It's a rainy Saturday morning, so what better way to overcome the weather than to check out some good reading material? Here's some excellent stuff I've come across lately:
Scaling Up Excellence - I finished up this excellent book by Robert Sutton on my drive back to Massachusetts last weekend. It's targeted toward managing growth of businesses, but has a ton of invaluable messages for coaches, too.
I've also decided to start including my top Tweet and Instagram posts of the week in this weekly feature. Here they are:
Thank you Thank you for joining me for my Coaches vs. COVID-19 presentation! I'm flattered that you took time out of your schedule to listen to my presentation, and even more excited that we were able to use this educational experience as an avenue for raising money for a great cause. If you have the means, but haven't donated to our fundraiser yet, you can do so HERE.
And, you can download your handouts at the link below:
In his outstanding new book, Back Mechanic, spine expert Dr. Stuart McGill speaks frequently to how he works with patients to “expand pain-free abilities” over the course of time. This begins with practicing good “spine hygiene” throughout daily activities while avoiding any positions or movements that provoke symptoms.
As a patient gets some asymptomatic time under his/her belt, new movements and exercises are gradually introduced. Over time, the individual’s pain-free movement repertoire can be integrated into a comprehensive exercise program. Effectively, it’s a way to test the waters without simply jumping into the deep end. This is an especially important process for patients who have lived with chronic back pain and need to break the cycle to relearn what it actually is like to feel good. As Dr. McGill writes,
“The approach that has produced the best results for us over the years has been to teach the patient pain-free movement. This is based on the ‘gate theory’ of pain. Finding simple movements that do not cause pain floods the proprioceptive system with joint and muscle sensor signals, leaving little room for pain signals to get through the neural ‘gates.’ These pain-free movements are repeated to encode the pattern in the brain. Slowly, the patient’s ability repertoire of pain free movement increases until they are able to move well, and for longer periods. They successfully replaced the pain inducing patterns wired into their brains with pain-free patterns.”
As I read through Dr. McGill’s work, I couldn’t help but think about how it can be adapted to other realms of the rehabilitation and fitness communities. As an example, speaking to my main realm of interest – training baseball players – we have to consider how this applies to return-to-throwing programs in the baseball rehabilitation world. Truth be told, this approach traditionally has not been applied well in most rehabilitation scenarios in overhead throwing athletes because they have just about the most specific kind of mechanical pain there is. In other words, the elbow or shoulder only bothers them in this position, and usually at higher velocities:
Most of the significant upper extremity throwing injuries you see don’t involve much pain at rest. Rather, the arm only hurts during the act of throwing. Unfortunately (or fortunately, depending on how you look at it), nothing in our daily lives really simulates the stress of throwing. As such, for a thrower, expanding pain-free abilities really have just traditionally meant:
You’d actually be surprised to find that there often aren’t any progressions that “link” one phase of this progression to the next. In the “not throwing” phase, we often see a lot of generic arm care exercises, but little attention to speed of movement, integrating the lower half and core, and incorporating training positions specific to an athlete’s arm slot. Unfortunately, just laying on a table and doing some exercises with a 5-pound dumbbell won’t necessarily prepare you to throw the ball on a line at 120-feet.
For this reason, we always seek out physical therapists who treat the athlete “globally” and appreciate the incremental stress of various phases of throwing. The name of the game is to incorporate several “test the water” steps between each of these three categories. We do the exact same things as players ramp up their off-season throwing programs. As physical therapist Charlie Weingroff has astutely observed in the past, “Training = Rehab, Rehab = Training.”
How do we bridge the gap between not throwing and flat-ground throwing as much as possible? For starters, rotator cuff exercises need to take place near 90 degrees of abduction to reflect the amount of scapular upward rotation and shoulder elevation that takes place during throwing. Moreover, it’s important to work closer to true end-range of external rotation in testing strength that “matters” during the lay-back phase of throwing. And, we need to test how they do with the external-to-internal rotation transition.
To this point, in my career, I’ve seen a lot of throwers who have passed physical exams of cuff strength in the adducted (arm at the side) position, but failed miserably in the “arm slot” positions that matter. Picking the right progressions really matters.
Additionally, more aggressive rotational medicine ball drills can help to teach force production, transfer, and acceptance in a manner specific to the throwing motion.
Unfortunately, at the end of the day, the only thing that can truly reflect the stress of throwing is actually throwing. And this is also why there have to be incremental steps from flat-ground work to mound work (where external rotation range-of-motion is considerably higher).
