Home 2014 January

Common Arm Care Mistakes: Installment 4

It's time for another installment of "Common Arm Care" mistakes, and in this go-round, I'm going to be talking about volume management.  This mistake can be summed up in one sentence:

If you keep adding things without taking something else away, you'll eventually wind up with overuse problems.

Effective, there is a "give and take" that is involved with the training of any throwing athlete.  The more throwing these athletes do, the less supplemental training they can incorporate. This can occur in a number of different contexts.

First, on the throwing side, you'll often see pitchers who are always seeking out the latest, greatist throwing programs.  However, they don't "program hop;" they just keep adding.  Before you know it, they're making 300 throws in every session - and throwing seven days a week - because they have to get in their long toss, weighted balls, underweight balls, mound work, and towel drills.  If you told them that practicing their nunchuck skills would help, they'd add that in, too.

Second, you have to be cognizant of the rest of your strength and power training volume.  When your pitch count goes up, you need to pare back on your upper body lifting volume; banging out a bunch of chin-ups isn't going to feel so hot after a 60-pitch outing.  Additionally, your medicine ball work volume needs to go down as the throwing volume goes up.

To give you some frame of reference for this, here's a little excerpt from Marlins closer Steve Cishek's off-season medicine ball programs.  Keep in mind that the total throws equals left-handed throws, plus right-handed throws, plus overhead throws.

October: break from rotation, no aggressive medicine ball or overhead work
November: 156 total throws
December (started throwing mid-December): 138 total throws
January (ramped up throwing): 66 total throws

Once spring training rolls around and he's throwing even more, he'll have even less.  A minor leaguer whose season wraps up a month earlier would actually be able to get an additional month of aggressive medicine ball work in.

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Third, pitchers often forget that throwing itself is a huge challenge to the rotator cuff.  So, if your throwing volume goes up as the season approaches, you should be doing less arm care work than you would have done in the off-season.  You can get away with this reduction in arm care work because you've already put in a great off-season to build things up.  Of course, if you throw year-round, then you're already behind the 8-ball when the season starts.

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Strength and Conditioning Stuff You Should Read: 1/29/14

Here's this week's list of recommended strength and conditioning reading:

5 Myths of Tommy John Surgery - Mike Reinold dispels five of the most common myths regarding Tommy John surgery, and also highlights some very surprising research on the perceptions of this surgery by the lay population.

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Detox Diets and Juice Cleanses: Could They Make You More Toxic? - As usual, the good folks at Precision Nutrition kick out some great content here.  I'll be referring folks to this article every time they ask about cleanses from here on out.

3 Things You Need to Unlearn - This is an excellent piece by Chris Colucci at T-Nation.  I especially liked point #2.

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8 Nutritional Strategies For Those Who Can’t Gain Weight

Throughout the off-season, my wife and I have professional baseball players staying with us quite a bit.  It's become very common for athletes to come to Boston for a few days, do a little "crash course" at Cressey Sports Performance on training and nutrition, and then head back home, where I'll program for them from afar.

In almost all these cases, one of the biggest eye-opening experiences for these athletes is eating with the Cresseys.  They learn new recipes and cooking practices, and many are a bit amazed at how much I eat in spite of the fact that I'm only about 185 pounds.  They come to Boston expecting to learn about arm care, pitching mechanics, and strength and conditioning, but the nutrition add-on is a nice bonus.

As an example, last year, one athlete put on over ten pounds in the month of January while staying with us before he headed to Big League Spring Training.  Sure, some of this is old weight that he had to "recoup," and some is likely just water weight.  However, being heavy enough going into spring training is profoundly important, particularly for position players who are out in the field almost every day between February and October.  Below are some nutritional strategies we've employed with not only Anthony, but a lot of our other skinny guys.

1. Get around big eaters, and make eating a social challenge.

With the skinny guys who complain about how they "eat all the time and still can't gain weight," it's not uncommon for them to get a big slice of humble pie when dining around bigger eaters.  In the Cressey household this month, Anthony had to keep up with me at every dinner - so if I got seconds, so did he.

I've also had athletes who always made a point of going out to eat with each other after training sessions.  It's instant accountability with respect to caloric instake.  Sushi is a great option in this regard.

