It goes without saying that in the overwhelming majority of cases of resistance training technique coaching, adding weight makes it harder to teach an exercise. In other words, we want to deload the movement as a regression, as many trainees get into "panic mode" when you put external load on them. A deadlift that is ugly at 135 pounds is definitely going to look even uglier at 315 pounds.
Lowering the weight is just one regression we can use to optimize technique. Other strategies include changing the exercise (e.g., trap bar deadlift over conventional deadlift), shortening the range of motion (e.g., rack pull vs. deadlift), eliminating fatigue (e.g., dropping a few reps off each set), tinkering with the base of support (e.g., split squat instead of lunging) and deceleration components (e.g., reverse lunges instead of forward lunges). I went into detail on these options and several more in an older article, 11 Ways to Make an Exercise Harder.
Sometimes, however, there are exceptions to these rules. In particular, I'm speaking to the idea that in some cases - as counterintuitive as it may seem - adding weight can actually improve your ability to clean up a movement pattern. Here are a few examples:
AnteriorCounterbalance - The best examples to which one can look on this front are the goblet squat and plate-loaded front squat. You can see individuals who have brutal squat patterns that are quickly cleaned up just be giving them some external loading in one of these positions to facilitate an easier posterior weight shift and better core engagement.
Truth be told, this same set-up can be used to improve lateral lunges, too. And, it can also help to explain why some lifters have much better front squat technique than with the back squat.
Olympic lifts - There is definitely a sweet spot for teaching the Olympic lifts, which require a higher speed of execution and "feel" of tension against external load. If you're teaching them to a more trained athlete with a decent foundation of strength and power, just putting a 5kg training plate on each side of the bar almost never works. The weight is so light that it's very easy for them to slip into bad patterns like curling the weight or cutting the lower body triple-extension short. Bumping those 5kgs up to 10 or even 20kg bumper plates can make a big difference in syncing everything up.
Deadlifts - While lowering the weight is usually essential for improving deadlift technique, one issue you may encounter is that at very light weights, if you don't have bumper plates, the plates have a smaller diameter. In other words, lowering the weight below 135 pounds may actually increase the range of motion of the movement. This is easily corrected by elevating those smaller plates on a riser (two aerobic steps works well) or going to a rack pull. However, if strength is adequate, just going to 135 is often the easiest correction, even if it means you need to knock a few reps off the set.
Medicine Ball Work - If a medicine ball is too light, an athlete will do one of two things. First, if it's a rotational drill, he'll use too much upper body work and not engage the hips correctly to create powerful rotation to transfer up the chain to the upper body. If it's an overhead stomp variation, he'll usually hold back because if the medicine ball is too light, it'll rebound excessively off the floor and hit him in the face before he can react to it. For this reason, we'll never do overhead stomps with anything less than 8lb medicine balls - and that would be with absolute beginners. Most folks do best with 10-12-pounders.
Turkish Get-up - I've evolved in the way that I teach the Turkish Get-up in recent years. In the past, I would teach it unloaded - and would always notice that lifters - especially hypermobile ones - would manage to slip into their faulty patterns really easily without external loading. Adding a kettlebell - even if it's only 4-8kg - can make a huge difference in keeping trainees more "compact" and under the kettlebell. Effectively, they guard against vulnerable positions that wouldn't be noticeable if they didn't have to support a load overhead.
Reactive Neuromuscular Training (RNT) - Popularized by physical therapist Gray Cook, RNT involved using resistance to pull individuals into their dysfunctional pattern in order to increase proprioceptive awareness and build-up antagonist co-contraction. The athlete (or patient in the clinical realm) acquires the kinesthetic awareness to avoid the dysfunctional pattern, and the strength and motor control to resist falling into it. Perhaps the most well known example of adding resistance to teach a good pattern is in using a band to drive valgus (caving in) at the knee during single-leg patterns.
Weighted Baseballs - We've used weighted baseballs as part of our throwing programs since 2008 with great results. The reason isn't just to get contrast between heavy and light to increase arm speed via post-activation potentiation, but also because using weighted implements can actually help to improve arm action and clean up mechanical faults in certain individuals. If a pitcher has a very long or deep arm action, weighted ball throws can help to shorten it up. If a pitcher has a short deceleration pattern (including a big whip-back), doing some weighted ball holds can teach and train a longer, more joint-friendly pattern.
There are just seven examples of how increasing external loading can actually facilitate teaching, but there are undoubtedly many more that you may already be using on a daily basis without even realizing it. There are many different ways to clean up movement, so don't ever rule anything out! Feel free to share additional strategies on this front in the comments section below.
