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Getting Geeky with AC Joints: Part 2

Getting Geeky with AC Joints: Part 2 In my last newsletter, I went into great detail on the types of acromioclavicular (AC) joint injuries we see, and some of the common inefficiencies that cause some folks to become symptomatic.  I also outlined some corrective exercise strategies to expedite recovery time.  This week, though, I discuss a very important - yet often-overlooked - piece of the puzzle: how to maintain a training effect in spite of these injuries. Ask anyone who has ever had an AC joint injury, and they'll tell you three things to avoid if you don't want to irritate it: 1. Avoid direct pressure to the area (particularly because it has very little muscle mass to cushion it) 2. Avoid reaching across the body (horizontal adduction) 3. Avoid reaching behind the body (full extension) We can use these three guidelines to get moving in the right direction with respect to maintaining a training effect in spite of the AC joint injury. With respect to #1 from above, front squats are an absolute no-no.  The pressure on the bar across the shoulder girdle can really take an upset AC joint and make it markedly worse.  And, since this is in many cases an injury that we're just "waiting out," simply training through it will only makes things worse long-term.  So, deadlift variations, single-leg variations, and back squats (assuming no other related problems) are likely better bets.  That said, we generally use the safety squat bar and giant cambered bar exclusively with those who present with AC joint problems.

Another important consideration in this regard is overhead pressing.  Believe it or not, many individuals with AC joint problems will actually tolerate overhead pressing quite well, as direct trauma to the AC joint won't really compromise scapulohumeral rhythm very much.  However, you have to consider two things. First, as I mentioned in my previous newsletter, some folks might have developed the AC joint issue over time due to a scapular anterior tilt causing the acromion and clavicle to sit differently.  This dyskinesis would also make overhead work less safe - so the individual would actually be training through a faulty movement pattern, and potentially injuring the rotator cuff, biceps tendon, bursa, and labrum. Second, if the individual is okay to overhead press from a movement standpoint, one needs to make sure that the bar, dumbbell, or kettlebell does not come down directly on the AC joint in the bottom position. With respect to #2 from above, obviously, dumbbell flyes and cable crossovers are out (not sure why they'd be "in" in the first place, but that's a whole different newsletter).  However, close-grip bench pressing variations will generally cause pain as well.  You also have to be careful with cable and medicine ball variations that may position the arm across the body. Moving on to #3, full extension of the humerus will light up an AC joint pretty quickly.  So, dips are out - and, honestly, I generally tell folks they're out for good after one has experienced any kind of AC joint issue.  Full range-of-motion (ROM) bench pressing and push-ups are generally issues as well, so I tend to start folks with more partial ROM work.  Examples would include dumbbell and barbell floor presses and board presses.  Here's a 3-board press:

As the shoulder starts to feel better, one can move down to 2-board, 1-board, and eventually full ROM bench press.  Remember, a medium or wide grip will generally be tolerated better than a close grip.

I also really like push-up iso holds at a pain-free ROM for these individuals because closed-chain exercises are always going to be a bit more shoulder friendly than open-chain variations.  This is really quite simple: set up as if you are going to do a push-up, and go down as far as you can with no pain.  When you reach your pain-free end-range, hold there while bracing the core, locking the shoulder blades down and back, and tightening the glutes; do not let the elbows flare out or hips sag!  We'll hold for anywhere from 10-60s, depending on fitness levels.  Over the course of time, increase the ROM as your symptoms reduce.

There you have it: acromioclavicular joints - from onset to corrective exercise - in a nutshell.  Obviously, make sure you seek out a qualified professional if you think you may have these issues, but keep this progression in mind as you return to (or just try to stay in) the iron game. Feedback on Building the Efficient Athlete "In my ten years in the fitness industry, I have been to many seminars and conferences - but the Building the Efficient Athlete Seminar was by far the most informative and comprehensive event I have attended in as long as I can remember.  The amount of knowledge you get when you combine Eric Cressey and Mike Robertson is unparalleled.  The seminar was filled with great classroom information, hands-on assessments, and on-site training tips.  I highly recommend this DVD set to any coach, trainer, or athlete who is looking to get a leg up on the competition." Mike Hanley, USAW, RKC Morganville, NJ www.HanleyStrength.com

Pick up your copy of Building the Efficient Athlete today!

