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Throwing Programs: Not One-Size-Fits-All

I received a few separate emails this week from folks wondering how I plan our guys' off-season throwing programs to include everything from long toss, to weighted baseballs, to mound work.

Most people expect to be handed a simple throwing program - as one might receive with an interval throwing program following rehabilitation.  The truth is that there isn't a single throwing program that I give to all our guys; rather, each is designed with the athlete's unique needs and circumstances taken into consideration.

With that in mind, I thought I'd outline some of the factors we consider when creating a throwing program for our professional baseball pitchers (many of these principles can also be applied to younger throwers):

1. Where they struggle on the mound (poor control, poor velocity, lack of athleticism, etc.)

2. Whether I want them using weighted balls in addition to long toss and bullpens or not

3. How many innings they threw the previous year (the more they throw, the later they start)

4. Whether they are going to big league or minor league spring training (we have minor league guys an additional 2-3 weeks)

5. How much "risk" we're willing to take with their throwing program (we'd be more aggressive with a 40th rounder than a big leaguer or first rounder; here is a detailed write-up on that front)

6. Whether they are a starter or reliever (relievers can start earlier because they've had fewer innings in the previous year)

7. What organization they are in (certain teams expect a LOT when guys show up, whereas others assume guys did very little throwing in the off-season and then hold them back when they arrive in spring training)

8. Whether guys play winter ball, Arizona Fall League, Team USA/Pan-American games, or go to instructionals

9. Whether they are big leaguers (season ends the last week in September, at the earliest) or minor leaguers (ends the first week in September)

10. What each guy tells you about his throwing history and how his arm feels.  Any pitcher can always tell you more than you can ever accurately assume - so you just have to be willing to listen to him.

Here are a few general rules of thumb:

1. Most throwing programs from professional organizations don't have their pitchers playing catch until January 1 - and I think this is WAY too late to give pitchers adequate time to develop arm speed and durability in the off-season.

2. Relievers start earlier than starters (we are starting our relief pitchers three weeks ahead of our starters this year, on average).

3. Medicine ball volume comes down and throwing volume goes up.

4. Most of our guys who don't go to instructionals, winter ball, the fall league, or Team USA start in November.  Starters are generally right around Thanksgiving among minor leaguers, with some relievers a bit earlier.  Big league guys don't start throwing until mid- to late-December or even January 1.

This is just the tip of the iceberg, but hopefully it gives you some insight into some of what goes through my mind as we work to increase throwing velocity and arm health.

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Managing Sidearm and Submarine Pitchers

Q: I just saw your post about Strasberg and pitching injuries.  This may be hopelessly naive, but - do "submarine" throwers face the same perils?  I'm old enough to remember Kent Telkulve, so it made me think.  It seems as though I see a fair number of throws from SS and 3B positions that appear somewhat submarine-like in motion, so the technique wouldn't be completely unknown. Thoughts? A: In short, the answer would be "yes," they do face the same perils. If you actually slow things down and example joint angles, you'll see that the shoulder and elbow positioning most of these guys get to is very similar to what you see in more overhand throwers.  The difference is in how much lateral trunk tilt they have; the more trunk tilt, the lower the release point.

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The primary difference you'll see is that sidearm/submarine throwers will typically break down at the elbow a lot more than the shoulder.  Aguinaldo and Chambers found that sidearm throwers had significantly higher elbow valgus torques than overhand throwers. It's not surprising, given that they do tend to lead with the elbow a bit more. Position players who throw more sidearm can largely get away with it because a) they don't have anywhere near the volume of throwing in a single outing or a season that pitchers do, and b) they aren't throwing off a mound.  We know that just stepping up onto the elevated mound dramatically increases arm stress.

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So, what are the practical applications of knowing the demands are, for the most part, very similar? First, spend a considerable amount more time focusing on core stability and working to iron out excessive right-left asymmetries that arise secondary to all the lateral trunk tilt.  In other words, worry as much about the spine as you do about the arm.

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Second, I'd put an even greater emphasis on soft tissue work at the medial elbow - particularly on the common flexor tendon (the muscles that join to create this tendon protect the ulnar collateral ligament from excessive valgus stress).

