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Baseball and Strength

Free Teleseminar Series at SportsRehabExpert.com I just wanted to give you all a heads-up on a great audio series - Sports Rehab to Sports Performance - that Joe Heiler has pulled together.  I'll was interviewed on Friday, and Joe's also chatted will Mike Boyle, Gray Cook, Kyle Kiesel, Stuart McGill, Phil Plisky, Brett Jones, and Charlie Weingroff.   The entire interview series is COMPLETELY FREE and begins airing later tomorrow night.  You can get more information HERE. Also, don't forget that the third annual Mike Boyle Strength & Conditioning Winter Seminar is fast approaching.  For more information, click here. Snowy Sunday Sentiments Yesterday, in an email exchange I was having with some guys who are really "in the know" in the world of baseball pitching, one of them commented that pitchers need to start thinking more along the lines of training like Troy Polamalu of the Pittsburgh Steelers.  In other words, less external loading, more pure-body weight drills, and a big focus on reactive ability (plyometrics drills, for the lay population). I'll be the first to recognize Polamalu's accomplishments on the field - including an interception return for a touchdown yesterday.  And, I admit that I don't know much about his training philosophy aside from what I have seen in 3-4 minute YouTube and NFL clips.  So, I guess you could say that my point of contention is with what some folks take from viewing these clips, as was the case with this email exchange.  So, I'll be very clear that I'm not criticizing the Sportslab philosophy; I'd love to buy these guys lunch and pick their brains, in fact. However, I've got two cents to add - or maybe even three our four cents, depending on how poorly the American dollar is doing nowadays.  I'm writing this on a snowy day in Massachusetts and I've got a little bit of extra time on my hands (a rarity during the baseball off-season for me). I think that it is wrong to assume that weight training is unnecessary and plyometrics are sufficient for injury prevention and performance enhancement in pitchers.  This is a common belief held among a large body of pitching coaches that I feel really needs to be addressed. The fundamental problem I see is that a system that relies extensively on training elastic qualities.  Or, in the terminology I like to use, it teaches an athlete to be more "spring," making better use of elastic energy from the tendons.  This works best in an athlete who is largely static, or has a solid base of muscular strength. Who would be a static athlete?  Well, one example would be an athlete who gained a lot of strength in the previous four years...say, Troy Polamalu.  He was a first-round draft pick out of USC, known for a good program under strength and conditioning coach Chris Carlisle.  They've packed lots of muscle and strength on loads of high school guys over the years, no doubt.  Polamalu may not realize it, but those four years of USC training probably set him up for the positive results he's seeing in this program - especially when you compare him to a good chunk of the NFL that now uses machine-based HIT training because they're afraid of weight-room injuries. Basically, for the most part, only the freaky athletes make it to the "big dance" in football, so the S&C coach is responsibly for not hurting them.   It's not much different in the world of baseball - but we're dealing with a MORE TRAINED population in the first place. I'm sure that many of you have read Moneyball (and if you haven't, you should).  One thing that they touch on over and over again is that high school draft picks don't pan out as well as college draft picks.

moneyball

Sure, it has to do with facing better hitters and maturing another four years psychologically.  However, one factor that nobody ever touches on is that these college draft picks have another four years of strength and conditioning under their belt in most cases.  It may not be baseball-specific in many cases, but I would definitely argue that it's better than nothing.  Strength goes a long way, but physiologically and psychologically. And, that's what I want you to think about until my next newsletter comes out - when I'll get a bit more to the science of all this, and how it's been demonstrated in professional baseball. New Blog Content Random Friday Thoughts How to Make an Exercise Tougher Another CP Intern on the Road to Diesel Frozen Ankles, Ugly Squatting Until next time, train hard and have fun. 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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Push-ups for Baseball Players

Q: I attended the baseball strength training clinic you gave in Long Island.  I have a question for you about push-ups for pitchers.  I am using push-ups with all player, and one of the parents has been concerned that push-ups are not good for pitchers.  I was wondering if you could help me explain why push-ups are good for pitchers. A: No problem.  The two big "players" in scapular dysfunction are lower trapezius and serratus anterior.  These muscles work in conjunction with the upper trapezius to upwardly rotate the scapula, which allows for safe overhead movements.  Research has shown that baseball pitchers have less scapular upward rotation compared with position players and non-athletes - so it's definitely an adaptive change that we need to work to address. Push-ups (when done correctly) can be useful for activating the serratus anterior, and as a closed-chain exercise, it has proprioceptive benefits at the shoulder girdle.  Plus, you get a considerable effect in terms of core stability training, as you're resisting the effects of gravity in the "plank" position where the lumbar spine wants to slip into extension. That said, if you're dealing with high school athletes, I'll warn you that over 90% of them (in my experience) need to be coached on how to do a push-up correctly.  It isn't as simple as "just do this," as most of them will resort to incorrect technique.  With a good pushup, the upper arms should be tucked to a 45-degree angle to the torso, and the athlete should actively "pull" himself down to the bottom position with the scapular retractors.  The hips shouldn't sag, and there shouldn't be a forward head posture.  Essentially, the chest - not the chin or hips - should get to the ground first.

