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The Be-All, End-All Throwing Program from your Favorite Snake-Oil Salesman

Note from EC: Today marks our second guest blog post from pitching expert Matt Blake.  I couldn't agree more with everything he says! [Cue the annoying, overly excited infomercial salesman voice] This is the throwing program that you have all been waiting for, it's the super-duper secret that people haven't been telling you about 95 mph throwers, and lucky for you, it is now available for F-R-E-E !!(For the first 5 days and then one incredibly low payment of $449 if you do not return the product within those 5 days).....All you have to do is order the product, follow it for a week and 95mph is a snap of the fingers away, it is just that easy...

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Alright, well I can honestly say I just made myself throw up in my mouth a little bit writing that out, and the sad part is that this type of advertising and promotion letters both the baseball and fitness industry. There are two main points that I want to touch on surrounding this type of promotion. 1) Yes, there are some good products out there, I'm not denying that, but I can promise you, anything that is worth having is not free, and does not pretend to be free to lure you in. 2)  There is no single product on the market that is the be-all, end-all in either industry. Eric and I have had this talk many times. Yes, he likes the kettlebell. No, it is not the end of the world. We can keep our squat racks; they still have use. And you know what? Product A may even work better when complemented by Product B.  Whoa, whoa whoa....are you trying to tell me that the kettlebell can be used in a program with dumbbells and barbells? That's not how this thing was sold to me. Yes, scary thought I know, but let's think about this for a second. And, I'm going to bring this back to the baseball side of things to avoid really stepping on my tongue. People ask Eric and me all the time whether or not we like long toss, medicine balls, weighted balls, aggressive velocity drills, lead-up drills, mound work, flat-ground bullpens, etc...and the answer I almost always give is "Yes." "Wait, what? I just asked you if you like seven different types of training for pitchers and you gave me one 'yes.'" That's correct, and to take it a step further and really complicate the matters, we even like kettlebells and different squat variations for pitchers among other things.  And we use a ton of different weights of both baseballs and medicine balls.

My perspective on this is that all of these modes of training have an application in building a pitcher capable of throwing the ball 95mph. Obviously, there are some genetic limitations and other factors involved in getting there, but to really optimize the training, I think all of these need to be applied in the right proportions. These proportions would be determined based upon the individual's current makeup (age, weight, relative strength, mechanical understanding, etc...) and their developmental goals, which should be discussed between player and coach to make sure everyone is on the same page and being realistic. A great example of this is the throwing program Eric used last winter for Shawn Haviland, a pitcher in the Oakland A's system that was drafted in the 33rd round in 2008. For Shawn's particular case, he was a player who pitched in the mid-to-high 80's with a good feel for pitching. As Eric wrote previously, as good as this is, late round draft picks do not get a lot of leeway to prove themselves and can be released in the blink of an eye. To give Shawn the best chance to succeed, Eric thought it might make sense to be a little more aggressive with his throwing program in an attempt to boost his velocity. So, aside from the strength training and mobility/flexibility work, throw in some med ball variations, aggressive long toss, a weighted ball program, and some extensive decelerator work and one might think we're playing with fire here. Well, this season Shawn took his velocity from 87-88 to 90-94.

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So, which piece of the puzzle gave Shawn this huge velocity gain? Was it the med ball throws or was it the weighted ball program? Was it the aggressive long toss or the increased strength? I'd like to believe that it was the individual's commitment to the program in its entirety. Each piece served to complement the next.  This was a program designed for Shawn Haviland to execute in the winter of 2008-2009; that's it. This same program may not make sense in the winter of 2009/2010. I'm sure some similar pieces will be involved, but in a different context with different proportions depending on where Shawn is in his developmental path. This same program certainly wouldn't be prescribed to a 15-year-old just learning about pitching mechanics and strength development, and probably would not be prescribed to a 1st round draft pick with a 92-95mph fastball and a million dollar signing bonus hanging over his head. That's the reality of the situation. Each case needs to be looked at in its own regard and after deciding on a strategic vision of where the player wants to be, then a comprehensive program would be built with the appropriate drills and exercises to help the player take his game to the desired level.  The X factor in all of this is how much time and effort a player is willing to commit to becoming a better player, because this ultimately determines where the player will end up. In the end, this all relates back to the first thought in this blog: there is no one single be-all, end-all answer for pitching development. There are modes of training that should be considered and blended to come up with the right recipe for the particular individual.  Yes, there will be crossovers for players at similar points in their development because we have a finite number of training applications, but they would be applied based on reason. So, before you jump at the next best gadget that is going to give you the 95mph arm you have been looking to buy, make yourself an informed consumer and do some active research to get multiple viewpoints. Believe me, the same product/program that claims to have given someone 95mph, probably has someone claiming that it ruined their arm. I would go as far as to say that neither of these claims are right in their entirety and that there are a lot of external factors involved, but it is your job to do the homework and decide for yourself. Matt Blake can be reached at mablak07@gmail.com. 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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So What Does a Pitching Coach Do, Anyway?