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New Blog Content Exercise of the Week Stuff You Should Read Jays Prospect Collins a Surprising Strikeout Machine Random Friday Thoughts How to Progress Back to Deadlifting After a Back Injury Have a great week! EC

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Getting Geeky with AC Joint Injuries

Getting Geeky with AC Joint Injuries Lately, I've gotten quite a few in-person evaluations and emails relating to acromioclavicular (AC) joint issues.  As such, I figured I'd devote a newsletter to talking about why these injuries are such a pain in the butt, what to do to train around them, and how to prevent them in the first place (or address the issue once it's in place). First off, there is a little bit about the joint that you ought to know.  While the glenohumeral joint (ball-and-socket) is stabilized by a combination of ligamentous and muscular (rotator cuff) restraints, the AC joint doesn't really have the benefit of muscles directly crossing the joint to stabilize it.  As such, it has to rely on ligaments almost exclusively to prevent against "shifting."

ac-joint

As you can imagine, then, a traumatic injury or a significant dysfunction that affects clavicle positioning can easily make that joint chronically hypermobile.  This is why many significant traumatic injuries may require surgery.  While almost all Grade 4-6 separations are treated surgically, Grades 1-2 separations are generally left alone to heal - with Grade 3 surgeries going in either direction. In many cases, you'll actually see a "piano key sign," which occurs when the separation allows the clavicle to ride up higher relative to the acromion.  Here's one I saw last year that was completely asymptomatic after conservative treatment.  It won't win him any beauty contests, and it may become arthritic way down the road, but for now, it's no problem.

pianokeysign

Now that I've grossed you out, let's talk about how an AC joint gets injured.  First, we've got traumatic (contact) injuries, and we can also see it in people who bench like this:

Actually, that's probably a fractured sternum, but you can probably get the takeaway point: don't bounce the bar off your chest, you weenie.  But I digress... Insidious (gradual) onset injuries occur just as frequently, and even moreso in a lifting population.  Most of the insidious onset AC joint problems I've encountered have been individuals with glaring scapular instability.  With lower trapezius and serratus anterior weakness in combination with shortness of pec minor, the scapula anteriorly tilts and abducts (wings out) - and you'll see that this leads to a more inferior (lower) resting posture.

scapanteriortilt

In the process, the interaction between the acromion (part of the scapula) and clavicle can go a little haywire.  The acromion and clavicle can get pulled apart slightly, or the entire complex can get pulled downward a bit.  In this latter situation, you can also see thoracic outlet syndrome (several important nerves track under the clavicle) and sternoclavicular joint issues in addition to the AC joint problems we're discussing. As such, regardless of whether we're dealing with a chronic or insidious onset AC joint issue, it's imperative to implement a good scapular stabilization program focusing on lower trapezius and serratus anterior to get the acromion "back in line" with the clavicle.  Likewise, soft tissue and flexibility work for the pec minor can also help the cause tremendously. Anecdotally, a good chunk of the insidious onset AC joint problems I've seen have been individuals with significant glenohumeral internal rotation deficits (GIRD).  The images below demonstrate a 34-degree GIRD on the right side.

gird1gird2

It isn't hard to understand why, either; if you lack internal rotation, you'll substitute scapular anterior tilt and abduction as a compensation pattern - whether you're lifting heavy stuff or just reaching for something.  And, as I discussed in the paragraph above, a scapular dyskinesis can definitely have a negative effect on the AC joint. Lastly, you can't ever overlook the role of thoracic spine mobility.  If your thoracic spine doesn't move, you'll get hypermobile at the scapulae as a compensation - and we already know that's not good.  And, as Bill Hartman discussed previously, simply mobilizing the thoracic spine can actually improve glenohumeral rotation range-of-motion, particularly in internal rotation.  Inside-Out is a fantastic resource in this regard - and is on sale this week, conveniently! So, as you can see, everything is interconnected!  In part 2 of this series, I'll discuss training modifications to work around acromioclavicular joint problems and progress back to more "normal" training programs. New Blog Content Birddogs, Continuing Education, and Terrible Journalism Stuff You Should Read Exercise of the Week: Dumbbell Reverse Lunge Random Friday Thoughts It's All About Specialization All the Best, EC Sign-up Today for our FREE Baseball Newsletter and Receive a Copy of the Exact Stretches used by Cressey Performance Pitchers after they Throw!
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Strength Training Programs: A Quick Fix for Painful Push-ups

Q: I've read a lot from you, Robertson, and Hartman about including push-up variations in strength training programs is really important for shoulder health.  Unfortunately, whenever I do them, I have pain in my bum shoulder.  Any ideas what to do?