For more information, check out Optimal Shoulder Performance.

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Strength Training for Pitchers

Strength Training for Pitchers

by: Eric Cressey

Recently, I received an email inquiry about the value of strength training for pitchers. The individual emailing me had come across the following quote from a pitching "authority:"

"Training will not teach you how to apply more force...only mechanics can do that. And pitching is not about applying more effort into a pitch but is about producing more skilled movements from better timing of all the parts. That will help produce more force.

"No matter how hard you try, you will not get that from your strength training program...no matter who designed it, how much they have promised you it would or your hope that it will be the secret for you."

To say that this surprised me would be an understatement. I'll start with the positive: I agree with him that pitching is all about producing skilled movements secondary to appropriate timing of all the involved "parts." I've very lucky to work hand-in-hand with some skilled pitching coaches who really know their stuff - and trust in me to do my job to complement the coaching they provide.

With that said, however, I disagree that you can't gain (or lose) velocity based exclusively on your strength and conditioning program. On countless occasions, I've seen guys gain velocity without making any changes to their throwing programs or mechanics. I know what many of the devil's advocates in the crowd are thinking: "you're just making that up!" So, if my word isn't enough, how about we just go to the research?

From: Derenne C, Ho KW, Murphy JC. Effects of general, special, and specific resistance training on throwing velocity in baseball: a brief review. J Strength Cond Res. 2001 Feb;15(1):148-56.

[Note from EC: Yes, it's pathetic that this REVIEW has been out almost seven years and people who are supposedly "in the know" still haven't come across ANY of the studies to which it alludes.]

Practical Applications

Throwing velocity can be increased by resistance training. A rationale for general, special, and specific resistance training to increase throwing velocity has been presented. The following findings and recommendations relevant to strength and conditioning specialists and pitching coaches can be useful from the review of literature.

In the "further reading" section at the end of this article, I have listed ten different studies that each demonstrated a positive effect of weight training on throwing velocity. The authors in the review above also have a table that summarizes 26 studies that examined the effect of different strength protocols on throwing velocity, and 22 of the 26 showed increases over controls who just threw. In other words, throwing and strength training is better than throwing alone for improving velocity -

independent of optimization of mechanics from outside coaching.

The saddest part is that the training programs referenced in this review were nothing short of foo-foo garbage. We're talking 3x10-12 light dumbbell drills and mind-numbing, rubber tubing blasphemy. If archaic stuff works, just imagine what happens when pitchers actually train the right way - and have pitching coaches to help them out?

Oh yeah, 10 mph gains in six months happen - and D1 college coaches and pro scouts start salivating over kids who are barely old enough to drive.

With that rant aside, I'd like to embark on another one: what about the indirect gains associated with strength training? Namely, what about the fact that it keeps guys healthy?

We know that:

a) Pitchers (compared to position players) have less scapular upward rotation at 60 and 90 degrees of abduction -and upward rotation is extremely important for safe overhead activity.

b) 86% of major league pitchers have supraspinatus partial thickness tears.

c) All pitchers have some degree of labral fraying - and the labrum provides approximately 50% of the stability in the glenohumeral joint

d) There is considerable research to suggest that congenital shoulder instability is one of the traits that makes some pitchers better than others (allows for more external rotation during the cocking phase to generate velocity).

e) Most pitchers lack internal rotation range-of-motion due to posterior rotator cuff (and possibly capsular) tightness and morphological changes to bone (retroversion). Subscapularis strength is incredibly important to prevent anterior shoulder instability in this scenario.

We also know that resistance training is the basis for modern physical therapy - which I'm pretty sure is aimed at restoring inappropriate movement patterns which can cause these structural/functional defects/abnormalities from reaching threshold and becoming symptomatic. Do you think that a good resistance training program could strengthen lower traps and serratus anterior to help alleviate this upward rotation problem? Could a solid subscapularis strengthening protocol help with preventing anterior instability? Could a strong rotator cuff and scapular stabilizers allow an individual to work around a torn supraspinatus?

And, last time I checked, strength and conditioning was about more than just being the "weights coach." We do a lot of flexibility/mobility and soft tissue work - and it just so happens that such work does wonders on pec minor, levator scapulae, rhomboids, infraspinatus/teres minor, and a host of other muscles in pitchers.

I also like to tell jokes, do magic tricks, and make shadow puppets on the wall. Am I to assume that these don't play a remarkable role in my athletes' success? I beg to differ. Sure, banging out a set of 20 chin-ups because one of my athletes called me out might make me look like a stupid monkey when my elbows refuse to extend for the subsequent ten minutes, but I still think what we do plays a very important role in our athletes success; otherwise, they wouldn't keep coming back. And, for the record, my shadow puppets are great for building camaraderie and bolstering spirits among the Cressey Performance troops - even if I'm just a "weights coach" or whatever.