Fortunately for most rehab specialists and the fitness professionals who pick up where they leave off, most return-to-action scenarios aren’t as complex as getting a MLB pitcher back on the mound. A general fitness client with a classic external impingement shoulder presentation might just need to test the waters in a progression along these lines:
Different people might start at different places on this continuum, and some folks might not need to progress all the way along. The point is that there needs to be a rhyme and reason to whatever continuum you create for expanding individuals’ pain-free abilities.
A lot of folks have a pretty good understanding of “progression.” This, to me, refers to how we sequentially teach movements and make training more challenging. Unfortunately, not nearly as many professionals understand “pain-free progression” under the unique circumstances surrounding injury.
This is one of many reasons why I think understanding post-rehab training is so important for the modern fitness professional. It’s a tremendous competitive advantage for differentiating oneself in the “training marketplace.” Moreover, on a purely ethical level, having a solid understanding of various injuries and their implications helps a coach deliver a safe training experience.
With all this in mind, I'd really encourage my readers to check out Dean Somerset's resource, Post-Rehab Essentials. It's a fantastic product that also happens to be on sale for $50 off through Sunday at midnight. You can learn more HERE.
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Today, I'm fortunate to have an interview with Yahoo Sports baseball writer, Jeff Passan. Jeff spent the past few years traveling the country to research why arm injuries in pitchers are at an all-time high, and his efforts culminated with the recent release of The Arm. I've read it, and it's fantastic.
EC: Why did you write this book?
JP: Originally, I wrote it because I thought maybe, just maybe, through reporting and research I could find a fix-all for elbow injuries and help rid the sport of Tommy John surgery. What I learned was that I was foolish to even conceive of that, considering people far smarter than I am have dedicated their careers to ramming dead ends. Because of that, while I still think the recoveries of Daniel Hudson and Todd Coffey are the heart of the book, I began to realize just how acute this is for children. When nearly 3 in 5 Tommy John surgeries is done on a teenager, and the rise of teenage surgeries has gone in lockstep with the ascent of the showcase circuit and desire for velocity, something is very wrong. This is a book about a lot of things. I hope amid those, the lessons to parents resonate and cause them to think twice this spring about sending their young kids especially back out for an extra inning or keeping them in the game too long.
EC: Let's stay with the teenage discussion, as I've been preaching about this problem it for a decade now! When you investigated the current state of teenage baseball, what did you find? And, what surprised you the most?
I found a wasteland of ignorance, greed and scars on the elbows of children. I always heard executives complaining off-handedly about the showcase circuit but didn't realize the pervasive grasp it has on the youth space. Major League Baseball's greatest failure was allowing a for-profit company to co-opt its pipeline. As much as Perfect Game wants to claim moral superiority and a concern for the arms of children, reality tells a different story. Showcases 11 months of the year. Radar guns trained on infielders throwing across the diamond. Out-of-control pitch counts for arms simply too young to handle the workload. And that's to say nothing of actively seeking out sub-standard players to fill out an event. The commodification of children is gross, and encouraging performance and winning over development at young ages simply reinforces some of the same principles that I fear ultimately lead to arm injuries.
EC: Many people claim these issues are isolated to just the United States, and that the Far East and Latin American are immune. They deny that arm injuries are occurring at high rates in these areas; what did you find?
At the major league level, one's ethnicity does not make him any likelier to hurt himself. The numbers are pretty flat across the board. We see with Latin American players how that manifests itself because so many spend their formative years in the minor leagues and we witness their ascent and, in unfortunate cases, injury. Japanese pitchers, on the other hand, have a reputation of clean mechanics and hard work, and while that may be true, the results are devastating. It's not just the recent study that showed 40 percent of a sample of 9- to 12-year-old Japanese children had suffered ulnar collateral ligament damage. It's what I saw first-hand: Little boys, some so young their adult teeth still weren't fully grown in, coming into a clinic especially for baseball players and being diagnosed with an arm injury. Avulsion fractures. Frayed ligaments. OCD lesions. You name it, these kids had it. And it made me wonder how the Japanese baseball culture can live with itself knowing that it's choosing blind tradition over something as fundamental as the health of children.
EC: Everyone likes to play Major League Baseball general manager on the internet, but I'm going to do you one better. I'll let you be MLB commissioner and task you with determining how to address the injury epidemic that's spanning from youth leagues all the way to MLB veterans. How do you handle it?