Third, as is usually the case, use these guys as relievers to keep their throwing volume lower while still maximizing their utility. Other than that, manage them as if you would any other pitcher - which should always be a tremendously individualized process, anyway! Please enter your email below to sign up for our FREE newsletter.

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More Than Just Pitching Mechanics: The Skinny on Stephen Strasburg’s Injury

Since a lot of folks reading this blog know me as "the baseball guy," I got quite a few email questions about the elbow injury Washington Nationals phenom Stephen Strasburg experienced the other day.  Likewise, it was the talk of Cressey Performance last Friday - and got tremendous attention in the media.  Everyone wants to know: how could this have been prevented?

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On Thursday's edition of Baseball Tonight, my buddy Curt Schilling made some excellent points about Strasburg's delivery that likely contributed to the injury over time.  Chris O'Leary has also written some great stuff about the Inverted W, which is pretty easily visualized in his delivery.

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The point I want to make, though, is that an injury like this can never, ever, ever, ever be pinned on one factor.  We have seen guys with "terrible mechanics" (I put that in quotes because I don't think there is such a thing as "perfect mechanics") pitch pain-free for their entire careers.  Likewise, we've seen guys with perfect mechanics break down.  We've seen guys with great bodies bite the big one while some guys with terrible bodies thrive.

The point is that while we are always going to strive to clean things up - physically, mechanically, psychologically, and in terms of managing stress throughout the competitive year - there is always going to be some happenstance in sports at a high level.  As former Blue Jays general manager JP Ricciardi told me last week when we chatted at length, "you've only got so many bullets in your arm."

Strasburg used up a lot of those bullets before he ever got drafted, so it's hard to fault the Nationals at all on this front.  In fact, from this ESPN article that was published when the team thought it was a strain of the common flexor tendon and not an ulnar collateral ligament injury (requiring Tommy John surgery), "Strasburg has told the team he had a similar problem in college at San Diego State and pitched through it."  It's safe to assume that the Nationals rule out a partial UCL tear in their pre-draft MRIs, but you have to consider what a common flexor tendon injury really means.

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As I wrote in in my "Understanding Elbow Pain" series (of interest: Anatomy, Pathology, Throwing Injuries, and Protecting Pitchers) the muscles that combine to form the common flexor tendon are the primary restraints - in addition to the ulnar collateral ligament - to valgus stress.  If they are weak, overused, injured, dense, fibrotic, or whatever else, more of that stress is going on that UCL - particularly if an athlete is throwing with mechanics that may increase that valgus stress (the Inverted W I noted above) - the party is going to end eventually.  Is it any surprise that this acute injury occurred just a few weeks after Strasburg dealt with a shoulder issue that put him on the disabled list for two weeks?  The body is a tremendously intricate system of checks and balances, and it bit him in the butt.

There are other factors, though.  As a great study from Olsen et al. showed, young pitchers who require surgery "significantly more months per year, games per year, innings per game, pitches per game, pitches per year, and warm-up pitches before a game. These pitchers were more frequently starting pitchers, pitched in more showcases, pitched with higher velocity, and pitched more often with arm pain and fatigue. They also used anti-inflammatory drugs and ice more frequently to prevent an injury."  And, they were also taller and heavier.

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Go back through the last 12-15 years of Stephen Strasburg's life and consider just how many times he's ramped up for spring ball, summer ball, fall ball, and showcases - only so that he can shut down for a week, just to ramp right back up again to try to impress someone else.  Think of how many radar guns he's had to pitch in front of constantly for the past 5-7 years - because velocity is all that matters, right?

Stephen Strasburg's injury wasn't caused by a single factor; it was a product of many.  And, it can't be pinned on Strasburg himself, any of his coaches or trainers, or any of the scouts that watched him.  Blame it in the system that is baseball in America today.

We already knew that this system was a disaster, though.  Yet, people still keep letting their kids go to showcases in December.  Heck, arguably the biggest underclassmen prospect event of the year - the World Wood Bat Tournament in Jupiter, FL - takes places at the end of October.  When they should be resting, playing another sport, or preparing their bodies in the weight room, the absolute best prospects in the country are pitching with dead, unprepared arms just because it's a convenient time for scouts and coaches to recruit - because the season is over.

They're wasting their bullets.

