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Strength and Conditioning Stuff You Should Read: 9/26/13

Here's this week's list of recommended strength and conditioning reading:

Hacking Sleep: Engineering a High Quality, Restful Night - Brian St. Pierre goes into great detail on how to improve sleep quality in order to optimize recovery and fitness progress.

What You Need to Know About GIRD - Mike Reinold put together a great review of the literature and outlined the common mistakes he sees with respect to glenohumeral internal rotation deficit (GIRD).  This is stuff that Mike and I discuss literally every week, so I'm glad he's finally put it into a comprehensive article.  If you're a coach who is universally prescribing sleeper stretch to all your players, this is must-read material; you'll reconsider it after you're done.

Injuries are an Opportunity - Andrew Ferreira is a CP pro guy in the Twins system, and he offered this great insight on how you can't just have a pity party when you get hurt; you have to use it as an avenue through which you can get better.

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Training Athletes with Funky Elbows: What a Valgus Carrying Angle Means

I talk a lot about how there's a difference between simply "training baseball players" and actually training baseball players with a genuine appreciation of the unique demands they encounter - as well as their bodies' responses to those demands.  Today's post will be a great example of how you can't just throw every throwing arm into a generic program.

One of the adaptations you'll commonly see in throwers is an acquired valgus carrying angle at the elbow.  For the laymen in the crowd, take note of how the throwing arm (in this case, the right arm, which is to the left side of the picture) has a "sharper" angle: 

 

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This is an adaptation to the incredible valgus stress during the lay-back portion of throwing.

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While the research on the subject isn't really out there, it's widely believed that a sharper valgus carrying angle predisposes throwers to elbow injuries, particularly ulnar collateral ligament (UCL) tears.  My good friend Mike Reinold actually has a lot of very good unpublished data on the topic, too. In my eyes, this verifies that we need need to treat throwers like this with extra care in light of this increased susceptibility to injury. 

From my perspective, I think it means more time off from throwing each off-season in order to regain passive stability, as the UCL is already stretched out more than in the normal pitcher.  Additionally, it may take longer for these athletes to regain good soft tissue quality, as the musculature at the medial elbow is likely working harder to make up for this loss of passive stability and the increased range-of-motion demands.  Another key point is that this valgus carrying angle may increase the likelihood of ulnar nerve hypermobility (snapping back and forth over the medial epicondyle during flexion/extension) or ulnar neuritis (irritation of the nerve from excessive stretch). If this nerve only has a limited number of flexion/extension cycles before it really gets irritated, then we need to use each throw wisely to put off the possibility of needing an ulnar nerve transposition surgery to set it where it needs to be.

Additionally, I think it means less aggressive throwing programs, particularly with respect to extreme long toss.  I think long toss has a ton of merit for a lot of throwers, but one concern with it is that it does increase valgus stress slightly as compared to throwing on a line at shorter distances.  With that in mind, these folks might respond better to other throwing initiatives, or simply less long toss than they otherwise might do.

From a training standpoint, we need to work to gain more active external rotation to ensure that more of the range-of-motion is occuring is at the shoulder than the elbow.  This should not be confused with simply stretching the shoulder into external rotation, which does much more harm than good in 99% of cases.  Rather, we need to educate athletes on how to get to lay-back without compensation. I like supine external rotation - an exercise I learned from physical therapist Eric Schoenberg - as a starting point.

Once we've been successful working with gravity, we'll progress this drills to prone to work against gravity, and then add in various holds at end-ranges of motion to strengthen athletes in external rotation closer to end-range.  Here's an example you can try at home:

In terms of contraindications, I can't say that it changes much as compared to what we avoid - back squats, Olympic lifts, etc. - with the rest of our throwers.  However, I think the fallout could be even more dramatic; just imagine these elbows catching a snatch overhead in the off-season after 200+ innings of wear and tear.

crazyvalgus

This picture also teaches us that one can simply be born with a more significant valgus carrying angle, but throwing during the adolescent and teenage years would make it more extreme.

Beyond training implications, for the reasons I noted above, it's also extremely important to take care of tissue quality at the common flexor tendon and pronator teres. I like a combination of instrument-assisted soft tissue mobilization and hands-on work like Active Release.

I hope this post brings to light an additional assessment and follow-up training principles you can use to give your throwers the quality training and (p)rehabilitation they need. If you're looking for more insights on training throwers, I'd highly recommend you check out our Elite Baseball Mentorships; the next course takes place on December 8-10.

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Cressey Performance Camo Shirts: 2013 Edition Now Available!

It's September, which means we just introduced our new edition Cressey Performance Elite Baseball Development t-shirts!  This go-round, you can rock the black with red camoflauge. 