A: Well, obviously, there are two things we need to rule out:

1. You may simply have a really irritated shoulder, which (in most cases) means that any sort of approximation or protraction movement could get it angrier, even if it is a closed-chain movement like the push-up that is normally pretty shoulder-friendly.  Likewise, if you have a significant acromioclavicular joint injury, the extension range-of-motion at the bottom of a push-up could exacerbate your symptoms.  So, obviously, the first step is to rule out if something is structurally wrong with your shoulder, and if so, if the push-up even belongs in your strength training program.

2. Your technique might just be atrocious.  If the elbows are flared out, hips are sagging, and/or you're in a forward head posture, simply changing your technique may very well alleviate those symptoms.  In a good push-up, the elbows should be tucked to a 45-degree angle to the body, with the hips, torso, neck, and head in a straight line.  The muscles of the upper back should essentially "pull" you down into the bottom position:

Once you've ruled out those two issues and still have some annoying issues, there is one more thing you can try: simply elevate the feet.  Looking to the research, Lear and Gross found that performing push-ups with the feet elevated significantly increased activation of the serratus anterior (SA).

If we can get more SA recruitment and less pectoralis minor contribution, it keeps us out of a position of scapular anterior tilt, which mechanically decreases the subacromial space through which the rotator cuff tendons pass.  In the picture below, think of the area just below the word "acromion" being smaller, and then picture what would happen to the tendons that pass through that region; they get impinged.  Serratus anterior (along with lower trapezius) can help prevent that.

scapula

That said, I've seen quite a few folks with persistent shoulder pain with bench pressing variations (barbell and DBs) and regular push-ups who were able to do the feet-elevated versions completely pain free in their strength training programs.  Obviously, begin with just body weight and see how it goes, but over time, you can start to add resistance and use the single-leg version.



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Shoulder Range-of-Motion Norms

Q: As far as the total motion concept goes, is there a certain minimum of total degrees of motion that the "baseline" limb should have? For example, if a right-hand dominant person has fairly limited total motion on the left side and even more limitations on the right, would the goal be to get total motion symmetrical first and then improve both from there?

A: It is definitely population-specific, as overhead throwing, for example, will simply move that total motion to a different range. So, a symmetrical shoulder might be: Right (dominant): 45°  IR + 125° ER = 170° Total Motion Left (non-dominant): 55° IR + 115° ER = 170° Total Motion The difference between the two would be attributed to retroversion (bony adaptations - more info HERE). A 10° internal rotation deficit would be completely normal in a unilateral overhead throwing population. Of course, if you get a freestyle swimmer, thinks get a bit interesting. You have to go a bit more by end-feel, and mandate that they have at least 25° degrees of total internal rotation. That said, in a "normal" weight training population, I like to have at least 90° of external rotation and 50+° of internal rotation. I wouldn't consider those "good" measurements, but they would be workable (assuming symmetrical total motion).

Now, you are going to have situations here and there where someone has lost total motion in the non-dominant side.  My experience has been that this occurs in athletes who spend too much time in computers and those who get "100% shut down" after an injury.

Believe it or not, I once saw a pro pitcher with only 6° (yes, single digits) of internal rotation on his throwing shoulder, and the medical staff's conclusion was to give him a cortisone shot and make him rest completely - no lifting, sprinting, stretching, anything (I wonder if they assigned an intern to him to help him wash his hair in the shower).  He basically just charted pitches for two months.  This guy lost total motion bilaterally, so the fact that he was forced into inactivity actually made his subsequent evaluation a bit more complex.  The good news is that these guys can generally be recognized by their terrible thoracic spine posture and increased body fat levels!

shoulder-performance-dvdcover

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Random Friday Thoughts: 6/19/09

