Home Posts tagged "Pitching Injuries"

Strength and Conditioning Stuff You Should Read: 2/15/17

It's been an exciting and busy week, thanks to the launch of the new Minimus 20v6 Cressey Trainer coinciding with the last week of the Major League Baseball off-season.

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I'm happy to report that the shoes have sold really well - to the point that we're already sold out in several sizes. With that in mind, there are still some options for you to get them:

1. If you're looking for international shipping, Eastbay.com is your best bet. They should be making the shoe available on their site either today (Wednesday) or tomorrow.

2. If you're in the U.S. and your size is already sold out HERE at New Balance's website, Eastbay.com is also your best bet.

3. If you're in Canada and your size is already sold out HERE at New Balance's Canadian site, you can try SportChek.ca or Eastbay.com.

Now that all that is out of the way, let's get to this week's content!

Meet the First Performance Coach to Get His Own Signature Training Shoe - This article at Stack.com takes a look at the design process behind the new Minimus 20v6 Cressey Training sneaker.

As Spring Training Begins, Pitchers Enter Tommy John Danger Zone - Along with Alan Jaeger and Mike Reinold, I was interviewed for this USA Today article on the spike in injuries seen during spring training each year. 

Power Development for Powerlifters - This is an excellent post from Cressey Sports Performance coach Tony Bonvechio. I wish I'd had it back in the early 2000s to help my bar speed along, as it took me a few years to figure out that getting faster was a key to getting stronger for me.

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The Best of 2016: Baseball Articles

With baseball athletes being the largest segment of the Cressey Sports Performance athletic clientele, it seems only fitting to devote a "Best of 2016" feature to the top baseball posts from last year. Check them out:

1. Preventing Baseball Injuries: Actions Speak Louder Than Words

This was my first post of 2016, and it turned out to be one of my most impactful. A cool follow-up note on this: one of the suggestions I had to reduce pitching injuries was to push the high school season back in warm weather states, and here in Florida, they actually moved it back two weeks for 2017. I doubt my writing had anything to do with it, but it's nice to see things moving in a positive direction. 

2. Should Lat Strains Even Be Happening?

The lat strain is becoming far more prevalent in higher levels of baseball as pitchers throw with more and more velocity. In this lengthy article, I discuss mechanisms of injury, diagnostic challenges, prevention strategies, and longer-term prognoses.

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3. 6 Saturday Shoulder Strategies

I wrote this as a "brain dump" in about 30 minutes on a Saturday morning, and it turned out to be a hit with the baseball audience.

4. Looking Closer at Pitching Injuries: An Interview with Jeff Passan

I interviewed Jeff Passan around the time of the launch of his popular book, The Arm, and we covered in more specific detail some of the areas he touched on in the book.

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5. Specificity, Delayed Transmutation, and Long-Term Baseball Development

This was actually a video blog more than an article, but it was still very popular - but didn't quite crack the top 5 videos of the year because it's more baseball specific.

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3 Tips for Improving Shoulder Health and Performance

Today's guest post comes from my good friend and Elite Baseball Mentorships colleague, Eric Schoenberg. Enjoy! -EC

It is well documented that shoulder pain/injury is a primary reason for lost time in the gym and on the baseball field. Often times, the culprit is not poor exercise selection, but instead poor exercise execution. Most high level performers are going to do the work that we ask them to do, the issue is whether they are practicing getting better or practicing getting worse.

The following three tips will be useful for any strength coach or physical therapist to help ensure optimal function of the shoulder.

1. Understand and Appreciate Relative Stiffness.

There are several examples of relative stiffness around the shoulder that can result in faulty movement, pain and/or decreased performance.

A primary culprit occurs when the relative stiffness of the deltoid is greater than the rotator cuff. The result of this will be superior translation of the humeral head.

55-deltoid-pull

This can lead to undersurface rotator cuff tears, biceps tendon irritation, cyst formation, inferior glenohumeral ligament tears, or humeral head abnormalities – all of which are common to throwers.

Consider this when attempting to strengthen the cuff. Check to see if the humerus is in extension, as demonstrated in this photo. This faulty "elbow behind the body" pattern will lead to over-recruitment of the posterior deltoid:

humeralextension

You also want to cue the athlete away from excessive horizontal abduction, as demonstrated in the next photo. Prone external rotation with no support results in increased use of deltoid to support the arm against gravity:

proneer1

Here it is corrected with support:

proneercorrected

More times than not, we see athletes doing the correct exercise with the wrong execution and getting poor results. We want to avoid allowing an athlete to practice getting better at moving incorrectly.

2. Stop rowing so much, especially if your rowing technique is incorrect!

Rowing variations are generally the safest and easiest upper body exercises to program. However, even though a row is usually pain free, it can sometimes lead to patterns that result in injury down the road.

For example: If the rhomboids and lats are too stiff, you will see limited upward rotation of the scapula. Regardless of how much you strengthen the serratus anterior and lower trapezius, these smaller muscles will never match the force production of the lats and rhomboids.