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  3 Big Leaguers, 3 100mph Arms, 2 Cresseys, an Absurd Amount of Sushi, & a Bus Boy Photobomb

2. Cook with more oil.

When an athlete's day is spent "uncomfortably full," finding convenient ways to add calories is incredibly important - especially if that individual has multiple training sessions per day and can't be worried about getting sick in the gym or on the field. Adding in some healthy oils - olive and coconut are my two "go-to" choices - can make it easier to get an extra 200+ calories at each meal.  The healthy fats the athletes get are nice perks of this approach, too.

3. Eat faster.

We always tell people who want to lose weight to eat slower, but many people fail to appreciate that eating faster is actually a great option for true "hard-gainers." You see, it takes time for the body to perceive fullness, so if you can get your calories in a bit faster, you can essentially trick yourself out of fullness. 

As an interesting aside to this, my business partner, Pete, is one of the slowest eaters on the planet.  No joke: it'll take him four hours to finish a protein bar.  And, not surprisingly, any time that Pete has put weight on in the past, he's had to be "uncomfortable full" for months on end.

Brian St. Pierre discussed this "speed of eating" phenomenon in The High Performance Handbook Nutrition Guide, if you're interested in learning more.

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4. Have convenient calories wherever you can’t miss them.

One other strategy Anthony uses are homemade protein bars.  They're made with healthier ingredients, and without preservatives. This means they have to be refrigerated, but it also means that they're going to go bad if he doesn't get in 2-3 per day, so there is incentive to consume them faster.  It's an easy 1,000 calories on top of his normal meals, and also provides some convenience when he's away from the kitchen.  Most importantly, though, he has to see them every time he opens the refrigerator for anything, so they're ultra-convenient.

5. Use liquid nutrition.

With most of our clients, we heavily emphasize eating real food and not getting calories from drinks.  In those who struggle to gain weight, however, big shakes can really help.  Tim Collins was a good example, as he'd have a 1,000+ calorie shake after each training session for his first few years of training until he arrived at a good weight...45 pounds heavier.

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With that said, stay away from those garbage high-calorie weight gainers.  They're usually loaded with sugar and unhealthy fats - not to mention low-quality protein. I would always much rather have guys make their own shakes with a decent low-carb protein powder, and then add almond or whole milk, coconut oil, fruits, natural nut butters, Greek yogurt, oats, ground flax, and even veggies.  If you're going to take in 1,000 calories in a shake, you might as well get some nutritional value from it.

6. Write it down.

One of the best ways to evaluate how much you're eating - whether you're trying to lose fat or gain muscle - is to simply write it down.  I'd estimate that in 95% of cases, having a "hard-gainer" do thise immediately eliminates the "but I eat all the time" argument.  Sometimes, just knowing that you aren't trying as hard as you think you are is the biggest key to subsequent progress.

7. Review medications.

Many medications can have a profound impact on appetite.  The most prominent effects I've seen are with ADD/ADHD medications, as most reduce appetite.  In one instance, we had an athlete struggle to gain weight for almost two years on Adderall, but then he put on over 40 pounds in a year after switching to Focalin for his ADHD.  It's completely outside of my scope of practice to make recommendations on this front, but if appetite suppression is a concern, it'd be good to talk with your doctor about other options that might be available.

8. Make time instead of finding time.

Having an insanely busy schedule usually leads people to eat unhealthy, convenient foods - and they get fatter.  Many folks who are underweight actually go in the opposite direction; they simply forget to eat when things get busy.  To that end, if you want to gain weight, you need to make eating a priority - and that starts with plugging a specific time you'll eat into your schedule.

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Pow! Cressey Performance Shaker Bottles

These bad boys are BPA-free, but loaded with awesome.  It's a traditional blender bottle, but with the CP logo.

CPShaker

They're $14.99 plus shipping, and you can pick one up HERE.

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Is Thoracic Spine Extension Work Necessary? – Part 3

Today marks the third and final installment of Eric Schoenberg's series on thoracic mobility drills - and whether or not they're indicated.  In case you missed them, be sure to check out Part 1 and Part 2.

In the final piece of this series, I want to tie things together with a few foundational concepts that we use in the daily management of our athletes and emphasize in our Elite Baseball Mentorships.