Now, I'm not saying that Strasburg's injury could have been avoided in a different system - but I'd be very willing to bet that it could have been pushed much further back - potentially long enough to allow him to get through a career.  An argument to my point would be that if it wasn't for all these exposures, he wouldn't have developed - but my contention to that fact was that it is well documented that Strasburg "blew up" from a good to an extraordinary pitcher with increased throwing velocity when he made a dedicated effort to getting fit when he arrived at college.

My hope is that young pitchers will learn from this example and appreciate that taking care of one's body is just as important as showing off one's talent.

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Strength and Conditioning Programs: Understanding the Absolute Strength to Absolute Speed Continuum

A few questions from one of our pro baseball guys inspired me to create this video "tutorial" on how to develop power.  It starts general, and progresses to specific.  Think about how it applies to YOUR sport and your training history.

For more detail, check out The Ultimate Off-Season Training Manual. Please enter your email below to sign up for our FREE newsletter and receive a FREE deadlift technique tutorial.4
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Case Study: More than Just Rotator Cuff Exercises

I had a one-time consultation client at Cressey Performance yesterday, and when I noticed that he had some interesting stuff going on, it made me realize that I need to do more "case studies" here in the blog. This guy had a history of on-and-off right-sided lower back and left shoulder pain.  Basically, it would act up every once in a while, then calm down when he cut out exercising.  Then, he'd return to training for a bit - only to have another set-back.  It has been one step forward, and one step back for years. Now, if you'd seen this guy move, you'd realize that the lower back and shoulder stuff were clearly closely related.  If you're at all familiar with the Postural Restoration Institute, he was a classic Left AIC pattern: adducted/internally rotated right hip and  abducted/externally rotated left hip - and the compensations working their way up to lead to a low right shoulder and prominent left rib flair.  Everything was definitely related.

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Not surprisingly, he'd been told he had scoliosis previously - but the "interesting" thing about it is that this was an acquired posture.  He hadn't had these when he was a kid; he developed them when he was a rower who was always on the right side of the boat.  If you can acquire them, you can "unacquire" them - but it takes time. We're getting him started on some drills to iron out his hip imbalances, but for the sake of this blog, I wanted to highlight what we saw with his shoulder, as I think it includes some great take-home messages on how to manage shoulder function - both in the presence and absence of pain. If you look at the research, if you look at shoulder total motion (internal rotation + external rotation with the scapula stabilized at 90 degrees of abduction), you should see symmetry between right and left in a healthy shoulder.  The internal and external components may be different between sides (e.g., more external rotation and less internal rotation in a throwing shoulder), but the total motion should be the same.  When it's not, "normalizing" total motion should be a primary goal, whether you're trying to address or prevent shoulder issues. In our case study's situation, here is what we measured with the goniometer: Left: 39° (IR) + 98° (ER) = 137° (TM) Right: 58° (IR) + 109° (ER) = 167° (TM) In other words, it was a 30° total motion deficit, with most of that deficit coming from internal rotation. The logical next step would be to manually stretch the shoulder girdle, right?  Well, certainly, it may be justified.  However, before I go having an athlete crank on a somewhat "delicate" joint, I like to see what we can do to get that area to relax without even touching it. The first thing we did was simply close down that left rib cage flair a bit while flexing his left hip and flexing his left arm overhead.  And, we just left him there to breath for 30 seconds or so.  Then, we remeasured: Left: 44° (IR) + 104° (ER) = 148° (TM) In other words, we got 11° of total motion without ever touching his shoulder.  His body did that work just by getting air in with a new posture (no left rib flair). Next, I simply had him get on all fours and go through a pretty low-key thoracic spine mobilization with his arm gently positioned behind his back so that it was on absolutely no stretch.  He did eight reps on each side, using cervical motion to drive a bit of thoracic extension and rotation and scapular movement.  Then, we remeasured: Left: 46° (IR) + 107° (ER) = 153° (TM) There's another 5° of total motion, and it got us a lot closer to where he needs to be - without ever touching his shoulder. And, the coolest part was that when he stood up, the low right shoulder was markedly less prominent - and it was a positioning that "stuck around" for the rest of his session. Sure, manual stretching of the shoulder is probably warranted for him to get those last 14 degrees, and I don't expect him to maintain all this range indefinitely after this session.  He'll need to be consistent with the movements to regain range bit-by-bit and use his strength training to ingrain it in his movement patterns, but the point is that the less aggressive, seemingly indirect, and self-applied interventions are often the best way to get lasting results.  And, when they work, it makes you realize just how "synced up" our entire body is from head-to-toe. For more information on the best assessments and corrective exercises for the shoulder, check out our Optimal Shoulder Performance DVD Set.