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It's time for the May installment of my random thoughts on sports performance training. I never really expected this series to last this long, but I'm enjoying it and the feedback has been awesome, so we'll keep it rolling. Here goes...
I'm a big fan of external focus cues. As an example, I've had much better luck with saying "show me the logo on your shirt" than "pull your chest up" when coaching a deadlift. Effectively, individuals seem to perform better when we let them organize themselves to their surrounding environment (in this case, the logo on the shirt), as opposed to us sending mixed messages that might interfere with how they would naturally figure out how to organize the body for optimal performance. The key word here, however, is performance. If you're just looking to run faster, jump higher, or throw harder or farther, external cues are your best bet.
What happens is there is aberrant movement, though? We've always heard that athletes are great compensators. If we just tell an athlete with very limited hip extension to "push the ground away" when he sprints, isn't he just going to continue to jack his lower back into excessive extension when the better long-term strategy is to get the hip extensors to do the job? To this point, there is actually some research (examples here and here) that internal focus cues definitely still have their place, especially when trying to modulate muscular recruitment patterns on single-joint exercises. I use internal focus cues (usually with tactile facilitate, or touching the region in question) every day to get better positional awareness and recruitment patterns, particularly with our arm care drills.
If you had to put me on the spot, I'd say that external focus cues are better and definitely a good place to start. I don't think we should throw the baby out with the bath water, though; internal cues definitely should always have a place in your coaching toolbox.
2. Barefoot deadlifting doesn't just clean up movement quality; it also makes it easier to coach.
I've written a lot in the past about how I like to have our athletes deadlift barefoot or in minimalist sneakers. Because the deadlift is a posterior chain dominant exercise and we want the athletes to think about driving their heels through the floor, it seems only fitting to make it easier for those heels to be in close proximity to the floor. Additionally, given that some people have mobility or stability restrictions that make it hard to get all the way down to the bar without compensation, being barefoot actually shortens an individual's range of motion by an inch or so.
That said, there are two technique flaws you can spot easier in a barefoot scenario. First, you never want to see an athlete deadlift on a pronated foot; rather, a supinated foot gives us the rigidity we need to put force into the ground. You'll commonly see athletes "spin out" and dump into pronation like this, though.
Second, you can more easily spot what the toes are doing. Often, when someone has a faulty hip hinge pattern, they'll simply pull the toes up rather than maintaining "tripod foot." This is most easily recognized on the decent of the lift.
You can certainly spot these issues when athletes have shoes on, but they are definitely easier to pick up in the barefoot scenario.
3. If you're successful in one rotational sport, you've got a higher likelihood of success in other rotational sports.
A few days ago, Bartolo Colon hit his first career home run at age 42. This feat is is impressive in itself, but it's more surprising to the casual observer when you realize that Colon is a) a pitcher and b) obese.
For me, though, this wasn't nearly as surprising as it was entertaining. Efficient rotation is efficient rotation, whether you're a hitter, pitcher, hockey player, or golfer. There's a reason hockey and baseball players are usually excellent golfers without much formal skill instruction; they understand sequencing from the ground up.
Bartolo Colon has 17 years of Major League Baseball service time, has thrown over 3,000 innings, and has won 221 MLB games. You break down or lose effectiveness long before any of those numbers happen if your body doesn't "get" efficient rotation.
4. A little upper trap rolling can go a long way in improving upward rotation of the scapula.
Serratus anterior, lower trap, and upper trap work together to get the upward rotation of the scapula that we want with overhead movement.It's important, though, that they all work together to do this. If you want to get up to speed on upward rotation, give this video a watch:
If you've read this blog or followed me on YouTube for any length of time, you've probably realized that I'm a huge serratus anterior guy. It's really important that you get serratus anterior going to create the rotational component of upward rotation that gets the shoulder blade around the rib cage. I have quite a few serratus activation videos (examples here, here, and here), but I think it's important to realize that if someone doesn't have good serratus recruitment, they'll often create a pure scapula elevation (shrugging) pattern instead of the clean upward rotation we want. Effectively, upper trap and levator scapulae can pick up the slack and do too much work. When I see this pattern, I'll often encourage individuals to try out a little bit of upper trap rolling with a lacrosse or baseball to reduce the bad stiffness "up top" before we get to work.
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It's time to kick off your week with some recommended strength and conditioning reading:
One Weird Trick: Half-Kneeling - CSP coach Miguel Aragoncillo highlights some of the common mistakes we see with folks in the half-kneeling position, and then outlines some strategies for cleaning it up.
Major League Wisdom - Mark Watts on EliteFTS published this compilation of audio interviews from Carlo Alvarez, Bob Alejo, Mike Boyle, and me, and it focuses heavily on our involvement in baseball. There is a lot of great stuff in here.