EC's Note: Today marks the first of what I hope will be many guest blog posts from Matt Blake, an absolutely fantastic pitching coach who works out of the cage at Cressey Performance.  Matt is way ahead of the curve with what he's doing, and the results he's gotten with a lot of our athletes - from high school all the way up to the professional ranks - are nothing short of fantastic.  I consider myself tremendously lucky to have him as a resource with whom I can interact every day. Today's post from him is a bit of an introduction and preview of what's in store from us in the months to come. Since Eric mentioned to me a couple of weeks ago that he would like me to start contributing some articles to his blog, I have been debating about how to introduce myself to the EricCressey.com crowd and what his audience might want to hear. All sorts of thoughts had run through my head on whether it should be oriented toward pitching mechanics, maybe talking about what Eric and I are doing together that separates us from other Elite Baseball Development programs, or maybe even a tidy little piece about who I am. Lucky for us, though, we have Eric's business partner Pete around, and he conveniently gave me my first blog topic on Saturday. As everyone on this blog probably knows, Mike Boyle recently released a new product called Functional Strength Coach 3.0 last week. So, on Friday, Eric loaned me his copy to take home to view. I did my part and watched 6 of the 8 DVDs that night (for those of you counting at home that was about 5-6 hours of material straight to the dome on Friday Night; I promise I'm not that big of a geek normally). Upon return on Saturday morning, and much to Eric's shock, I gave him back the six DVDs that I had already watched and told him I would only need the other two for the afternoon.

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Here is where the crew of pro baseball guys from Pete's office chimes in. "Why would you spend six hours of your Friday night watching DVDs that have nothing to do with your field?" At first, I was kind of tongue tied, like, "Yeah, I guess that was pretty foolish, I teach pitching, so why would I want to know how to train people for functional strength?" And, to be honest, I continued to think about this most of Saturday, trying to justify why I just did that.  As I came to my contemplative answer, I realized the very exact same reason I am working with Eric at all, is why I'm watching these DVDs on Friday night. When it comes down to it, I believe to be the best at anything, you need to understand the inherent depth of complexities for what you're dealing with and this more often than not may involve pursuing multiple fields of knowledge to truly grasp your own discipline. In some sense, I believe the leaders in any field are polymaths of sort and this is something Eric clearly demonstrates in his own regard. With that said, for me to provide the most knowledge and best service to an individual, a team, or camp of baseball players, I should understand why we are using foam rolling before we static stretch. Why would SMR of this nature would make sense before stretching and then proceeding into a dynamic warm-up?

I should understand what flexibility deficits are and why they are affecting a player's performance.  I need to know why mobilizing the hips and thoracic spine while stabilizing the lumbar spine is allowing us to create more torque and whip for a pitcher. All of these things have huge ramifications for both player and coach, and if I want to optimize my players' talent, then I need to be able to convey to them the importance of our drills and Eric's exercises. There is a reason for all of it, we're not just throwing darts at the wall and hoping it works out for the player.  I'm also not going to claim to have all the answers for this, and that is why I am constantly searching for the next piece to add to my arsenal. It could be a psychological book about focus, or even an Eastern Martial arts book about how Tai Chi helps you find your center. Not any one of these books would have all of the answers on how to be a great pitcher, and they may even have none...but, at the end of the day, if I can take one thing away from Mike Boyle and add it to my knowledge of pitching in any way, then I just made myself better as a "Pitching Coach," whatever that may be loosely defined as. So I guess to answer their question: I was really watching Functional Strength Coach 3.0 because I plan on helping Eric turn out a large number of pitchers in Hudson, MA who are capable of throwing a baseball freakishly hard and stay healthy while doing so.