This only encompasses a few of the seemingly countless examples I can come up with at a moment's notice. Pitchers are an at-risk population; your number one job in working with a pitcher is to keep him healthy. And, I'm going to go out on a limb and say that a guy who is healthy and super-confident over his monster legs and butt is going to throw a lot harder than a guy who is in pain and as skinny as an Olsen twin because his stubborn pitching coach said strength training doesn't work. You've got to train ass to throw gas!

Last fall, I started working with a pro ball player whose velocity was down from 94 to 88 thanks to a long season - but also because he'd had lower back issues that have prevented him from training. In other words, he counts on strength training to keep his velocity up. And, sure enough, it was a big component of getting him healthy prior to this season.

Putting it into Practice

I suspect that some of the reluctance to recognize strength training as important to pitchers is the notion that it will make pitchers too bulky and ruin pitching-specific flexibility. Likewise, there are a lot of meatheads out there who think that baseball guys can train just like other athletes. While there are a lot of similarities, it's really important to make some specific upper body modifications for the overhead throwing athlete. Contraindicated exercises in our baseball programs include:

  • Overhead lifting (not chin-ups, though)
  • Straight-bar benching
  • Upright rows
  • Front/Side raises (especially empty can - why anyone would do a provocative test as a training measure is beyond me)
  • Olympic lifts aside from high pulls
  • Back squats

The next question, obviously, is "what do you do instead?" Here's a small list:

  • Push-up variations: chain, band-resisted, blast strap
  • Multi-purpose bar benching (neutral grip benching bar)
  • DB bench pressing variations
  • Every row and chin-up you can imagine (excluding upright rows)
  • Loads of thick handle/grip training
  • Medicine ball throws
  • Specialty squat bars: giant cambered bar, safety squat bar
  • Front Squats
  • Deadlift variations

The Take-Home Message

There is nothing fundamentally wrong with strength training program for pitchers. In reality, what is wrong is the assumption that all strength training programs are useless because some are poorly designed and not suited to athletes' needs and limitations. Be leery of people who say strength training isn't important. Everyone - from endurance athletes, to grandmothers, to pitchers - needs it!

Further Reading

1. Bagonzi, J.A. The effects of graded weighted baseballs, free weight training, and simulative isometric exercise on the velocity of a thrown baseball. Master's thesis, Indiana University. 1978.

2. Brose, D.E., and D.L. Hanson. Effects of overload training on velocity and accuracy of throwing. Res. Q. 38:528-533. 1967.

3. Jackson, J.B. The effects of weight training on the velocity of a thrown baseball. Master's thesis, Central Michigan University,. 1994.

4. Lachowetz, T., J. Evon, and J. Pastiglione. The effects of an upper-body strength program on intercollegiate baseball throwing velocity. J. Strength Cond. Res. 12:116-119. 1998.

5. Logan, G.A., W.C. McKinney, and W. Rowe. Effect of resistance through a throwing range of motion on the velocity of a baseball. Percept. Motor Skills. 25:55-58. 1966.

6. Newton, R.U., and K.P. McEvoy. Baseball throwing velocity: A comparison of medicine ball training and weight training. J. Strength Cond. Res. 8:198-203. 1994.

7. Potteiger, J.A., H.N. Williford, D.L. Blessing, and J. Smidt. Effect of two training methods on improving baseball performance variables. J. Appl. Sport Sci. Res. 6:2-6. 1992.

8. Sullivan, J.W. The effects of three experimental training factors upon baseball throwing velocity and selected strength measures. Doctoral dissertation, Indiana University,. 1970.

9. Swangard, T.M. The effect of isotonic weight training programs on the development of bat swinging, throwing, and running ability of college baseball players. Master's thesis, University of Oregon,. 1965.

10. Thompson, C.W., and E.T. Martin. Weight training and baseball throwing speed. J. Assoc. Phys. Mental Rehabil. 19:194-196. 1965.

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A New Model for Training Between Starts: Part 2