JP: Wow. OK. So, I'm assuming an unlimited budget here, because a lot of these things are going to take money. Let's start with the kids first. I appreciate what Pitch Smart is trying to do. I also think it's not conservative enough with the youngest kids. If baseball is injuring its youngest players -- and doctors and studies alike believe it is -- we need to focus on the two likeliest culprits: overuse and excessive maximum-effort throwing. Curb the first with lower pitch limits. It's not like 8- or 9-year-old kids need to be building toward triple-digit pitches. And in concert with that, advocate an epistemological change in how we approach youth baseball: as an apparatus for development over competition. Don't get me wrong. Competition is great. But if competitiveness in this space leads to the things that lead to an increase in injuries, we can satisfy our competitive jones elsewhere and instead emphasize developing safer development and the importance of control and command over velocity. This demands better coaching, and free coaching clinics run by MLB-trained advocates at least gives us a better chance of empowering those whose voices are critical with the necessary education.
There are so many more things in the youth space I could do, but I want to move on to the pros, because if I were in power and had carte blanche, the first thing I would do is force the 30 teams to abandon their injury-prevention fiefdoms and band resources to help start solving this problem. This is a matter of the greater good. Baseball as a sport is facing another generation of pitchers arriving with Tommy John surgery scars on their elbows, and if a team found something that could mitigate injuries, those children deserve to know. I understand the desire for a competitive advantage. I also see this as a moral imperative for baseball to do what it can to solve it. Beyond that, continuing to fund the current epidemiological studies, working hand in hand with the tech companies -- so many of which seem to have a problem getting their products to market -- and pioneering in-house research through a think tank-like establishment devoted not just to the arm but varying other ends of research. In other words, I'd throw the full weight of MLB behind this, not just monetarily but starting with the first commercial of the World Series, which is a close-up camera shot first on Matt Harvey's elbow, then Stephen Strasburg's, then Jose Fernandez's. And as the camera pans back to reveal their familiar faces, each says: "This could be you." Then some stats on year-round baseball -- oh, yeah; as commissioner, I'd shut that down and hold twice-a-year showcases at which the top prospects can show up and show off their stuff for everyone in the industry, like a combine -- and some other scary numbers and, boom: Immediate education on Tommy John surgery through people not wearing white lab coats.
EC: Thanks for joining us, Jeff! Whether you're a baseball player, coach, parent, scout, or fan, I'd strongly encourage you to pick up a copy of The Arm.
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This was my 14th year of speaking on the Perform Better Tour. It's hard to believe that I've been a part of this great experience for a decade now, having given my first presentation back in 2007 at age 25. A few years ago, to "commemorate" my 10th year on the tour, I decided to devote my talk to, "10 Years, 10 Lessons: How to Perform Better in Business and Training."
In the years I've had the honor of presenting on the PB Tour, a lot has changed in my life. I've gone from a single guy with minimal responsibilities to a married father of three daughters. We have Cressey Sports Performance facilities in both Hudson, MA and Palm Beach Gardens, FL, and my wife and I split our year between the two. We've got more than a dozen employees between the two locations. I've authored over 1,000 published articles, published six books and co-created seven video resources that have been sold in over 60 countries around the world. I've has been an invited guest speaker in six countries and over 25 U.S. states. This website now gets over 500,000 unique visitors each month.
I mention these things not to brag, but only to emphasize that I've learned a ton in the past 14 years. Unfortunately, it's far too much to include in a single 75-minute presentation, so there were some important points that I couldn't include. With that in mind, I thought a quick blog on the topic would allow me to bring things to the forefront. Since EricCressey.com typically sticks to the training realm, I wanted to highlight some fitness business lessons that have come to mind that didn't quite make the cut for my presentation.
1. There are tremendous parallels among business, sports, and military success.
Whether it's leadership or culture lessons, we always have something to gain in seeking out wisdom from other disciplines. I always have an audiobook "in play" on this front. Success leaves clues, regardless of the industry in which it occurs.
If you're looking for a great book in this regard, I'd recommend Extreme Ownership.
2. Contrarians falter eventually - even if they don't realize it.
Particularly in this social media era, you'll see people who always insist on being contrarians. To me, this is a "short-term gain, long-term pain" strategy for professional success (or lack thereof). Being a "renegade" may seem appealing for garnering attention in the short term, but over the long haul, it'll lead to a lot of broken relationships and dissatisfaction.
I spend a LOT of time withholding what I'd really like to say on social media because you never know who is reading and judging. It's easy to say "I got this many retweets for ranting about XYZ," but it's impossible to quantify bridges burned in the process. How many people chose to avoid training with you because you came across as too negative on social media? You'll really never know. To that end, I think that professional restraint has served me very well. I'd much rather be vanilla and get along with everyone.
3. You can change behaviors or beliefs, but it's very rare feat to change both.
You're better off picking one. I first read this in Robert Sutton's Scaling Up Excellence, and as I thought back on my work with both employees and clients, it couldn't have possibly made any more sense.