Eric C. has written about the concept of relative stiffness on this blog on numerous occasions.  So, feel free to refer back to his articles for more background information.  Relative stiffness or relative flexibility was introduced to me by Shirley Sahrmann and the incredible faculty at Washington University in St. Louis. This is a pillar of their Movement System Impairment model

Today, I am going to discuss how relative flexibility impacts the thoracic spine and shed some more light on why T-spine extension work is not always necessary in the baseball athlete.          

Relative flexibility describes the relationship of how the amount of stiffness (or tension) in one area of soft tissue (muscles, ligaments, tendons, etc.) results in compensatory movement at an adjoining joint that is controlled by less stiffness.  This relationship can change (positively or negatively) based on the exercises we choose and the manner in which we perform them.

There are countless examples of relative stiffness in the body.  One of the most common examples that we see involves the lumbar spine.  If the lats are stiffer than the anterior core, then the athlete will be more prone to an extended posture. The athlete will compensate with lumbar extension with overhead activity.  The video that I included in part 2 of this series is a good example:

In this video, Lats, lumbar extensors > (stiffer than) Anterior Core = Lumbar extension tendency.

Note: Clearly, there is a lot more involved (fascia, ligaments, structural issues, motor control, relative position of adjacent joints, etc.) than just this simple math problem, but for the scope of this article, we will leave it at this.  This example is fairly straightforward and I think we are all on the same page here.  We would not program activities that would further encourage lumbar extension and drive the improper recruitment and motor pattern.

In this case, we know that simply “stretching” or foam rolling the lats will not work in isolation. We need to go ahead and “stiffen” the anterior core, while at the same time, downregulating the overuse of the lats.  We often will do this by using exericses that encourage a neutral alignment with overhead activity (i.e. wall slides, back to wall shoulder flexion) as well as limiting the amount of carrying by our sides (e.g. deadlifts, dumbbell lunges, farmer’s walks, etc.) and instead, focusing on options like bottoms-up kettlebell carries, landmine presses, and goblet variations.

In the case of someone that is in too much thoracic extension (or relative thoracic flexion), though, things can get a little more confusing.  The athlete will have increased stiffness of the thoracic extensors vs. flexors: Thoracic Extensors > (stiffer than) Thoracic Flexors = Thoracic extension tendency.

However, we often see the emphasis remain on bench T-spine mobs, quadruped extension/rotations, and side-lying windmill variations? This results in two problems:

  1. The athlete will actually become hypermobile (segmentally) and develop a local stability issue. (inverted U-curve)
  2. The athlete has difficulty “getting out of extension” due to increased relative stiffness of the thoracic extensors, lats, and scapulothoracic musculature.

This inability to properly flex the spine at ball release can result in a decrease in the required scapular upward rotation and elevation to maintain proper scapulohumeral and glenohumeral joint congruency.  This is a fancy way of saying that if your upper back isn’t positioned correctly, the ball won’t sit flush with the socket. This process can contribute to some of the shoulder and elbow pathologies that we so commonly see in the throwing population.

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There is one more point that needs to be addressed to complete this series – and that is the role of the rectus abdominus in thoracic spine mobility.  In this case, the athlete will present in too much thoracic flexion and may appear as though they would benefit from T-spine extension mobility drills.  However, this athlete will not benefit from these exercises unless we appreciate the following point.

When we cue an athlete to limit his extension or “rib flare” we often say “ribs down”.  This seems like a relatively benign cue to help promote a neutral spine and pelvic orientation.  However, we must be sure that the athlete is able to properly recruit external obliques (often with lower level exercises such as back to wall shoulder flexion or a dead bug variation) to help achieve this movement correction.

The reason for this is that increased stiffness of rectus abdominus (dominance) limits ability of T-spine to move out of flexion (or neutral).  Using our relative stiffness example from before, if: Rectus abdominus > (stiffer than) Thoracic Extensors = Thoracic Flexion Tendency.

Therefore, if an athlete is actually is in too much flexion… i.e. sway back (most commonly - posterior tilt and lumbar extension - hanging on rectus as their anti-gravity muscle), he will have a very difficult time getting out of flexion.  This occurs regardless of how many T-spine drills we prescribe.  This is akin to stretching rectus femoris when someone is stuck in a faulty thoracic and lumbopelvic position.

