Home 2011 (Page 19)

Stuff You Should Read: 2/22/11

Here are a few good reads to check out this week: 15 Muscle Building Tips at a Restaurant - I came across this article by Vince Delmonte on how to maintain a healthy eating schedule even when you're eating out.  This is a place where a lot of people fail, so I think it's an excellent article for folks to read as a reminder. Small in Stature, Royals Pitcher Tim Collins a Force on the Hill - Here's  piece at MLB.com on Cressey Performance athlete and Kansas City Royals pitcher Tim Collins.  I've been training Tim since he was 18 years old, and he's got a tremendous story. Scalenes: Breathing and the Thoracic Spine - This is an excellent post from Patrick Ward on how aberrant breathing patterns can markedly influence upper extremity function. Sign-up Today for our FREE Newsletter and receive a detailed deadlift technique tutorial!
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Strength Training Programs: How Many Sets and Reps? – Part 2

In today's post, we've got the second half of a Q&A response regarding how to determine the optimal number of sets and reps for strength exercises.  In case you missed the first installment, be sure to check out Strength Training Programs: How Many Sets and Reps - Part 1.  We pick up with factors 7-13:

7. Whether You’re Trying to Correct Muscle Imbalances – In Part 1 (Bulletpoint 4) of my five-part Correcting Bad Posture series, I talked about how I like to use a 2:1 pull-to-pushing ratio with those who have significant upper body muscle imbalances.  In addition to upping the sets, you can also use higher rep schemes.  So, something like this would be an easy way to accumulate more volume:

A1) Chest-Supported Row - Neutral Grip: 4x8
A2) Low Incline Barbell Press: 3x6

Effectively, you're not only getting more total sets in favor of "postural balance;" you're also getting more reps per set.

8. How Neurally Efficient a Client/Athlete Is – Some athletes – especially those who tend to be of a more slow-twitch muscle fiber predominance – always seem to need to get more sets in on their strength exercises.  This is impacted in a lot of them by a previous history of endurance training – whether it’s high school soccer or a dedicated running career – that made them less efficient at tapping in to high threshold motor units.  The same holds true for female athletes; they always seem to need a little extra volume on strength exercises; it’s almost as if they can’t ramp up to a max as quickly as men.  I don't think you necessarily need to increase reps per set, but definitely ought to consider adding an additional set or two.

9. Whether You’re Trying to Achieve a Metabolic Training Benefit – Some programs use a concept called metabolic resistance training to improve cardiovascular conditioning and increase energy expenditure so that you can burn fat faster. Generally, in programs like these, you’ll need more sets and higher reps to elicit this training effect.

10. Whether You’re Dealing with a Post-Injury Client – In these folks, you want to keep the sets and reps down and gradually ease them back in to things.  So, while a “normal” client might be fluctuating up and down to impose and decrease training stress, respectively, an post-injury client would be gradually increasing the sets and reps to match his/her capacity for loading at a particular time.

That said, you have to be cognizant of giving them sufficient volume to maintain a training effect and keep them from going insane.  So, using the example of someone with shoulder pain, you might have to cut back on pressing movements, but you can really bump up the volume on horizontal pulling sets and reps.

11. What Else You're Doing - The base mesocycle of the Smolov Squat Program goes like this:

Monday: 4x9
Wednesday: 5x7
Friday: 7x5
Saturday: 10x3

Sure, this is a ton of work (and very specific work at that), but quite a few lifters have used it with excellent success.  You know what, though?  Try adding a lot of extra sets and reps for "other stuff" and you'll fail...miserably.  You can't specialize on everything all at once.  If sets and reps go up in one facet of your strength and conditioning program, they have to come down somewhere else.

