Home 2017 December

Checks and Balances in the Shoulder of the Throwing Athlete

For today's guest post, I've collaborated with physical therapist Eric Schoenberg, one of my co-presenters at the Elite Baseball Mentorship. Enjoy! -EC

The #1 reason why a player or team does not succeed in baseball is injury. Today, there is a surplus of information, but at the same time a lack of basic understanding of how to keep a baseball player healthy. When in doubt, you can never go wrong by understanding and relying upon anatomy and quality human movement.

One key principle to understand in this regard is that there is a tremendous system of checks and balances working at the shoulder girdle to make sure that we control both the big movements (osteokinematics) and subtle joint movements (arthrokinematics) in a small window for health and performance. If we look to anatomy, we can appreciate a very important concept by looking at the attachment points for the deltoid, latissimus dorsi, and pectoralist major: your three biggest prime movers in the upper extremity. You'll notice that all three attach on the shaft of the humerus, not the humeral head. Take a look at their attachment sites on this anatomical chart, and then compare them to where the rotator cuff (supraspinatus, subscapularis, teres major, and teres minor) attach further up on the humeral head.

Source: http://howtorelief.com/humerus-anatomy-bony-landmarks-muscle-attachment/

You can appreciate that all these big muscles attach on the anterior (front) aspect of the humerus, which means that they have powerful pulls into internal rotation that have to be counteracted by fewer, smaller muscles that attach on the posterior (back) aspect of the shoulder.

Here are three specific implications of these anatomical observations that relate to how you manage your throwing athletes:

1. The Deltoid is strong/active enough!

The deltoid works in conjunction with the supraspinatus to form a “force couple.”

Source: www.MikeReinold.com

If the strength, recruitment, or timing of the deltoid is greater than the supraspinatus, then the result will be superior migration of the humeral head in the glenoid. This results in superior humeral head stress (chondral defect), undersurface rotator cuff tear, labral pathology, among other structural injuries to the glenohumeral joint.

Tip: Be sure that athletes feel rotator cuff strengthening exercises in the cuff and not the deltoid or biceps.

2. The lat is strong/active enough!

The lat (as it acts on the scapula) is opposed by the serratus anterior, lower trapezius, and upper trapezius to control scapular rotation. Increased relative stiffness of the lat results in excessive scapular depression and downward rotation at rest.

Additionally, if you have decreased activation or muscle performance of the scapular upward rotators and elevators with overhead motion, the outcome will be inferior migration of the glenoid on the humeral head.

This results in superior humeral head stress (chondral defect), undersurface rotator cuff tear, labral pathology, among other structural injuries to the glenohumeral joint.

Tip: Be sure that the athlete’s programs have a good balance of overhead reaching tasks done with proper mechanics and timing of the glenohumeral and scapulothoracic joints.

3. The pecs are strong/active enough!

Pectoralis major's impact on the anterior glenohumeral joint is opposed by the rotator cuff to prevent anterior humeral glide. Effectively, the pec and lats want to pull the ball forward on the socket as the arm goes through gross movements, and the rotator cuff works hard to prevent this gliding at the joint level.

Dominance of pec major over the rotator cuff muscles (namely subscapularis) will play a role in an athlete presenting with anterior humeral glide. We often hear the athlete report “tightness” in the front of the shoulder and their first option is to "stretch it."

This can lead to anterior shoulder pain and potential structural pathology including anterior joint laxity, biceps tendon pathology, and labral pathology – all common injuries in throwing athletes.

Tip: Rather than trying to decrease the “tightness” in the front of the shoulder by aggressively stretching—instead, focus on improving static alignment, proprioceptive awareness, and recruitment of the cuff. If you couple this with some self-massage work, this approach will yield far more favorable results.

In closing, the shoulder joint is happiest when alignment is optimal. Injury will occur if preferred alignment is altered. Examples of altered alignment at rest or with movement are the humeral head is riding too high in the socket, the socket is riding too low on the humeral head, or the humerus is gliding too far forward. The resultant stress to the active or passive restraints of the shoulder leads to injury and loss of playing time. Do yourself (and the players that you work with) a favor and master the basics to help improve success on the field.

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 January 14-16, 2018. For more information, click here.  The early-bird registration discount ends tonight at midnight.

About the Co-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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Strength and Conditioning Stuff You Should Read: 12/13/17

Happy Wednesday! Here are a few recommended reads to get you over Hump Day.

