I've received a lot of emails just recently (as well as some in-person questions) asking me what I think of Crossfit for strength and conditioning programs with baseball players and, more specifically, pitchers.
Let me preface this email with a few qualifying statements. First, the only exercise "system" with which I agree wholeheartedly is my own. Cressey Sports Performance programming may be similar in some respects to those of everyone from Mike Boyle, to Louis Simmons, to Ron Wolforth, to the Crossfit folks - but taken as a whole, it's entirely unique to me. In other words, I will never agree completely with anyone (just ask my wife!).
Second, in spite of the criticism Crossfit has received from some people I really respect, I do feel that there are some things they're doing correctly. For starters, I think that the camaraderie and enthusiasm that typifies their training groups is fantastic; anything that gets people (who might otherwise be sedentary) motivated to exercise is a plus. Moreover, they aren't proponents of steady-state cardio for fat loss, and they tend to gravitate toward compound movements. So, good on them for those favorable traits. Additionally, I know some outstanding coaches who run Crossfit franchises, so their excellent skill sets may be overshadowed by what less prepared coaches are doing simply because they have the same affiliation.
However, there are several issues that concern me with applying a Crossfit mentality to the baseball world:
1) The randomness of the "workout of the day" is simply not appropriate for a sport that has quite possibly the most specific sport-imposed asymmetries in the world of athletics. I've written about these asymmetries in the past, and they can only be corrected with specific corrective training modalities.
I'm reminded of this constantly at this time of year, as we get new baseball players at all levels now that seasons are wrapping up. When a player presents with a 45-degree glenohumeral internal rotation deficit, a prominent scapular dyskinesis, terrible right thoracic rotation, a big left rib flair, a right hip that's stuck in adduction, and a complete lack of rotary stability, the last thing he needs to do is a 15-minute tri-set of cleans, kipping pull-ups, and push-ups - following by some 400m sprints. It not only undermines specificity of exercise selection, but also the entire concept of periodization.
Getting guys strong isn't hard. Neither is getting them powerful or building better endurance. Finding the right mix to accomplish all these initiatives while keeping them healthy is the challenge.
2) The energy systems development found in Crossfit is inconsistent with the demands of baseball. I wrote extensively about my complete and utter distaste for distance running in the baseball world, and while Crossfit doesn't go this far, in my eyes, anything over 60yds is "excessive distance" for baseball guys. Most of my guys sprint two times a week during the off-season, and occasionally we'll go to three with certain athletes. Let's just say that elite sprinters aren't doing Crossfit, and the energy systems demands of baseball players aren't much different than those of elite sprinters.
3) I have huge concerns about poor exercise technique in conditions of fatigue in anyone, but these situations concern me even more in a population like baseball players that has a remarkably high injury rate as-is. The fact that 57% of pitchers suffer some sort of shoulder injury during each season says something. Just think of what that rate is when you factor in problems in other areas, too! The primary goal should not be entertainment or variety (or "muscle confusion," for all the morons in pro baseball who call P90X their "hardcore" off-season program). Rather, the goals should be a) keeping guys on the field and b) safe performance enhancement strategies (in that order).
As an example, all I need to do is look back on a program we used in one of our first pro pitchers back for the off-season last fall. He had a total of 20 pull-up and 64 push-up variation reps per week (in addition to some dumbbell bench pressing and loads of horizontal pulling/scapular stability/cuff work). This 84-rep figure might be on the low-end of a Crossfit program for a single day. Just like with throwing, it's important to do things RIGHT before even considering doing them A LOT.
4) Several of the exercises in typical Crossfit programs (if there is such a thing) concern me in light of what we know about baseball players. I'll cover this in a lot more detail in an article within the next few weeks, but suffice it to say that most have significant shoulder (if not full-body) laxity (acquired and congenital), abnormal labral features, partial thickness supraspinatus tears, poor scapular upward rotation, retroversion (gives rise to greater external rotation), and diminished rotator cuff strength in the throwing shoulder (particularly after a long season). Most pro pitchers will have more than 190 degrees of total motion at the shoulder, whereas many of the general population folks I encounter rarely exceed 160 degrees.