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Obviously, there is a lot more to pitching and what we are working on together than that, but I think that should get the ball rolling. Over the next few months, I will be contributing more substantive articles that will cover a lot of the biomechanical aspects of a pitcher's delivery that Eric and I see daily and how best to activate and optimize awareness for each piece of the puzzle. We'll talk about what a flexibility deficit looks like in a pitcher and what its ramifications are in a player's mechanics. We'll discuss how we attack something of this nature with soft tissue/mobility/strength work and then how we teach the player to incorporate this back into his personal mechanics through progressive drill work. The end goal is obviously to remove the limitation, and in turn, raising a pitcher's velocity ceiling and keep him healthy. This could include anything from hip mobility, to thoracic spine mobility, to glenohumeral internal rotation deficit (GIRD), to a host of other issues. All of these issues could be holding a player back from optimal performance and maybe even putting a pitcher at a serious risk for injury. Well, that is more than enough for one blog, and I want apologize for ransacking your daily allowance of blog reading time if you made it this far with me. I tried to get a word count limitation on my post from Eric, but he told me to just let it rip. I guess this was my definition of letting it rip... Matt Blake can be reached at mablak07@gmail.com. Please enter your email below to sign up for our FREE newsletter.
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The Rocker Inferior Capsule Stretch

One of the most common functional limitations we see in those with shoulder issues is the inability to achieve full overhead range of motion.  This can occur due to soft tissue restrictions (lat, pec minor, long head of triceps, among others), weakness (lower traps, serratus anterior), joint restrictions (thoracic spine), or a combination of several of these factors.  The end result is often that a quick assessment reveals something like this:

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In a "healthy" shoulder, with the lower back flat, both upper arms should be flat on the table.  This is a great position to quickly check what's going on and eliminate the muscular strength side of things, as gravity does the work for you as the arms flop down.

The question, of course, is how do you fix it once it's there?  Well, the truth is that there are several things you'd need to do a few different assessments to see exactly what's up, and while that's beyond the scope of an individual article, we can touch on one of them with some detail - thanks to Tim DiFrancesco, a great physical therapist who provided today's guest post below.  From Tim:

I developed the inferior capsule rocker stretch to address limited mobility of the glenohumeral joint's inferior capsule.  This limitation is often a major factor in dysfunctional shoulders of overhead athletes and/or those performing regular overhead activities of daily living.  It is appropriate and necessary to assess inferior capsule mobility in those performing regular over-head activities as well as when there is a shoulder pathology suspected. Inferior capsule integrity can be assessed with an inferior glide looking at accessory joint motion.  This is paramount to address with these populations due to the fact that a restricted inferior capsule is often associated with superior humeral-head migration.  Impingement then results. To perform the stretch: 1. Begin in quadruped position and rock hips back to heels (place pad under knees).  Hands flat on the floor in front. 2. Reach the right arm out into flexion/elevation in pronated position (fixing the scapula and locking the thoracic spine).

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3. Roll the palm open into a supinated position (decreasing the chance of subacromial impingement). 4. Slide the arm out into the scapular plane (decreasing the amount of stress on the rotator cuff tendons and surrounding soft tissue structures). 5. Reach the left hand under the right axillary (armpit) region (cupping the latissimus dorsi).

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6. Rock or shift the body weight into the right shoulder until a strong but comfortable stretch is felt in the right axillary region.

7. Hold for 30-60 seconds without pain.  If pain is noticed in one focal location at the anterior/superior aspect of the shoulder, then reposition the shoulder into more precise supination and scaption. You can also perform a similar stretch with the arm crossing the body (adduction).

Timothy DiFrancesco, PT, DPT, ATC, CSCS graduated from Endicott College in 2003 with his Bachelor's degree in science/athletic training. While at Endicott Tim was a four year member of the varsity men's basketball team. Tim immediately went on to the University of Massachusetts Lowell where he earned his Doctorate of Physical Therapy in 2006.

In 2007, Tim co-founded TD Athletes Edge, LLC, which offers a systematic, results-driven approach to performance training and rehabilitation. In addition to his work as President of TDAE he currently works as a physical therapist on Boston's Northshore and is an adjunct faculty member at Salem State College. He recently accepted the position as the Head Athletic Trainer and Strength & Conditioning Coach with the NBA D-League Bakersfield Jam.  Tim has a passion for working with athletes and patients of all levels to help them achieve their goals and reach their performance potential. 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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The Biggest Mistake Pro Baseball Players Make?