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The best approach in our case above is to “allow” t-spine mobility (extension) to occur by decreasing rectus dominance and getting someone out of T-spine flexion.  I am all for cuing the ribs down and establishing alignment, but HOW we get an athlete to do this is of the utmost importance.  The main point here is forcing T-spine extension in the presence of increased relative stiffness of rectus abdominus is not going to give us results.  In other words, weak external obliques will result in rectus overuse and thoracic “immobility” regardless of how many T-spine mobility drills we include in our programs. 

To summarize, this is a very important (and difficult) concept that – like everything else – requires a trained eye and an individualized approach.  If an athlete has too much thoracic and lumbar extension, this can result in scapular depression and downward rotation via, among others things, excessive lat dominance, which leads to a lot of our shoulder and elbow dysfunction.  On the other hand, too little thoracic extension results in scapular anterior tilt and decreased glenohumeral external rotation (“lay back”), also resulting in dysfunction and pathology. 

As a quick review, you want to be able to answer the following questions before prescribing T-Spine extension exercises:

  • Is there a lack of T-spine extension (or rotation). If not, then why prescribe T-spine extension mobility drills?
  • Where is the extension coming from (upper or lower T-spine, L-spine, C-spine)?
  • Is the athlete already at end-range extension and if so, is our attempt to “gain” extension at end-range creating unwanted motion elsewhere? (hypermobility)
  • Lastly, if an athlete presents with mal-alignment (too much thoracic extension or thoracic flexion): first, identify it, then determine why this is happening prior to simply prescribing a bunch of mobility exercises.

Conclusion

This point, along with many others, is a main reason why we chose to develop the Elite Baseball Mentorship program.  As we gather together in these groups, many conventionally accepted ideas and concepts are questioned and explored and the demand for proof (whether it be from research or experience) requires us all to think more critically.  Most importantly, with baseball-related injuries continuing to rise, this allows us to question the status quo of generally accepted baseball-specific protocols.  Ultimately, this collaboration allows us all to advance the bar and develop a better opportunity for our athletes to meet their goals through better health and performance.

Also, if you are interested in more information like this, we would love to see you at one of our Elite Baseball Mentorships. We'll be hosting these events in June, October, and December of 2014. Please click here for more information.

Author’s Note: I would like to thank Michele Ionno, MS, SPT (Wash U Program in Physical Therapy) for his contribution to the 3rd phase of this blog series.

About the Author

Eric Schoenberg, MSPT, CSCS is co-owner of Momentum Physical Therapy, located in Milford, MA.  He can be reached at eric@momentumpt.com

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Is Thoracic Spine Extension Work Necessary? – Part 2

Today is Part 2 of a detailed series on the thoracic spine from Eric Schoenberg.  If you missed it, be sure to check out Part 1. -EC

At this point, we need to quickly touch on the concept of “neutral.”  This is certainly a hot topic in the physical therapy and strength and conditioning worlds, as it should be.  For our purposes, we like to be clear that when someone is too flexed (i.e. fully slumped posture), our cue is to “extend back to neutral.”  In addition, when someone is too extended, the cue would be to “flex back to neutral.”  This holds true in all segments of the body and in all three planes of motion (e.g. pelvic tilt, genu valgus, etc.)  The problem that we tend to see is we don’t grade our correction and “overcorrect.”  This results in fixing one problem only to create a new one in the opposite direction.  

In Malcolm Gladwell’s new book, David and Goliath, he refers to this as the “inverted U curve.”  Its application here is that IF an athlete truly lacks T-spine mobility, then once we properly gain it, continued efforts to improve (rather than just maintain) this mobility will ultimately create a brand new problem (hypermobility).  This needs to be considered when we write new programs and lends itself nicely to the importance of thorough evaluation and re-evaluations.

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To quickly recap part 1, for the purpose of this series, a cue to “extend the T-spine” is really a case of moving out of excessive flexion and learning to control flexion throughout the throwing motion.