12. Whether Soreness is of Concern - With our in-season athletes, we want to avoid soreness at all costs.  The easiest way to do this is to avoid changing strength exercises, but this isn't really feasible, as most athletes will get sick and tired of doing the same thing over and over again all season.  So, we need to be careful about strategically substituting new strength exercises during in-season training.  One way to make it go smoothly is to simply keep the sets and reps down in the first round through a new training program.  Let's say that we were doing front squats in-season.  We'd probably go something like this:

Week 1: 1x3 reps
Week 2: 3x3 reps
Week 3: 3x3 reps
Week 4: 2x3 reps (deload)

This leads me to my final point...

13. Whether or Not an Athlete is In-Season - If an athlete is in-season, less is more.  I prefer to have our athletes leave the gym feeling refreshed after their in-season training sessions - so they might be completely finished with a lift after only 8-10 sets of strength exercises in session.  You can get in more sets and reps during the off-season.

That wraps up the primary considerations that come to mind for determining the sets and reps in a strength training program.  Of course, there are many more to consider.  A closing suggestion I'd add is to try to review as many different programs by various coaches as possible. Chances are that you'll pick up some important trends that will help you to write your own programs.

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Strength Training Programs: How Many Sets and Reps? – Part 1

Q: I know this is a loaded question with hours upon hours of answers, but I'm trying to make some sense about the different kinds of ways/philosophies involved in writing strength and conditioning programs. I have read different articles and chapters in books that discuss program development, looked at programs at my current job, and can write a basic one for a new athlete. It's not the exercises; I'm familiar with plenty and love seeing something new. My problems come more with the sets and reps and when they change and why; I can’t seem to map out the actual progression of the program.

What philosophies, if one, do you follow and what basic rules do you find to be the most important when determining the sets and reps?

A: This is a loaded question!  The best way to get better with programming is simply to write a ton of programs and see what works and what doesn't.  However, with respect to your specific questions on sets and reps, what you choose to utilize is going to be dictated by:

1. The duration of a session - You won't be able to do 6 sets of 4 reps if you only have an client/athlete for an hour and want to accomplish other things.  This is, in particular, a big issue in collegiate strength and conditioning programs because the NCAA allows only limited number of hours per week with athletes, and sport coaches and strength and conditioning coaches have to share this time.  Additionally, it's a challenge for personal trainers in private training set-ups where clients may train in 30-, 45-, or 60-minute blocks.

I've written several times in the past about how I would never allow our business model to dictate our training model - and this sets and reps question is one reason why.  At Cressey Sports Performance, we do all semi-private training, which allows for sliding starts and finishes.  It allows us to get in all the work we need to do with clients - regardless of the sets and reps in question.  Likewise, as you'll see in the rest of this two-part series, you'll appreciate that it's why we don't have one program standardized for everyone on the dry erase board; every single CSP client has a unique program  because they all have unique needs.

2. Competing demands - The more variety (plyos, conditioning, medicine ball work, etc) that you want to add to a program, the less volume you'll be able to do on strength training.  We have limited time and recovery capacity, so we can't just keep adding all the time.

For me, a good example is what happens over the course of the baseball off-season.  Lifting volume is high when they get back, throwing is a no-go, movement training is 2x/week, and medicine ball is light.  After the first month, medicine ball work goes up, lifting comes down a bit.

Then, at the start of January, medicine ball and lifting volume comes back down and throwing volume increases.  We then get rid of medicine ball work almost altogether and go to 3x/week movement training as the season approaches, throwing intensifies, and guys do more hitting.  So, it doesn't just depend on the exercises; it depends on the big picture.

A great follow-up read to this point would be my post, Weight Training Programs: You Can’t Just Keep Adding.

3. Exercise selection - If you're doing more sets, you'll want to do it on "money" exercises like deadlifts and not curls, etc.  Moreover, certain exercises lend themselves better to higher reps than others.  For instance, we never front squat anyone over six reps, because technical breakdown often occurs with fatigue.  You also wouldn’t want to do cleans for sets of 15!