The other day, I got to chatting with Tim Collins and Matt Kramer, two of Cressey Performance's longest tenured pro baseball guys.  These two guys were among my first pro baseball guys to get back from the long season and start up training.  Tim's notorious for getting back in the gym just a day or two after his season ends!

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We were discussing baseball development, and one of them mentioned that one of his teammates had just commented on how he was taking a few weeks off and then was going to start training again.  Keep in mind that this conversation took place on October 1, and just about every minor league baseball team wrapped things up on September 7 (playoffs excluded).  While some guys were called up to play at high levels, and others shipped off to instructionals or the Arizona Fall League, most guys went straight home. Now, "home" is a big improvement from the typical professional baseball lifestyle, which (as I described here) consists of a lot of late nights, long bus rides, unhealthy food, alcohol, and (specific to the topic at hand) erratic training.

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In most cases, the weight rooms aren't even close to adequate.  And, obviously, you can never have a great training stimulus in-season; guys just do what they can to "get by."  Yes, they "get by" for almost seven months per year - which obviously makes the other five months incredibly important. Now, if someone takes an extra month off after the season, he's only getting 80% of the benefit of the off-season that his teammates are getting.  In a sport where only 3% of draft picks make it to the big leagues, if I'm a prospect, I don't like my chances if I only have 80% of the preparation of those around me. Let's do the math on that for a guy who gets released after three years in the minor leagues.  That's three months of preparation down the tubes.  Next, consider how many guys who have COMPLETELY OVERHAULED their physiques and performance in preparing for the NFL combine in less than three months. Last off-season, we put 17 pounds of meat on one of our pitchers (and he got leaner!) between November 11 and February 20. He looked like a completely different person - in just three months and nine days.  His broad jump went up ten inches and vertical jump up 4.3 inches in spite of this big jump in body weight, meaning that he improved in both relative and absolute power.  This is not uncommon at all in the baseball guys with whom I've worked, particularly those who were drafted out of high school and never got the benefit of college strength and conditioning. All that said, in my eyes, guys should be back in the gym as soon as possible after the season ends - even if it's just a few days per week.  Simply getting the ball rolling on the endocrine, immunological, and rehabilitative benefits of strength training will do wonders in itself.  Getting started on improving soft tissue quality and addressing mobility/stability deficits is also tremendously valuable, as it paves the way for better training as the December-February "crunch time."  These guys can take a week to gather their thoughts, and then get back to work; otherwise, they'll have more vacation time when they're out of work!

Truth be told, it's one of just a few common mistakes we see, and this could be applied to just about any professional sport; I just chose baseball because it's what I see the most.  Of course, the guys who probably ought to be reading this are the ones who are probably sitting poolside sipping martinis, or cuddling up in their snuggies and then having Mom's homemade pancakes for breakfast at 1PM!

(For the record, I worked really hard to resist the temptation to insert the "In a Snuggie Rap" video here.  Search for it on Youtube, if you're interested.)

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“My Coach Says I Shouldn’t Lift…”

I got this question in person from the parent of a new athlete the other day and thought I'd turn it into a blog post, as I've received the email before on many occasions. Q: I read with great interest your blog on Crossfit for Baseball, but my question would be what your response would be to a coach that insists that baseball players shouldn't lift weights PERIOD?  My son's baseball coach is completely against it. A:  This is definitely going to be one of those "where to even begin" responses, but I'll do my best.  Rather than reinvent the wheel, I'll start with a quote directly from my e-book, The Truth About Unstable Surface Training: "...resistance training exercises performed on stable surfaces have been demonstrated effective in numerous research studies with respect to improving a variety of athletic qualities, including:
  • muscular strength (5)
  • power (5)
  • aerobic endurance (53)
  • running efficiency (54)
  • anaerobic endurance (5)
  • rate of force development (66,90)
  • hypertrophy (5)
  • reactive strength (66,90)
  • agility (47)
These qualities transfer to improved performance in a variety of sporting tasks, including vertical jump (74), throwing velocity (79), sprinting speed (22), and running economy (53)." (FYI, these numbers are references from the e-book, so if any of you would like the exact studies, please just request them in the comments section) Now, I'm going to go out on a limb and assume that your coach IS NOT looking to field a team that lacks agility, sprinting speed, jumping prowess, throwing velocity, rate of force development (think of a catcher's pop time).  In fact, even those who are clinging to a worthless training initiative like long-distance running for pitchers can get closer to their chosen training effect (as silly as it is) from lifting! Taking this a step further, we know that resistance training can enhance immune and endocrine function, so players will get sick less often and feel better when game time rolls around. And, just as importantly, remember that resistance training is one of the foundations of modern physical therapy.  Would your coach tell a physical therapist that resistance training as part of a rehabilitation program was inappropriate? Of course not!  How in the world it is within his scope of practice to tell a kid that lifting is bad for him - either in terms of increasing injury potential or decreasing performance - is completely beyond me.  Throwing a baseball is the single-fastest motion in sports; you simply don't decelerate 7,500 degrees/second of humeral internal rotation without at least a bit of muscular contribution. And, let's not forget that an ideal strength and conditioning program encompasses a lot more than just strength exercises. It includes good self massage work (foam rollers, etc), mobility training, sprinting/agility/plyos, and much, much more.  It begins with a detailed assessment to determine what mobility or stability deficits may lead to injury down the road.  It may also be the only avenue through which an athlete learns proper nutrition. The fundamental problem is that many baseball coaches think of garbage like this when they hear the words "lifting weights:"