In part 2 of this series, we will focus on the postural alignment and movement examination and its implications in developing an individualized exercise prescription for the athlete.  As a quick side note, it is of particular importance to recognize that the body segments don’t work in isolation.  This is a simple statement; however, when attempting to capture the role of a particular body segment or group of exercises, we are missing the big picture if we try to develop a concept without appreciating the kinetic chain.

In our opinion, the hallmark of an effective examination is the ability to properly identify the athlete’s unique postural alignment and movement tendencies.  These exams must be done with the shirt off to appreciate the bony and soft tissue anatomy. With respect to the thoracic spine, we first identify whether that athlete is in flexion, neutral, or extension.

Here's an example of an athlete with a flattened T-spine, and shoulder blades that have no idea what to do!

FlattenedTSpine

Additionally, we need to appreciate the position of the scapula and its impact on the appearance of perceived thoracic flexion.  An athlete that presents with scapular anterior tilt, abduction, and/or internal rotation can easily fool you into thinking that the athlete’s upper back is “rounded” or kyphotic. An athlete with a flat thoracic spine (hypokyphosis) will have a more prominent scapula due to lack of normal contour of the T-spine and ribcage.  In extreme cases, we will see the following:

1. Hypokyphosis (lack of T-spine flexion)

Hypokyphosis

2. Scheurmann's Disease (greater than 60 degrees, and structural)

Scheurmanns

On x-ray, these cases will show a change in the normal vertebral “wedging.”  The intervention in this case is NOT to attempt to fix the mobility issue, but first determine if the issue is osseous/structural in nature.  Just like any other joint (the hip immediately comes to mind), you can’t stretch bone and any attempt to do so will result in an unhappy athlete!  These are extreme examples, but certainly something that warrants inclusion in this article.

However, more commonly in the physical therapy or strength and conditioning settings, we will see more “middle of the road” cases where there is too much or too little thoracic mobility. As you can see in the lateral view below, this athlete appears to be in excessive thoracic flexion, but it's really just anterior tilting of the scapulae.

SideView

However, in the posterior view, you'd be able to appreciate that the T-spine is relatively extended compared to accepted norms (40° flexion = normal curve). 

Moving forward, static alignment does not tell the whole story, so don’t test it alone and don’t let it fool you.  All too often, I hear people trying to prove a point about pitching mechanics or exercise technique and the only proof is a still photo.  This practice needs to stop because it is impossible to capture the complexity of human movement and make a conclusive statement from a screen shot. This concept is why the combination of the postural exam and movement analysis is so critical.

Athletes don’t get injured when they are standing still. They get injured moving (incorrectly!).  For that reason, watch your athlete’s move.  The concepts of FMS or whatever collection of multi-joint movements you like to combine to form a “movement examination” are great tools to collect data on your athlete’s preferred movement patterns.  However, it is also critical to watch the athlete perform the unique movements of their chosen sport. 

In our case, we like to talk to our athlete’s about pitching and we certainly like to watch them throw.  Asking questions like:  “What do you struggle with mechanically” or “where do you break down when you get tired” gives us valuable insight into movement tendencies and injury risk.  With respect to exercise, we observe closely to make sure we are achieving the desired result of the exercise.  In addition, we ask our athletes where they feel a particular exercise to help determine activation patterns and sequencing (motor control).

In addition to watching our athletes throw/pitch, swing, and/or run, we employ simple movement tests such as standing bilateral shoulder flexion (and abduction) to gather critical information about movement quality, timing, and relative stiffness. 

With respect to the video above, consider the excessive extension moment at the thoracic (and lumbar spine) due to increased relative flexibility resulting from poor anterior core stiffness.  This video brings up a lot of questions in my mind:

  • Does this athlete need more mobility work into thoracic extension? 
  • If he attempted these exercises, how can you be sure the motion will even come from the right place?
  • If an athlete is truly “lax” congenitally, then why would they lack mobility at the T-Spine and nowhere else?  
  • Are you sure his lack of shoulder flexion is due to decreased thoracic mobility? 
  • Or, is he too flexible in his spine and too readily pulls into extension due to the stiffness of his lats? 

My point here is we need to consider the fact that improperly prescribed exercise will make the athlete worse than no exercise at all.  So, if you’re not sure, don’t guess.  Refer out or continue to re-assess until it becomes clear what the athlete needs.