Usually, it’s also good to just “call it” on a particular exercise and move on to the next if someone has already dropped the weight on subsequent sets and form continues to deteriorate.  That energy is better spent on different exercises where technique can remain perfect even in the presence of fatigue.

4. Training age - As a general rule of thumb, the more experienced they are, the more sets and FEWER reps they'll need.  At this point in my training career, I just won't get strong on sets of five. Here's another good follow-up read: Why I Don't Like the 5x5 Workout.

Conversely, beginners generally need more sets and reps to pick up on things.  That doesn’t mean that you should just do three sets of 15 reps on everything with a novice, though.  I find myself teaching squat and deadlift variations with four sets of five reps quite a bit; the load, however, is light enough that the lifter could usually do 10-12 reps.  In other words, it’s just technique practice.

5. The Training Goal and Client/Athlete in Question – While taking heavy singles over 90% of one’s 1-rep max may be ideal for helping folks get strong, working at such a high percentage in some populations warps the risk: reward circumstances. Whether it’s older folks, those with injuries, or athletes who have a lot more to lose by getting hurt than they have to gain by adding five pounds to their squat, you have to take each individual situation into consideration.  I always remind people that we lift weights to improve quality of life, not just so that we can talk about how heavy the weights we lifted were.

6. Whether You Want to Impose or Remove Fatigue – In a “loading” week, volume is going to be higher.  If you’re deloading, though, that volume is going to be reduced.  Aside from beginner strength training programs, volume should never be the same over several weeks in a row.  I discuss several deloading strategies in my e-book, The Art of the Deload.

I’ll be back in a tomorrow with more factors that influence the sets and reps in a strength training program.  In the meantime, if you're looking for a comprehensive strength and conditioning program to take all the guesswork out of things for you, check out The High Performance Handbook.

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Sleep-Slurping: My Dog Really is this Lazy

The scary part is that he did this for about 45 seconds right after he woke up from his nap.  I actually had time to go grab my camera, and then still get all this footage.

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5 Reasons Direct Rotator Cuff Exercises are Necessary in a Strength Training Program

If you've read much of my stuff, you've probably come to realize that I'm quite the shoulder geek.  With that title comes a lot of questions at seminars and via email, and one of the more common ones is whether I think direct rotator cuff strengthening exercises are necessary for everyone.  A lot of coaches say that they aren't essential, but I beg to differ for five reasons.  Here's why: 1. Bad Posture - Nowadays, pretty much everyone has rounded shoulders - which means that the scapulae are winged out.  When a shoulder blade isn't sitting right, the rotator cuff muscles that attach to that scapula are at a mechanical disadvantage because they are outside of their ideal length-tension relationship for creating force; it's analogous to trying to shoot a cannon from a canoe.

Incorporating some direct rotator cuff exercises not only strengthens muscles that you know will be operating at a mechanical disadvantage, but also educates a lifter about how the scapula should be positioned for ideal shoulder function. 2. Shoulder impingement is a physiological norm. - Research from Flatow et al. demonstrated that everyone – regardless of age, activity level, sport of choice, acromion type, gender, you name it – has direct impingement on their rotator cuff tendons.  If you know a region is going to get beaten up regardless of what you do in your life, why wouldn't you opt to strengthen it proactively?