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Related Posts

Shoulder Range-of-Motion Norms Mobilizing the Throwing Shoulder: The Do and Don't

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Random Wednesday Thoughts: 8/6/10

1. Mike Reinold polled some of the best in the world of manual therapy, physical therapy, and strength and conditioning (plus a schmuck named "Cressey") to ask for their best career advice for students and young professionals in our fields.  Here is the post that emerged; it came out really well - and actually serves as an awesome adjunct to yesterday's advice on starting out in the fitness industry. 2. I'm pumped to report that my advanced copy of Gray Cook's new book, Movement, arrived yesterday.  I'm digging in to it tonight.  You can pre-order your own HERE.

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Gray's been talking about this book (and working on it) for years now, and there is no doubt in my mind that he won't disappoint. I'm really looking forward to it. 3. Here's a link to an interview with Cressey Performance and Lincoln-Sudbury athlete Adam Ravenelle, who is committed to play baseball at Vanderbilt: Player Perspective: Adam Ravenelle The thing I like the most about this interview is the fact that Adam emphasized the importance of in-season training and how valuable it is to young pitchers.  You'd be amazed at how many guys work their butts off in the off-season and show up to the start of the season strong...only to skip their lifting and flexibility work for the next 6-8 months.  It's one step forward, and one step back - but not for guys like Adam who "get it."  "Rav" has gained over 50 pounds with us since 2007 while going from the high 70s to low 90mph range - and having an open-minded and dedicated attitude toward in-season training has been a big part of it. 3. Speaking of throwing the baseball faster, Haag et al. found that pre-throwing static stretching did not negatively affect baseball pitching velocity.  This is pretty significant, as many modern coaches generally encourage players to universally avoid static stretching right before training and competition for fear of reductions in power output (that research horse has been beaten to death). Personally, though, I've always felt that it was really valuable to stretch the throwing shoulder in the majority of our pitchers before they threw (the exceptions being the ones with crazy laxity).  Typically, we stretch guys (or encourage them to stretch themselves) into shoulder internal rotation and flexion.  It's safe to assume that getting range in their directions is going to not only minimize the effect of the peel-back mechanism for SLAP lesions at lay-back, but also enable them to have a longer, smoother deceleration arc.

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While more research is definitely warranted, my hunch is that static stretching is less "inhibitory" in the upper body than the lower body because the upper body deals with predominantly open-chain motion, and is therefore more heavily reliant on mobility than stability. 5. Last, but certainly not least, here's a quick article about CP athlete Tim Collins, who was traded for the second time in three weeks, this time to the Royals. Related Posts The Importance of Strength and Conditioning for High School Baseball Players The Lucky 13: Cressey's Top Reading Recommendations Enter your email below to subscribe to our FREE newsletter:
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The #1 Cause of Inconsistent Pitching Velocity

As anyone who reads my posts regularly surely knows, I've devoted a significant portion of my life to figuring out how to make guys throw baseballs faster.  However, my interest in velocity isn't just limited to how to get to "X" miles per hour; it also extends to understanding how to stay (or improve upon) "X" miles per hour over the course of a single appearance, season, or career while staying healthy and developing the rest of one's pitching arsenal.  Erratic radar gun readings are as much a problem as insufficient radar gun readings.

My foremost observation on this front has been that velocity is much more erratic in high level teenagers than any other population. At Cressey Sports Performance, we've had loads of high school guys top the 90mph mark over the years, so we've built up a good sample size to consider.  While some of these guys are quite consistent, I find that they tend to have more 4-6mph drop-offs here and there than any other population with which I've worked.  A guy that is 90-94 on one day might come back at 86-88 five days later - seemingly out of the blue.