Strength Development Roundtable - Greg Robins, Tony Bonvechio, and I hopped on a Facebook Live Q&A to talk about all sorts of strength development topics, from percentage-based training, to exercise sequencing, and velocity-based training. Our signal cut out for a second, so it was actually broken into two parts. That said, you can watch them both here if you missed them live:
Over the past year or so, Cubs pitcher Jake Arrieta has been a highly celebrated MLB athlete not only for his dominant performances (including two no-hitters) on the mound, but also for "reincarnating" his career with a new organization. Previously, Arrieta had been a member of the Baltimore Orioles organization - and while he had been a Major League regular, his performance had been relatively unremarkable. That all changed when he arrived in Chicago.
Source: Yahoo Sports
In Tom Verducci's recent piece for Sports Illustrated, Arrieta detailed that his struggles with the Orioles were heavily impacted by constant adjustments with everything from mechanics, to pitch selection, to where he stood on the rubber. He was even quoted as saying, "I pitched for years not being comfortable with anything I was doing. I was trying to be somebody else."
I'm always cautious to take everything I hear in the sports media with a grain of salt, and this blog is certainly not intended to be a criticism of anyone in the Orioles organization. However, what I can say is that this story isn't unfamiliar in the world of Major League Baseball. There is a lot of overcoaching that goes on as many coaches try to fit pitchers and hitters into specific mechanic models. In other words, rather than looking for ways to make Jake Arrieta into the best Jake Arrieta possible, some coaches look to make athletes into Greg Maddux or Nolan Ryan - and they usually wind up with Henry Rowengartner (minus the arm speed).
This "phenomenon" isn't confined to baseball, however. In his outstanding book, The End of Average, Harvard professor Todd Rose, writes: "The real difficulty is not finding new ways to distinguish talent; it is getting rid of the one dimensional blinders that prevented us from seeing it all along." Moreover, he adds, "We live in a world that demands we be the same as everyone else - only better - and reduces the American dream to a narrow yearning to be relatively better than the people around us rather than the best version of ourselves."
As Rose notes, we can extend this concept to the idea of standardized testing for students and conventional hiring procedures for new employees, both of which often overlook the brilliant individuals among us who may be wildly capable of remarkable contributions if put in the right situations. In short, pushing the "average" rarely allows anyone to demonstrate - let alone leverage - their unique potential.
This is where coaching becomes more of an art than just a science. On the pitching side of things, we know there are certain positions all successful pitchers get to in their deliveries - and there are certainly bad positions they should probably avoid to stay healthy. With that said, we have to "reconcile" this knowledge with the realization that some of these "bad positions" may help pitchers generate greater velocity, influence pitch movement, or add deception. If we try to change them - especially at the highest level - we may take away exactly what makes a pitcher successful.
You can draw parallels in a lifting environment. Some of the best deadlifters of all time pull conventional, and others use a sumo stance. Their individual anthropometry, training histories, and success to date govern the decision of how to pick heavy things up off the ground.
It's important to note, however, that it's very easy to play Monday Morning Quarterback in situations like these, as hindsight is always 20/20. Long-time CSP athlete Corey Kluber won the American League Cy Young award in 2014 in large part because he switched to a 2-seam fastball with the help of Indians pitching coaches Ruben Niebla and Mickey Calloway. And, another long-time CSP athlete, Jeremy Hazelbaker, is one of the feel-good stories of Major League Baseball after a subtle adjustment to his swing from a Midwest hitting coach, Mike Shirley, yielded huge results and put him on the Cardinals opening day roster after seven years in the minor leagues.
Arrieta's Cubs teammate Jason Hammel spent some time with us at Cressey Sports Performance this off-season and made some mechanical adjustments, and he is off to a good start with a 4-0 record and 1.85 ERA. The point is that we hear a lot more about failures than we do about success stories, and it's really easy to rant when things don't work out. Subtle adjustments that keep guys healthy and confident don't always show up on the radar - and as a result, some really important and tactful coaches from all walks of life don't always get the recognition they deserve.
So when is it right to tinker on the coaching side? And, are there commonalities among what we'd see in pitchers, lifters, and other facets of the performance world? Here are seven questions I think you need to ask to determine whether the time is right to make a change:
1. Has the athlete been injured using the approach?
If an athlete can't stay healthy, a change might be imperative.
2. Has the athlete stagnated or been ineffective with the approach?
The more an athlete struggles doing it his way, the more open he'll be to modifying an approach. Career minor leaguers will buy in a lot easier than big leaguers - and the minor leaguers definitely have much less to lose if things don't work out. Conversely, Jason Hammel already had over eight years of MLB service time before I even met him; we weren't about to drastically change things.