Another simple movement test that we will have the athlete perform is standing thoracic flexion and extension.  Here we will assess the timing (quality), location, and amount of available range of motion that the athlete is working with.

It is also good practice to watch an athlete perform an exercise prior to putting it in his program. 

This athlete (also pictured above) demonstrates faulty movement by not getting out of extension at the top of his pushup prior to initiating the “pike” portion of the yoga push up.  When corrected, in the video below, he did a better job of getting his T-spine in position to allow his scapula to have a better platform to upwardly rotate and elevate as his hands moved overhead.  This was not a mobility issue; this was a patterning or motor control problem.

I should mention that in a full examination, we would consider movement testing of thoracic rotation and sidebending, ventilation, rib cage alignment, quadruped position/movement, etc.  But, for the purposes of this series, we again are choosing to focus primarily on the sagittal plane.  Pay attention to the way in which the athlete returns from flexion to get a good idea of his/her recruitment strategies.

In conclusion, the combination of static posture, movement testing, and unique athletic movement allows us to create a well-rounded profile of the athlete’s strengths and weaknesses.  Be sure that your examination a) identifies areas of limitation that need to be addressed and b) determines the reason why the athlete has these impairments.

In the third and final part of this series, we will discuss the concepts of relative flexibility and motor control as it relates to the topic of thoracic spine extension.

Also, if you’re interested in more information like this, we would love to see you at one of our Elite Baseball Mentorships, with the next one taking place in June. Click here to learn more.

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Is Thoracic Spine Extension Work Necessary? – Part 1

Today’s guest post comes from my friend and colleague, physical therapist Eric Schoenberg.  Eric is an integral part of our Elite Baseball Mentorships, and here, he kicks off a three-part series that I think you'll find very educational - even if it is a bit "geeky" along the way.  It'll test what you know and make you question some of the stuff you do with your training and work with clients. -EC

I’ll start by saying this is a classic case of giving an athlete what they need, not what we predict or assume they will need.  Let’s be clear up front: there are a lot of athletes that lack thoracic extension and rotation and certainly can benefit from T-spine mobility work.  This is especially true for your general population clients that live in flexion all day – although not every “average joe” is stuck in flexion; this is a wrong assumption!  However, for the purpose of this series, I am going to make a case for the following statement:

Not every individual - especially in baseball populations - needs thoracic extension and rotation mobility drills!  

In fact, to take it a step further, I would argue that in some cases, performing these types of exercises will actually make the athlete worse.

During our Elite Baseball Mentorship in August, I mentioned in passing during the postural examination portion of the breakout session that a lot of athletes present with flattened thoracic spines and some are actually relatively extended.  I followed this up by stating that some people don’t really need any T-Spine extension work.  This simple statement was met with a lot of surprise and follow up questions.

As a result, Eric and I thought it would be a good idea to explore this concept in greater detail.  As is often the case, a relatively benign statement takes on a life of its own and turns into a multi-part blog series.  As we develop these concepts, please feel free to share your thoughts and experiences in the comments section below.

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The general assumption of the group was that everyone was kyphotic and T-spine extension was a default group of exercises that EVERY athlete needed.  This premise, however, does not take into account a host of key considerations, such as:

  • Defining T-Spine Extension. (part 1)
  • Anatomy and role of the Thoracic Spine, (part 1)
  • Scapulothoracic joint kinematics, (part 1)
  • Importance of a thorough static postural alignment and movement examination, (part 2)
  • Scapular position/prominence, (part 2)
  • Effect of the T-Spine on adjacent joints such as cervical spine, lumbar spine, pelvis, scapula, humerus, and ribcage, (part 2)
  • Concept of relative stiffness, (part 3)
  • Faulty motor control resulting in limited thoracic flexion (yes, lack of flexion!), (part 3)
  • Timing and amount of relative T-spine extension and rotation in the pitching delivery. (covered in part recently by Matt Blake and Eric C. here and here.)