A New Model for Training Between Starts: Part 2

By: Eric Cressey

In Part 1 of this article series, I discussed everything that was wrong with distance running for pitchers.  In Part 2, I'll outline my thoughts on how to best integrate conditioning for pitchers between throwing sessions.  This article will focus on managing starters, but I suspect you'll find that managing relievers isn't entirely different aside from the fact that you'll need to "roll with the punches" a bit more. I think the best way to introduce this article is to describe a coincidence from the beginning of the year.    On January 5, I received an email from one of my pro pitchers asking me if I could outline some thoughts on my between-start strength and conditioning mentality, as his old college pitching coach had asked for his input from him, as he was a student of the game and had tried some non-traditional ideas. In response to that email, I replied with essentially everything I'll describe in this article - plus everything I outlined in Part 1 with respect to how bad a choice distance running is. The coincidence didn't become apparent until a week or two later when I got my hands on the January installment of the Journal of Strength and Conditioning Research, which featured a study entitled "Noncompatibility of power and endurance training among college baseball players." These researchers divided a collegiate pitching staff into two groups of eight over the course of a season, and each group did everything identically - except the running portion of their training programs.  Three days per week, the "sprint" group did 10-30 sprints of 15-60m with 10-60s rest between bouts.  The endurance group performed moderate-to-high intensity jogging or cycling 3-4 days per week for anywhere from 20-60 minutes. Over the course of the season, the endurance group's peak power output dropped by an average of 39.5 watts while the sprinting group increased by an average of 210.6 watts (1).  So, basically what I'm saying is that I was right all along - and I'm totally going to brag about it.  Part 1 of this series simply justified all of my thoughts; now it's time to put them into a framework. Some Prerequisite Q&A As a response to Part 1, I got an email from a college pitching coach looking for some further details, and here were his questions (bold) and my answers: Q: Is running 1-2 miles once a week considered distance running? A: I'd call anything over 150m "distance running" in a pitching population, believe it or not.  I haven't had a baseball player run over 60 yards in two years - and even when they go 60, they're build-ups, so only about 50% of that distance is at or near top speed. Q: Is running 10 poles in 30s with one minute of rest considered distance? A: Let's say it takes 30s to run a pole, and then you rest a minute (1:2 work: rest ratio).  Then, you go out and pitch, where you exert effort for one second and rest 20s (1:20 work:rest ratio).  This is the equivalent of a 100m sprinter training like a 1500m runner. Q: Don't you need some endurance to pitch a complete 9-inning game? A: If all endurance was created equal, why didn't Lance Armstrong win the New York or Boston Marathon?  Endurance is very skill specific.  Additionally, there is a huge difference between exerting maximal power over 20-25 individual efforts with near complete rest (a sample inning) and exerting submaximal efforts repeatedly with no or minimal rest. Q: What about guys who are overweight?  What should they do? A: Fat guys should be paperweights, bouncers, sumo wrestlers, or eating contest champions.  If they want to be successful players at the D1 level or beyond, they'll sack up and stop eating crap.  Several years ago, I promised myself that I would never, ever try to use extra conditioning to make up for poor diet. Q: What are your thoughts on interval training? A: We know that interval training is superior to steady state cardio for fat loss, but the important consideration is that it must be specific to the sport in question. These responses should set the stage for the following points: 1. The secret is to keep any longer duration stuff low-intensity (under 70% HRR) and everything else at or above 90% of max effort (this includes starts, agilities, and sprints up to 60yds).  For more background on this, check out the McCarthy et al. study I outlined in Part 1. 2. Ideally, the low-intensity work would involve significant joint ranges-of-motion (more to come on this below). 3. Don't forget that pitchers rarely run more than 15 yards in a game situation. 4. Strength training and mobility training far outweigh running on the importance scale. 5.  If you need to develop pitching specific stamina, the best way to achieve that end is to simply pitch and build pitch counts progressively.  If that needs to be supplemented with something to expedite the process a bit, you can add in some medicine ball medleys - which can also be useful for ironing out side-to-side imbalances, if implemented appropriately.  However, a good off-season throwing program and appropriate management of a pitcher early in the season should develop all the pitching specific endurance that is required. The 5-Day Rotation In a case of a five-day rotation, here is how we typically structure things.  Keep in mind that dynamic flexibility and static stretching are performed every day. Day 0: pitch Day 1 (or right after pitching, if possible): challenging lower body lift, push-up variation (light), horizontal pulling (light), cuff work Day 2: movement training only, focused on 10-15yd starts, agility work, and some top speed work (50-60 yds) Day 3: bullpen (usually), single-leg work, challenging upper body lift (less vertical pulling in-season), cuff work Day 4: low-intensity dynamic flexibility circuits only Day 5: next pitching outing Notes: 1. When a guy happens to get five days between starts, we'll typically split the Day 3 lifting session into two sessions and do some movement training on Day 4 as well. 2. I know a lot of guys (myself included) are advocates of throwing more than once between starts.  For simplicity's sake, I haven't included those sessions. 3.  There are definitely exceptions to this rule.  For instance, if a guy is having a hard time recovering, we'll take Day 2 off altogether and just do our sprint work after the bullpen and before lifting on Day 3.  That adds a full day of rest to the rotation in addition to the really light Day 4. The 7-Day Rotation With a 7-day rotation, we've got a lot more wiggle room to get aggressive with things.  This is why in-season can still be a time of tremendous improvements in the college game, especially since you can work in a good 2-3 throwing sessions between starts.  Again, dynamic flexibility and static stretching are performed every day.  To keep this simple, I'm going to assume we've got a Saturday starter. Saturday: pitch Sunday: challenging lower body lift, light cuff work Monday: movement training only, focused on 10-15yd starts, agility work, and some top speed work (50-60 yds); upper body lift Tuesday: low-Intensity resistance training (<30% of 1RM) circuits, extended dynamic flexibility circuits Wednesday: full-body lift Thursday: movement training only, focused on 10-15yd starts, agility work, and some top speed work (50-60 yds); Friday: low-intensity dynamic flexibility circuits only Saturday: pitch again Of course, traveling logistics can throw a wrench in the plans on this front sometimes, but the good news is that collegiate pitchers have six days to roll with the punches to get back on schedule. Closing Thoughts As you can see, I am a big fan of quality over quantity. Our guys only sprint twice in most weeks - and certainly not more than three times.  This certainly isn't the only way to approach training between starts, but I've found it to be the most effective of what our guys have tried. References 1. Rhea MR, Oliverson JR, Marshall G, Peterson MD, Kenn JG, Ayllón FN. Noncompatibility of power and endurance training among college baseball players. J Strength Cond Res 2008 Jan;22(1):230-4. 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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Maximum Strength for Baseball