If someone is very set in their beliefs (e.g., I won't change my diet), you need to change the surroundings to impact their behaviors (e.g., get junk food out of the house). Make it harder for them to eat like crap.
If someone is set in their behaviors (e.g., lifting with brutal technique), you have to change their beliefs (e.g., teach them what good technique actually is). Make it harder for them to "accept" lifting like crap.
4. Clients want novelty.
No matter how much we've all convinced ourselves that clients simply need the basics, the truth is that they'll always be inclined to seek out novelty. With that in mind, if you don't plan to create it in your training programs, you better create it in your training atmosphere and culture.
5. It's much easier to spend other people's money than it is to spend your own.
This is my response when people ask me whether I think it's a good idea to bring on investors or bank loans when starting a fitness industry. When someone else is throwing in the cash, it's pretty tempting to buy 17 different kinds of leg curl machines when you probably don't even need one.
Think long and hard about whether you need every single dollar you spend when you open a gym.
6. I'm not sure that I buy the "10,000 Hour to Mastery" rule.
Malcolm Gladwell first introduced the 10,000 Hour Rule in his best-seller, Outliers. The premise was pretty simple: those who were remarkably successful in their fields had accumulated 10,000 hours of deliberate practice to attain a level of mastery.
As is the case with a number of other people in the field, I'm not so sure about this number anymore.
First, I know of a lot of people who have 10,000 hours that really haven't done much of it with deep study. There are a lot of people who lead very distracted lives. "Deliberate" practice seems to mean something different to everyone.
Second, I think that fitness business success requires mastery in multiple realms. The chances of you getting sufficient amounts in all of these realms over 10,000 hours are really low. For instance, to build on what Michael Gerber presented in The E-Myth, I'd say that I'm a pretty good technician (coach) and entrepreneur (idea generator), but still have a lot to learn as a manager of people.
Third, remember that we're in a constantly changing field; new research emerges every single day. Putting in 10,000 hours of archaeology training might make you a fossil expert for life, but in the fitness industry, putting in 10,000 hours early in your career and then getting comfortable makes you the fossil - and really quickly.
7. It's good to know your personality and have others who do, too, to keep things in check.
I'm a giver, an eternal optimist, and an "idea guy."
I have a wife that is quick to tell me when someone is taking advantage of my kindness.
I have a business partner, Pete Dupuis, who slows me down on the ideas front to think things through.
Having a great network is important, but having people who understand your personality and not just your expertise is invaluable.
8. Be succinct.
In coaching, you want your cues to be clear, concise, and firm. Don't overwhelm clients with too many cues, and don't give a cue unless you can deliver it with 100% confidence.
In networking, don't send long emails, especially if it's a first outreach. In this busy world, nobody wants to read a novel. Attention spans (mine included, admittedly) are growing shorter and shorter with each passing day.
With your resume, don't list every single course that you’ve taken in college. If you include any at all, only highlight the ones that had a profound impact on you or give you a competitive advantage as compared to other applicants. In fact, you're probably better off trimming your whole resume down. Nobody cares that you scooped ice cream for a summer job when you were 13.
9. Solve problems.
Every successful business in any industry solves a problem.
Paypal made currency transfer easier in an era of writing checks and cumbersome bank transfers. Venmo has taken this convenience to another level.
The Diaper Genie eliminated the problem of dirty diapers smelling up the house if you didn't take the trash out every two hours. Don't laugh, it sold for $75 million all the way back in 1999.
Cressey Sports Performance offered innovative baseball-specific strength and conditioning when others didn't; we found a gap in the market and filled it.
With all this in mind, if there are already three Crossfits in your town, are you really solving a problem by opening the fourth? Unless you're willing to go down the miserable path of competing on price, you better think long and hard about how you're going to differentiate your offering so that you can actually solve a problem that hasn't already been solved.
10. Peers are likely just as important as mentors.
This is a lesson I've learned from watching about 12 years worth of Cressey Sports Performance intern classes. Consider our staff the mentors who are doing the teaching, and the interns as peers to each other. The mentor group has evolved a bit, with some staff expansion/turnover and more expertise at the interns' fingertips. The curriculum has evolved to provide more education, and fine tune the way we teach older material.
However, looking back, some intern classes seemed to thrive a little more than others. When you consider all the factors that could impact these outcomes, the one that seems to stand out is the camaraderie among the intern class. If they lived together - or at least spent a lot of time outside the gym together - they seemed to do even better. Peers have a pronounced impact on the way we process information and, just as importantly, how we reflect upon and utilize it.