In short, the shoulders you are training when working with baseball players (and pitchers, in particular) are not the same as the ones you see when you walk into a regular ol' gym. Want proof? Back in 2007, on my first day working with a guy who is now a middle reliever in the big leagues, I started to teach him to front squat. He told me that with only the bar across his shoulder girdle, he felt like his humerus was going to pop out of the socket. Not surprisingly, he could contort his spine and wrists like a 14-year-old female gymnast. This laxity helps make him a great pitcher, but it would destroy him in a program where even the most conservative exercises are done to the point that fatigue compromises ideal form. And, let's be honest; if I was dumb enough to let someone with a multi-million dollar arm do this, I'd have agents and GMs and athletic trainers from a lot of major league systems coming after me with baseball bats!
5) Beyond just "acts of commission" with inappropriate exercise selection and volume, there are also "acts of omission." For example, a rotational sport like baseball requires a lot of dedicated work to address thoracic spine and hip mobility and anti-extension and anti-rotatoin core stability. If you exhaust your training time and recovery capacity with other things, there may not be enough time or energy to pay attention to these important components.
All that said, I would encourage anyone who deals with baseball players to learn to borrow bits and pieces from a variety of methods available today. Along the way, take into account the unique characteristics of the overhead throwing athlete and manage accordingly. Simply saying "I'm a Crossfit guy" and adhering to an approach that was never intended for a baseball population does a huge disservice to the athletes that count on you to bring them the most up-to-date, cutting-edge training practices available.
If you're interested in learning more about some of the asymmetries and training techniques I noted above, I'd strongly encourage you to check out Optimal Shoulder Performance, where both Mike Reinold and I go into some detail on assessment and corrective exercise for pitchers in this seminar (and there's also a lot more fantastic information for anyone looking to develop pitchers). You can buy it HERE, or learn more about it HERE.
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Getting Geeky with AC Joints: Part 2
In my last newsletter, I went into great detail on the types of acromioclavicular (AC) joint injuries we see, and some of the common inefficiencies that cause some folks to become symptomatic. I also outlined some corrective exercise strategies to expedite recovery time. This week, though, I discuss a very important - yet often-overlooked - piece of the puzzle: how to maintain a training effect in spite of these injuries.
Ask anyone who has ever had an AC joint injury, and they'll tell you three things to avoid if you don't want to irritate it:
1. Avoid direct pressure to the area (particularly because it has very little muscle mass to cushion it)2. Avoid reaching across the body (horizontal adduction)
3. Avoid reaching behind the body (full extension)
We can use these three guidelines to get moving in the right direction with respect to maintaining a training effect in spite of the AC joint injury.
With respect to #1 from above, front squats are an absolute no-no. The pressure on the bar across the shoulder girdle can really take an upset AC joint and make it markedly worse. And, since this is in many cases an injury that we're just "waiting out," simply training through it will only makes things worse long-term. So, deadlift variations, single-leg variations, and back squats (assuming no other related problems) are likely better bets. That said, we generally use the safety squat bar and giant cambered bar exclusively with those who present with AC joint problems.
Another important consideration in this regard is overhead pressing. Believe it or not, many individuals with AC joint problems will actually tolerate overhead pressing quite well, as direct trauma to the AC joint won't really compromise scapulohumeral rhythm very much. However, you have to consider two things.
First, as I mentioned in my previous newsletter, some folks might have developed the AC joint issue over time due to a scapular anterior tilt causing the acromion and clavicle to sit differently. This dyskinesis would also make overhead work less safe - so the individual would actually be training through a faulty movement pattern, and potentially injuring the rotator cuff, biceps tendon, bursa, and labrum.
Second, if the individual is okay to overhead press from a movement standpoint, one needs to make sure that the bar, dumbbell, or kettlebell does not come down directly on the AC joint in the bottom position.
With respect to #2 from above, obviously, dumbbell flyes and cable crossovers are out (not sure why they'd be "in" in the first place, but that's a whole different newsletter). However, close-grip bench pressing variations will generally cause pain as well. You also have to be careful with cable and medicine ball variations that may position the arm across the body.