It's been a while since my last dose of Friday Randomness, but when you're got so much intern hazing going on, it's hard to even imagine topping that kind of content! 1. I recently contributed to another T-Muscle feature; check out Advice You Don't Want to Hear: Volume 2 for a little dose of tough love.  I'm the last one down. 2. I have to say, I'm pretty proud of myself.  My fiancee's been out of town since Monday morning, and while the fridge is just about empty and I'm down to one pair of clean underwear, the place didn't burn down, and I didn't put an eye out. 3. Here's a quick takeaway from a great Elbow Biomechanics talk by Mike Reinold earlier this week... Obviously, in dealing with loads of baseball guys, I see a lot of elbow issues come through my door.  The overwhelming majority of those folks are medial elbow pain, but we also see a fair amount of lateral elbow pain - even though we program for these individuals very similarly, as their inefficiencies are pretty much identical.  I've seen it in practice, but never actually gotten the numbers on the forces involved. The same medial tensile force that can wreak havoc with an ulnar collateral ligament or ulnar nerve also applies approximately 500N on the radioulnar joint during the late cocking (maximum external rotation) phase of throwing; that's about one-third of the total stress on the elbow.  This lateral area also takes on about 800N of force at the moment arm deceleration begins (elbow extended out in front). As always, a picture is worth a thousand words:

compressive-forces

I always knew it was going on, and always worked to prevent problems in the area, but suffice it to say that it was nice to get some numbers on this.    If you see these issues, you've obviously got to look at mechanics, but more importantly, tissue quality, all the common flexibility deficits we see in pitchers, and overall strength of the rotator cuff, scapular stabilizers, core, lower body, and muscles acting at the elbow to provide valgus stability. For more information, I highly recommend you check out the 2008 Ultimate Pitching Coaches Boot Camp DVD set.

4. Bill, Mike, and I film our new DVD next weekend out in Indianapolis, so I'm going to end this one here and get to work on finishing up the script.  Stay tuned on this front; we are excited about how thorough this is.

Have a great weekend!

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Forearms/Biceps Soft Tissue Work

I've written previously about the many flexibility deficits we see in baseball players (particularly pitchers).  One of the biggest issues we face is a loss of elbow extension range-of-motion.  This adaptive change most likely occurs because of the insane amounts of eccentric muscle action required to decelerate the 2,500 degrees/second of elbow extension that occurs during pitching.  You'll find some serious shortness/tissue restrictions in biceps brachii, brachioradialis, brachialis, and all the rest of the muscles acting at the elbow and wrist. Unfortunately, it's not an area you can really work on with the foam roller or baseball, as it's in a tough spot.  For that reason, we prefer using The Stick - and hold it in place with the j-hooks in a power rack.  Here is how it works when rolling out the anterior forearm musculature (this same technique can be utilized on the elbow flexors):

Follow that up with some longer duration holds of this stretch, and you'll get that elbow extension back in no time.

elbow-flexors-stretch

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Risk-Reward in Training Athletes and Clients

Risk-Reward in Training Athletes and Clients This week, approximately 1,500 players will be drafted in the 2009 Major League Baseball Draft.  Historically, a whopping 2-3% of these players will ever actually make it to the big leagues.  In fact, only about 2/3 of all first-round draft picks - seemingly the most qualified candidates - ever make it to the major leagues. For this reason, many have labeled competing in the professional baseball ranks a "War of Attrition."  High-round picks get preferentially escorted through the minor leagues, while a lot of the late-round picks fight for their positions in the minors - especially since they know a brand new class of 40-50 draft picks and a bunch of free agent signees will line up to take their jobs each year.  Along the way, loads of guys incur career-ending injuries. Here, we come to several decisions in how to train athletes. First, all athletes have unique movement inefficiencies, so we screen these issues and address them individually.  Nothing remarkable there. Second, some athletes have bigger contracts, so you have to be more conservative with their programming.  Sure, they might get benefits out of more aggressive programming, but it also increases the likelihood that you'll mess up an athlete with multi-million dollar contracts in his immediate future. Take, for instance, Cressey Performance athlete Shawn Haviland. Shawn was drafted out of Harvard by the Oakland A's in the 33rd Round of the 2008 Draft after being named Ivy League Pitcher of the Year.  As Shawn himself has said, he "would have signed for a plane ticket to Arizona."  In other words, he didn't get an $8 million signing bonus; he's a very low-risk investment.  Life goes on for his organization if he doesn't work out because they can just draft another 50 guys the following year.  After all, he's just another 6-0 right-hander in the system - a dime a dozen, if you will.

