Home Posts tagged "Baseball Workouts" (Page 19)

The Truth About Shoulder Impingement: Part 1


Shoulder Impingement….Yes, We Get It.

Roughly 10-15 times per week, I get emails from folks who claim that they have "shoulder impingement.” Honestly, I roll my eyes the second I read these emails.

Don’t get me wrong: I’m not making light of their pain. It’s just that it drives me crazy when doctors throw this blanket statement out there. I will be completely and 100% clear with the following statement:

Shoulder impingement is a physiological norm. Everyone – regardless of age, activity level, sport of choice, acromion type, gender, you name it – has it.

Don’t reach up to touch that mouse on your computer; you’ll aggravate your impingement and your supraspinatus will explode!

And, don’t scratch that itch on the back of your neck; your impingement will go crazy and your labrum will disintegrate!

Don’t believe me? Check out research from Flatow et al. from 1994.

Yes, this has been out since 1994.

So, the next logical question is: why do some people have pain with impingement while others don’t?

In reality, there are several factors that dictate whether or not someone is in pain, including:

1. Tissue quality – the most “impinged” structures are more likely to break down in older age than they are in earlier years.  Younger individuals can regenerate faster even when overall stress on the tissues is held constant, so how you handle a 50-year-old with "impingement" is going to be somewhat different from how you handle a 15-year-old with "impingement."

2. Degree of elevation – the more one abducts or flexes the humerus, the greater the degree of impingement. This is why folks need to start in a more adducted (arm at side) position early on in rehab.  Those that impinge early in their arc tend to be dealing with subacromial impingement, whereas those who hit it at the absolute top tend to be more AC joint impingement.

painfularc-for-acj

3. Acromion type – flat acromions have significantly less contact area with the rotator cuff tendons than hooked or beaked acromions. These structures may change over time due to…

4. Bone Spurs – bone spurs on the underside of the acromion will increase the amount of impingement.

5. Strength of the rotator cuff – the stronger the cuff, the better its ability to depress the humeral head and minimize this impingement

6. Scapular stability – the more stable the scapula, the more likely it is to posteriorly tilt and upwardly rotate effectively when the humerus is raised into the zones of greater impingement. This scapular stability includes adequate length of the downward rotators (pec minor, levator scapulae, and rhomboids) with adequate strength of the upward rotators (lower traps, serratus anterior, upper traps).

7. Thoracic spine mobility – the posture of the thoracic spine dictates the position of the scapulae, which in turn affects impingement as noted in #6.  Assess and Correct is an awesome product for improving thoracic spine mobility - and you can also find some good drills in my recent post, Shoulder Hurts? Start Here.

8. Increased internal rotation – Certain movements that lock the humeral head in internal rotation increase the degree of impingement during dynamic activities. It’s why some people can’t bench press early-on in their rehabilitation programs, yet they can do dumbbell bench presses with a neutral grip pain-free. It’s also the reason why upright rows are a stupid exercise, in my opinion.

9. Breathing patterns – think about what happens when someone has poor diaphragmatic function and becomes a “chest breather:” the shoulders shrug up, and you get extra tightness in the levator scapulae, scalenes, pec minor, and sternocleidomastoid (among other supplemental respiratory muscles). In the process, the degree of impingement can increase.

10. Other issues further down the kinetic chain – I could go on and on about a variety of issues in this regard, but it’s impossible to be exhaustive – so I’ll just give an example. If someone has poor core stability in the sagittal plane that is manifested in an inability to resist the effects of gravity during a push-up, the hips will “sag” to the floor. As this happens, and the upper body remains strong, the scapulae are shifted into an anterior tilt –which increases the amount of impingement on the rotator cuff. So, weakness and/or immobility in other areas can certainly predispose an individual to shoulder problems.

This can also be carried forward to pitchers. We know that shoulder problems are more likely to occur in throwers who have poor lead leg hip internal rotation, as it causes the stride leg to open up early, leaving the arm “trailing behind” where it should be.

Speaking of pitchers, a phrase that has been coined with respect to the “unique” kind of impingement you see in them is “internal impingement.” In next week’s newsletter, I’ll discuss the different kinds of impingement – and why it’s still a cop-out diagnosis for any health care professional to just say you have one or the other rather than tell you explicitly what dysfunctions need to be addressed.