Looking back on my own early career development, I was really fortunate to have great peers. My collaborative efforts with Mike Robertson in the early 2000s definitely stand out above all else on this front. Mike really pushed me to be better, and I think he'd say that I did the same for him.
Building on this, what becomes even more powerful is when a mentor becomes a peer. Alwyn Cosgrove really took me under his wing about a decade ago, and now that I'm a more seasoned fitness professional and business owner, I can contribute more of value to discussions with Alwyn. Likewise, I find myself reaching out to former interns of mine for advice all the time. And, sometimes we hire them to "formalize" their "peer" status.
As the old saying goes, you're an average of the five people with whom you spend the most time. Make sure that it's a good blend of mentors and peers.
Speaking of mentorship, my business partner, Pete and I will be hosting our fifth CSP Business-Building Mentorship on September 22-24. For the first time, this event will be offered in an online format. Pete and I have spent over 13 years crafting the operational systems and strategies that fuel CSP today, and we’re excited to pull back the curtain for fellow gym owners. You can learn more HERE.
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Happy Friday! I hope everyone is gearing up for a great weekend. Before you kick off the festivities, though, here are a few good reads to wrap up your week:
The $100 Billion Hoax - My buddy Adam Bornstein authored this fantastic post on how outrageously spending has increased in the health, fitness, and nutritional supplement sectors while Americans have become more obese than ever.
The Arm - Jeff Passan recently released this great read - and it's the culmination of several years of research all around the country to examine the causes of the pitching injury epidemic. He actually stopped by CSP-Florida last spring to interview me. The finished product is great "infotainment," where you'll learn to see injuries through a different light while being drawn in by various stories on baseball development, new research on the horizon, and rehabilitation struggles. I'll be posting an interview with Jeff on EricCressey.com soon.
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It's time for the April installment of my random thoughts on sports performance training. Here are a few ideas that are currently rattling around my brain.
1. The absolute speed-strength continuum doesn't matter if you're weak.
I posted this on my Facebook page last week, but thought it merited a mention here. With respect to this old video of mine...
One thing I didn't mention that is an important consideration, though, is that an athlete has to have a foundation of strength and work capacity to even "get on" this continuum. This is one reason why it's absolutely absurd for a 10-year-old to be embarking on a crazy aggressive throwing program. Before he introduces overload/underload throwing or high volume, he needs to establish a base of general stability and work capacity to be able to handle more specific stress.
2. In-season training isn't just about lifting.
When people hear "in-season lifting," they seem to immediately think that the sole justifications for incorporating it is to maintain strength, power, and muscle mass. Surely, that's a huge part of the equation. However, I'm quick to point out to our athletes that in-season training includes a lot more.
Each time an athlete trains at Cressey Sports Performance during the season, he's also going through his foam rolling work. And, he's working his way through a more individualized warm-up than he'd typically get at the field during practice or at games.
Likewise, it's an exposure to an environment that "nurtures" good lifestyle behaviors. There are invariably discussions about optimizing sleep quality, and improving nutrition. These exchanges just don't happen as often at the field.
All that in mind, in-season training isn't just about lifting weights.
3. There aren't absolutes when it comes to discussing packing the neck.
I can't definitely tell you that packing the neck during lifting will guarantee that you'll lift more weight.
However, I think it's very safe to say that if - 20 years down the road - we take MRIs of the necks of lifters who lifted with a more neutral cervical spine posture and compared them to MRIs of those who looked up at the ceiling when they squatted and deadlifted, the packed neck group's diagnostic imaging would be a LOT cleaner.
4. Culture matters more than expertise, programming, finances, and just about anything else.
I've been fortunate to visit a lot of different strength and conditioning facilities in the private, collegiate, and professional sector. Without fail, the most successful facilities are the ones with an awesome culture. In other words, the athletes and staff are excited to be there. They're thrilled about the prospects of innovations, and there is great communication without consideration of organizational rank, service time, or any other sort of hierarchy. I think this awesome post from Matt Duffy of the Giants is a great example of this in action in professional sports.
Culture matters because it's a limiting factor. Expertise and good programming are super important, but they don't matter if you don't have an environment that accommodates the implementation of these things. And, if you look at professional sports, you can't outspend a crappy culture. This is why you can see small market teams competing with the highest payroll teams in just about every professional sport. And, it's one reason why you see fancy facilities with seemingly limitless financial resources fail miserably in the private sector all the time.
This is one reason why I always emphasize to our staff and interns that we hire based on both competency and fit.