ap-shawn-haviland-action

This is the exact conversation Shawn and I had last October when we first met up.  He'd been 86-88mph on the radar gun most of last year, and that really isn't going to earn you a long stay in professional baseball.  So, we decided to be more aggressive with his off-season programming than we would with someone who'd just become a first-round pick. All off-season, he lifted, sprinted, accumulated 80-120 medicine ball throws three times a week, did some extreme long-toss, threw the weighted balls around, and consistently worked on his flexibility and tissue quality.  It flies in the face of the conventional wisdom that says: a) we shouldn't long toss more than 120 feet, b) weighted balls are the devil, c) only distance running and steady-state cardio will "build leg strength" in pitchers, d) lifting will ruin flexibility, and e) medicine ball throwing will cause oblique strains (yes, I've really heard that one).  However, it worked. Now, seven months later, Shawn was just named a Midwest League All-Star.  He is consistently 91-94mph and has completely changed his body.  In short, he took a chance, worked his butt off, and got better. Shawn's program wasn't "unsafe;" it was just "less conservative."  It was at a different point on the continuum on which every strength and conditioning coach and personal trainer works on a daily basis.  This program was obviously different than what I'd do with, say, a 40-year-old marathon runner, but it's also different than I'd do with a first-round pick with Shawn's exact build, competitive demands, and inefficiencies.  And, if I had a pitcher with those exact same characteristics and an extensive injury history, we'd be even more conservative.  Otherwise, the risk: reward would be completely out of whack. Often, in our industry, we get far too caught up in numbers - whether it's the weight one lifts or his/her body fat percentage.  In reality, I look at what I do as a means to an end.  People train with us first and foremost to stay healthy, whether they're pitching in the professional baseball ranks or just carrying their kids around.  What you do in the gym should improve quality of life first and foremost, and any activity that carries a high likelihood of injury is very rarely worth the risk. Why pick up a stone - which demands compression and lumbar flexion - when you're not a strongman competitor and could just as easily do a more controlled trap bar deadlift? Why behind-the-neck overhead press - which puts the shoulder at one of its most at-risk position - when you've already had four shoulder surgeries and still have hunchback posture? When it really comes down to it, you have to fit the program to the athlete, and not the athlete to the program.  For more information, a few resources I'd recommend: 1. My article, 6 Mistakes: Fitting Round Pegs into Square Holes 2. The Building the Efficient Athlete DVD Set 3. The 2008 Indianapolis Performance Enhancement DVD Set 4. For those of you interested in a bit of what we did with Shawn, check out this Athlete Profile on him. New Article at T-Nation For those who missed it, Part 3 of my "Lower Back Savers" series was posted at T-Nation last week.  You can check it out HERE (and be sure to check out Part 1 and Part 2 if you missed them in previous weeks). New Blog Content Random Friday Thoughts Bogus Workouts and the Official Blog of... Building Vibrant Health: Part 2 Friday Night Journals Have a great week! EC Sign-up Today for our FREE Baseball Newsletter and Receive a Copy of the Exact Stretches used by Cressey Performance Pitchers after they Throw!
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Hip Injuries In Baseball

Q&A: Hip Injuries in Baseball Q: On Sunday, The New York Times published this article that discusses the dramatic increase in hip injuries in Major League Baseball in recent years.  I know you work with a ton of baseball players and was curious about your thoughts on the article.  Do you agree with their theories? A: As always, my answer is "kind of" or "maybe."  I think they make some great points in the article, but as is the case with mainstream media articles, they're written by reporters with word count limits, so a lot of the most important points get omitted.  For example, with respect to the hips, it isn't as simple as "weak or strong."  You can have guys with ridiculously strong adductors that are completely overused, balled up, and short - but terribly weak hip extensors and abductors.  So, part of the problem is that journalists don't even qualify as casual observers to exercise physiology, so the public only gets part of the story.