As a guy who trains a ton of baseball players - and is a competitive powerlifter (and weight-training author), I get a ton of questions from both baseball coaches/players and folks looking to get stronger (and healthier, for that matter).  And, to take it a step further, since the release of Maximum Strength, I've gotten a lot of questions about whether or not Maximum Strength is appropriate for baseball players. My response is "yes" - but only  with some important modifications: 1. Substitution of dumbbell bench pressing in place of barbell bench pressing (rep count will have to come up a bit higher, as you aren't going to be doing heavy dumbbell bench pressing singles) 2. Substitution of clap push-ups in place of speed benching 3. Substitution of front squats in place of back squats 4. Substitution of alternating low incline dumbbell press in place of 1-arm dumbbell push press 5. Really emphasize the sleeper stretch, wall triceps stretch, and elbow flexors stretches - particularly after you throw.

goodsleeper3 wall-triceps-stretch

wrist-flexors-stretch

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A Great Weekend in Houston

As I mentioned last week, this past weekend was Ron Wolforth's Ultimate Pitching Coaches Bootcamp just outside of Houston, TX.  To say that it was an awesome experience would be an understatement.  I considered myself really lucky to be presenting alongside the likes of Brent Strom (St. Louis Cardinals), Phil Donley (Philadelphia Phillies consultant who has rehabbed loads of million-dollar arms), Perry Husband (Downright Filthy Pitching), and Ron himself.  These guys are not only getting important information out there for coaches, but also getting their hands dirty in the trenches to take athletes and coaches to the next level with new information.

Just as great as the presenters were the 100+ attendees.  In addition to many enthusiastic high school and private sector coaches and a few physical therapists, you had pitching coaches and/or baseball strength coaches from big-time colleges like Vanderbilt, South Carolina, Auburn, Kennesaw St., Savannah College of Art and Design, Michigan, Virginia Tech, Columbia, and Trinity.  These guys immediately earned a ton of respect in my book for thinking outside the box, and it makes me want to encourage a lot of my stud athletes their way post-high school because I know that they're going to get coaches who are always looking for ways to help them succeed. The title of my presentation was "Building the Complete and Superior Pitching Athlete."  In my introduction to the coaches, I tried to make it very clear that my goal wasn't to try to teach them everything there was to know about S&C for baseball players, but rather to give them the knowledge (and resources, in the form of my handouts) to become informed consumers in dealing with the folks who carry out their players' programs.  I wanted them to know that you CAN give a pitcher a tremendous training effect without injuries to the throwing arm or interfering with velocity by losing pitching-specific mobility. I think that the secret to appreciating what it takes is understanding that baseball strength and conditioning is not just about lifting and running.  Sure, these are components of the overall process, but if you only address these two components, you DO run the risk of impairing a pitcher's development.  Sure, you've got to pay attention to these issues, but you also have to strategically address flexibility and mobility (yes, they are different), optimize soft tissue quality, and appreciate that you can use medicine ball work to maintain pitching-specific mobility during down-periods from throwing without all the stresses that come with throwing itself.

I also tried to get folks to think about what they already are doing with respect to distance running, "core" training, upper and lower body lifting, assessments, warm-ups (check out the Monster Mobility Pack for ideas), and post-throwing flexibility work.  I discussed the difference between inefficiency and pathology and how your can have a terrible-looking MRI and/or x-ray and still be pain free.

You can still get all the information from the event by purchasing the DVDs of the entire weekend.  I'd highly recommend them, as they include some great pitching analysis and recommendations from Brent Strom, awesome information on glenohumeral internal rotation deficit (GIRD) by Phil Donley, intriguing thoughts on "effective velocity" from Perry Husband, and excellent ideas on "blending" by Ron Wolforth.  Just head over to Pitching Central's UPCBC page and pick up a copy now.

upcbc-08-pic

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Training the Baseball Catcher