With this in mind, the best “fix” is to increase stiffness and muscle performance of serratus and lower trapezius while simultaneously decreasing the stiffness and use of the lats/rhomboids.

This can be done by modifying the way we row. In this great video, EC discusses how to correct the row and ensure the scapula is moving properly on the ribcage with both phases of the rowing pattern.

In addition, we should program pressing or reaching exercises such as landmines, kettlebell presses, overhead carry variations.

3. Don’t let good lower body days double as “bad” upper body days.

We sometimes see athletes come in complaining about an increase in symptoms following lower body days. They will report something like “I don’t know what I did to my shoulder; I lifted lower body yesterday.” 

By now we know that a common cause of shoulder pain is the scapula being too depressed and downwardly rotated.

ScapularDownwardRotation-300x225-2

If an athlete performed deadlifts, back squats, or any lower body exercise where the weight was held by their sides (DB reverse lunges, step ups, RDLs, Bulgarian split squats, etc.), chances are they were feeding the pattern of depression and downward rotation.

Taking this a step further, we commonly see these exercises resulting in postures and stabilization strategies that present with increased lumbar lordosis and anterior pelvic tilt. When this goes uncorrected, scapular alignment suffers. Here’s a look at a reverse lunge with excessive hip extension, lumbar extension, and anterior pelvic tilt:

revlunge

Remember, there is no “corrective’ in the world that will counteract the stress of carrying 120-pound DBs by your side while training on a lower body day. This does not mean that you shouldn’t program it; instead, it means that we should just be aware of the consequences.

The solution to this is to consider alternate loading strategies (such as a Safety Squat Bar, KB Goblet set-up, or weight vests) that will allow the shoulder girdle to be freed up and positioned more optimally.  If we pair this with consistent attention to proper alignment and movement strategies, we can use lower body days as another opportunity to enhance shoulder function.

Looking to learn more about our unique approach to assessing and managing throwing athletes? Check out the upcoming Elite Baseball Mentorship Upper Extremity Course on December 18-20. For more information, click here. Don't delay, though; the early-bird registration deadline is November 18.

About the Author

Eric Schoenberg (@PTMomentum) is a physical therapist and strength coach located in Milford, MA where he is co-owner of Momentum Physical Therapy. Eric is addicted to baseball and plays a part in the Elite Baseball Mentorship Seminars at Cressey Sports Performance. He can be reached at eric@momentumpt.com.

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Random Thoughts on Sports Performance Training – Installment 22

It's time for the September installment of this series. With the baseball season wrapping up for many minor league and high school players - plus the start of post-season play nearly upon us - I've got a lot of new thoughts rattling around my brain.

1. There's no such thing as "catching the injury bug." 

This is a term that gets thrown around a lot in professional sports. Certainly, there is a significant amount of happenstance in professional sports. Quarterbacks get sacked from the blind side and injure acromioclavicular joints (get well soon, Jimmy G!!!). Hitters get hit by pitches, and outfielders run into walls. Not all injuries are preventable, but not everything we assume to be "happenstance" is unpreventable, either. Additionally, there's something to be said about finding ways to shorten the down time on the disabled list when players are hurt. This recent article in Hardball Times does a good job of highlighting this observation: Doing What it Takes to Keep Players Healthy.

With respect to preventing injuries, most of the focus goes on training and rehabilitation initiatives. Is there a good strength and conditioning program? Are there good manual therapists on hand? Does the organization prioritize high quality nutrition? Are recovery options plentiful? The list goes on and on.

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There are, however, many overlooked factors that are outside the control of the sports medicine staffs in these organizations. For instance, if a front office creates a roster of players who a) are older and b) have more extensive injury histories, it's going to be a lot harder to keep that team on the field. Additionally, how bullpens are managed factors into injury risk heavily. Some relief pitchers get absolutely abused between game appearances and scenarios where they warm up and don't go into the game. I once had a MLB lefty specialist say that he threw more in two months in the big leagues than he did in 100+ innings as a college starer. 

The point is that while some injuries are, in fact, happenstance, the majority are highly preventable - particularly if as many different factors as possible are taken into consideration. The injury bug excuse just doesn't hold water.

2. There are varying levels of "strong enough."

In the strength training world, you'll often hear debates on the question, "how strong is strong enough for athletes?" Truth be told, it's not a simple question to answer.

First and foremost, you get what you train. So, I might just squat and deadlift all the time, but never build an appreciable level of single-leg strength. So, if my sport requires a ton of single-leg strength, I'm really not strong at all in a specific sense. That said, no competitive powerlifter is going to be able to hand his hat on a good Bulgarian split squat number; he's got to squat and deadlift heavy to be successful.

Taking this a step further, though, we have to consider what we're trying to strong enough to do? Is it strong enough to safely perform sprint work and plyos in training, as would be the case after a few months in post-op ACL rehabilitation scenario? Or, is it strong enough to be able to safely participate in athletics, as an athlete would be later in the rehabilitation timeline?