Click here to purchase the most comprehensive shoulder resource available today: Sturdy Shoulder Solutions

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Random Friday Thoughts: 10/31/08

It's Halloween, and as you're reading this, I'm down in Georgia for baseball stuff. Because I'm actually writing this on Tuesday night, it's hard to get in the mood and be spooky, but I'll do my best. 1. I'll be doing a LOT of baseball seminars over the next few months: November 8-9 (NY), December 14-16 (TX), January 30 (MA), and February 14 (MA). For more information, check out my schedule page. 2. I actually think the Fat Tax is a good idea. While we're at it, can we institute an a**hole tax for guys who curl in the squat rack? My girlfriend was lifting at a gym down in Southern CT this week, and she told me a guy took up a squat rack all morning to do three curl variations - and then proceeded to set up two bars in the rack to do dips. The good news for him, though, is that the Horse's A** trophy he receives partially offsets the tax. 3. When dealing with athletes post-ACL reconstruction, it's obviously important to get range-of-motion back quickly. However, the direction of that ROM can actually tell you quite a bit about what is going on. When someone is struggling to get knee extension, the problems are usually do to scarring. Flexion problems, on the other hand, are usually related to graft tensioning issues. In other words, when there is loss of flexion, it is usually surgical. When there is loss of extension, it is usually rehabilitative. When there is a loss of both flexion and extension, the problem is - you guessed it - Richard Simmons. Yes, he's spooked, spooky, and stupid. I don't want your trick or your treat, Richard; I just want you to put some pants on and get a haircut. 4. Scientists recently confirmed a virgin birth in a shark. Apparently, the baby shark (called a pup, for reasons I can't explain) carried no male genetic material. Immediately upon its birth, the shark started bitching about how it didn't want to get too bulky. Scientists fear for the pup's survival, as it refuses to swim fast enough to catch its prey because it doesn't want to get out of the "fat burning zone." 5. I went into quite a bit of detail on why I dislike the term "shoulder impingement" in my newsletter this week. Check it out HERE. Just five this week, as I've got lots to do. Have a great weekend!
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Random Thursday Thoughts: 9/17/08

We are publishing this on Thursday night again, as I am going to be up early tomorrow to train, do an evaluation on a pro baseball pitcher who is in town from South Carolina, and then hit the road to get to Stamford, CT in time to speak on a roundtable at Ryan Lee’s Bootcamp. I’m looking forward to a great weekend and catching up with plenty of friends in the industry – including Mike Roussell and Alwyn Cosgrove, which leads me to… 1. For those who missed it, it isn’t too late to get the EricCressey.com subscriber-only discount on Warp Speed Fat Loss. Check out this week's newsletter for more details – or just head over to pick up a discounted copy through the following link (coupon code is embedded already): Warp Speed Fat Loss 2. Still overpriced and lame. 3. Alan Aragon had a great article published at T-Nation yesterday. Definitely check it out: A Musclehead’s Guide to Alcohol 4. Anyone who can find me a good study that shows that you can isolate the vastus medialis effectively gets a gold star. If you want to save yourself a few days of frustrating Pubmed searching, you’ll give up now, because you aren’t going to find it. 5. Someone asked what I thought the best substitute for front squats would be in the Maximum Strength program if one didn’t have access to a power rack. I’d probably go with walking dumbbell lunges – mostly because it’d be funny to see someone do clusters with lunges! For the record, that was a joke, folks; lunge clusters would be stupid. 6. Some researchers say that we all would die of heart disease eventually if we “outlasted” everything else. I, on the other hand, would likely die from the monotony and pure frustration of trying to explain to baseball players and coaches why distance running is stupid. To tack a few years onto my life, please do me a favor; if you are a baseball player or coach, you need to read these two articles – and then forward them on to everyone you know who also plays or coaches. Part 1 Part 2 7. Someone asked me the other day if I thought all problems were related to anterior pelvic tilt. While it’s a big problem in athletes, I would not attribute any of the following problems to anterior pelvic tilt: gonorrhea, shingles, global warming, diarrhea, traffic jams, or that annoying cashier at Trader Joe’s who always insists on commenting on how I’m buying a lot of eggs. I do hope that bastard’s hip flexors are tight, though; he rubs me the wrong way. Michelle would probably kill him for a stupid comment like that. 8. I’ll be introducing a new product next week. While many of you might be disappointed that it won’t be the 2009 Mike Robertson Pin-up Calendar (March is the Funky Knee Surgery Scar Month; it drives the ladies wild), I’m sure you’ll be delighted with the content. This is absolutely, positively, a must-read for all personal trainers and strength and conditioning coaches. And, I suspect that a lot of you everyday gym-goers will like the content as well. If you aren’t already signed up for my free newsletter, sign up using the opt-in feature to the top-right of your screen (Name and Email Address) and you’ll be among the first to know. Have a great weekend, folks!
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Training around Elbow Issues in Overhead Athletes