3. Rotator cuff tears are far more common than you think. - In consideration of the previous point, it should be no surprise that rotator cuff tears are actually far more common than one might realize - even if you look at asymptomatic subjects.  Connor et al. discovered that on MRI, 40% of asymptomatic tennis/baseball players had evidence of partial or full-thickness cuff tears.  The general population is no different; Sher et al. took MRIs of 96 asymptomatic subjects, finding rotator cuff tears in 34% of cases, and 54% of those older than 60.  And these studies don't even include the ones who are actually in pain!  It makes sense to strengthen these areas proactively - even if your shoulder doesn't hurt...yet. 4. Lots of people also have labral tears. - In the past, I've written quite a bit about Active vs. Passive Restraints.  In the shoulder, the rotator cuff would be considered an active restraint, as it's something that can be strengthened to improve dynamic stability.  The labrum, on the other hand, doesn't get stronger with exercise; it's a passive restraint that provides stability.  So, if the labrum is torn or frayed (as it very commonly is in both lifters and overhead throwing athletes), then the active restraints - the rotator cuff tendons - need to pick up the slack. 5. The "Just do normal stuff and the rotator cuff will take care of itself" philosophy isn't working. - That's been tried for quite some time, and nowadays, as a society, we move like absolute crap and - as noted above - have a boatload of issues on MRI even if we're asymptomatic.  With respect to the cuff, we've built the deltoids up to the point that they absolutely overwhelm the rotator cuff (particularly the supraspinatus), which is trying to prevent the humeral head from migrating upward into the acromion.

My article, Clearing up the Rotator Cuff Controversy demonstrates some of our favorite rotator cuff exercises and talks about how to include them in a weekly strength training program. For more information, check out the Optimal Shoulder Performance DVD Set.

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Nate Green’s Hero Handbook: Cool (and Free) Read with No Strings Attached

I'll be brief today, as I have a lot going on, and frankly, Nate Green can better explain what he has going on than I can. Nate's a great dude and excellent writer, and he's doing a free giveaway at his website of his "Hero Handbook," which is basically a how-to guide that covers everything from personal, to physical, to professional development.  So, whether you want to get strong, get lean, get self-employed, or get a girlfriend/boyfriend, it's a good read.  I really enjoyed it. No charge; it's just a sweet free gift Nate's made available as a thank you to his readers.  It's so thorough that it deserves more than just a "Stuff You Should Read" column, so I'm giving it an entire blog.  Check it out: The Hero Handbook.
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Stuff You’ll LOVE to Read: Valentine’s Day Edition

Sappy title, huh?  Well, the truth is that people around the world will spend loads of money on flowers that will die in the next week - so we'll carry that theme forward with today's list of recommended reading.  Check these out: White Sox, Brewers Lead Injury Prevention Parade - A big thanks goes out to Mike Stare, DPT for sending this article my way.  It's always good to see quantifiable evidence of just how bad injuries in major league baseball have gotten.  One really important thing to consider is that man games (and money) lost to injuries doesn't always paint a true picture of how effective a team's medical staff is.  Teams with good medical staffs are more likely to sign better players in spite of pre-existing injuries (the 2009 Red Sox signed John Smoltz, Billy Wagner, and Brad Penny when they were all coming off surgery, for instance), so they'll understandably have higher rates in spite of the fact that they're doing a lot of things really well.  Muddy waters, indeed. Smith Machine Salaries - Speaking of wasteful spending, this post is about two years old and is very, very sad, but true.  I'm sure it's even worse nowadays. Baseball Showcases: A Great Way to Waste Money and Get Injured - This is timely on a number of fronts, as there are loads of showcases going on right now.  Many of the participants are kids who haven't even picked up a baseball since last August, yet they're throwing full speed in front of radar guns.  Sad. Happy Valentine's Day, everyone; try not to think about all the money you spent on flowers! Sign-up Today for our FREE Newsletter and receive a detailed deadlift technique tutorial!
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Strength Training Programs: Is Cross-Training Necessary?

As I noted earlier in the week, I’m two weeks in to the new Lean Hybrid Muscle program and really enjoying it.  It’s a pretty significant change of pace from what I might call my normal programming that’s geared toward predominantly increasing strength and overall athleticism – but it’s working extremely well.  As the saying goes, “The best program is the one you’re not on.” This temporary paradigm shift got me to thinking that it'd be a good idea to bring in the LHM creators, Mike Westerdal and Elliott Hulse, in for an interview to talk about whether this kind of cross-training is necessary in a strength and conditioning program.  Here goes...