Get Up to Get Down: The Impact of Scapular Movement on Pitch Location - With tomorrow being the early bird registration discount deadlift on our January Elite Baseball Mentorship, I thought it'd be a good time to reincarnate this great guest post from Eric Schoenberg from the archives. You can learn more about the mentorship HERE.

9 Reasons Nutrition Can Feel So Confusing - This is a great video from Dr. John Berardi and his team at Precision Nutrition. They outline the problem, but just as importantly, get folks started on some strategies for improvement.

Gym Owner Musings - Installment 9 - My business partner, Pete Dupuis, always delivers some good thoughts in this random collection of reflections on what he's learned on the business side of fitness.

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10 More Important Notes on Assessments

About 2.5 years ago, I wrote up an article, 10 Important Notes on Assessments, that was one of my most popular posts of the year. And since I’ve spent a good chunk of the past week going through the L2 Fitness Summit Video Series, Dean Somerset’s presentations on the assessment side of things made me realize that I'm ready for a sequel. Here are a few thoughts that came to mind.

1. Just like training, assessments are getting more specialized.

As the sports performance and even personal training worlds get more specialized, the assessments we need to utilize with our clients must be correctly matched up to the people in front of us. As examples, rotator cuff strength tests are huge for a baseball pitcher, but relatively unimportant for a soccer player. We’d “weight” a single-leg squat test result as less significant for a kayaker than we would for a basketball player. The goals of the client and the functional demands of their sport guide the assessments – both in terms of which ones we perform and how we value the results.

However, the challenge is that you can’t test everything, so it’s important to prioritize. If we used every assessment under the sun, the evaluation would last all day – and we’d spend an entire session pointing out everything that’s wrong with someone. I’d much rather use this time to build rapport.

A VO2max test isn’t high on my list of priorities for baseball players even if it might shed some light on their aerobic base. I can probably get the information I need just as easily – and much more affordably – by taking a quick resting heart rate measurement.

2. Every good test that has an unfavorable outcome immediately sets you up for an even more telling retest.

Assessments give you a glimpse into what could potentially be wrong or right about how someone moves. The more important question is: what interventions make a difference? Their squat pattern improves when you give them an anterior counterbalance? Their hip internal rotation improves when you add some core recruitment? Their shoulder pain goes away when the massage therapist works on their scalenes?

One tenet of the Selective Functional Movement Screen (SFMA) system is to always start with dysfunctional, non-painful patterns. What interventions clean up aberrant movement in non-painful areas to give us "easy" adaptations? This not only expands our movement repertoire, but also facilitates buy-in from the athlete/client.

3. Never go to movement screens without first performing a thorough health history and client “interview.”

I think we can all agree that a pre-participation evaluation can dramatically reduce the likelihood in training. And, I'd argue that the single most important part of this evaluation is the health history and conversation you have with them before they even start the movement screen portion of it.

As an example, imagine you have a hypermobile female client with a history of serious anterior shoulder instability that hasn't been surgically treated. If you do thorough paperwork and a detailed conversation with her, you'll quickly ascertain that you have to be careful with anything that involves shoulder external rotation. If you don't do that preliminary work, though, you might very well pop her shoulder out of the socket doing a basic external rotation range-of-motion test.

Summarily: paperwork first, conversation second, movement third!

4. Have assessment regressions for people who can’t perform certain tests due to pain or poor movement competencies.

I like to use a Titliest Performance Institute screen – lumbar locked rotation – to assess thoracic rotation. It requires an individual to get into a lot of knee flexion, though. So, if you have someone who is extremely short in their quads – or has had a knee replacement and permanently lost that motion, then it’s not a solid test.

You’re better off going to a seated thoracic rotation screen with these folks.

As a good rule of thumb, you’ll need more alternatives to general screens (involving more joints and motor control challenges) than you will for specific assessments (involving fewer). So, as you look through your assessment approach, start to consider how you’ll regress things when things don't go as planned.

5. Don’t overlook evaluating training technique as a means of assessing.

During almost every evaluation of someone who has struggled with pain or performance (which is really everyone), I look at technique exercises they commonly perform. For our pitchers, this might be arm care exercises, or a video of a bullpen. For powerlifters, it might be technique on the squat, bench press, or deadlift. As much as our assessment protocols can be thorough, they’ll never fully offer the specificity that comes from watching people actually train.