However, I don't think it's just a random occurrence.  Rather, in my experience, EVERY single time it happens, it's because he has let his body weight drop - usually due to being on the road for games and not packing enough food.  We see it all the time in kids who throw great up in New England, but then head down South for tournaments.  All of a sudden, they are living out of hotels and eating out of restaurants multiple times per day - which certainly isn't going to be as conducive to maintaining body weight as "grazing" around the house and chowing down on Mom's home-cooking multiple times per day.  To make matters worse, a lot of kids lose their appetites when they get out in the heat - and not many people from across the country are prepared for the weather in Georgia or South Carolina in July.  So, insufficient caloric intake becomes completely inadequate caloric intake - and that's not exactly a recipe for throwing the baseball faster.

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Beyond just the body weight factor, though, you also have to look at the fact that the advanced teenage pitchers are generally also the best athletes - so their coaches almost always have them out in the outfield or at SS/3B when they aren't pitching.  Playing a position interferes with a solid throwing program and just doesn't give a kid a chance to rest. There are more calories burned, too!

What's interesting, though, is that kids who don't throw as hard - say, 70-82 - never have variability in their velocity readings; they are super consistent.  Why? Well, for one, they usually aren't quite good enough to get on travel teams and in competitive scenarios that would require them to have to consciously consider how to maintain their weight.  Rather, it's Mom's home-cooking all the time - so it's easier to maintain their weight.  And, they may not be talented enough to be able to play other positions when they aren't pitching.

This difference is really interesting because both populations - independent of strength and conditioning - are at ages where their bodies are changing and (presumably) getting heavier naturally as they go through puberty and gain muscle mass. 

This rarely applies to anyone who has pitched in the professional ranks for more than a year or two.  You never see a professional pitcher go out and throw 5-7mph slower than normal unless he is hurt or coming back on very short rest.  These guys have found their "set points," and have learned over the years how to get in enough calories when on the road (out on their own means cooking for themselves, plus eating whatever their clubhouse dues gets them at the park).  Plus, they aren't playing the field.

All that said, regardless of your age, experience level, and current velocity, don't skimp on calories.  If you look at every bit of research on the pitching motion, body weight predicts pitching velocity. If you're on the road, make sure you pack some shakes, trail mix, bars, fruit, nuts, jerky, or whatever other convenience food helps you to get in the calories you need to light up the radar gun.  Also, 8 Nutritional Strategies for Those Who Can't Gain Weight is one of my most popular articles of all time, if you're looking for some succinct thoughts on the topic.

And, if you're one of the pitchers who desparately needs to put on 15-20 pounds to make a big jump in velocity this summer, then the CSP Collegiate Elite Baseball Development Program is for you. For more information on this 10-week program, click here.

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Ulnar Collateral Ligament Injuries in Quarterbacks vs. Pitchers

Here's an interesting study on the incidence of ulnar collateral ligament (UCL) injuries in professional football quarterbacks.  With only ten reported cases between 1994 and 2008, it's obviously (and not surprisingly) much lower than the rates we see in professional baseball players.  This is right in line with what I discussed in Weighted Baseballs: Safe and Effective or Stupid and Dangerous?

Bengals Seahawks Football However, what is very interesting to me is that 9/10 cases were treated non-operatively; in other words, Tommy John surgery is much less prescribed in football quarterbacks than baseball pitchers - meaning that the quarterbacks respond better to conservative treatment. What's up with that?  They are the same injuries - and presumably the same rehabilitation programs. In my eyes, it's due to the sheer nature of the stress we see in a baseball pitch in comparison to a football throw.  As a quarterback, you can probably "get by" with a slightly insufficient UCL if you have adequate muscular strength, flexibility, and tissue quality.  While this is still the case in some baseball pitchers, the stresses on the passive structure (UCL) are still markedly higher on each throw, meaning that your chances of getting by conservatively are probably slightly poorer.

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I'm sure that the nature of the sporting year plays into this as well.  Football quarterbacks never attempt to throw year-round, so there isn't a rush to return to throwing.  There are, however, a lot of stupid baseball pitchers who think that they can pitch year-round, so kids often "jump the gun" on their throwing programs and make things worse before they can heal completely. That said, we've still worked with a lot of pitchers who have been able to come back and throw completely pain-free after being diagnosed with a partial UCL tear and undergoing conservative treatment (physical therapy).  It's an individual thing. Related Posts Understanding Elbow Pain - Part 3: Throwing Injuries Understanding Elbow Pain - Part 4: Protecting Pitchers Please enter your email below to sign up for our FREE newsletter.
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Swimming for Pitchers?