EC: Whenever you see people who are successful across multiple disciplines, you look for commonalities in the way that they prepare themselves.  Mike, you’ve done well for yourself in powerlifting, and Elliott, you’re an accomplished strongman competitor.  What do you believe to be the most important factors governing one’s success in strength sports?  I figured that before we talk about what might need to be changed from time-to-time, we ought to talk about what should always stay the same. EH: In my experience there are only a handful of tired and true principles that govern success and achievement in all areas of life.  Whether you are a strength athlete or a stay-at-home-mom, the same principles apply.  Like Ralph Waldo Emerson once said, “methods are many, but principles are few.” So, instead of spouting off some of my training methods here, I will share three foundation principles that I tend to value and refer to most when taking aim towards any particular goal - strength or otherwise. The first is CLARITY.  It is paramount that we know exactly what effect we would like our actions to produce.  You cannot hit a target that you can’t see. The next is COMMITMENT.  Most people have a vague and fuzzy idea of what they want, but even worse is that most think of these things as “nice-to-haves,” as opposed to “I-WILL-haves.”  The difference between someone who is “trying” to win because it would be nice and the person who DOES win is commitment.  Winners commit 100% to reaching their goal.  They never have a backdoor to escape and never take “no” for an answer.

The third principle governing one's success is DISCIPLINE!  I once heard that discipline is, “doing what you have to do, whether you feel like it or not.”  I like to think of myself as a robot.  Once I set my mind on a particular target, I must then put fickle emotion aside and continue to do everyday what I set out to do from the get-go...whether I “feel like it or not.” MW:  Elliott is a tough act to follow when it comes to success.  A lot of people - myself included - like listening to him not only because of his strength and conditioning knowledge but also because of his general leadership when it comes to personal development in other areas of life as well. Eric, this a great question.  I’ve actually had the privilege of interviewing hundreds of different athletes for a book I published at Critical Bench.  It included in MMA fighter, powerliftes, strongman competitors, bodybuilders, pro athletes and industry experts.  I’ve thought a lot about this and really tried to figure out the common denominators when it comes to excelling in sports.

It almost never has to do with an exact training method or style.  Guys get huge with heavy lifting and guys get huge with volume training.  Powerlifters have attained world class status having trained with  Westside as with Sheiko training.  What it really comes down to is a few other factors that I’ll list below: -You have to surround yourself with other successful people: people that are already in a place where you want to go.  If you hang around with a bunch of lazy deadbeats you’re going to get dragged down with them.  Instead, find people that are the best at what they do and try to make them a part of your life. -To take this a step further you have to visualize yourself or imagine yourself becoming what you want before it’s ever happened.  If you don’t already think you can bench press 600 pounds there’s no way that will ever manifest itself in real life until you brain can accept it as reality. Now you may think this is hocus pocus talk, but when they asked Joe Montana what it felt like to win the Super Bowl.  He said it felt like the other 300 times I won it.  The reporter said, “300 times?”  “That’s right” Montana replied, “I’ve been winning the Super Bowl in my backyard since I was 12-years old.”

-The next thing I see from a lot of successful strength athletes is sacrifice.  Many things in life are possible, but you have to decide if what it takes to reach that goal is worth the sacrifice.  The energy you exert on a certain sport may affect your energy levels for other areas of your life.  During a heavy powerlifting cycle, I’m toast even when I’m not training.  I find myself resting a lot more.  So you have to ask yourself.  What exactly do you want and are you willing to do what it takes to achieve the goal?  So guys who get to the very top level often sacrifice things like certain social events, for example. -My cousin is a successful business owner and recently gave me a valuable lesson that I believe can be applied not only to business, but also to strength sports.  He told me to just keep showing up.  It sounds pretty simple but most people don’t have the consistency to just keep showing up and stick with something until the end.  Lots of small steps over a long period of time add up. Unfortunately, it’s very rare that you’ll find a secret shortcut or magic bullet.  Just keep showing up and over time you’ll get better. -My last point is similar to my first point.  I mentioned surrounding yourself with successful people.  You also need to eliminate negativity from your life and your training.  If people are complaining about bad luck, aches, pains, circumstances and a host of other problems, you can’t let that stuff get into your head.  I swear these things happen to these people because that’s what they think about and talk about all the time.  Why not spend your time with people who are focused on where they are going and what they want?