Does an athlete just need to be strong enough to need to even consider this continuum? Or, does he need to be strong enough to make good use of strength-speed and speed-strength training initiatives?

Is the athlete strong enough to not have to worry about training limit strength (the far left of this continuum) as much? Not many athletes ever get to this point because it takes a ton of hard work, consistency, and even a genetic predisposition to being strong to get there. However, I've seen several in my career, and we needed to spend a lot more time training absolute speed and speed-strength.

Above all else, I'd say that in the athletic world, the "strong enough" classification refers to a coach's refusal to push an athlete further due to the potential for injury. For example, there is no doubt in my mind that one of our pro outfielders could unquestionably train to attain a 600-pound raw squat in a matter of 3-4 months. The risk of pushing toward this goal just isn't worth the risk; he has other athletic qualities to which we can devote his training time and recovery capacity - and without the risk. If he could only squat 185 pounds, though, it would be an entirely different story.

3. If applied incorrectly, cross-training can beat athletes up as much as it can help them.

I'm all for young athletes playing as many sports as possible. A rich proprioceptive environment creates an awesome foundation for future athletic development in more specific endeavors. Likewise, later on, once an athlete has specialized, there is definitely a time of year for cross training - but it definitely has to be applied correctly. What am I getting at?

[bctt tweet="The lower the movement variability in one's sport, the less bold the cross-training can be."]

To put this in context, imagine a soccer midfielder or football defensive back. Both these athletes have a ton of movement variability in their sport participation; there is a lot of change-of-direction, full-tilt sprinting, backpedaling, jumping, and a host of additional sport-specific skills. Asking one of these athletes to go out and play ultimate frisbee or beach volleyball for a change of pace isn't going to dramatically increase their injury risk.

Conversely, take the typical pro golfer or baseball pitcher into this same challenge, and it's going to be a pretty stressful event with a much higher likelihood of injury. It's not to say these athletes are soft or "delicate;" it's just that the majority of their athletic calendars take place with more specificity, and there is less movement variability to their sports challenges. With both the golf swing and pitching delivery, you want to consistently repeat your mechanics.

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Invariably, during interleague play in Major League Baseball, we see an American League pitcher who gets injured running the bases or swinging at the plate. Specificity of training matters, and it takes a considerable volume of specificity to build a tolerance to competing at a high level.

This isn't just specific to amplitude of movement (range of motion). Rather, the direction and magnitude of forces need to be considered. As an example, elite swimmers have a high pain tolerance from the insane volumes they do in the pool, but get them into an ultimate frisbee game, and you're going to see some awkward movements because they aren't accustomed to ground reaction forces and moving in the frontal and transverse planes.

Just keep it in mind as you plan your cross-training activities. Just because you see NFL players dominating a game of "Tag" doesn't mean that your 51-year-old master's division swimming star is going to do as well with it.

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Random Thoughts on Sports Performance Training – Installment 21

It's time for the August installment of this popular series, and with the Olympics in full swing, MLB season in the home stretch, and the NFL season rapidly approaching, there's plenty of material rattling around my brain. 

1. Don't criticize what you don't understand.

Maybe it's just because all the aforementioned sporting events are taking simultaneously and we're on sports social media overload right now, but it seems like a lot of people are ranting and raving about high-level athletes' preparation. They're cranky about Usain Bolt's hamstrings issue and how it's being managed. They're shocked the Kerri Walsh Jennings has had so many shoulder surgeries. They're flustered about Michael Phelps using cupping. They're floored by Prince Fielder's retirement after a second cervical fusion surgery. And they're cranky because they're confident that they can do a better job in spite of the fact that they have exactly ZERO knowledge of any of these situations.

If there's one thing I've learned from a lot of work with professional and Olympic athletes over the years, it's that nothing is ever as simple as it seems. What you read in the media is usually a partial truth (if that). For instance, I know of pitchers who have gone on the disabled list with calf strains or neck stiffness when they just needed to iron out mechanics or rest up from a high workload. I've also known athletes whose performance has suffered tremendously as they tried to plow through nagging injuries. They're getting blown up on Twitter when they should be getting commended for putting the team's needs ahead of their own personal health.

The point is that if you don't have any knowledge of the unique situations, blindly criticizing athletes and their sports medicine teams is a cheap shot. And, in my eyes, it makes you look incredibly unprofessional.

I'd also add that it's important to remember that you never know who is reading your criticism. Burning that bridge because you "just had to get it off your chest" could interfere with future job possibilities, or even the opportunity to work with the athletes in question.

So, sit back, chill out, and just be a sports fan, but not a Monday Morning Quarterback. You can't rehab someone on Twitter.

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2. Use the bottoms-up get-up to remind hypermobile athletes to avoid elbow hyperextension - and cue "grabbing"the floor. 

I love using Turkish Get-ups with athletes for a host of reasons; this drill really trains whole-body mobility and stability and delivers a great training effect without insane external loading. That said, one thing you have to be really careful of with using get-ups is that hypermobile (loose jointed) individuals will often wind up with elbows hyperextended - both on the support and overhead arms.