6. Don’t use tests to embarrass people.

As an extension of the previous point, if you know someone is going to fail miserably on a screen, don’t test it. If you have a 350-pound woman who wants to lose 200 pounds, she’s not going to do well on a push-up test. You can assume that her upper body strength and core stability aren’t sufficient to handle her body weight.

I keep coming back to it:


7. Watch for straining.

This is something I’ve watched for a lot more in recent years after spending time around my business partner, Shane Rye, who’s one of the best manual therapists I have ever seen. He’s a master of watching people move and picking up on where they tend to store their tone. Maybe it’s jaw clenching when you test rotator cuff strength, or making an aggressive fist when you check their active straight leg raise. Watching for changes in accessory tone can give you a glimpse into where you might get the best benefit with your manual therapy work – and how you might coach them differently while they’re training.

8. The best outcome of an assessment might actually be a referral for a more thorough assessment.

At least once a year, I have an assessment come in - but without doing any training, I refer them on for further evaluation. Usually, it's because something very "clinical" in nature presents, and I feel that they need to see a medical professional before we start working with them. It doesn't happen often, but I'm never shy about "punting" when I feel that someone else is better equipped than I am to help the person in front of me.

9. Don’t take their word for it on body weight.

I once had a 6-8 pitcher tell me that he weighed 235 pounds. The next day, he walked in and remarked, “Coach, I actually weighed in this morning. I was 253 pounds.” Now, 18 pounds isn’t as huge a percentage of total body mass on a 6-8, 253 guy as it is on a 14-year-old, 110 pound female teenager, but it’s still tell us a lot that he could actually swing 18 pounds without even feeling it. That’s a sign of an athlete with poor body awareness and a lack of nutritional control (they definitely weren’t a good 18 pounds). You're better off measuring than just asking.

A side note: this applies to male athletes only; I never weigh female athletes for obvious reasons.

10. Take meticulous notes.

I often find myself looking back on notes we have on long-term clients to see how their movement (and prescribed training) has evolved over the years. It wouldn't be possible if I wasn't very detailed in my note-taking - and this is something I'm always striving to improve upon, as we want to create sustainable systems in our business.

Employees move on, so a client's programming responsibilities may be shifted to other staff members. Sports medicine professionals may want to work from some of our notes. Teams and agents might want information on what we discovered with a player and how we plan to manage them. The more you document, the more prepared you'll be in these situations when collaboration is necessary.

Most importantly, though, whenever I write a new program for a client, I have their evaluation form and their previous program open on my computer. I want to see what I initially noticed and put it alongside the up-to-date programming to verify where we are in our progressions. It's this kind of documentation that allows me to program for dozens of athletes who are not only in our facility, but across the country and overseas.

Wrap-up

I've been assessing athletes for close to 15 years, and I find that our evaluations evolve every single year. If you're looking to stay on top of some of the latest developments on this front, I'd strongly encourage you check out the L2 Fitness Summit Video Series, the new resource from Dean Somerset and Dr. Mike Israetel. It's available at an introductory discount through Sunday at midnight.  You can learn more HERE.

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Should You Even Stretch?

Today's guest post comes from Dean Somerset. In reviewing his outstanding resource, The L2 Fitness Summit Video Series (which is on sale for $50 off this week), I thought Dean did a great job discussing active vs. passive range of motion, and asked if he'd be willing to expand on the topic in a guest post, and he kindly agreed. Check it out! -EC

Mobility training is a hop topic right now. Head over to Instagram and you’ll see incredible feats of flexibility that don’t seem like something humans should be able to do without calling 911 due to some terrible accident having taken place.

While these feats are undoubtedly cool to see, there’s also the big question of “why should you even do that stuff? Is it beneficial to health, longevity, or physical performance? Is it something that helps you achieve a specific goal, or prevent injury or get hot dates for the weekends?”

First, let’s look at what is involved in being flexible and having some solid mobility.

Flexibility is typically defined as the available range of motion available to a joint or specific motion.

Mobility is typically defined as the usable range of motion available to an individual.

Another way to look at it, flexibility is your passive range of motion, whereas mobility is your active range of motion, and each is very important, as is their interplay with one another.

The passive range of motion is the theoretical limit of your available range that you could move through for funky stuff like splits, squats, overhead presses, or other movements you’d want to do on a daily basis in the gym. It can be expanded with some “unlocking” options if it’s restricted by motor control issues like guarding tension, or by prolonged static stretching to adapt the tissues that might impede further mobility, such as the joint capsule, ligaments, fascia, or other tissues.