Moving on to #3, full extension of the humerus will light up an AC joint pretty quickly. So, dips are out - and, honestly, I generally tell folks they're out for good after one has experienced any kind of AC joint issue. Full range-of-motion (ROM) bench pressing and push-ups are generally issues as well, so I tend to start folks with more partial ROM work. Examples would include dumbbell and barbell floor presses and board presses. Here's a 3-board press:
As the shoulder starts to feel better, one can move down to 2-board, 1-board, and eventually full ROM bench press. Remember, a medium or wide grip will generally be tolerated better than a close grip.
I also really like push-up iso holds at a pain-free ROM for these individuals because closed-chain exercises are always going to be a bit more shoulder friendly than open-chain variations. This is really quite simple: set up as if you are going to do a push-up, and go down as far as you can with no pain. When you reach your pain-free end-range, hold there while bracing the core, locking the shoulder blades down and back, and tightening the glutes; do not let the elbows flare out or hips sag! We'll hold for anywhere from 10-60s, depending on fitness levels. Over the course of time, increase the ROM as your symptoms reduce.
There you have it: acromioclavicular joints - from onset to corrective exercise - in a nutshell. Obviously, make sure you seek out a qualified professional if you think you may have these issues, but keep this progression in mind as you return to (or just try to stay in) the iron game.
Feedback on Building the Efficient Athlete
"In my ten years in the fitness industry, I have been to many seminars and conferences - but the Building the Efficient Athlete Seminar was by far the most informative and comprehensive event I have attended in as long as I can remember. The amount of knowledge you get when you combine Eric Cressey and Mike Robertson is unparalleled. The seminar was filled with great classroom information, hands-on assessments, and on-site training tips. I highly recommend this DVD set to any coach, trainer, or athlete who is looking to get a leg up on the competition."
Mike Hanley, USAW, RKC
Morganville, NJ
www.HanleyStrength.com
Getting Geeky with AC Joint Injuries
Lately, I've gotten quite a few in-person evaluations and emails relating to acromioclavicular (AC) joint issues. As such, I figured I'd devote a newsletter to talking about why these injuries are such a pain in the butt, what to do to train around them, and how to prevent them in the first place (or address the issue once it's in place).
First off, there is a little bit about the joint that you ought to know. While the glenohumeral joint (ball-and-socket) is stabilized by a combination of ligamentous and muscular (rotator cuff) restraints, the AC joint doesn't really have the benefit of muscles directly crossing the joint to stabilize it. As such, it has to rely on ligaments almost exclusively to prevent against "shifting."
As you can imagine, then, a traumatic injury or a significant dysfunction that affects clavicle positioning can easily make that joint chronically hypermobile. This is why many significant traumatic injuries may require surgery. While almost all Grade 4-6 separations are treated surgically, Grades 1-2 separations are generally left alone to heal - with Grade 3 surgeries going in either direction.
In many cases, you'll actually see a "piano key sign," which occurs when the separation allows the clavicle to ride up higher relative to the acromion. Here's one I saw last year that was completely asymptomatic after conservative treatment. It won't win him any beauty contests, and it may become arthritic way down the road, but for now, it's no problem.
Now that I've grossed you out, let's talk about how an AC joint gets injured. First, we've got traumatic (contact) injuries, and we can also see it in people who bench like this:
Actually, that's probably a fractured sternum, but you can probably get the takeaway point: don't bounce the bar off your chest, you weenie. But I digress...
Insidious (gradual) onset injuries occur just as frequently, and even moreso in a lifting population. Most of the insidious onset AC joint problems I've encountered have been individuals with glaring scapular instability. With lower trapezius and serratus anterior weakness in combination with shortness of pec minor, the scapula anteriorly tilts and abducts (wings out) - and you'll see that this leads to a more inferior (lower) resting posture.
In the process, the interaction between the acromion (part of the scapula) and clavicle can go a little haywire. The acromion and clavicle can get pulled apart slightly, or the entire complex can get pulled downward a bit. In this latter situation, you can also see thoracic outlet syndrome (several important nerves track under the clavicle) and sternoclavicular joint issues in addition to the AC joint problems we're discussing.