174px-Gray_111_-_Vertebral_column-colouredIn an attempt to properly define thoracic spine extension with respect to the baseball player, we must first look at functional anatomy. The thoracic spine, with its rib attachments from T1-T10, is built for stability – most notably to protect the internal organs.  In addition, the T-spine has thinner intervertebral discs, a feature that adds to its relative inflexibility.  The sagittal alignment of the thoracic spine is kyphotic: 40 degrees in adults. (Neumann D.A. 2002).  With that said, we are not really talking about the T-spine being “extended”, but instead are talking about the relative amount of flexion that an athlete is in.  With that description, it’s important to appreciate that T-spine extension drills are working to put an athlete into an acceptable amount of flexion!  It is this flexion (or convexity) that provides a surface for the concave, ventral surface of the scapula to “float” on and create the scapulothoracic joint. (medial border of scapula and ribs 2-7).

For these reasons, we need to not just label an athlete as being “kyphotic” or having a “flat T-spine.”  Instead, we should attempt to define which segments of the T-spine have static or dynamic alignment issue and/or movement dysfunction and address them accordingly.

An important concept to look at is the T-spine is comprised of 12 vertebrae, so we will often find components of flexion, extension, and rotation within those 12 segments. Crosbie, et al. reports that the majority of T-spine extension occurs in the lower T-spine during overhead arm movement. This makes sense due to the thoracolumbar junction and the shape of the lower thoracic vertebrae.  The T10-T12 vertebrae are similar in size and function to the lumbar vertebrae.  T10 has a different rib articulation than T2-9 and T11/T12 have no facets on their transverse process for rib attachments (thus, increasing relative mobility).  So, more often than not, when we see anterior pelvic tilt, and lumbar extension compensation, we can assume that the lower T-spine is doing the same thing.  So what if, for the purposes of this article, we grouped the lumbar spine as T10-L5?

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As a quick aside, it is recognized that the thoracic spine moves in three planes of motion.  More specifically, with respect to the frontal and transverse plane, with single arm elevation, the upper T-spine (T1-T5) has ipsilateral coupling of the lateral bending and rotation, whereas in the mid-lower T-spine T6-T12, we see contralateral coupling of lateral bending and rotation.  So in the frontal and transverse planes, the T-spine essentially works as two distinctly different subgroups.  This is important to consider when prescribing exercises to address a perceived movement impairment.  In addition, it is important to remember that the thoracic spine and hips (along with a stable lumbar spine) provide the rotational separation needed to excel in the game of baseball. However, for the purposes of this article, we will focus on the sagittal plane motion of flexion/extension.

As we continue to look at the sagittal plane, but shift our focus to T1, we see a smaller vertebrae (see picture above) that more resembles C7 (and other cervical vertebrae) than the caudal segments (T2-T9).  A case can be made that T1 (cervicothoracic junction) functions more like a cervical vertebrae than a thoracic vertebrae.

This leaves us with T2-T9: eight segments with an extreme mobility problem!  This is where we are really trying to mobilize “out of too much flexion” to get to an acceptable (neutral) position to allow for enough scapular (namely upward rotation and elevation) and glenohumeral motion to give us enough “space” to throw a baseball without causing an impingement.

So how can we be sure that we are following all these rules in three planes of motion when we are performing our T-spine mobility drills?  Are we in fact gaining motion in the correct segments within the context of their coupled motions?  Or, are we simply “mobilizing” what moves easiest and taking the “path of least resistance”?

Check back later in the week for part 2 of this series to read more about evaluation of static alignment and movement testing.  In addition, we will discuss how scapula position can fool us and (in part 3) how too many “abs” can be a bad thing.

In addition, if you’re interested in more information like this, we would love to see you at one of our Elite Baseball Mentorship, with the next one taking place in June. Click here to learn more.

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Common Arm Care Mistakes: Installment 3

In continuing with our series on common errors I see throwers make in their arm care programs, today, I want to focus on how we coach pulling motions in these populations.  Check out this video to learn more:

Throwers need to learn how to move the scapula on the rib cage in order to get to a good position of upward rotation to throw.  If you just pin everything down with the lats, you interfere with that upward rotation potential.  The scapula needs to be stable, but it also needs to be mobile enough to move freely on the rib cage.

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Strength and Conditioning Stuff You Should Read: 1/15/14

Here's this week's list of recommended strength and conditioning reading:

Does training heavier lead to more hypertrophy? - This excellent review from Chris Beardsley summarizes the research to-date on the impact of various loads on muscle growth.