(Sorry, but that digression was totally worth it.) First, I agree that one of the reasons we are seeing more of these issues is because doctors have become better at diagnosing the problems.  The "corollary" to this would be that the issues are perceived as more severe because so few physical therapists, athletic trainers, and strength and conditioning coaches are comfortable treating and preventing the problems.  That's not to say that hip issues aren't serious in nature; it simply implies that there is a divide between diagnostic capabilities and treatment/prevention strategies. Second, I agree wholeheartedly that early specialization at the youth levels can lead to injuries down the road.  We're dealing with some significant rotational velocities at the hips.  In previous analyses of professional hitters, the hips rotated at a velocity of 714°/second.  This same velocity isn't the same with little leaguers, but with skeletally immature children, it doesn't take as much stress to impose the same kind of damage.  So, I don't see it as at all remarkable that some pro ballplayers have hip problems after they may have played baseball year-round from age 9 all the way to the time they got drafted.  They also have bad shoulders, elbows, knees, and lower backs that have taked years to reach threshold.  It just so happens that folks are getting better at diagnosing these problems, so we now have an "epidemic," in some folks' eyes. What I can tell you, though, is that it's borderline idiocy to think that strength training is responsible for these problems.  Injuries don't occur simply because you enhance strength. In fact, muscular strength reduces the time to threshold for tendinopathies, and takes stress off passive restraints such as ligaments, menisci, labrums, and discs. Making this assumption is like saying that strength training drills to bolster scapular stability may be the reason we see more shoulder and elbow injuries nowadays.  Um, no.  Shoulders and elbows crap out because of faulty mechanics, poor flexibility (e.g., shoulder internal rotation ROM), bad tissue quality, and muscular weakness.  Granted, the shoulder (non-weight-bearing) and hips (weight-bearing) have different demands, but nobody ever tried to pin the exorbitant amount of arm problems in pitchers on "the advent of strength training." That said, injuries occur when you ignore things that need to be addressed: pure and simple. To that end, I can tell you that a large percentage of the baseball players I see - including position players, pitchers, and catchers - have some signficant hip ROM and tissue quality problems.  In terms of range of motion, the most common culprints are hip internal rotation deficit (HIRD) and a lack of hip extension and knee flexion (rectus femoris shortness).  Pitchers are often asymmetrical in hip flexion, too, with the front leg having much more ROM. In terms of tissue quality, the hip external rotations, hip flexors, and adductors are usually very restricted. This is has proven true of guys who lift and guys who don't lift.  The latter group just so happens to be skinny and weak, too! Done appropriately, strength training isn't causing the problem - particularly when we are talking about huge contracts that restrict how aggressive programming can be.  Trust me; guys with $20 million/year contracts aren't squatting 500 pounds very often...or ever. The risk-reward is way out of whack, and no pro strength coach is going to put his job on the line with programming like that. However, strength training may be indirectly contributing to the problem by shifting an athlete's focus away from flexibility training and foam rolling/massage.  Pro athletes are like everyone else in this world in that they have a limited time to devote to training, but to take it a step further, they have a lot of competing demands for their attention: hitting, throwing, lifting, sprinting, stretching, and soft tissue work.  So, they have to pick the modalities that give them the biggest return on time investment and prioritize accordingly in terms of how much time they devote to these initiatives.  Some guys make bad choices in this regard, and hip flexibility and tissue quality get ignored.

mm1

Baseball is a sport that doesn't permit ignorance, unfortunately, and this is one of many reasons why it has one of the highest injury rates in all of professional sports.  We are talking about an extremely long competitive season with near daily games - a schedule that makes it challenging to maintain/build strength, flexibility, and tissue quality.  Throwing a baseball is also the fastest motion in all of sports.  Rotational sports have the pelvis and torso rotating in opposite directions at the same time.  And, as I noted in Oblique Strains and Rotational Power, most professional ballplayers have a stride length of about 380% of hip width during hitting.  It is really just a matter of which joint will break down first: hip, knee, or lower back.  Taking immobile hips with poor tissue quality out into a long season with these demands is like doing calf raises in the power rack when someone is around with a video camera: you are just asking for a world of hurt.

So, what to do?  Well, first, get cracking on tissue quality with regular foam rolling and massage (the more an athlete can afford, the better).  Here is the sequence all Cressey Performance athletes go through before training.

In many of our guys, we also add in extra adductor rolling on the stretching table.