3. Is the athlete novice enough that a change is easy to acquire and implement?
It's a lot easier to correct a 135-pound deadlift than it is to correct a 500-pound deadlift. You're best of fixing faulty patterns before a lifter has years to accumulate volume of loading the dysfunction. This is one reason why I'd rather work with a young athlete before he has a chance to start lifting on his own; there aren't any bad patterns to "undo."
4. What's the minimum effective dose that can be applied to "test the waters" of change?
Can a "tinker" be applied instead of an "overhaul?" Switching from a 4-seam fastball to a 2-seam fastball is a lot less aggressive than switching from a 4-seam fastball to a knuckleball. And, it's probably easier to go from an ultra-wise sumo deadlift to a narrower sumo stance than it is to go all the way to a conventional set-up.
5. How can you involve the athlete in the decision-making process with respect to modifications?
The concept of cognitive dissonance tells us that people really don't like conflict and generally like to avoid it. This works hand-in-hand with the concept of confirmation bias; we like to hear information that agrees with our beliefs and actions. In their fantastic book, Decisive, Chip and Dan Heath write, “In reviewing more than 91 studies of over 8,000 participants, the researchers concluded that we are more than twice as likely to favor confirming information than dis-confirming information.” Furthermore, the Heaths note, “The confirmation bias also increased when people had previously invested a lot of time or effort in a given issue.”
How, then, can we involve our athletes and clients in the decision-making process so that they effectively feel that the necessary changes are their ideas? And, can we regularly solicit feedback along the way to emphasize that it's "their show?"
6. How can we change the situation rather than the person?
In Switch: How to Change Things When Change is Hard, another great read from the Heath brothers, the authors note that you will almost never effect quick change a person, but you can always work to change the situation that governs how a person acts. If a pitcher's velocity isn't very good in the first inning (particularly during colder times of year), there's a good chance he needs to extend his warm-up. However, many pitchers are very rigid about messing with pre-game routines. Maybe you just encourage him to do more of it inside where it's warmer, or have him wear a long-sleeve shirt until he starts sweating. Here, you're impacting his surroundings far more than his beliefs.
7. Can the change be more efficiently implemented utilizing an athlete or client's learning style?
All individuals have slightly different learning styles (one more reason "average"coaching isn't optimal). Some athletes simply need to be told what to do. Others can just observe an exercise to learn it. Finally, there are those who need to actually be put in the right position to feel and exercise and learn it that way. And, you can even break these three categories down even further with more specific visual, auditory, and kinesthetic awareness coaching cues. The more we understand individual learning styles, the more we can streamline our coaching with clear and concise direction. If a adjustment is perceived easy to understand and implement, an athlete will be far more likely to "buy in."
On the whole, I think there is a lot of over-coaching going on in today's sports. Above all else, I think us coaches need to talk less and listen more so that athletes can be athletic. And, when a change is warranted, we need to make sure it's a tinker and not an overhaul - and it's important to give an athlete or client and ownership stake in the process.
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Also, just a heads-up that Pete Dupuis and I also ran some live Q&As on the business of fitness on my Facebook page last week. We plan to do more in the future, but in the meantime, you can check this week's recordings below:
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Last week, I came across a meta-analysis that examined the existing body of research on latissimus dorsi and teres major strains in professional baseball pitchers. While the collective sample size was small (30 total athletes), one resounding theme was present:
Lat strains can be pain in the butt to rehabilitate.
In these studies, 29 pitchers were managed conservatively, while one pitcher required surgery for the issue. In the conservative group, the average return-to-pitching timeline was 100 days, whereas the surgical case was 140 days." Perhaps of more significance, though, the researchers noted that "five patients in the conservative group suffered from complications and/or setbacks during their treatment and rehabilitation."
We have to keep the sample sizes in these studies in mind, too. They haven't had a large pool from which to draw, and many researchers might not appreciate how different "return-to-pitching" is than "feeling like your old self." The general consensus among guys I know who have had the surgery seems to be that it's 8-10 months before you're back to feeling 100% in games.
Let's face it: if you're missing 3.5-5 months with an injury - and adding even more time to get back to 100% - you might as well just cash in an entire season. That's not only a lot of money wasted on disabled list time at the Major League level, but also a lot of lost developmental time in the minor league ranks.