Heartburn, Reflux, and GERD: 10 Lifestyle and Nutrition Tips for Feeling Better Now - Precision Nutrition's Ryan Andrews wrote this great piece that will benefit anyone who's suffered from these common ailments.

7 Ways to Dominate the Pull-up - Nick Tumminello highlights seven strategies you can employ if you're struggling with pull-ups. Some of them are ones you may have heard, but as we've come to expect from Nick, there are also some innovative new exercises to try.

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Quick and Easy Ways to Feel and Move Better: Installment 52

It's been a while since we published an installment of Quick and Easy Ways to Feel and Move Better, but we're back at it today, thanks to CP coach Greg Robins, who has these five tips for you:

1. With deadlift technique, take tension out of the bar one hand at a time.

In my experience the single most difficult lesson to teach a newcomer to deadlifting is how to leverage their weight against the bar. This concept goes by many names, for example: taking the slack out, pulling the tension out, etc. Whatever your cue of choice, learning how to leverage is the “ah-ha” moment for many new lifters. In the following video, I demonstrate a drill that I find very helpful. It may just need to be done in the beginning stages of learning the lift, or it might be something you use for the rest of your life. Either way, it’s definitely worth a look:

2. Use this example to teach the difference between retraction and posterior tilting of the shoulder blades.

To piggy back off the video in point 1, check out this quick video on how to differentiate between retraction, and posterior tilting of the shoulder blades, and why it’s important to learn the latter when setting up for a deadlift.

3. Mimic a good standing posture with prone bridge variations.

The prone bridge, or “plank” exercise is probably the most popular core training exercise since the sit-up. It is an absolute go-to in our programming when teaching people how to resist extension and train the anterior core properly. Unfortunately, it’s also butchered more often than not.

A truly well done prone bridge is one that mimics correct alignment in a good standing posture. It is NOT just a position sans any low back extension. Let’s take a look at what I mean.

First, you need to position the shoulder blades correctly. Too often, people will excessively protract the scaps and embrace a more rounded over upper back position, seen here:

IMG_9444

Instead, slightly tilt the shoulder blades back, and place them in a position more like the one seen here:

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Next, do not allow excessive flexion of the spine from top to bottom:

IMG_9446

In this last picture, we are allowing the person to completely dominate the movement with the rectus abdominis and are not promoting proper recruitment from the internal and external obliques or the transverse abdominis.

To bring this all together, here is a picture of good standing posture with 90 degrees of shoulder flexion; note the similarities to a properly executed prone bridge.

IMG_9442

4. Try out this variation of the lower trap raise.

I like this variation for a few reasons:

  • It allows some of the more extended populations to stay in a better spinal positioning.
  • It promotes proper positioning of the shoulder blades in a back squat or overhead squat exercise.
  • It takes away some of the resistance gravity places on us in a prone positioning.
  • It helps develop a proper squat pattern and bottom position
  • It’s efficient, allowing people to train multiple aspects of good movement at the same time.
  • For more advanced populations you can get rid of the wall, and do it in a freestanding deep squat position.

5. Remember that not everything needs to be “difficult.”

Throughout a strength-training program, you will have exercises that are meant to be loaded up to their limit, and others that are there purely to practice a position or motor control pattern. As a client or athlete becomes more advanced, certain exercises will become less challenging. This doesn’t mean that you need to continually find ways to make a movement harder and harder. Too often, when we do so, we take away from the integrity of the movement.

Sure, you can load up your basic deadlift, squat, and lunge patterns until the cows come home, but exercises like the rollout, prone bridge, or side plank will eventually reach a limit in ways that you can productively make them “harder.” This by no means renders them useless, though. In fact, by loading them excessively, or adding an infinite amount of bells and whistles to them, you will mostly find ways to compensate and stray further from their intention. As they become easier to complete, it just changes their purpose from one of teaching the body, to one of reminding the body how to recruit properly.

Some exercises do have a ceiling, and once it’s reached, you don’t need to try and blast through it. Let them serve their purpose, and let the big movements account for your substantial progressions.

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LEARN HOW TO DEADLIFT
  • Avoid the most common deadlifting mistakes
  • 9 - minute instructional video
  • 3 part follow up series