet to be appreciated - and many athletes go directly from high school to the professional ranks without ever having touched a weight in their lives.  As a result, many baseball athletes don't have the underlying strength to effectively make use of the reactive training that typifies the training presented to them. And, in many cases, it will take a long time to get it during the season in the minor leagues, where they'll have competing demands (games, practice, travel) and limited equipment access.  It's why I've seen several professional baseball players come my way with vertical jumps of less than 20".  As a frame of reference, you need to be over 28.5" to be in the top 13 on my HIGH SCHOOL record board. Pro athletes?  Really? These guys can be conundrums from a training standpoint, as you have to realize that sprinting is possibly the single-most reactive/plyometric training drill there is; we are talking roughly four times body weight in ground reaction forces with each stride - and that's in single-leg stance.  So, we have somewhat of an injury predisposition, but more important, it comes down to training economy.  They aren't strong enough (relative to their body weight) to get much out of the sprinting, and would benefit more from strength training, bilateral jumping variations, and single-leg low hops.  However, they need to jump and sprint as part of their profession, so we've got to prepare them for that as well.

ellsbury-jump

All that in mind, the problem isn't traditional strength and conditioning, in my eyes.  It builds a solid base of strength for many athletes and helps to increase body weight, which in itself is a predictive factor for velocity.  However, the shortcomings of this S&C occur when coaches don't understand how to modify traditional strength and conditioning to suit the needs of the baseball athlete.  And, problems kick in when folks don't appreciate that even just a little bit of strength goes a long way. New Blog Content Random Friday Thoughts Inverted Row Ignorance Maximum Strength Feedback: 1/20/09 Stuff You Should Read: 1/22/09 All the Best, EC References 1. Komi, PV. Stretch-shortening cycle. In: Strength and Power in Sport (2nd Ed.) P.V. Komi, ed. Oxford: Blackwell, 2003: 184-202. Sign-up Today for our FREE Baseball Newsletter and Receive a Copy of the Exact Stretches used by Cressey Performance Pitchers after they Throw!
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