For these tissues to adapt to static stretching, it typically takes a very long time in the stretch (think 5-30 minutes on a daily basis for months on end), and also works best in younger individuals versus older. Odds are, once your epiphyseal plates at the ends of your bones fuse, expanding your passive range is going to be fairly limited.

Now if you have the passive range of motion, you should be able to use it. The active range of motion should be relatively close to what the passive available range currently is. If you can’t use that range, there’s a problem.
While much of the limits to passive range of motion may be structural, the limits to active range of motion are usually more neural. The efferent division of the nervous system controls motor function, including developing sufficient strength across entire ranges of motion or within portions of that range commonly used.

Coming back to the original question of this post, should you even stretch? That depends on whether you need more passive or active range of motion, and what methods of development are best for improving those characteristics.

If you have enough flexibility to do all of the things you want to do in life, you don’t need to develop more flexibility. Would more be good to have if you needed it? Sure, but at current time, you’re golden.

If you can get enough hip flexion to squat to depth for a powerlifting meet, more range won’t give you more white lights.

If you can’t get to this range of motion needed for the activities you want to do, that’s when stretching could be beneficial. Progress tends to be slow for this, but can happen relatively easily if you’re patient. It may mean watching The Walking Dead or Game of Thrones while holding a stretch, but you can do it.

If you have the range but can’t access it, that’s when active mobility comes into play. A basic approach would be to put the joint into a range of motion it wouldn’t normally be able to get into on its’ own with the help of either external loading or some supportive structure, and then developing muscle tension in that new position.

Creating agonist and antagonist muscle tension in the new position can help develop range-specific strength while also training the motor pattern to create activity in that range that it’s not used to developing, which can help you to access later.

Another option would be to take off the brakes from the system to see if that helps. Some higher threshold core activation exercises seem to help reduce resting neural tone into the distal tissues, and helps expand the available range of motion effectively.

Once you have access to that range in both passive and active capabilities, it’s time to train it. Use big ranges of motion with max contractile ability, then add loading to it to help cement that ability to use through all the challenges you can throw at it.

 

So this comes back to the original question: Should you even stretch? I have a simple flow chart to explain the basis of this post and give some direction on what you should do.

If you have both the flexibility and control through the range of motion to do what you want to do, you don’t need to stretch.

If you have the flexibility but not the control, you need to do more active controlled tension drills to help access that range of motion. If you don’t even have the range of motion to do the activity you’re looking to do, that’s where things like static stretching, PNF style contractions, high threshold strategies, joint mobilization or self-myofascial release (foam rolling) can come in very handy.

Haphazardly stretching everything for everyone is rarely ever a beneficial way of training, let alone a good use of time for many individuals with whom it may not be recommended. More range of motion is often not necessary, or even attainable in the case of structural restrictions, but if you enjoy stretching and it makes you feel good, that’s reason enough to continue if you like. However, if it’s not giving you any specific benefits, it may be worth choosing any of the other options we went through today and see if they produce more of a benefit to your training.

Along with Dr. Mike Israetel, Dean is the co-creator of the L2 Fitness Summit Video Series, which was released today. I'm in the process of working my way through this new continuing education resource; Dean offers a nice glimpse into some assessment components that go beyond typical movement screens, and Mike's presentation on hypertrophy mechanisms and strategies was insightful as well. These are some seemingly minimally-related topics, but they did a good job of pulling everything together. It's on sale for $50 off this week, and definitely worth a look - especially with it being the end of the year and NSCA CEUs being available for the resource. Check it out HERE.

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Strength and Conditioning Stuff You Should Read: 12/4/17

Happy Monday! It's been two weeks since my last recommended reading compilation, as I took a little blog hiatus last week in light of some travel and the chaos that is the professional baseball offseason. The good news is that it gave me time to stockpile some good content for you. Here goes...

Tinkering vs. Overhauling - and the Problem with Average - One of our interns asked me about my thoughts on the "average" range of motion at a particular joint, and it got me to thinking about this article I wrote last year. There are big problems with using averages in the world of health and human performances, so I'd encourage you to give it a read to learn more.

Core Control, Hamstrings Patterning, and Pitching Success - This was a whopper of an Instagram post from CSP-MA pitching coordinator, Christian Wonders. Be sure to check out all four parts.

Brett Bartholomew on the Art of Conscious Coaching - This was an excellent podcast from Mike Robertson, as Brett is a skilled coach and charismatic personality. It's definitely worth a listen.

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