Can someone please tell me how my "biceps will develop" with this?  Only at "Expert Village" does the biceps EXTEND the elbow.  Yikes.

Ouch.

The take-home message is that a lot of coaches think that lifting programs are either a) a waste of time or b) flat-out dangerous.  Sadly, as the videos above demonstrate, in many cases, they're right. However, completely contraindicating lifting can really stunt the development of players and predispose them to injuries.  Throwing is dangerous when done incorrectly, and so are sprinting, fielding ground balls, and taking batting practice.  We don't contraindicate those, though, do we?  We educate athletes on how to participate in these training initiatives properly.

I can tell you that at Cressey Performance, each one of our pro baseball players lifts four times a week, throws the medicine ball 2-3 times a week, and does supplemental movement training 2-3 days per week during the off-season - and they continue lifting during the season (at a lower frequency and volume).  This is true of both position players and pitchers.

Our high school guys get after it as well; I don't know of many other private sector facilities in the country who have eight high school guys throwing 90mph+ before the age of 18 (with several more right on the cusp of this milestone).  Something is working.

And, beyond just the direct training benefits of this system, there is something to be said for the camaraderie strength and conditioning does for teammates on top of regular practices.  The fact that kids actually requested this says volumes!

Hopefully, blogs like this - and bright coaches who are "in the know" - will help to spread the word about what safe, effective training is - and where to get it.

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Strength and Conditioning Programs: Crossfit for Baseball?

I've received a lot of emails just recently (as well as some in-person questions) asking me what I think of Crossfit for strength and conditioning programs with baseball players and, more specifically, pitchers.

Let me preface this email with a few qualifying statements.  First, the only exercise "system" with which I agree wholeheartedly is my own.  Cressey Sports Performance programming may be similar in some respects to those of everyone from Mike Boyle, to Louis Simmons, to Ron Wolforth, to the Crossfit folks - but taken as a whole, it's entirely unique to me.  In other words, I will never agree completely with anyone (just ask my wife!).

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Second, in spite of the criticism Crossfit has received from some people I really respect, I do feel that there are some things they're doing correctly.  For starters, I think that the camaraderie and enthusiasm that typifies their training groups is fantastic; anything that gets people (who might otherwise be sedentary) motivated to exercise is a plus.  Moreover, they aren't proponents of steady-state cardio for fat loss, and they tend to gravitate toward compound movements.  So, good on them for those favorable traits. Additionally, I know some outstanding coaches who run Crossfit franchises, so their excellent skill sets may be overshadowed by what less prepared coaches are doing simply because they have the same affiliation.

However, there are several issues that concern me with applying a Crossfit mentality to the baseball world:

1) The randomness of the "workout of the day" is simply not appropriate for a sport that has quite possibly the most specific sport-imposed asymmetries in the world of athletics.  I've written about these asymmetries in the past, and they can only be corrected with specific corrective training modalities.