Q: I'm a personal trainer who just started training a couple of baseball catchers.  I understand that your facility specializes in training baseball players.  I just want to know if you guys have any tips, or recommend any resources to find out common structural issues that occur with this position.  Perhaps what you guys have found through training catchers?  What lifts they should avoid, more specifically? I have begun doing a ton of research and just wanted some ideas from you guys to help me out.  Any information would be greatly appreciated. A: Well, first, there are certain things that none of my baseball guys do: -Overhead lifting (excluding pull-up/chin-up variations) -Straight-bar benching -Upright rows -Front/Side Raises -Olympic Lifts (aside from the occasional high pull) -Back Squats (we use safety squat and giant cambered bars instead, plus front squats) I could go on and on with respect to the reasons for these exclusions, but for the sake of this blog, suffice it to say that it's for shoulder and elbow protection reasons.  Fortunately, I wrote about my rationale in an old newsletter. Catchers are obviously different than pitchers and position players in that they spend a lot of time squatting, so we have particular concerns at the knees and hips. Whether or not I squat my catchers is dependent on age, training experience, time of year, and - most importantly - injury history.  If a guy is older and more banged up, we aren't going to be squatting much, if at all.  However, if we're talking about a younger athlete who has a lot more to gain from squatting (particularly if he isn't specialized in baseball yet), I definitely think there is a role for it. That said, regardless of age and injury history, I don't squat my catchers deep in-season.  We'll do some hip-dominant squatting (paused or light tap and go) to a box set at right about parallel, but for the most part, it's deadlift variations.  We get our range-of-motion in the lower body with these guys with single-leg work. As for structural issues, always check everything at the hip and ankle, as you should with any baseball player; it isn't just about shoulders and elbows (although you will want to screen those, too, obviously).  Believe it or not, a lot of the pitching flexibility deficits about which I've written also hold true in catchers. Additionally, I've found that a lot of catchers tend to lean to one side (adduct one femur), and over time, it can lead to some noteworthy imbalances in hip rotation range-of-motion.  You'll also see a lot of catchers who lack thoracic spine range-of-motion because they spend so much time slumped over (not necessarily ideal catching posture, but it does happen when you're stuck down there for nine innings). 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 Truth About Shoulder Impingement: Part 2

In Part I, I went into some detail on why I really didn’t like the catch-all term “shoulder impingement.” This week, I’m going to talk about the different kinds of shoulder impingement: external and internal.

External impingement, also known as outlet impingement, is the one we hear about the most. Here, we’re dealing with compression of the rotator cuff – usually the supraspinatus, and over time, the infraspinatus (and biceps tendon) – by the undersurface of the acromion. This impingement can lead to bursal-sided rotator cuff tears - and happens a lot more with ordinary weekend warriors and very common in lifters (not to mention much more prevalent in older populations.

External impingement can be further subdivided into primary and secondary classifications. In primary impingement, the cause is related to the acromion – either due to bone spurring or congenital shape. As you can see in the photo below, hook (II) and beak (III) are worst than flat (I), as there are marked difference in “clearance” under the acromion.

Secondary impingement, on the other hand, is usually related to poor scapular stability (related to both tightness and weakness, as described in last week’s newsletter), which alters the position of the scapula. In both cases, pain is at the front and/or side of the shoulder and is irritated with overhead activity, scapular protraction, and several other activities (depending on the severity of the tissue problems). You’ll also generally see a lack of external rotation range-of-motion, as these are folks who do too much bench pressing and computer work (both of which shorten the internal rotators).

Conversely, internal impingement, also known as posterosuperior impingement, really wasn’t proposed until the early 1990s. This form of impingement is more common in younger individuals who are involved in overhead sports, making it more of an “athletic impingement.” Adaptive shortening and scarring of the posterior rotator cuff in these athletes causes a loss of internal rotation and an upward translation of the humeral head during the late cocking phase of throwing (or swimming): external rotation and abduction.  These issues are magnified by poor scapular control, insufficient thoracic rotation, and weakness of the rotator cuff.

When the humeral head translates superiorly excessively in this position, it impinges on the posterior labrum and glenoid (socket), irritating the rotator cuff and biceps tendon along the way. So, pain usually starts in the back of the shoulder, as you are seeing irritation of the posterior fibers of the supraspinatus and anterior fibers of the infraspinatus tendons. Gradually, this pain may “shift” toward the front as the biceps tendon, and that implies labral involvement.  At least initially, the pain is purely mechanical in nature; it won't bother an athlete unless the "apprehension" position (full external rotation at 90 degrees of abduction) is created.

We often hear about SLAP lesions in the news. This refers to a superior labrum, anterior-posterior injury. In reality, when we are talking about labral injuries in overhead athletes as they relate to internal impingement, it’s mostly just posterior (although serious cases can eventually affect the anterior labrum, too). There are different kinds of SLAP lesions (1-4). Every baseball pitcher you’ll meet has a SLAP 1, which is just fraying. SLAP 2 lesions are far more serious and often require surgical intervention. SLAP 1 issues become SLAP 2 lesions when poor mobility and dynamic stability aren't established.