We see a lot of baseball players, so a lot of these guys come to use with elbow problems. In most cases, the doctors they’ve seen have said, flat-out, “NO LIFTING WEIGHTS.” This drives me nuts for a variety of reasons: 1. They’ve still got two good legs, one good arm, and a bunch of core musculature that needs to be strong and functional. 2. This recommendation implicitly means “Stay away from personal trainers and strength coaches.” It’s probably due to the fact that there are a lot of bonehead personal trainers out there who could do more harm than good, but the truth is that these services comprise more than just lifting weights. We do a lot of mobility and activation work and self-myofascial release on the foam roller. Collectively, #1 and #2 demonstrate that this blanket recommendation includes an insanely ignorant omission, as the majority of elbow problems can be attributed to mobility and strength deficits at the shoulder. You can train a shoulder a thousand different ways without even involving elbow motion – let alone challenging it sufficiently to cause a problem. In fact, I'd estimate that you could prevent 90% of elbow problems in baseball guys if we simply taught all of them how to sleeper stretch in their early teenage years: I'd strongly encourage you to check out this article I wrote, where I go over the common mistakes folks make when performing the sleeper stretch. 3. This recommendation flat-out ignores the specific nature of the overwhelming majority of elbow problems in throwing athletes. Let me elaborate.. In my estimation, 95% of baseball players with elbow pain couldn’t elicit their pain in a weight room if they wanted to; seriously! The reason is that this elbow pain is typically mechanical in nature; that is, it’s only aggravated by specific activities (in their case, throwing). Believe it or not, I have had guys do everything from pull-ups, to dumbbell bench presses, to rows, to push-ups, to grip work just days out from elbow surgery. It isn’t true in every case, but it’s definitely the majority. And, they can all get diesel in the lower body during this time period. Some great related reading for you: Inefficiency vs. Pathology Lay Back to Throw Gas

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The Empty Can

Q: A trainer at my gym was telling me that the best way for a bodybuilding competitor to perform lateral raises was to execute them in or slightly behind the frontal plane and in the "empty-can" hand position (he said this is good for long-term shoulder health since he claimed it would strengthen the supraspinatus) while leaning slightly forward. Do you think this recommendation is conducive to long-term shoulder health, or would it lead to excessive wear and tear and potentially create impingement problems? Or is it a case of this being perfectly acceptable for some populations and a nightmare for others? If it is the latter, who can perform them this way and who should avoid them? A: I disagree wholeheartedly. The empty can is a provocative test; it's what we do when we want to see just how angry an injured supraspinatus is. If you want to keep the supraspinatus healthy, you don't need to make a dedicated effort to strengthen it. You need to strengthen the muscles that position the scapula so that there is more clearance through which that tendon can pass under the acromion process. These would include lower trapezius and serratus anterior. Strengthening the muscles of the rotator cuff will help to depress the humeral head as well. There is also a definite role for thoracic spine mobility (as I wrote about in a previous newsletter) in this situation, as it helps dictate the positioning of the scapulae. 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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Random Friday Thoughts: 8/29/08