EC:  Great points - and definitely a lot of stuff that I've seen in my successful clients and training partners, too. Back to the subject at-hand, though: "cross-training" within a strength training program.  How often do you guys intentionally deviate from your “normal” programming – whether it’s to shake things up for specific physiological reasons or just to get a little mental break? MW:  As a competitive powerlifter I trained the same way for several years straight.  This is not the fault of the sport, but I was doing the same kind of training for too long.  I believe that the lack of conditioning and doing the same strength exercises for too long eventually led to me gaining some unnecessary weight and even contributed to a lower back and shoulder injury. Now, I love powerlifting and if your only goal is one-rep max strength, it’s the way to go. I wanted to drop a weight class, heal up some injuries, and get some of my athleticism back, though, so it felt good to try a more hybrid program.  If you compete in any specific sport you need to train for that sport.  However, at this stage of my life I have multiple goals and feel that training for them at the same time is working since I’m not trying to be the absolute best at any skill set.  I do want to compete again and when I do I’ll have to cut back on the conditioning and hypertrophy work and focus more on nervous system training again.  For now, though, I’m really enjoying the feeling of being more well rounded and athletic.

EH: As a professional strongman I had followed a pretty similar program of power-building mixed with strongman implements for about 3 years straight, never “mixing it up.”  This not only led to weaknesses in some areas of overall health and performance, but also created the muscular imbalances that caused me to tear my biceps tendon last spring. Now, I am committed to working towards multiple performance goals within 12-24 month periods so as to avoid the lopsidedness that caused my injury.  For example, I have gone from competing as a pro strongman to running a 10 mile “psycho race” called the Tough Mudder this spring.  Next, I am going to qualify for the Crossfit games before building my lifts back up to compete in a raw power lifting meet in the winter. This may sound crazy to most people, but I’m going to give it a try. It doesn’t mean that my new approach is the right one for everyone, but I’d like to see if it is possible to excel in multiple fitness qualities at once.  And I do recognize balance as a foundational principle as well. EC: How long do these “cross-training” periods typically last? EH: If you mean “periods” as in using hybrid training for only a portion of time during the year, then I would say “forever” – unless you are a professional athlete or bodybuilder who needs to excel in one fitness quality over another in order to compete in your sport. If building a leaner, more functional and athletic physique is your goal, then I invite you to use this type of training all the time.  The beauty of hybrid training is that you can adjust your parameters in order to emphasize one quality over another. For example, if building muscle mass is your goal, then you would continue to use more strength and hypertrophy work over conditioning – but without totally ignoring the latter.

MW: That would depend on who you’re asking.  If you compete in a sport with a specific skill set like powerlifting this would be more an off-season conditioning program to do for a couple months.  I see a lot of powerlifters train 12 weeks for a meet followed by two weeks completely off.  Of course, there are deload weeks in the meet cycle as well.  I’ve seen guys throw together three of these 12-week cycles back-to-back.  After that, they usually know they need a break or their body forces them to slow down.  Adding in some cross training workouts or hybrid training could be beneficial at this time for a couple months. Now if you don’t compete in a specialized sport I truly believe you can train “Hybrid Style” all year long.  You’ll feel good, look good and have great conditioning.  If you decide to compete in any one area of fitness you’ll need to focus more on that area, though, to be competitive. EC: How about when you return to your “conventional” programming?  What kind of favorable adaptations (or unfavorable de-adaptations) have you seen? MW: The biggest advantage I can see when returning to powerlifting would be injury prevention.  With the different programming, I get a chance to work on any imbalances and heal up any nagging injuries.  The health benefits are there too.  The reduction in body fat and the cardiovascular conditioning helps me perform better on dynamic training days. The down side is that my one-rep max strength takes a bit of a hit and I have to get the nervous system re-adjusted to doing really heavy weights.  I am really glad that Lean Hybrid Muscle has powerbuilding days so that I can maintain some strength. In my case, coming from a powerlifting style of training, strength was down a bit.  However, for someone that has never trained with triples, doubles. or singles they could absolutely increase strength while following this program. EH: The fact is that if you are working toward excellence in one particular fitness quality and you incorporate too much training from a contradictory quality, your performance will suffer.  I make no claims otherwise and my experience tells me it’s true.