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These shirts are 90% cotton and 10% polyester and insanely comfortable.  They do, however, run a bit small.  So, if you normally wear a large, order a XL.  If you're normally a XL, get a XXL.

Each shirt is $24.99 + S&H, and you can click the links below to add shirts to your cart:

XXL

Extra Large

Large

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Regaining Scapular Control: Always Good Intentions, Often Bad Technique

The prone 1-arm trap raise (also known as the prone Y) is one of my favorite arm care drills. Unfortunately, it's also a drill that can be performed incorrectly in a number of different ways.  Additionally, as with most exercises, there's a big difference between "decent" and "optimal," and when it comes to taking care of throwing arms, even the most subtle adjustment can reduce injury risk or take away someone's pain.  A key part of being able to adjust on the fly is to appreciate how an athlete's resting posture looks.

With all these important considerations in mind, check out this detailed video tutorial so that you can make the most of this awesome exercise.

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Strength and Conditioning Stuff You Should Read: 9/12/13

Here's this week's recommended strength and conditioning reading:

How Concern Over Pitcher Usage Can Actually Give College Coaches a Recruiting Advantage - I've been very outspoken in the past about how prior overuse invariably winds up predicting future injury, and this article reflects on the topic as well - including a mention of CP athlete and Vanderbilt Tyler Beede. If you're looking for a good complementary resource, check out this page, which tracks the highest pitch counts in D1 baseball each season.

Real Core Training: Offset Loading: I have to show some love for former CP intern Kyle Arsenault for having his first article published at T-Nation.  It came out great!

Interview with Me - I appeared on the "Smart Science of Slim" podcast.  You can check it out here on YouTube:

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Exercise of the Week: 1-arm Bottoms-Up Kettlebell Carry

I've talked quite a bit in the past about how much I like bottoms-up kettlebell exercises to get great "reflexive" firing of the rotator cuff and scapular stabilizers in a more unstable environment. I'm also a big fan of carrying variations - so it gets me pretty pumped up when I can combine the two!  With that in mind, today, I want to talk about the 1-arm Bottoms-up Kettlebell Carry.

This is an exercise that I really like to utilize with a lot of our baseball players early in the off-season, as it teaches them to relax the latissimus dorsi to allow proper scapular upward rotation to take place.  My two biggest cues are to "keep the biceps quiet" and "don't let the lower back arch."  If you do these two things, chances are that everything else will "click" just right.  Check out this video for a more detailed coaching tutorial:

I like to program 2-4 sets of 30-40yds on each arm. We'll often use this in place of a pressing exercise with our baseball guys, particularly in the early off-season when we're working to establish optimal scapular upward rotation after a long season.  Give it a shot for yourself and you'll find that it'll quickly be a great addition to your strength training programs, whether you're a throwing athlete or not!

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The Curious Case of the Yips: Both Psychological and Physical for Pitchers?

There may not be more perplexing phenomenon in the baseball world than a pitcher with a case of the yips.  For those of you who aren't "down with the lingo," this term refers to an extended period of time when a pitcher simply can't throw the ball where he wants to throw it.  And, the yips can certainly extend to position players, as there are countless instances of catchers mysteriously struggling to throw the ball back to the pitcher, and infielders who can't make clean throws to first base - in spite of years of doing these things successfully. Perhaps the two most noteworthy cases of the past few decades were Rick Ankiel and Chuck Knoblauch, who were both forced to change positions because they couldn't overcome the issue.

Clearly there is a heavy psychological component to this issue - and that's a big part of how the yips have historically been managed.  Whether it's visiting with sports psychologists or chatting with pitching coaches, the powers that be aim to modify the thoughts that go through the pitcher's head prior to throwing.  And, there's certainly nothing wrong with that approach, as it's clearly part of the problem.  However, in today's article, I want to view the yips through a bit of a different paradigm.

One thing that nobody ever seems to mention is that the yips don't happen in high school players. Why?  It's because the frame of reference is different.  You see, high school kids don't throw enough strikes normally for us to even perceive when something is out of whack.  I've spoken with a ton of professional pitchers and they universally agree that they weren't able to repeat their mechanics consistently until they were in the 18-20 age range.  Until that point, their bodies were changing dramatically and they hadn't had sufficient throws under their belt to master the pattern and consistently repeat it.  Plus, they were pitching off different mounds each time out, and the quality of the mound can have a dramatic impact on one's delivery.  With these factors in mind, I think we can all agree that the yips are a problem confined to the college and professional ranks.  If a high school kid or pop star is missing wildly, we just chalk it up to poor skill or inexperience.