Get-up hip hinge

With that in mind, I like the idea of using a bottoms-up Turkish get-up because it's more grip intensive and strictly mandates a more neutral wrist position. This activation of the flexors of the fingers, wrist, and elbow gets the muscles that prevent elbow hyperextension a little more "pre-tensioned," so it's a lot harder to slip into bad patterns.

The bottom arm is a bit trickier, but I have had some success with the cue, "grab the floor as if you're trying to palm a basketball." That same activation of the flexors can help to keep a slight flex in the elbow.

3. A training effect prepares you, but an education sustains you.

This morning, I woke up to this article about Cubs pitcher Jason Hammel "reinventing himself" this past offseason. Part of that process involved getting started up with Cressey Sports Performance, and we've be really cheering him on as he's put forth a career year to be a big part of the Cubs' success. As the article details, one of Jason's biggest struggles was fading in the second half of the season. This was something he and I discussed at length during his initial evaluation last November. Even though it was 8-9 months away, we started talking about in-season training approaches and how to sustain performance well into the second half of the long MLB season. Thus far, he's done a great job of it; in five starts since the All-Star Break, he's 5-0 with a 1.16 ERA.

I often tell our athletes that the training effects we deliver in the off-season gets them through the first half of the season, but it's the education we impart that should sustain them through the second half of the year. The MLB calendar spans from mid-February (spring training) all the way to early October (and even longer if a team makes the playoffs). Nothing we can do in the offseason is guaranteed to last for eight months, but education certainly can. We need to work hard to help athletes understand what is unique about their bodies so that they can be advocates for themselves - and their own best coaches. 

Jason's success has been a good reminder:

[bctt tweet="Coaching isn't just about building athleticism; it's also about educating."]

4. I still don't like Olympic lifts for baseball players.

By this point, most of you have probably heard (or seen) an Armenia Olympic lifter end up with a gruesome elbow injury on the jerk portion of a clean and jerk. It was a combination valgus stress - elbow hyperextension injury - which just so happens to be the exact same kind of stresses that lead to most pitching injuries at the elbow. Keep in mind that this was on a jerk - and the valgus stress is actually magnified on a snatch because of the bar path and distance traveled prior to the attempted catch.

I've written previously at length on my feelings about the topic: Should Baseball Players Olympic Lift? I think there are much better ways to train power in a specific context and with less injury risk.

Some coaches will argue, "But this is a max attempt in the Olympics! Our technique is much better than this and we aren't taking those kind of chances!" The truth is that video doesn't lie; you see a lot of ugly Olympic lifting technique all over the 'net. And, athletes will always want to push the limits and hit personal records. Moreover, baseball players have a lot more funky presentations (valgus carrying angle, medial elbow instability, and joint hypermobility) that muddy the waters further.

crazyvalgus

Perhaps more importantly, I know of very few high level arms who Olympic lift. We've demonstrated over and over again that you can build huge arm speed without snatches, jerks, and cleans, so why take the chance?

I should reiterate: I think the Olympic lifts are absolutely fantastic for other athletes. Baseball is just a different beast.

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Random Thoughts on Sports Performance Training – Installment 20

It's hard to believe that we're 20 installments deep on this series, but I'm glad they've been so well received and definitely plan to continue to write them. Before I get to the meat and potatoes, just a quick friendly reminder that the introductory $100 off Elite Athletic Development seminar DVDs ends tonight at midnight.

1. Tall athletes are usually longer term projects.

When you have a 15-year-old 6-6, 150-pound kid with size 17 shoes, you have your work cut out for you.

These athletes are challenging for a number of reasons:

a. Their bone growth has usually outpaced their flexibility (except in kids - usually those who haven't finished puberty - who have preserved their childhood joint laxity). This often means that they have to do a fair amount of "preliminary" work just to get into good positions to benefit from big bang exercises.

b. Their center of mass has rapidly shifted up away from their base of support, creating a constantly unstable state.

c. A longer spine is a lot harder to stabilize than a shorter one.

d. You can put 20 pounds on one of these athletes and barely notice. As a frame of reference, in the picture below, the 6-6 athlete on the left added 31 pounds between September and February (when this picture was taken) to get to approximately 200 pounds. Meanwhile, Greg Robins (the CSP coach in the middle) actually weighs more than him even though his about eight inches shorter.

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e. Even if you put that 20 pounds on them, it might not be enough to have a "grounding" effect on the athlete. Unless an athlete is very gifted in terms of reactive ability (as you might see with lighter weight NBA players), you might need to add a lot more weight for them to learn how to properly load the lower extremity to create athletic movement using the stretch-shortening cycle. 

f. At younger ages, they're often put in positions that don't require as much movement (first base, DH, or pitcher in baseball; center in basketball; goalie in soccer; etc.). This may rob them of crucial exposure to movement "education."

 The take home points?

[bctt tweet="In tall athletes, push patience, consistency, calories, and perfect technique on fundamentals."]