Competency can be taught, but fit is something that is directly drawn from one's character. Character is something that needs to be established at a young age and reinforced over the course of decades in a professional career. It's a challenge to hire someone with the right fit for your culture, and this is one reason why we like to hire from our internship program; it's a test drive to determine "fit" and work to fine-tune it if the alignment isn't quite perfect.
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Happy April Fools' Day! I don't have any clever tricks to play on you, so I'll have to just go with posting good content from around the 'net. Enjoy!
Identifying an Untouched Fitness Niche - My business partner, Pete Dupuis, talks about taking lessons learned in building the CSP baseball niche and applying them to other realms in the fitness industry.
Dry Needling is the Next Big Thing in Physical Therapy - Dr. James Spencer offers a tremendously thorough review of what dry needling is, and how it works. James has been a great resource for many athletes at Cressey Sports Performance - Florida.
If you were to spend a day at either the MA or FL Cressey Sports Performance location, invariably, you’d see something that might surprise you: athletes training in spite of the fact that they recently had surgery. On a regular basis, we have athletes referred our way after everything from Tommy John surgeries to knee replacements. They may be on crutches, using an ankle boot, in an elbow brace, wearing a shoulder sling, or even rocking a back brace. Working with post-operative athletes has become a big niche for us; we work hand-in-hand with surgeons and rehabilitation specialists to make sure that we deliver a great training effect in spite of these athletes’ short-term limitations.
Unfortunately, athletes will sometimes run across hyper-protective therapists and doctors who are overly cautious in this period. Certainly, for a period, this is incredibly important, as there are risks of not only the repair being vulnerable to movements and direct pressure, but also it being compromised by infection in the first few weeks. However, in my opinion, it’s absolutely unnecessary to tell an athlete to just take 3-4 months off completely from exercise and instead just “rehab” – and yes, I have heard this before.
With this in mind, I wanted to outline six reasons I think strategically implemented strength and conditioning work in the post-surgery period is incredibly important.
1. It’s important to make an athlete feel like an athlete, not a patient.
There is a different vibe in a physical therapy clinic or training room as compared to a strength and conditioning setting. This isn't intended to be a knock on rehabilitation specialists, but athletes would rather hang out in the latter realm! And, while great therapists make rehabilitation upbeat and keep the athlete's competitive psyche engaged, getting back into the gym affords a big mental boost - a break from their current physical reality - for athletes.
Speaking of mental boosts, I won't even bother to highlight the favorable impacts of exercise on mood and the reduction in risk of a wide variety of chronic diseases. Suffice it to say that there are a ton, and it's important that athletes continue to have these benefits during their rehabilitation period. If you really want to dig deeper, I'd highly recommend this recently published meta-analysis: Exercise as a treatment for depression.
2. Small hinges swing big doors in terms of behaviors.
Most people eat healthier when they train. Whether this is conscious or subconscious is dependent on the individual, but it's something I've seen time and time again.
Likewise, many student athletes perform better in the classroom when exercising regularly, and struggle to stay on task when they’re given too much free time.
What's my point? Effectively, training pushes out certain bad behaviors. Likewise, on a physiological level, it supports better brain activity that makes for more productive members of society.
3. Injuries don’t occur in isolation.
Pitchers don’t just blow out their elbows because of functional deficits at the elbow. Rather, the elbow usually gets thrown under the bus from a collection of physical deficits all along the kinetic chain. As an example, Garrison et al (2013) demonstrated that players with ulnar collateral ligament tears scored significantly worse on the Y-balance test than their healthy peers.
With this in mind, it would be silly to spend months and months only focusing on rehabilitating the arm to the exclusion of the rest of the body. Unfortunately, physical therapists only have so much time with athletes because of insurance restrictions, so they may not get to these important complementary rehabilitation approaches. This is a great place for a competent strength and conditioning professional to pick up the slack.
4. Training improves body composition, which facilitates a number of favorable outcomes.
It drives me bonkers when I hear about an individual dropping a bunch of muscle mass and gaining substantial body fat during the post-surgery period. This should never happen.
Just as a healthy body composition will help a grandfather avoid setbacks following a hip replacement, having a good strength-to-body weight ratio will increase the likelihood that a college soccer player will avoid setbacks after a meniscal repair.
These benefits aren't just conferred to weight-bearing scenarios. Remember, obesity is arguably the biggest limitation to diagnostic imaging accuracy. In other words, if you have a setback in your rehabilitation and need an MRI or x-ray, being fatter makes it hard for your radiologist to give you an accurate reading. An ounce of prevention is worth a pound of cure.