Drawing parallels in other sports proves to be difficult, though.  Among athletes who need to accurately project an object from a consistent release point, you just don't see the yips outside of baseball players.  Quarterbacks don't get it, and I've never seen a track and field thrower accidentally fire an implement into a terrified crowd.  Olympic archers and biathlon competitors don't miss targets by large margins, and I've never heard of a tennis player whose career ended from double faulting over and over again.  Certainly, if all these issues were purely psychological, we would have found cases of the yips across other sporting disciplines, right?  There simply have to be examples of other professional athletes' minds being so jumbled that tens of thousands of reps worth of motor control and precision would be seemingly wiped clean from the slate, right? 

Nope. It doesn't seem to work that way. So what is so unique about pitching, then? 

Stress and adaptation to that stress.

You see, throwing a baseball is the single fastest motion in all of sports - and that means serious stress on not just the arm, but also the rest of the body.  Additionally, the Major League Baseball season is among the longest in professional sports - lasting from mid-February to some point in October (depending on post-season play) - and eight months is plenty of time for things to go in the wrong direction as players may get more and more detrained.

Rotator cuff strength drops over the course of the season. Scapular upward rotation diminishes.  Tissue quality gets "gunkier" with each throwing session. Some players lose hip, shoulder, and elbow range of motion. Others acquire more ligamentous laxity and become increasingly unstable. Body weight may drop, and lower body strength and core stability fall off.  And when these issues collectively build, elbows, shoulders, lower backs, and any of a number of other areas may even become symptomatic. 

To be clear, what I'm saying is that guys don't magically forget how to throw strikes after tens of thousands of reps.  Rather, their bodies often let them down and don't enable them to physically get to the positions needed to repeat the mechanics to which they've grown accustomed.  They're like the teenagers who are growing into their bodies all over again.

If you need further proof, check out this great study from Kibler et al. Researchers noted that in the tennis serve, a 20% decrease in kinetic energy from the hip and trunk means the shoulder must generate 34% more velocity to get same force to the racket. It's safe to assume that the stress of pitching in this context is even higher because arm speed must be greater.  If you're 10-15 pounds lighter and have lost a bunch of your lower body strength, how can we know if your issues are purely psychological and not physical? In attempting to maintain velocity and compete, you have to compensate in any of a number of ways - and that's how physical problems quickly become mechanical and psychological ones.

As another example, it's not uncommon to see pitchers get hurt when they've been quickly transitioned from relieving to starting roles without adequate time to build up their pitch counts.  And, I wouldn't be surprised if the incidence of the yips is much higher among those who don't get hurt.  When you throw fatigue in the mix, altered mechanics (whether they appreciate it or not) are the only way guys can continue to try to compete.  This is one reason why it's so important to bring guys along slowly and methodically with this transition.

When we see a guy who is struggling with his command or velocity, the first thing we ask is, "Is he hurt?"  Yet, when he responds "No," nobody ever asks if he feels fatigued or weak.  So, maybe it's a paradigm that needs to shift?  I can remember chatting with a major league pitcher a while back roughly 2/3 of the way through his season.  He told me he'd had outings when he had absolutely no idea where the ball was going, and had actually developed a new pitch by accident because his mechanics were so off. Not surprisingly, the evaluation I then performed revealed a lot of things he needed to address physically - and he was clearly fatigued.  Nobody had even touched them, though, because his velocity, command, and numbers were good. This is like refusing to change the oil and tires on your car proactively because it seems to be running fine. Maybe the yips are just the equivalent of breaking down on the side of the road after ignoring those routine service appointments?

With all these factors in mind, I think it's safe to say that there is a definite role for physical shortcomings and both acute and chronic fatigue in the development of the yips.  It just may not be easily "diagnosed" because a) symptoms may be absent and b) many athletes aren't assessed appropriately when they're doing well, so there isn't a standard against which to compare.

Here is where I think so many players have struggled to overcome the problem.  They think that throwing more to "re-master" their mechanics is the way to fix the problem.  In throwing more, two things happen:

1. If each throw isn't right on the money mechanically, they're simply re-engraining those problems.

2. With each passing throw, they're imposing more fatigue - especially when those throws are off the mound (and if you want to re-master your mechanics, you want this level of true specificity).

Conversely, my first suggestion to athletes with the yips is always to simply take the ball out of their hands for 7-10 days.  I think it's important not only because it's a chance to acutely avoid reaffirming bad habits, but more because it's a chance to temporarily remove fatigue so that one can build up strength and stability in the right places, improve tissue quality, and normalize body weight. When that happens, "muscle memory" can kick in. 