Last week, I had three separate pitchers ask me what I thought about swimming between starts.  My answer was pretty straightforward: I am not a fan at all.

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There are several reasons for my contention with this as a useful modality. Like pitchers, swimmers have some of the most dysfunctional shoulders in the entire sporting world; they have glaring scapular instability, big internal rotation deficits, and insufficient dynamic stability. Sound familiar?  These are the exact same things we work to address too keep our pitchers healthy. For me, cross-training is about getting athletes out of pattern overload - not finding a similar means of reinforcing imbalances.  Telling a pitcher to go swim is like encouraging a distance runner with a bum Achilles tendon to go jump rope instead.  It's an epic fail waiting to happen.

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When it really comes down to it, I’d rather have guys actually throwing if they are going to develop imbalances.  Pattern overload might as well give you improved motor control and technical precision if it's going to increase your susceptibility to injury! Speaking of specificity, the energy systems demands of swimming (longer distances, usually) don't reflect what we see in pitching (short bursts of intense exertion).  So, the arguments are in many ways similar to my contention with distance running for pitchers. And, more anecdotally, while incredible athletes in the pool, most of the swimmers I have encountered have been far less than athletic on solid ground, presumably because the majority of their training takes place in the water, where stability demands are markedly different.  I'd much rather see supplemental baseball training take place with closed-chain motion on solid ground - just like it does in pitching.

Finally, I'd like to see pitchers lift more - because they simply don't do enough of it during the season.  With limited time between outings, it's important to get in the most important stuff first - and I just don't see swimming as "important" when compared to flexibility training, soft tissue work, the throwing program, and strength training.

I'm sticking to my guns here.  I'd much rather see pitchers doing what I outlined HERE between starts, as it keeps them strong, gets them moving in ways that don't further ingrain imbalances, and avoids conflicting with the metabolic demands on pitching. 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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AC Joint Impingement vs. “Regular” Shoulder Impingement

I've seen a few acromioclavicular (AC) joint impingement cases at our facility in the last couple of weeks and thought it'd be good to do a quick blog to talk about how different they are from "regular" (external) shoulder impingement cases.  And, it is a very important differentiation to make. I've already written at length about AC joint issues in Getting Geeky with AC Joint Injuries: Part 1 and Part 2.  And, I kicked out a two-part series called The Truth About Shoulder Impingement; here are Part 1 and Part 2. While I talk a lot about the symptoms for both, several provocative tests for these issues, and training modifications to avoid exacerbating pain under these conditions, there was one important "differential assessment that I missed."  Mike Reinold actually taught me it as we were planning the Optimal Shoulder Performance DVD set.

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Just paying close attention to (and asking about) where folks have their pain during overhead motion can tell you quite a bit.  In an external impingement - where we're talking about the rotator cuff tendons and bursa rubbing up against the undersurface of the acromion - you'll usually get pain as folks approach 90 degrees of abduction (arm directly out to the side).  That pain will persist as they go further overhead, and in my experience, start to die off as they get to the top.

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Conversely, for those with AC joint impingement - what is essentially bone rubbing up against bone - you see a "painful arc" only at the last portion of abduction:

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You can usually confirm your suspicions on this front with direct palpation of the AC joint and checking to see if folks have pain when reaching across the chest.

Much of the training modifications will be the same for these two conditions, but there are also going to be several key things that should be managed completely differently.  For instance, front squatting someone with an AC joint issue would not be a good idea due to the direct pressure of the bar on the AC joint; it would, however, be just fine for most cases of external shoulder impingement.  In another example, some serious AC joint issues are exacerbated even by just doing the end-range of a rowing motion (to much shoulder extension/horizontal abduction) - whereas even folks with full-blown rotator cuff tears can generally do rows pain-free.

Assess, don't assume!

For more information - including loads more assessments like these - check out the Optimal Shoulder Performance DVD set.

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