5. Exercise facilitates motor learning improvements.
When rehabbing, you’re trying to acquire new, favorable movement patterns. Research (good reads here and here) has demonstrated improved motor learning when new tasks are introduced alongside exercise (particularly aerobic exercise).
Maintaining a robust aerobic system and solid work capacity makes rehabilitation efforts more effective.
6. Contralateral strength training has carryover to immobilized limbs.
Via a mechanism known as cross-transfer (or cross-education), an untrained limb's performance improves when the opposite limb is trained. As an example, if you have knee surgery on your right leg, but do what you can do to safely train your left leg while your right knee is immobilized, you'll still get carryover to the post-surgery (right) side. It won't do much to attenuate the atrophy of muscle mass on an immobilized limb, but it will absolutely reduce the fall-off in strength, power, and proprioception. Effectively, it's "free rehab" that offers a huge leg up with respect to return to play.
As an aside, research on cross-transfer from Hortobagyi et al has demonstrated that the strength carryover seems to be stronger with eccentric exercise, so prioritizing this approach seems to have extra merit.
Some Important Notes
Before I sign off on this one, I should be clear on a few things:
1. Not every trainer and strength and conditioning coach is prepared to take on every injury.
If you’ve never heard the word “spondylolysis,” you shouldn’t be programming for a kid in a back brace. And, if you don’t know the difference between an ulnar nerve transposition and an ulnar collateral ligament reconstruction, you’re not ready to take on a post-op baseball elbow. Don’t be a cowboy.
2. Effective post-operative training mandates outstanding communication.
You should be speaking on a regular basis with the physical therapist or athletic trainer who is overseeing the rehabilitation plan. They’ll let you know if an athlete is prepared for progressions, and also to help you avoid overlapping with what they do in the rehabilitation sessions. I’d even encourage you to sit in on some of their rehabilitation sessions not only to monitor progress, but also as continuing education.
3. When in doubt, hold athletes back.
One of my graduate school professors, Dr. David Tiberio, once said that physical therapists “should be as aggressive as possible, but do no harm.” I’ll take this a step further and say that fitness professionals conditioning “should be conservative and do no harm” during the rehabilitation process. It’s our job to maintain/improve fitness and facilitate return-to-play, but in no way set back the recovery process. In short, let the rehab folks take all the chances when it comes to progressions.
4. Remember that progressions occur via many avenues.
Progressions don’t just come in terms of exercise selection, but also absolute loading, speed of movement, volume, frequency, duration, and a host of other factors. You need to keep all of them in mind when programming and coaching, as even one factor that is out of whack can set a rehabilitation program back. Additionally, there will be times when stress in one area goes up, which means it must be reduced in another area. As an example, during rehabilitation from Tommy John surgery, the stress on the medial elbow increases when an athlete begins throwing at the 4-6 month mark, and many athletes will benefit from a reduction in the amount of gripping they do in their strength training and rehabilitation programs.
5. Watch for "accidental" stabilization demands.
Many muscles work reflexively, with the rotator cuff being the absolute best example. After a shoulder surgery, you have to be careful training the opposite side too soon (or with too much loading) because the cuff on the surgery side can turn on reflexively. As the aforementioned cross-transfer effect dictates, it's not as simple as right vs. left training effects; our nervous system governs everything - and in curious ways.
Wrap-up
I hope that in publishing this article, I made a strong case for the importance of appropriate exercise during the post-surgery period. Remember that what is "appropriate" will be different for each individual, and should be determined via a collaborative effort with input from a surgeon, rehabilitation specialist, strength and conditioning professional, and the athlete. And, it should always be a fluid process that can be progressed or regressed based on how the athlete is doing.
For the fitness professionals out there, if you're looking for more information, here are a few good reads:
Today's guest post comes from former Cressey Sports Performance intern and current University of Washington Strength and Conditioning Coach, Dave Rak. Enjoy! -EC
Coaches often talk about gaining an extra step when it comes to improving speed. For a baseball player an extra step could be the difference between a stolen base or a jog back to the dugout. There are many ways to gain that valuable extra step. Strength training, drill work, and refining technique all play an important part. As a coach you need to help the athlete feel the correct positions in order to maximize efficiency when stealing bases. Here are 4 simple ways to improve common mistakes.
1. Videotape everything.
With almost everyone having a smartphone or a tablet device on them 24/7, cameras are easily accessible, which leaves no excuse as to why you can’t video tape your athletes. Whether you are working 1-on-1 with an athlete, or with all of your position players at once, video feedback will be crucial. This gives the athlete a view from your perspective as to how they could improve their movements. Video feedback will not only allow you to show the athlete what is going on from a technical standpoint, but in a team setting, it will allow you to work efficiently with large groups. As a coach you will be able to see every rep from each of your athletes. This allows you to go back, take notes, and identify what needs to be worked on for each player. The athlete can use this information to better correct movements and execute proper form.