So, the leaner more conditioned Elliott Hulse no longer has the strength to log press 365 lbs over head, I can no longer front squat 455 lbs.  So, strength has been lost. However, things are far more balanced, where now I can only front squat about 365, I can also run a mile under seven minutes and I don’t bend over panting for air after climbing a flight of stairs, like the bigger, stronger version of me did. Ha! EC: Not a bad tradeoff at all! Thanks so much for your time, fellas. For more information on Mike and Elliott's strength and conditioning programs, check out Lean Hybrid Muscle. Sign-up Today for our FREE Newsletter and receive a detailed deadlift technique tutorial!
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Sneak Preview: Cressey Performance Elite Baseball Development Promo Video

Here's a little step inside my "winter world" - with a longer version coming in the next week.  This is just the teaser!

Cressey Performance Promo Video Trailer from Lasting Memories Videotaping on Vimeo.

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Does a Normal Elbow Really Exist?

I've written quite a bit in the past about how diagnostic imaging (x-rays, MRIs, etc) doesn't always tell the entire story, and that incidental findings are very common.  This applies to the lower back, shoulders, and knees (and surely several other joints).  The scary thing, though, is that we see these crazy structural abnormalities not just in adults, but in kids, too.  Last month, I highlighted research that showed that 64% of 14-15 year-old athletes have structural abnormalities in their knees - even without the presence of symptoms.  Just a month later, newer research is showing that the knee isn't the only hinge joint affected; young throwers' elbows are usually a structural mess as well.  In an American Journal of Sports Medicine study of 23 uninjured, asymptomatic high school pitchers (average age of 16), researchers found the following: Three participants (13%) had no abnormalities. Fifteen individuals (65%) had asymmetrical anterior band ulnar collateral ligament thickening, including 4 individuals who also had mild sublime tubercle/anteromedial facet edema. Fourteen participants (61%) had posteromedial subchondral sclerosis of the ulnotrochlear articulation, including 8 (35%) with a posteromedial ulnotrochlear osteophyte, and 4 (17%) with mild posteromedial ulnotrochlear chondromalacia. Ten individuals (43%) had multiple abnormal findings in the throwing elbow. For me, the 35% with the osteophytes (and chondromalacia) are the biggest concern.  Thickening of the ulnar collateral ligament isn't surprising at all, but marked osseous (bone) abnormalities is a big concern.

Also, as a brief, but important aside, this study was done at the Mayo Clinic in Rochester, Minnesota - which isn't exactly the hotbed of baseball activity that you get down in the South.  Recent research also shows that players in Southern (warm weather) climates have decreased shoulder internal rotation range of motion and external rotation strength compared to their Northern (cold weather) climate counterparts. In other words, I'll be money that the numbers reported in this study are nothing compared to the young pitchers who are constantly abused year-round in the South. The next time you think to yourself that all young athletes - especially throwers - can be managed the same, think again.  Every body is unique - and that's why I'm so adamant about the importance of assessing young athletes. It's one reason why I filmed the Everything Elbow in-service, which would be a great thing to watch if you're someone who manages pitchers.

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LEARN HOW TO DEADLIFT
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