Second, you've got to hammer on flexibility.  We spend a ton of time with both static stretching and dynamic flexibility.  Here are a few of the static stretching favorites (the first to gain hip internal rotation, and the second to gain hip extension and knee flexion ROM):

lyingknee-to-kneestretch

kneelingheeltobuttstretch

Third, as Dr. Eric Cobb has written, you use resistance training to "cement neural patterns."    This includes all sorts of lower-body lifting variations - from single-leg movements, to glute-ham raise, to deadlifting and squatting variations - and multi-directional core stability drills.  And, often overlooked is the valuable role of medicine ball training in teaching good hip (and scap) loading patterns:

For more information, check out my previous newsletter, Medicine Ball Madness, which describes our off-season medicine ball programs in considerable detail.

All taken together, my take is that the increase in hip injuries at the MLB level has everything to do with early baseball specialization and improved diagnostic capabilities.  However, when you examine hip dysfunction under a broader scope, you'll see that this joint breaks down for many of the same reasons that lower backs and knees reach threshold: inattention to tissue quality and targeted flexibility training.  Strength training works synergistically with these other components of an effective program just like it would at any other joint.

*A special thanks goes out to Tony "Explosive Calves" Gentilcore for being a good sport in the videos in this newsletter.

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Gaining Weight, Gaining Velocity, Losing Control

Q: My son pitches for a Division II baseball program - well, at least, until recently. Since he began his strength training regimen one year ago, his pitches have gained velocity, but he no longer has control over the ball. Is it possible that his training has changed the mechanics in his arm so much that he has no idea where the ball is going after it leaves his hand? He's frustrated - we are talking about one of the best and strongest in collegiate baseball and now they won't even put him on the mound. I asked some baseball veteran friends about it and they suggested he has to retrain his arm since he has become so much stronger. What are your thoughts? A: I've definitely seen guys who have gained muscle mass and lost velocity because they didn't train the right way, and it can absolutely go in the opposite direction as well and affect control. I agree with your pitching coaches that he probably needs to retrain his mechanics with the added weight, but to be honest, it's something that should have been happening with a gradual weight gain anyway.  I would be more inclined to look to address any range of motion (ROM) deficits he may have acquired through the process of gaining weight. For instance, if he lost some hip rotation ROM, it could markedly affect control.  A guy without enough hip internal rotation will fly open early on his front leg and, as a result, the arm lags behind (and out of the scapular plane, which can also lead to arm problems).  A guy who loses external rotation tends to stay closed, which means he either throws more across his body (increased arm stress) or miss high and inside frequently (in the case of a RHP vs. right-handed batter, or LHP vs. left-handed batter). Likewise, a pitcher who bench presses until he's blue in the face can lose both external rotation and horizontal abduction ROM.  These ROM factors are two (of many) predictors of velocity, and while a decrease in one or both normally equates to a drop in velocity, it could also cause a pitcher to change his arm slot.  I actually wrote more about this in an old newsletter: Lay Back to Throw Gas. These are just some thoughts.  I'd need to do some ROM tests and see some videos of him throwing to know for sure if any of my impressions are on the money. For more information, I'd definitely recommend you check out the 2008 Ultimate Pitching Coaches Bootcamp DVD Set. Sign-up Today for our FREE Baseball Newsletter and Receive a Copy of the Exact Stretches used by Cressey Performance Pitchers after they Throw!
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A Good Rule of Thumb for Working with Injured Pitchers

If you have a pitcher athlete with good shoulder ROM (normal GIRD and symmetrical total motion), sufficient thoracic spine mobility, good scapular stability, and adequate tissue quality who has rehabbed and long-tossed pain-free, but has shoulder/elbow pain when he gets back on the mound, CHECK THE HIPS! Staying closed and flying open will be your two most common culprits; this cannot be seen in a doctor's office!  Changing lead leg positioning is a quick way to indirectly (and negatively) impact the position of the arm.  Guys who stay closed have to throw across their body, and guys who fly open often have problems with the arm trailing too far behind (out of the scapular plane). For more information, check out the Optimal Shoulder Performance DVD Set. Sign-up Today for our FREE Baseball Newsletter and Receive a Copy of the Exact Stretches used by Cressey Performance Pitchers after they Throw!
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