To make matters worse, the rehabilitation process can be delayed because lat strain diagnoses can be somewhat challenging. According to Dr. Leon Scott, a sports medicine physician and Assistant Professor of Orthopaedics & Rehabilitation at Vanderbilt University, "Because lat strain diagnoses aren't all that simple to make, especially if a physician’s exam is limited and relies heavily on an MRI, they are often a missed diagnosis. A standard MRI may not be distal enough to capture the area of injury. Arthrogram images are an even smaller field, leading to a missed diagnosis." He also notes that in one acute lat injury he saw in the past, "With a wide field shoulder MRI, there was acute edema, hematoma seen at the bone-tendon interface. It was hard to miss." In short, ordering physicians may be trying to use a narrow imaging technique for a shoulder injury when they should be painting with a broader brush that would also pick up an upper arm injury.
Source: By Anatomography (en:Anatomography (setting page of this image)) [CC BY-SA 2.1 jp (http://creativecommons.org/licenses/by-sa/2.1/jp/deed.en)], via Wikimedia Commons
One professional player I saw struggled with getting a definitive diagnosis that his lat strain needed surgery for two years. At first, they suspected his anterior shoulder pain was occurring because of a labral tear, but a labral "clean-up" surgery didn't change his symptoms. Perhaps more interesting, though, the surgeon didn't even see the lat tear while he was doing the arthroscopic intervention. Five months later, another surgeon went in to repair the lat - which was actually significantly detached from the bone.
The first take-home message here is that if you're a thrower and you have shoulder pain, you need to make sure that you see a sports medicine physician who sees a lot of throwing injuries. A lat strain can be a tricky diagnosis, and even the most well-intentioned physicians may not know to look for it. This is especially because it often presents as pain in the front of the shoulder, in the event of a tendinous injury. You can see this clearly demonstrated by the attachment points in the image above, but I'll take more about this later when we get to functional anatomy.
As I pondered the research article and actually discussed it with a few of my staff members, I realized that we have literally never had a lat strain happen with one of our regular clients at Cressey Sports Performance - and we see a lot of pitchers. I say this not to brag (or jinx us), but rather to just bring to light that success leaves clues - which I'll also get to later on in this article.
That said, I should note that my ideas in this article also draw heavily on our experiences working with a lot of frustrated pitchers who have come to work with us after the injury has occurred because they need help bouncing back. Failures (in this case, injuries) also leave clues.
Before we get to all these observations and potential countermeasures to prevent lat strains, I think it's incredibly important to discuss the functional anatomy of the latissimus dorsi and teres major. And, as an extension, we'll discuss how this functional anatomy understanding needs to be put alongside biomechanics research and anecdotal observations of injured athletes to pull together a hypothesis for the "perfect storm" of lat injury risk.
The latissimus dorsi is a big muscle with huge functional implications.
It attaches on the thoracolumbar fascia (lower back) and runs all the way up to the intertubercular groove of the humerus (front of the upper arm). This is why it has to be considered as a differential diagnosis for anterior shoulder pain in throwers - alongside everything from biceps and rotator cuff tendinopathy or tears, to labral injuries, to anterior capsule injuries, to thoracic outlet syndrome.
As an interesting aside, there are a number of anatomical variants present along this lengthy anatomical course. In a small percentage of people, the lat actually attaches on the ilium (top of the pelvis). In just under half of individuals, it has a direct attachment on the scapula. The number of costal (rib) and vertebral attachments also varies from person to person.
Everyone knows about the functions of the lat at the shoulder - extension, adduction, internal rotation, and horizontal abduction - but in consideration of this expansive functional anatomy profile, we have to appreciate that it has several other key roles to consider.
Lat is a key core stabilizer - to the point that it can be heavily overused and pull athletes into a "gross extension" pattern. Notice the big anterior pelvis tilt and lordosis here - but also take note of the position of humeral extension (and the indirect effects on forward head posture).
Given its attachment on the scapula in some individuals - and the indirect impacts of "crossing" the scapular region - the lat also contributes to scapular depression.
Finally, it's been theorized that an aberrant, extension-biased posture would interfere with optimal diaphragmatic function (via loss of the zone of apposition). Because the lat is also an accessory respiratory (inhalation) muscle, you could say that it has to pick up the slack for a problem it actually helps create! My favorable experiences with the Postural Restoration Institute and my own anecdotal observations definitely support this theory.
For all intents and purposes, you can view teres major as a "mini-lat." It shares the same scapula-to-humerus functional relationship and actions, but doesn't impact the rib cage or lumbar spine directly.
Implications for Throwers
By appreciating the functional anatomy of the lat, we can recognize just how vital it is to throwing a baseball hard. In short, it connects the lower body to the upper body to allow for force transfer that ultimately leads to arm speed and ball velocity.