Most importantly, having video allows you to study the athlete’s movement and learn what corrections need to be made. This grows your knowledge on this specific movement. You may not have all the answers right away, but video will help you and your athletes figure out what can be corrected. Video is nothing new in sports and especially baseball; why not use it when trying to gain an extra step on your steal jump?
Video programs such as Hudl Technique (formerly known as Ubersense) and Coach’s Eye are great apps that can be used on a smartphone or tablet to record video It can then be played back in different speeds for the athlete.
2. Overload the movement.
After breaking down video of my athletes I noticed some players were over reaching or stepping too high with their right foot on their initial leg drive. This is wasted movement that does nothing but prolong the steal jump, and put the athlete in a poor position to accelerate from. The photo below is an example of an ineffective directional step. The foot comes up too high, which prolongs the movement:
By taking a smaller and more direct step the athlete will achieve a better position for acceleration. Below is a video that shows an example of a more efficient step.
To help with this common mistake, you can physically pull the runner towards second base and overload the movement using a bungee cord attached at the waste as seen in the video below.
Lee Taft suggested told me about this drill, and it has been very helpful with allowing my athletes to figure out how to make that direction step more efficient. The pull of the bungee cord forces the runner to be quicker and more direct with their step. The pull of the cord will cause the athlete to shift their weight towards second base and onto the right foot. Once they take a directional step they have to replace the foot quickly, if they don’t they will fall. The bungee cord allows the athlete to feel their mistakes in the moment. After a few repetitions the athlete should be able to make the adjustment on their own.
NOTE: Bungee cords work better than jump stretch bands for these drills.
3. Gently resist the movement.
A lot of time is spent on developing power and becoming more explosive in the weight room. The initial push of the steal jump is a great place to show off these attributes. Using video feedback, you can easily see if an athlete is lacking that “push” when they take off for second base. Yelling “triple extension”, or “push harder” may not always work. Instead give the athlete something to push against. To do this take the bungee cord from our previous drill and instead of overloading the sprint, gently resist the start. This will make the athlete have to overcome the resistance of the bungee cord when they make their first move. This should force the athlete to get better extension with their left leg. The video below is an example.
Again, the bungee cord will work better than a pair of jump stretch bands.
The athlete should feel the resistance of the cord before they start their sprint. This will force them to be aggressive when they push off. The goal is for the athlete to feel how hard they need to push with the lower body. It is also important to note that too much resistance will change the outcome of the drill. We are not weighing down the runner and having the partner get dragged behind. The runner should have to overcome the resistance on the push off and then be able to run normally as they accelerate.
4. Use a towel to teach arm movement.
After speaking with Lee Taft about what I was seeing with my athletes I began to realize how important the arms are, especially in the initial move. Lee helped me to realize that by achieving better arm action, common mistakes will be corrected on their own. These mistakes include: popping up on their first move, weak initial push-off, inability to stay low through the acceleration phase, and not turning the body quick enough to get into a linear sprint.
To help get the athlete to become more aggressive and throw the arms on their initial move we can hold a towel or shirt behind him. One of my former players actually came up with this idea on the spot during a training session. We told him to knock the towel out of his partner’s hand, which forced him to drive his arm back in a more aggressive manner. Originally this athlete did not have an aggressive arm action from the start position, preventing him for getting his body turned efficiently. This drill is an exaggerated movement; keep in mind the goal is to get a feel for what his arms should be doing.
Throwing the arms too much can be a bad thing and can cause the runner to over rotate. Make sure to find a good middle ground.
In addition to the actual action of the arms, the hand placement is also important. Longer arms require a greater distance to be traveled which takes up more time. Instead of letting the arms dangle near the knees, try to move the hands to belt level. This shortens the path of the hands, therefore allowing the runner to drive their arms back faster. This will get he body turned in a quicker fashion.
The purpose of these drills is to allow the athlete to feel mistakes and then provide an opportunity to self-correct. When the runner gets out of position the bungee cords will provide instant feedback. The video will provide visual feedback as well. The towel drill forces the athlete to accomplish a movement with the arms that they previously may not have done. The ultimate goal is for the athlete to feel the correct technique for themselves and carry it over into game time situations.
About the Author
David Rak is in his third year as an assistant strength & conditioning coach at the University of Washington. David directly oversees sports performance for Baseball, Men's & Women's Golf, and Men's Tennis. He can be reached at davidrak25@gmail.com.
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