I'm reminded of this constantly at this time of year, as we get new baseball players at all levels now that seasons are wrapping up. When a player presents with a 45-degree glenohumeral internal rotation deficit, a prominent scapular dyskinesis, terrible right thoracic rotation, a big left rib flair, a right hip that's stuck in adduction, and a complete lack of rotary stability, the last thing he needs to do is a 15-minute tri-set of cleans, kipping pull-ups, and push-ups - following by some 400m sprints. It not only undermines specificity of exercise selection, but also the entire concept of periodization.

Getting guys strong isn't hard.  Neither is getting them powerful or building better endurance.  Finding the right mix to accomplish all these initiatives while keeping them healthy is the challenge.

2) The energy systems development found in Crossfit is inconsistent with the demands of baseball.  I wrote extensively about my complete and utter distaste for distance running in the baseball world, and while Crossfit doesn't go this far, in my eyes, anything over 60yds is "excessive distance" for baseball guys.  Most of my guys sprint two times a week during the off-season, and occasionally we'll go to three with certain athletes.  Let's just say that elite sprinters aren't doing Crossfit, and the energy systems demands of baseball players aren't much different than those of elite sprinters.

3) I have huge concerns about poor exercise technique in conditions of fatigue in anyone, but these situations concern me even more in a population like baseball players that has a remarkably high injury rate as-is.  The fact that 57% of pitchers suffer some sort of shoulder injury during each season says something.  Just think of what that rate is when you factor in problems in other areas, too!  The primary goal should not be entertainment or variety (or "muscle confusion," for all the morons in pro baseball who call P90X their "hardcore" off-season program).  Rather, the goals should be a) keeping guys on the field and b) safe performance enhancement strategies (in that order).

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As an example, all I need to do is look back on a program we used in one of our first pro pitchers back for the off-season last fall.  He had a total of 20 pull-up and 64 push-up variation reps per week (in addition to some dumbbell bench pressing and loads of horizontal pulling/scapular stability/cuff work).  This 84-rep figure might be on the low-end of a Crossfit program for a single day.  Just like with throwing, it's important to do things RIGHT before even considering doing them A LOT.

4) Several of the exercises in typical Crossfit programs (if there is such a thing) concern me in light of what we know about baseball players.  I'll cover this in a lot more detail in an article within the next few weeks, but suffice it to say that most have significant shoulder (if not full-body) laxity (acquired and congenital), abnormal labral features, partial thickness supraspinatus tears, poor scapular upward rotation, retroversion (gives rise to greater external rotation), and diminished rotator cuff strength in the throwing shoulder (particularly after a long season).  Most pro pitchers will have more than 190 degrees of total motion at the shoulder, whereas many of the general population folks I encounter rarely exceed 160 degrees.

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In short, the shoulders you are training when working with baseball players (and pitchers, in particular) are not the same as the ones you see when you walk into a regular ol' gym.  Want proof? Back in 2007, on my first day working with a guy who is now a middle reliever in the big leagues, I started to teach him to front squat.  He told me that with only the bar across his shoulder girdle, he felt like his humerus was going to pop out of the socket.  Not surprisingly, he could contort his spine and wrists like a 14-year-old female gymnast.  This laxity helps make him a great pitcher, but it would destroy him in a program where even the most conservative exercises are done to the point that fatigue compromises ideal form.  And, let's be honest; if I was dumb enough to let someone with a multi-million dollar arm do this, I'd have agents and GMs and athletic trainers from a lot of major league systems coming after me with baseball bats!

5) Beyond just "acts of commission" with inappropriate exercise selection and volume, there are also "acts of omission."  For example, a rotational sport like baseball requires a lot of dedicated work to address thoracic spine and hip mobility and anti-extension and anti-rotatoin core stability.  If you exhaust your training time and recovery capacity with other things, there may not be enough time or energy to pay attention to these important components.

All that said, I would encourage anyone who deals with baseball players to learn to borrow bits and pieces from a variety of methods available today.   Along the way, take into account the unique characteristics of the overhead throwing athlete and manage accordingly.  Simply saying "I'm a Crossfit guy"  and adhering to an approach that was never intended for a baseball population does a huge disservice to the athletes that count on you to bring them the most up-to-date, cutting-edge training practices available.

If you're interested in learning more about some of the asymmetries and training techniques I noted above, I'd strongly encourage you to check out Optimal Shoulder Performance, where both Mike Reinold and I go into some detail on assessment and corrective exercise for pitchers in this seminar (and there's also a lot more fantastic information for anyone looking to develop pitchers). You can buy it HERE, or learn more about it HERE.

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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!

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