Not surprisingly, a 1987 study from Gowan et al. observed that lat recruitment during the acceleration phase of throwing was substantially higher in professional pitchers than in amateurs. Not surprisingly, experienced, accomplished athletes know how to use big-boy muscles (prime movers) to do big-boy jobs (accelerate the arm, which is the fastest motion in all of sports). The amateur pitchers actually continued to heavily rely on smaller, stabilizing muscles - the rotator cuff, biceps, and posterior deltoid - during acceleration. That's not a safe or effective long-term strategy.
This is likely why we rarely see lat strains in younger athletes; you probably have to throw 90mph+ to effectively "use" the lat, and muscles that don't get used usually don't get strained. The younger kids are more likely to have rotator cuff pain, irritation of the long head of the biceps tendon, or proximal humeral growth plate issues.
There's a bit more to "lat overuse" than just the acceleration phase of throwing, though. During the lay-back (extreme cocking, or maximum external rotation) portion of throwing, the lat and teres major are two of several muscles (including notables like subscapularis pectoralis major) that are working eccentrically to prevent the humerus (upper arm) from flying off the body.
This eccentric pre-stretch also helps to store elastic energy that is subsequently released during the acceleration phase to create ball velocity. Most muscle strains occur - whether it's acutely or chronically - as muscles and tendons are stretched during the eccentric phase of activity. Hamstrings strains usually occur at the terminal swing phase of sprinting. Middle-aged men rupture Achilles tendons when they land on dorsiflexed ankles - where the calves are maximally stretched. The lats and teres major are the most overstretched at this lay-back phase of throwing.
On a chronic note, repeated exposures to aggressive eccentric stress can lead to muscle shortening. Reinold et al (2012) demonstrated this with respect to elbow extension and shoulder internal rotation. My experience has been that pitchers who trend toward the "tight" end of the continuum also lose shoulder flexion and "true" external rotation over the course of the season. As I describe in the video below, this is very likely related to stiffness or shortness in the lats - and the research has demonstrated that it is associated with an increased risk of elbow injuries in pitchers.
Beyond just the specific roles of the lats during the throwing motion, we have to also appreciate that they're heavily overused during daily life because of their roles as core stabilizers and accessory respiratory muscles. And, given that we don't spend a lot of time in our daily lives with our arms overhead and shoulders externally rotated, they aren't afforded a whole lot of length throughout the day. Take a chronically shortened muscle, overuse it, and then throw it into the fastest motion in all of sports, and you've got a recipe for strains. However, you can't throw hard without it. Hence, this Tweet from me a few years ago:
Why Do These Injuries Take So Long to Heal?
Having established the injury mechanisms, it's important to also consider why lat strains in throwers take so long to rehabilitate. I see four primary reasons that differentiate lat strains from just "any other muscle strain:"
First, as we noted earlier, early diagnosis may not happen. This can occur because the athlete just ignores the issue as normal soreness, or they manage it as "biceps tendonitis." Or, a physician may not recognize that a lat injury could create anterior shoulder symptoms. Finally, a typical MRI might just miss the injury altogether. All these factors can potentially lead athletes down the wrong rehabilitation path.
Second, my experience has been that many of these injuries are far more chronic than they are traumatic. More often than not, when you dig deeper into the history of a pitcher who has a lat strain, he's thrown through some kind of extended soreness/discomfort for weeks, months, or years. Eventually, it becomes too much to stand and begins to significantly interfere with pitching performance. Given that the issue developed over an extended period of time, it isn't going to go away overnight.
Third, as I discussed in my functional anatomy musings earlier, the lats are heavily involved in multiple planes of motion. I've theorized in the past about how muscles that play crucial roles in multiple plans are more likely to be stubborn rehabilitation projects:
Pull a quad (rectus femoris), and you’ll usually bounce back really quickly. Pull an oblique and it’s much more stubborn. What’s the difference? The rectus femoris is really all about the sagittal plane, whereas the obliques have a big role in controlling excessive motion in the sagittal, frontal, and transverse planes. The more complex the job of the muscle, the more significant the injury – and the longer the rehab. Hamstrings have roles outside the sagittal plane and can be equally stubborn, too.
Fourth, the proximal humerus (upper arm) area really seems to scar down faster than almost any other region in the body - and this is particularly true of throwing shoulders because of the eccentric stress pitchers encounter. There are 17 muscles that attach to the scapula, and most of these structures cross the glenohumeral (ball-and-socket) joint. Perhaps more significantly, eight of these tendons attach in close proximity to the insertion of the latissimus dorsi and teres major. Throw eight tendons in a very small area that experiences a lot of eccentric stress, and you'll wind up with a gritty, fibrotic mess eventually.
Whether it's a chronic or traumatic onset lat issue in a pitcher, one theme always seems to hold true: symptoms emerge after a dramatic increase in throwing stress.
On multiple occasions, I've seen lat strains that have come about because a reliever pitcher was moved into the starting rotation without a gradual increase in pitch count.