1. As you probably know, I haven't been updating here quite as frequently of late, but fortunately, it's with good reason. The summer's winding down, so we've been getting our fall schedule all squared away with the high school guys - plus some local college guys at programs that don't have organized S&C programs. Additionally, all of our minor leaguers are in the final few days of their seasons right now, so coordinating with them and a few agents has been a priority right now. Fortunately, though, there are also some exciting things in store for this blog... 2. Basically, we're going to be combining EricCressey.com with EricCressey.Blogspot.com. So, my blog will be available directly from EricCressey.com. In the process, we have to transfer a ton of content - but the good news is that the finished product will look a lot more professional and organized when all is said and done. In the meantime, thanks for your patience as we make this switch. 3. I was chatting yesterday with Doug Carroll, a great hitting coach with whom we work. Doug played professional baseball to a very high level in both the Mariners and Devil Rays organizations. We both agreed that one thing you’ll notice in the majority of high level athletes is that they really don’t give a crap what anyone outside their family thinks of them. I think that if more people approached their lifting with this mindset, we’ve have a lot more people who were really big and strong. Interestingly, this closely parallels my approach to internet forums - and, thus far, ignoring what the haters say has been a great decision. 4. Never forget that you don’t have to leave the gym exhausted for the session to be considered productive. Take a 300-pound lineman and have him run five miles; he’ll be completely exhausted by the end of the session. He’ll also be slower, more likely to get injured, and definitely more likely to want to kick your teeth in. 5. Something you might not know: there are estrogen receptors on the anterior cruciate ligament (ACL) that – along with several other factors – make females more susceptible to ACL ruptures. The cyclical nature of estrogen and progesterone markedly influences ACL strength via fibroblast activity – so at certain times of the month, the ACL is more likely to tear. The ACL may also be predisposed to dramatic mood swings that make everything your fault, fellas. 6. I had a new article published yesterday, in case you missed it: 5 More Common Technique Mistakes. 7. I got two separate bills from Comcast in the past two days for a total of over $314. Do you think they read my blog, or is their billing system simply as hopelessly inadequate as their customer service? 8. Someone asked me yesterday, "Are single-leg leg press a good unilateral leg exercise? I hate lunges." Sorry, dude; single-leg leg presses don't count for anything. 9. I'm working on a detailed write-up on my views on running for pitchers right now. I think it'll open a lot of eyes - if I ever get time to finish it! I also have a new e-book in the works that I think will open a lot of eyes. 10. Have a great holiday weekend, everyone.
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Quick Monday Mentions

It was a hectic day, and I just (finally) got internet access at our new place, so I'm going to be brief and use today for a few quick notes: 1. Congratulations to Cressey Performance athletes Derek Lowe (Lincoln-Sudbury) and John McKenna (Algonquin). Derek verbally committed to the William & Mary baseball program, and John did the same for the University of Massachusetts. Congratulations, guys; we're proud of you! 2. I just got an email from Patrick Gagnon about the second annual Vinkofest, which will take place in Montreal September 27-28. I spoke at the event last year, and Pat did a great job organizing it. While I won't be in attendance this year, I'd definitely encourage any of you who can make it to get out and check this event out. They have some great speakers, including John Berardi, Christian Thibaudeau, and Dave Barr. For more information, check out MuscleDriveThru.com.
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Cressey Performance Athlete Commits to Stanford

Cressey Performance athlete and Weston High pitcher Sahil Bloom committed late last week to Stanford. Here's a great article from the Boston Globe on his signing and training with us. Weston High pitcher buffing up his body as well as his scores Congratulations, Sahil!
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Diminutive Reliever Shows Stature Isn’t Everything

Here's a great article about Cressey Performance athlete Tim Collins in the Toronto Blue Jays system. Diminutive Reliever Shows Stature Isn't Everything Atta' boy, Tim!
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Random Friday Thoughts: 8/1/08

1. It's going to be a quick one today, as we're getting ready to leave for Cassandra Forsythe's wedding in Vermont. For the record, this will likely be the last time she's referred to as Cassandra Forsythe; she'll be Forsythe-Pribanic by the end of the weekend! 2. One more reason to not use the abductor machine: OUCH! 3. Researchers have found that participation in a football game leads to a HEIGHT loss of almost one centimeter - likely due to compressive forces. Just imagine what happens when you put 500 pounds on your back and go for a squatting session! I haven't seen any acute research in this regard, but there is evidence to show that retired weightlifters have reduced disc heights when compared with controls who didn't lift. I'd be willing to bet that they also have fewer broken hips, can carry their own groceries, and pick up way more hotties in the convalescent home, so I'll take functional capacity over a perfect MRI anyday. 4. Good points on the negative effects of flip-flops, but I don't buy the argument that barefoot training is just as bad. The only reason it's "bad" is that you can't put orthotics on a bare foot... 5. My girlfriend cooked up some protein bars from John Berardi's Gourmet Nutrition cookbook; awesome stuff! It's the summer in the Northeast, so there are a lot of blueberries on-hand; they're a great addition to the apple cinnamon bars, if you haven't tried them already. 6. Tony Gentilcore started a training log over at T-Nation that describes a lot of the madness at Cressey Performance in our training group. It's worth checking out - at the very least, to make sure that you make fun of Tony. 7. I mentioned it in my newsletter the other day, but if you are a fitness professional and haven't signed up for Ryan Lee's Bootcamp, I'd highly recommend you check it out. 8. Atta boy, Sam! Talk about clutch - and they had an 11-10 extra innings walk-off win last night. Good luck this weekend, Sudbury Legion. I've got to run - but not before leaving you with a bit of nostalgic weekend motivation from the greatest motivator of all time!
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