 2. It's not your job to have all the answers.

Earlier this week, I sent along a nutrition question to Cressey Sports Performance's first employee, Brian St. Pierre. Brian is now Director of Performance Nutrition for Precision Nutrition and a tremendous resource we have at our fingertips on everything relating to nutrition and supplementation. Within 24 hours, Brian had sent along a 244-word reply that covered his anecdotal experiences on the topic in question, along with some recommended reading in case I was interested in what the peer-reviewed evidence demonstrated.

I'd love to have all the answers, but I simply don't. As such, I refer out all the time - whether it's a question like this on the nutrition front, or sending a client to a physical therapist. Your job is to deliver the best possible outcomes for your athletes/clients, and referring out regularly usually leads to those ends - and creates learning opportunities for you via the collaborative efforts that occur during the referral.

It's not your job to have all the answers; it's your job to know where you can find them.

3. It's important to understand how much relative strength an athlete needs - and that is sport and position specific.

I'll use my experience with baseball to make this point.

Pitching is a combination of absolute and relative strength and power. From an absolute standpoint, more body weight equates to more force to push off the mound, and more momentum moving downhill; that's why gaining weight can have such a profound impact on pitching velocity.

On the other hand, from a relative strength and power standpoint, you eventually have to "accept" all the force you create. We know that there are substantial ground reaction forces taken on by the front leg, and research has demonstrated that they are (not surprisingly) directly impacted by body weight. Additionally, according to 1998 research on professional pitchers from Werner et al., at ball release, the distraction forces on the shoulder are approximately 108% of body weight. You could also make the argument that these forces are even higher now, as average fastball velocity has crept up significantly since 1998, and the subjects in that study averaged only 89mph. As is the case with body weight increases, as arm speed rises, so do shoulder distraction forces. 

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In hitting, "accepting" force on the front side isn't as stressful because we don't hit downhill on a mound. However, batters have to run the bases, and that's a significant relative strength challenge.

With all this in mind, you it's important to realize that some athletes need to gain weight, some athletes need to lose weight, and some athletes are good right where they are. Obviously, body composition plays into this as well, but speaking in general terms, understanding strength-to-bodyweight ratios in sport-specific contexts is really important for all strength and conditioning coaches.

4. Use upper body drivers in your lower body mobility work.

This video from Mike Robertson got me thinking a lot:

We've done quite a bit of upper body reaching in our warm-ups with drills like the lateral lunge with overhead reach, but typical, this motion has really only occurred in the sagittal plane:

Conversely, if you look at the bowler squat, the upper body reach drives hip internal rotation, adduction, and flexion on the support leg.

Moving forward, I plan to get a lot more creative with using reaching to challenge folks in the transverse and frontal planes during our warm-ups.

Speaking of Mike Robertson, along with Carolina Panthers strength coach Joe Kenn, he's the co-creator of the Elite Athletic Development 3.0 DVD set. It's a fantastic resource that I'd highly recommend, and it's on sale for $100 off through the end of the day today. Click here to learn more.

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5 Steps to Becoming a Baseball Specialist

Today's guest post comes from physical therapist, Eric Schoenberg. Eric is an integral part of the Elite Baseball Mentorships team. 

EBM-Cressey

A thought came to mind as I was considering how we can work towards reducing the incidence of injury in baseball: we need more specialists.

If we use the field of medicine as a model, the Total Knee Replacement has pretty much been mastered. Of course, there is room for improvement, but over the past 25 years, this surgery has become a massive success. The biggest reason for this is a progression of specialization:

MD > Orthopedist > Orthopedic Surgeon > Knee Specialist > Total Knee Replacement (TKR) Specialist

If you need a knee replacement, you don’t go to your primary care physician. Instead, you schedule an appointment with an Orthopedic Surgeon that specializes in TKR. So, if you are a baseball player, why does it make sense to work with a “general” strength coach or physical therapist?
[bctt tweet="Every profession matures into a state of “super-specialization” as it develops."]

Strength coaches and physical therapists have a great opportunity ahead of us to move our professions forward in this manner.

The current entry point for a strength coach is minimal. Most commonly, entry into the field falls somewhere between a fitness certification and a 4-year degree. In some cases, you will see dual degrees, Master’s degrees, and the occasional PhD.

However, there is no direct path available to niche into a “baseball specialist.” Instead, we have private sector, college, and even some professional strength coaches that may have seen baseball players by chance, but have no more experience with them than any other sport. It’s not a criticism of them, though; there simply isn’t an established “curriculum” they can pursue. As a result, in most cases, highly “specialized” baseball players are being managed by “general” strength coaches.

I have to believe that this is as much of a contributing factor as any to the high incidence of injury in the baseball world. By the time these athletes make it far enough in their careers to have access to “baseball specialists,” they are often too damaged for even the experts to manage.