In other instances, the lat got cranky after a big velocity jump in a single off-season. This is usually the case in a high school kid who jumps from 84 to 94mph in a single winter. As my friend Derek Johnson, the pitching coach for the Milwaukee Brewers has said, the "arm is writing checks the butt can't cash."
Sometimes, it may come about after a single outing with an abnormally high pitch count. The pitcher just can't bounce back in time for the next start, and the subsequent start becomes the straw that breaks the camel's back. y experience has been that when you throw the typical "high arm speed" (90mph+) high school pitcher out for back-to-back outings of 100+ pitches - even on a seven-day rotation - things often start to head down the wrong path. This doesn't happen nearly as frequently in the college game, and I think this speaks to the fact that there is clearly something really important that's occurring in terms of work capacity and/or strength improvements for pitchers in the 16-19 age range.
Finally, lat issues seem to be particularly common when you see high school and college starters switch from a 7-day rotation to a 5-day rotation when they enter professional baseball. It isn't as much of a dramatic increase in stress as it is a significant loss in recovery time or capacity. I've heard many guys over the years say that they have to learn to pitch with only 90% of what they're typicaly capable.
Beyond just the increase in throwing stress, there are a few things I've found to be common in the lat strain pitchers I've seen in recent years.
1. The lower traps can't keep up with the lat.
The lower traps are very important for providing posterior tilt (slight tipping back) of the scapula and assisting in upward rotation. These two functions make it essential for a pitcher to get his scapula in the right position during the lay-back phase of throwing.
Conversely, the lat has more of a "gross" depression effect on the scapula; it pulls it down, but doesn't contribute to posterior tilting or upward rotation. This might help with an adult rotator cuff pain patient who has an aggressive scapular elevation (shrug) substitution pattern, but it's actually problematic for a thrower who is trying to get his scapula up and around the rib cage to make sure that the ball-on-socket congruency is "flush" when it really matters:
As such, you can say that the lat and lower trap "compete" for scapular control - and the lat has a big advantage because of its cross-sectional area and multiple attachment points. It's also much easier to train and strengthen - even if it's accidentally.
To this end, we'll often hear throwers cued "down and back" during their arm care drills. The intension - improving posterior tilt via lower trap activation - is really good, but the outcome usually isn't. Unless athletes are actually put in a position of posterior tilt where they can actually feel the lower traps working, they don't get it. Instead, they pull further down into scapular depression, which feeds the lat-dominant strategy. This is why we teach almost all our throwers to differentiate between depression and posterior tilt on their first day in the gym.
2. The rotator cuff can't keep up with the lat.
As I noted earlier, the lat has numerous functional roles at the shoulder. Because the attachment point of the lat is on the shaft of the humerus and not the ball, the lat really can't have any direct control on the positioning of the ball in the socket. In fact, it actually indirectly destabilizes the throwing shoulder because it contributes to an anterior (forward) gliding of the ball on the socket during the lay-back phase of throwing. This anterior glide is counteracted by the rotator cuff musculature.
Whenever we evaluate movement, we have to consider both osteokinematics (gross movements - flexion, extension, etc. - of bones at joints) and arthrokinematics (subtle movements - rolling, rocking, gliding, etc. - of bones at joint surfaces).
To paraphrase something that physical therapist Shirley Sahrmann has noted many times, whenever you see a strained or overworked muscle, look for a dysfunctional synergist. In this case, the synergists to the lat and teres major are the rotator cuff muscles. We just rarely consider lat strains as a consequence of rotator cuff weakness because it's usually the biceps tendon, labrum, capsule, or rotator cuff itself that winds up cranky before the lat starts barking.
3. Guys usually have a history of doing a lot of lat dominant lifting.
In a baseball population, throwing is lat dominant. Breathing is lat dominant. Core stabilization is lat dominant. When you add in a lot of lat dominant lifting to the mix - particularly during the in-season period - things don't usually go well. I'm just going to put this out there:
I've never met a high-level thrower who had "weak" lats.
I'm speaking with respect to both relative and absolute measures. Relatively speaking, I've never looked at a guy and said, "Well, if he added 50 pounds to his best weighted chin-up, he'd definitely throw harder and be healthier. His rotator cuff and lower traps are too strong." Absolutely speaking, I have yet to see any research examining the relationship between lat strength and throwing velocity. I'm very confident that there is a point of diminishing returns where getting stronger doesn't help add any more velocity. Moreover, it may actually interfere with improvements - and increase susceptibility to injury. This includes elbow irritation, as heavy weighted pull-ups and chin-ups are brutal on the medial elbow in lifters who don't even throw a baseball for a living.