Imagine driving your car after someone has adjusted all the mirrors, moved the seat up, lowered the steering wheel, messed with the alignment, and changed all the pre-set radio stations. It feels brutally awkward in spite of the fact that it's the same car you've had for years, and you might even be a danger on the road.  This is what pitchers often feel and look like at the end of a long season if they haven't been managed correctly on the physical side.  If you fix all these issues with the car, it goes back to feeling normal; you don't just forget all those years of safe and "natural" driving.  You wouldn't just call your driver's education instructor for a pep talk and then hop back into the funky new version of your car, would you?  The only differences are that you can easily recognize everything that's out of whack with a car, and a quick tune-up at the mechanic only takes a few minutes. Conversely, it's hard to self-assess physically, very few people truly understand how pitchers should move, and physical adaptation takes time.

This isn't a knock on sports psychologists or pitching coaches, as they are absolutely, positively a huge part of the process with getting a pitcher with the yips back on track.  However, it'd be extremely ignorant to overlook the pronounced physical adaptations and detraining that often take place with pitchers - and how this might interfere with one's ability to repeat mechanics that until that point had become second nature.

Wrap-up

A lot of you will read this article and think that it doesn't apply to you.  And, while you may not have experienced the yips yourself or in one of the players you coach, my hope is that this article effectively served as a call for you to establish baseline evaluations of movement quality.  If there isn't a thorough preliminary assessment against which to compare when things go south, you're really just guessing about how much is physical, psychological, and mechanical. If you're not assessing, you're assuming - and if assuming worked, this wouldn't be a problem that had shaved years off a lot of careers.

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Strength and Conditioning Stuff You Should Read: 8/31/13

It's a bit belated in light of my traveling schedule, but here's this week's list of recommended strength and conditioning reading:

Research Review: Older and Inflamed? Try Exercise - This was a thorough, yet understandable review of some recent research on inflammation as it relates to exercise, courtesy of the good folks at Precision Nutrition.

Training Speed to Get Strong - I wrote this article for T-Nation just over two years ago, and the information is still very on-point and important for intermediate to advanced lifters to understand.  I just didn't want it to slip into internet obscurity, so I'm bumping it up here.

Giving up the PED Guessing Game - This was one of the absolute best perspectives on the performance enhancing drugs debate, as it was written by Gabe Kapler, a former player who has been very outspoken in discussing why he decided to stay clean throughout his career. I think it's a particular good perspective because Kapler also managed in the minor leagues and mentored a lot of younger players - and because he was a heavy fitness and nutrition enthusiast himself.

I hope everyone has a great holiday weekend!

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Strength and Conditioning Stuff You Should Read: 8/19/13

Here's this week's list of recommended strength and conditioning reading.  We've got more of a baseball focus this week.

Teres Major: An Important Muscle that is Often Overlooked in Throwers - Here's an awesome post from Mike Reinold with both an anatomical and functional basis.

Our Turn to Learn: A Baseball Tradition Reconsidered - I'm quickly becoming a big fan of Gabe Kapler's guest blogs on WEEI.com.  In this piece, he talks about how American baseball could steal some great lessons from the Japanese approach to batting practice.

7 Ways to Stand Out at a Camp - This was a good piece in New England Baseball Journal about how kids can stand out at college baseball camps. I think the body language point is the best one.

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Mobility Exercise of the Week: Supine Alternating Shoulder Flexion on Doubled Tennis Ball

In this installment of "Exercise of the Week," I've got a great drill you can use to improve upper extremity mobility.  I originally learned this from Sue Falsone of the LA Dodgers a few years ago. 

We've found this to be super helpful not only with folks who have poor thoracic spine mobility, but also those who have limited shoulder flexion and scapular upward rotation.  There's a bit of research and anecdotal evidence out there to support the idea that improving thoracic mobility in turn improves scapular upward rotation and glenohumeral (ball and socket) range of motion.  Basically, by reducing bad stiffness in one area, it makes it easier to establish good stiffness elsewhere - and that provides for better overall mobility.  So, reduced thoracic stiffness = better scapular upward rotation = better ball-and-socket congruency = better arm range of motion.

Internal rotation, in particular, seems to improve the quickest - and that's one reason why we'll always work proximal - positioning breathing, thoracic mobility, scapular control, and soft tissue work - before we ever stretch a throwing shoulder.  The glenohumeral joint is somewhat of a delicate one, so you never want to crank on it - especially if you haven't exhausted more conservative options.  This fits that bill.

Additionally, some folks with a more adducted scapula positioning will benefit quite a bit from this drill, as it essentially works out to self myofascial release on overactive rhomboids.  Get them to relax, and the shoulder blade will move better on the rib cage.

scapularadduction

All you need is a doubled tennis ball and some masking or duct tape.  Tape two balls together, and then go follow the instructions below.

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