Here are five tips to establish yourself as a trusted resource in the baseball community:

1. Watch baseball.

Don’t just watch it for entertainment value. Study the movements. Use slow motion and rewind on your TV. Watch video online and gain a better understanding of the actions and positions unique to the sport. Once you think you have it figured out, you are only just scratching the surface. Keep studying! Start to recognize why faulty mechanics can lead to improper distribution of stress and ultimately injury. By doing this, you can pair this knowledge with your individual assessment of the athlete to create a more optimal training program.

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2. Spend time on a field.

Baseball players are unique in their habits and tendencies. Gain a “feel” for the game. Understand the culture of the game. Learn how to identify with and communicate with athletes that are much younger than you. Understand that most of their time on the field is spent standing around and waiting. Educate your players on how to optimize this time to prepare mentally, hydrate, properly warm up, etc. It is not enough to say you used to play baseball 20 years ago; nobody cares. My credibility and effectiveness in managing baseball players increased 10x once I started spending time at the field as part of a team. Create an angle to quickly establish trust and common ground with the athlete and watch your results dramatically improve.

3. Understand the unique physical characteristics and demands of baseball players.

Baseball players have physical characteristics that differ from other sports. Educate yourself for the benefit of your athletes. Learn about humeral retroversion, gross extension patterns, laxity, valgus stress, dynamic stability, rotator cuff timing, etc. Work towards understanding the importance of stability of the landing leg, proper hip hinge pattern, and the importance of tri-planar single leg balance. Don’t “stretch” a guy that is already too loose. Instead, give him some stability and watch his pain go away. The baseball player’s anatomy is a long way from “neutral.” Do your best to bring them closer to the middle and not further away. For example, your ability to recognize that a baseball player should not be cued to pull their shoulder blades “down and back” because their shoulder blades are ALREADY down and back may save dozens of careers.

adductedscap

4. Master functional anatomy and human movement.

Understand the critical role of the scapula. Train the rotator cuff in the throwing position through the entire range of motion (especially end-range external rotation). Learn how the kinetic chain applies specifically to baseball. Hitting and throwing are highly coordinated, precisely timed, multidirectional movements. Don’t train your athletes with single joint exercises that only occur in the sagittal plane. Learn about hip/trunk separation to maximize power and explosiveness. Be able to educate the athlete on what it means to have a labral tear or understand the specifics of an ulnar nerve transposition. If you can’t explain these pathologies, then how can you minimize risk when working with these athletes? Take pride in your job on this front.

5. Be willing to respectfully challenge the “institution of baseball.”

CSP coach Tony Bonvechio wrote a blog post a while back where he warned about the dangers of the phrase “this is how I’ve always done it.” I find myself observing on a daily basis that regardless of level – little league, high school, college, pro ball – at least 80% of the player’s warm up routine is exactly the same. How can that be? We have progressed as a profession; however, kids on baseball fields across the world are all doing the same useless warm-up routine.

An example of progress is Joe Maddon and the Chicago Cubs. He has softened the traditional stance of getting to the ballpark at 1pm for a 7pm game. Instead, they have created a culture that emphasizes more sleep, nutrition, and recovery and his players love him for it. (and, by the way, the team is doing pretty well, too).

If we want different results, we have to continue to move towards a different approach. The efforts of strength coaches and physical therapists to move towards becoming baseball specialists will go a long way in helping to reach this goal.

If you are interested in learning more about our approach to managing baseball athletes, we'd love to see you at one of our Elite Baseball Mentorships. The next three-day course - this one focused on the lower-extremity - is August 21-23, with Thursday, July 21 serving as the early-bird registration deadline. You can learn more HERE.

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6 Saturday Shoulder Strategies

Tomorrow is the early-bird registration deadline for my upcoming shoulder seminar in Chicago, so I thought I'd use today's post to throw out some thoughts on training the shoulders.

1. In the upper extremity, the assessments are often the solutions, too.

Imagine you're assessing an athlete, and their squat pattern is absolutely brutal. Usually, the last thing you're going to do is go right to a squat as part of their training. In other words, simply coaching it differently usually won't improve the pattern immediately. Rather, you typically need "rebuild" the pattern by working with everything from ankle and hip mobility to core control, ultimately progressing to movements that replicate the squatting pattern.

Interestingly, the upper extremity is usually the opposite in that the assessment might also be the drill you use to correct the movement. For instance, an aberrant shoulder flexion pattern like this...

...might be quickly corrected with some of these three cues on a back to wall shoulder flexion pattern.

This is also true of push-up assessments and shoulder abduction and external rotation tests we do; funky patterns are usually cleaned up quickly with some subtle cueing. This just isn't the case as much in the lower body, though. Why the difference?

My theory is that because we're weight-bearing all day, the lower extremity is potentially less responsive to the addition of good stiffness in the right places. Conversely, a little bit of stiffness in serratus anterior, lower trap, or posterior cuff seems to go a long way in quickly improving upper extremity movement. My experience with the Postural Restoration Institute also leads me to believe that creating a good zone of apposition can have lead to a more pronounced transient movement in the upper extremity than it does in the lower extremity. This is likely because the rib cage is directly involved with the shoulder girdle, whereas the relationship with the lower extremity (ribs --> spine --> pelvis) is less direct. 