So, just to bring you up to speed, we’ve got two different kinds of impingement, one of which (external) has two subcategories that mandate different treatment strategies (primary = surgery, secondary = corrective exercise). We also have two separate areas where pain presents (external = front/side, internal = back). That’s just the tip of the iceberg, though, as we have two more considerations…

First, symptomatic internal impingement tends to be "mechanical pain." Unless you’re dealing with a more advanced case, athletes with symptomatic internal impingement only have pain when they get into the late cocking phase (and sometimes follow-through). It usually isn’t present when they’re just sitting around – and for this reason, they can usually be more aggressive in the weight room with upper body training. Keep in mind that I use the term “symptomatic” because I think that internal impingement is a physiological norm, just like I observed last week with external impingement.  You're essentially just going to go out of your way to avoid this "apprehension" position in the weight room by omitting exercises like back squats.  An apprehension test - illustrated in the most enthusiastic video in internet history - is a quick and easy assessment many doctors and rehabilitation specialists use to check for symptomatic internal impingement, as it reproduces the injury mechanism.

Second, and perhaps more importantly, you are dealing with two rotator cuff tears that are fundamentally different. It’s these differences that make me think doctors need to get rid of the term “impingement.” Here’s the scoop:

Let’s say that we have two guys with partial thickness tears of the supraspinatus – one from external impingement and one from internal impingement.

With external impingement, we’re usually dealing with a bursal-sided tear, as the rubbing comes from the top (acromion). These issues will generally heal more quickly because the bursa actually has a decent blood supply.

With internal impingement, on the other hand, we’ve got an articular-sided tear, meaning that the wear on the tendon comes from underneath (glenoid). The tear is more interstitial in nature. Blood supply isn’t quite as good in this area, so healing is slower (or non-existent).

Traditionally, articular has been an athletic injury, and bursal has been a general population issue. This is not always the case, though.

Factor in the activity demands of overhead throwers, and they have more challenging tears and greater functional demands. Fortunately, they also typically have age and tissue quality on their sides, so things tend to even out.

With all these factors in mind, if a doctor ever tells you that you have "shoulder impingement," ask:

1. Internal or external?

2. If external, is it primary or secondary? (It’ll probably be both)

3. If internal, is there labral involvement? Biceps tendon?

4. If internal, what is the internal rotation deficit? (They should measure it, as this will begin to dictate the rehabilitation plan)

5. Given my age, activity level, and the nature of the tear, do you feel that surgical or conservative treatment is best?

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Dr. William Brady: Integrated Diagnosis

This past weekend, I attended a great seminar here in Boston with Dr. William Brady.  In fact, it was among the best I've seen.  I was the only non-chiropractor/manual therapist in attendance, but walked away from the seminar with some tremendously valuable insights that'll help me with each and every one of my clients moving forward.

The first lesson of the day is that those of you who have an opportunity to see Dr. Brady speak should absolutely, positively check him out: Integrated Diagnosis.  Diagnostically, he's among the best I've ever seen - and that includes his ability to teach others.

The second lesson of the day revolves around an important concept Dr. Brady extended - and my take on how you can modify this message to accommodate your role as a coach, trainer, or fitness enthusiast/athlete.  There is a reason that almost any doctor or physical therapist gets results - and it resolves around understanding where symptom threshold occurs.  To illustrate this, let's examine a shoulder problem purely from a soft tissue perspective.

Dr. Brady talked about how you have building blocks to threshold.  Let's say that after an accurate physical examination, this particular shoulder problem (supraspinatus tendinosis, for example) presents with soft tissue restrictions at the infraspinatus, teres minor, subscapularis, inferior capsule, and pec minor.  So, symptom threshold (the dotted line) might look like this relative to baseline (straight line):

Pec Minor - - - - - - - - - - - Inferior Capsule Subscapularis Teres Minor Infraspinatus BASELINE - NO SYMPTOMS

So, imagine a therapist who just addresses pec minor.  He gets that patient below threshold, but doesn't necessarily "fix" him; he might be back in with the same problem weeks later.  This is confounded by the fact that "overuse" is actually one of the building blocks, too.  So, even if you leave all the soft tissue restrictions alone, simply resting will get someone below threshold - even if the therapist has done ZERO to address the underlying problems.

This is one reason why a MRI might not tell you much at all about someone's problem.  With this problem, the MRI would probably just say "supraspinatus tendinopathy" and recommend physical therapy and rest from painful activities.  So, in the "full picture" - where soft tissue work is one of several components (assume they are equal contributors, for the sake of our argument) - the building blocks to threshold might look something like this:

Overuse Rotator Cuff Weakness Scapular Stability Poor Glenohumeral (Ball-and-Socket) Range of Motion - - - - - - - - - - - - - - - - Soft Tissue Restrictions Poor Thoracic Spine Mobility Type 3 Acromion (non-modifiable, without surgery) Poor Exercise Technique Poor Cervical Spine Function Opposite Hip/Ankle Restrictions (baseball pitchers are great examples) Inappropriate Structural Balance in Programming (e.g., pressing more than pulling) Faulty Breathing Patterns BASELINE - NO SYMPTOMS

So, we've got 12 factors, and it's been my experience that conventional physical therapy only treats the first four - which would, in fact, bring a patient below symptom threshold.  Put that patient back in the real-world with the other eight factors still present (seven of which are modifiable), and as soon as he gets back to bench pressing with terrible technique Monday, Wednesday, and Friday, he's going to be back in for more physical therapy sooner than later.

So, what do we do in an ideal scenario (not always possible with today's insurance plans)?