Just like you don't have to squat 800 pounds to have an elite vertical jump - but you probably won't jump high if you only squat 200 pounds - your lats just need to be strong enough to throw hard.
Also worthy of mention is the fact that exercises like deadlifts, farmer's walks, and dumbbell lunges, and any other drill where weights are held in the hands are actually very lat intensive. With the arms at the sides, the lats are almost fully shortened - and the lat is working hard as a core stabilizer against appreciable external loading.
The take-home message is that you really have to critically examine your entire strength training program for how much lat-dominant work your athletes are doing. My rule of thumb is that an athlete has to have full shoulder flexion and great cuff strength to "earn the right" to do pull-ups in his off-season programming, and we don't use any pull-ups or pulldowns with in-season programs. We can accomplish everything we need with horizontal pulling variations.
4. Guys usually accumulated a lot of innings or appearances without much, if any, manual therapy
NASCARs require more upkeep that ordinary automobiles. If you're going to push a car to its limits, you better plan on changing the oil and tires more frequently. The same goes for a high level throwing arm. Manual therapy is a game-changer for maintaining or improving range-of-motion and bouncing back between outings.
The lats and teres major get pushed really hard during the throwing motion, and it's important to do regular routine manual therapy maintenance to keep them "supple" with a variety of soft tissue approaches. I've seen athletes that responded really well to cupping, some to Graston Technique, some to Active Release Technique, some to dry needling, and others to more traditional massage. Everyone is different - but everyone needs it.
Also worth of note, trigger points in the latissimus dorsi may actually relate to discomfort in other regions. Chris Howard, massage therapist at Cressey Sports Performance – MA, notes:
“Trigger points in the latissimus dorsi can refer pain and discomfort to the medial and inferior border of the scapula extending to the posterior shoulder, medial triceps region and down to the pinky and ring finger. Trigger points not only cause pain, but can also mimic nerve symptoms by causing numbness and tingling in their referral zone. Of particular interest to this article is the fact that trigger points, regardless of whether they are active or latent, have the ability to alter muscle activation patterns. In other words, once trigger points are present in muscles of the shoulder girdle, the normal activation pattern is altered, which can lead to abuse of some of the smaller muscles.”
5. Guys have insufficient anterior core control.
The stiffer (or shorter) your lats are, the more you need to have great anterior (front) core control to prevent this from happening:
When the core control isn't present, the lats are never really challenged to approach their end range - which is full shoulder flexion. Learning to add some good stiffness to lock the ribs to the pelvis during overhead motion obviously protects the lower back, but it also has the added benefit of making lats "healthier."
6. They turn all rowing motions into lat dominant movements.
Rather than reinvent the wheel on this point, check out this detailed rowing technique video I filmed a while back. In particular, points #1, #2, #4, and #6 are the most common findings in a very lat-dominant individual. I'd encourage you to watch the entire video, though, as it's not uncommon to see multiple mistakes at a time:
7. Guys have lost shoulder flexion.
If a muscle is fundamentally short, it's going to be more likely to strain. These are usually the ones who have failed miserably on points 1-6 over an extended period of time.
Several years ago, in the heart of the ACL prevention program craze, Mike Boyle made a bold statement, "ACL injury prevention is just good training." In short, if you teach athletes to move well with comprehensive, well-rounded programming and solid coaching to ensure good training technique, you're going to markedly reduce the incidence of ACL injuries. I couldn't agree more - and I'd argue that lat strain prevention training in pitchers is just good training, too.
1. Maintain tissue quality with regular manual therapy, and complement it with daily foam rolling.
2. Make athletes earn the right to do pull-ups.
3. Don’t do pull-ups/pulldowns during the season.
4. Make sure that the rotator cuff, lower trap, and anterior core are strong enough to keep up with the lats.
5. Be cognizant of overdoing it on drills like deadlifts, farmers walks, and DB lunges/split squats. These are all great exercises that can have their place, but anything done to excess can be a problem.
6. Ensure appropriate training technique. Specifically, don't overuse the lats when you aren't supposed to use them at all.
7. Closely monitor athletes who have seen dramatic jumps in pitching velocity or workload - and avoid building up pitch counts too quickly.
8. Constantly solicit feedback from pitchers so that mild lat soreness is discovered before it can become a full blown injury.
Obviously, once an athlete already has a teres major or lat strain, things are a lot hairier. That's really the point of the article, though: as always, prevention is the absolute best treatment.
Happy Sunday - and month of May - to you. Let's get the week started with some recommended reading:
The End of Average - I just finished this (audio)book from Todd Rose, and found it to be fantastic. It really makes you reconsider how we really evaluate success - or even competency or fit in job applicants.