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These differences also seem to at least partially explain why upper extremity posture is much easier to change than lower extremity positioning. It's far more common to see a scapular anterior tilt change markedly than it is to see an anterior pelvic tilt substantially reduced.

Just thinking out loud here, though. Fun stuff.

2. Anterior shoulder pain usually isn't "biceps tendinitis."

First off, true tendinitis is actually quite rare. In this landmark paper, Maffulli et al. went to great lengths to demonstrate that the overwhelming majority of the overuse tendon conditions we see are actually tendinOSIS (degenerative) and not tendinITIS (inflammatory). It may seem like wordplay, but it's actually a very important differentiation to make: if you're dealing with a biceps issue, it's probably tendinosis.

shoulder

Second, if you speak with any forward thinking orthopedic shoulder specialist or rehabilitation expert, they'll tell you that there are a lot of differential diagnoses for anterior (front) shoulder pain. It could be referred pain from further up (cervical disc issues, tissue density at scalenes/sternocleidomastoid/subclavius/pec minor, or thoracic outlet syndome), rotator cuff injury or tendinopathy, anterior capsule injury, a lat strain or tendinopathy, labral pathology, nerve irritation at the shoulder itself, arthritis, a Bankart lesion, osteolysis of the distal clavicle, AC joint injury, and a host of other factors.

3. Thoracic outlet surgery really isn't a shoulder surgery.

With Matt Harvey opting for thoracic outlet surgery this week, I've seen just about every major sporting news outlet call it "shoulder surgery." Sorry, but that really isn't the case unless you have a very expansive definition of the word "shoulder."

With this intervention, the surgeon is removing the first (top) rib to provide "clearance" for the nerves and vascular structures to pass underneath the clavicle.

Gray112thoracicoutlet

Additionally, surgeons may opt to perform a scalenectomy, where they surgically remove a portion of the anterior scalenes, which may have hypertrophied (grown) due to chronic overuse. Again, this is not a "shoulder" procedure.

Finally, more and more surgeons are also incorporating a pec minor release as part of the surgical intervention. This is because the nerve and vascular structures that may be impinged at the scalenes or first rib can also be impinged at the coracoid process of the scapular if an individual is too anterior-tilted. While the coracobrachialis and short head of the biceps both attach here, the pec minor is likely the biggest player in creating these potential problems.

pecminor

This, for me, is the only time this becomes somewhat of a "shoulder" surgery - and it's an indirect relationship that doesn't truly involve the joint. We're still nowhere near the glenohumeral (ball-and-socket) joint that most people consider the true shoulder.

All that said, many people consider the "shoulder girdle" a collection of joints that includes the sternoclavicular, acromioclavicular, glenohumeral, and scapulothoracic articulations. In this case, though, the media just doesn't have a clue what they're trying to describe. With that in mind, hopefully this turned into somewhat of an educational rant.

4. Medicine ball scoop tosses tend to be a better than shotputs for cranky shoulders.

Rotational medicine ball training is a big part of our baseball workouts, and it's something we try to include as an integral part of retraining throwing patterns even while guys may be rehabilitating shoulder issues. When you compare rotational shotputs with rotational scoop tosses...

...you can see that the scoop toss requires far less shoulder internal rotation and horizontal adduction, and distraction forces on the joint are far lower at ball release. The shotput is much more stressful to the joint, so it's better saved for much later on in the rehab process.

5. Adequate rotator cuff control is about sufficient strength and proper timing - in the right positions.

To have a healthy shoulder, your cuff needs to be strong and "aware" enough to do its job in the position that matters. If you think about the most shoulder problem, there is pain at some extreme: the overhead position of a press, the lay-back phase of throwing, or the bar-on-your back position in squatting. For some reason, though, the overwhelming majority of cuff strength tests take place with the arms at the sides or right at 90 degrees of elevation. Sure, these positions might give us a glimpse at strength without provoking symptoms, but they really don't speak much to functional capacity in the positions that matter. 

With that in mind, I love the idea of testing rotator cuff strength and timing in the positions that matter. Here's an example:

Eric-Cressey-Shoulder_OS___0-300x156

Obviously, you can make it even more functional by going into a half-kneeling, split-stance, or standing position. The point is that there are a lot of athletes who can test pretty well in positions that don't matter, but horribly in the postures that do.

6. Pre-operative physical therapy for the shoulder is likely really underutilized.

It's not uncommon to hear about someone with an ACL tear going through a month or so of physical therapy before the surgery actually takes place. Basically, they get a head start on range-of-motion and motor control work while swelling goes down (and, in some cases, some healing of an associated MCL injury may need to occur).

I'm surprised this approach isn't utilized as much with shoulder surgeries. It wouldn't be applicable to every situation, of course, but I think that in some cases, it can be useful to have a pre-operative baseline of range-of-motion. This is particularly true in cases of chronic throwing shoulder injuries where regaining the right amount of external rotation is crucial for return to high level function. Adding in some work on cuff strength/timing, scapular control, and thoracic mobility before hopping in a sling for 4-6 weeks probably wouldn't hurt the case, either. And, as an added bonus, if this was more common, I think we'd find quite a few people who just so happen to become asymptomatic, allowing them to cancel their surgeries. It's probably wishful thinking on my part, but that's what these random thoughts articles are all about.