1. More time with patient education (exercise technique, programming strategies - or just outsource it to a qualified professional or good book/article or DVD). 2. Address Thoracic Mobility (Assess and Correct is a great resource for this)

Layout 1

3. When present, address Hip and Ankle Mobility 4. Retrain some breathing patterns with initial instructions home exercises 5. Provide some take-home neck drills and get people out of chronic forward head posture

All told, I think this could be as simple as 4-5 extra drills in each shoulder rehab program plus a brief sit-down conversation with each patient on exercise program modifications; it really is that simple.  Unfortunately, it rarely happens - and that's when things become chronic.

So, fitness professionals and coaches need to step up as advocates for their clients and athletes, respectively, and fitness enthusiasts need to be relatively informed "consumers" to look out for themselves.

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The Truth About Shoulder Impingement: Part 1


Shoulder Impingement….Yes, We Get It.

Roughly 10-15 times per week, I get emails from folks who claim that they have "shoulder impingement.” Honestly, I roll my eyes the second I read these emails.

Don’t get me wrong: I’m not making light of their pain. It’s just that it drives me crazy when doctors throw this blanket statement out there. I will be completely and 100% clear with the following statement:

Shoulder impingement is a physiological norm. Everyone – regardless of age, activity level, sport of choice, acromion type, gender, you name it – has it.

Don’t reach up to touch that mouse on your computer; you’ll aggravate your impingement and your supraspinatus will explode!

And, don’t scratch that itch on the back of your neck; your impingement will go crazy and your labrum will disintegrate!

Don’t believe me? Check out research from Flatow et al. from 1994.

Yes, this has been out since 1994.

So, the next logical question is: why do some people have pain with impingement while others don’t?

In reality, there are several factors that dictate whether or not someone is in pain, including:

1. Tissue quality – the most “impinged” structures are more likely to break down in older age than they are in earlier years.  Younger individuals can regenerate faster even when overall stress on the tissues is held constant, so how you handle a 50-year-old with "impingement" is going to be somewhat different from how you handle a 15-year-old with "impingement."

2. Degree of elevation – the more one abducts or flexes the humerus, the greater the degree of impingement. This is why folks need to start in a more adducted (arm at side) position early on in rehab.  Those that impinge early in their arc tend to be dealing with subacromial impingement, whereas those who hit it at the absolute top tend to be more AC joint impingement.

painfularc-for-acj

3. Acromion type – flat acromions have significantly less contact area with the rotator cuff tendons than hooked or beaked acromions. These structures may change over time due to…

4. Bone Spurs – bone spurs on the underside of the acromion will increase the amount of impingement.

5. Strength of the rotator cuff – the stronger the cuff, the better its ability to depress the humeral head and minimize this impingement

6. Scapular stability – the more stable the scapula, the more likely it is to posteriorly tilt and upwardly rotate effectively when the humerus is raised into the zones of greater impingement. This scapular stability includes adequate length of the downward rotators (pec minor, levator scapulae, and rhomboids) with adequate strength of the upward rotators (lower traps, serratus anterior, upper traps).

7. Thoracic spine mobility – the posture of the thoracic spine dictates the position of the scapulae, which in turn affects impingement as noted in #6.  Assess and Correct is an awesome product for improving thoracic spine mobility - and you can also find some good drills in my recent post, Shoulder Hurts? Start Here.

8. Increased internal rotation – Certain movements that lock the humeral head in internal rotation increase the degree of impingement during dynamic activities. It’s why some people can’t bench press early-on in their rehabilitation programs, yet they can do dumbbell bench presses with a neutral grip pain-free. It’s also the reason why upright rows are a stupid exercise, in my opinion.

9. Breathing patterns – think about what happens when someone has poor diaphragmatic function and becomes a “chest breather:” the shoulders shrug up, and you get extra tightness in the levator scapulae, scalenes, pec minor, and sternocleidomastoid (among other supplemental respiratory muscles). In the process, the degree of impingement can increase.

10. Other issues further down the kinetic chain – I could go on and on about a variety of issues in this regard, but it’s impossible to be exhaustive – so I’ll just give an example. If someone has poor core stability in the sagittal plane that is manifested in an inability to resist the effects of gravity during a push-up, the hips will “sag” to the floor. As this happens, and the upper body remains strong, the scapulae are shifted into an anterior tilt –which increases the amount of impingement on the rotator cuff. So, weakness and/or immobility in other areas can certainly predispose an individual to shoulder problems.

This can also be carried forward to pitchers. We know that shoulder problems are more likely to occur in throwers who have poor lead leg hip internal rotation, as it causes the stride leg to open up early, leaving the arm “trailing behind” where it should be.

Speaking of pitchers, a phrase that has been coined with respect to the “unique” kind of impingement you see in them is “internal impingement.” In next week’s newsletter, I’ll discuss the different kinds of impingement – and why it’s still a cop-out diagnosis for any health care professional to just say you have one or the other rather than tell you explicitly what dysfunctions need to be addressed.

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