For more information on my July 31 seminar in Chicago, click here.

Have a great weekend!

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Cressey Sports Performance Lower Extremity Elite Baseball Mentorship – August 21-23, 2016

We're excited to announce our next Elite Baseball Mentorship offering: a lower-extremity course that will take place on August 21-23, 2016 at our Hudson, MA facility.

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The Cressey Sports Performance Elite Baseball Mentorships provide an educational opportunity to become a trusted resource to this dramatically underserved athletic population. Through a combination of classroom presentations, practical demonstrations, case studies, video analysis, and observation of training, you’ll learn about our integrated system for performance enhancement and injury prevention and rehabilitation in baseball athletes. Cressey Sports Performance has become a trusted resource for over 100 professional players from all over the country each off-season, and this is your opportunity to experience “why” first-hand at our state-of-the-art facility.

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Course Description:

The Lower Extremity Cressey Sports Performance Elite Baseball Mentorship complements our upper extremity course by introducing attendees to the most common injuries and movement impairments encountered by baseball players in a sport that combines violent extension, rotation, change-of-direction, acceleration, and top speed sprinting. Core control and lower extremity function considerations will be applied to the throwing and hitting motions.

Course Agenda:

Sunday

Morning Session: Lecture

8:30-9:00AM – Registration and Introduction (Eric Cressey)
9:00-10:00AM – Movement Impairments of the Lower Extremity and Core (Eric Schoenberg)
10:00-11:00AM – Common Injuries and their Mechanisms (Eric Cressey)
11:00-11:15AM – Break
11:15AM-12:15PM – Common Mistakes in Training and Rehabilitating the Core and Lower-Extremity (Eric Schoenberg)
12:15-1:00PM – Lunch (provided)

Afternoon Session: Lecture and Video Analysis

1:00-2:00PM – Understanding and Managing Asymmetry in Rotational Sport Athletes (Eric Cressey)
2:00-3:15PM – Video Evaluation of Throwers: Lower-Extremity Considerations for Push-off and Foot-Plant (Matt Blake)
3:15-3:30PM – Break
3:30-4:45PM – (Matt Blake) – Video Evaluation of Hitters: Lower-Extremity Demands and Sequencing
4:45-5:30PM – Case Studies and Q&A

5:30PM Reception (Dinner Provided)

Monday

Morning Session: Practical

8:00AM-10:00AM – Lower-Extremity Physical Assessment: Static and Dynamic (Eric Cressey and Eric Schoenberg)
10:00-11:30AM – Lower-Extremity Prehabilitation/Rehabilitation Exercises (Eric Cressey and Eric Schoenberg)
11:30AM-12:00PM – Lunch (on your own)

Afternoon Session: Observation at Cressey Sports Performance – 12PM-6PM*

Tuesday

Morning Session: Practical

8:00AM-9:30AM – Training Power Outside the Sagittal Plane (Eric Cressey and Eric Schoenberg)
9:30-11:00AM – Individualizing Driveline to the Pitcher (Matt Blake)
11:30AM-12:00PM – Lunch (on your own)

Afternoon Session: Observation at Cressey Sports Performance – 12PM-6PM*

* The afternoon observation sessions on Monday and Tuesday will allow attendees to see in real-time the day-to-day operation of the comprehensive baseball training programs unique to Cressey Sports Performance. This observation of live training on the CSP floor with our professional, college, and high school baseball players will allow you to experience firsthand our approaches to:

• Programming
• Proper coaching cues for optimal results
• Soft tissue techniques
• Activation and mobility drills
• Strength/power development
• Medicine ball work
• Multi-directional stability
• Metabolic conditioning
• Sprint/agility programs
• Base stealing technique

In addition, you will experience:

• Live throwing sessions
• Biomechanical video analysis using the Right View Pro system
• Movement evaluation
• Live evaluations of attendees with Eric Schoenberg

Location:

Cressey Sports Performance
577 Main St.
Suite 310
Hudson, MA 01749

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Cost:

$999

No sign-ups will be accepted on the day of the event.

Continuing Education Credits:

2.0 NSCA CEUs (20 contact hours)

Registration Information:

Click here to register using our 100% secure server.

Notes:

• No prerequisites required.
• Participants will receive a manual of notes from the event’s presentations.
• Space is extremely limited
• We are keeping the size of this seminar small so that we can make it a far more productive educational experience.
•This event will not be videotaped.

For details about travel, accommodations, and other logistics, please email cspmass@gmail.com.

We hope to see you there!
  

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Tinkering vs. Overhauling – and the Problems with “Average”

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.

Arrieta

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).

Rookie_of_the_year

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."

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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.

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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.”

decisive--jacket

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."

Closing Thoughts

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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