As such, regardless of whether we're dealing with a chronic or insidious onset AC joint issue, it's imperative to implement a good scapular stabilization program focusing on lower trapezius and serratus anterior to get the acromion "back in line" with the clavicle. Likewise, soft tissue and flexibility work for the pec minor can also help the cause tremendously.
Anecdotally, a good chunk of the insidious onset AC joint problems I've seen have been individuals with significant glenohumeral internal rotation deficits (GIRD). The images below demonstrate a 34-degree GIRD on the right side.
It isn't hard to understand why, either; if you lack internal rotation, you'll substitute scapular anterior tilt and abduction as a compensation pattern - whether you're lifting heavy stuff or just reaching for something. And, as I discussed in the paragraph above, a scapular dyskinesis can definitely have a negative effect on the AC joint.
Lastly, you can't ever overlook the role of thoracic spine mobility. If your thoracic spine doesn't move, you'll get hypermobile at the scapulae as a compensation - and we already know that's not good. And, as Bill Hartman discussed previously, simply mobilizing the thoracic spine can actually improve glenohumeral rotation range-of-motion, particularly in internal rotation. Inside-Out is a fantastic resource in this regard - and is on sale this week, conveniently!
So, as you can see, everything is interconnected! In part 2 of this series, I'll discuss training modifications to work around acromioclavicular joint problems and progress back to more "normal" training programs.
New Blog ContentBirddogs, Continuing Education, and Terrible JournalismStuff You Should ReadExercise of the Week: Dumbbell Reverse LungeRandom Friday ThoughtsIt's All About Specialization
All the Best,
EC
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Q: I've read a lot from you, Robertson, and Hartman about including push-up variations in strength training programs is really important for shoulder health. Unfortunately, whenever I do them, I have pain in my bum shoulder. Any ideas what to do?
A: Well, obviously, there are two things we need to rule out:
1. You may simply have a really irritated shoulder, which (in most cases) means that any sort of approximation or protraction movement could get it angrier, even if it is a closed-chain movement like the push-up that is normally pretty shoulder-friendly. Likewise, if you have a significant acromioclavicular joint injury, the extension range-of-motion at the bottom of a push-up could exacerbate your symptoms. So, obviously, the first step is to rule out if something is structurally wrong with your shoulder, and if so, if the push-up even belongs in your strength training program.
2. Your technique might just be atrocious. If the elbows are flared out, hips are sagging, and/or you're in a forward head posture, simply changing your technique may very well alleviate those symptoms. In a good push-up, the elbows should be tucked to a 45-degree angle to the body, with the hips, torso, neck, and head in a straight line. The muscles of the upper back should essentially "pull" you down into the bottom position:
Once you've ruled out those two issues and still have some annoying issues, there is one more thing you can try: simply elevate the feet. Looking to the research, Lear and Gross found that performing push-ups with the feet elevated significantly increased activation of the serratus anterior (SA).
If we can get more SA recruitment and less pectoralis minor contribution, it keeps us out of a position of scapular anterior tilt, which mechanically decreases the subacromial space through which the rotator cuff tendons pass. In the picture below, think of the area just below the word "acromion" being smaller, and then picture what would happen to the tendons that pass through that region; they get impinged. Serratus anterior (along with lower trapezius) can help prevent that.
That said, I've seen quite a few folks with persistent shoulder pain with bench pressing variations (barbell and DBs) and regular push-ups who were able to do the feet-elevated versions completely pain free in their strength training programs. Obviously, begin with just body weight and see how it goes, but over time, you can start to add resistance and use the single-leg version.
Q: As far as the total motion concept goes, is there a certain minimum of total degrees of motion that the "baseline" limb should have? For example, if a right-hand dominant person has fairly limited total motion on the left side and even more limitations on the right, would the goal be to get total motion symmetrical first and then improve both from there?
A: It is definitely population-specific, as overhead throwing, for example, will simply move that total motion to a different range. So, a symmetrical shoulder might be:
Right (dominant): 45° IR + 125° ER = 170° Total Motion
Left (non-dominant): 55° IR + 115° ER = 170° Total Motion
The difference between the two would be attributed to retroversion (bony adaptations - more info HERE). A 10° internal rotation deficit would be completely normal in a unilateral overhead throwing population.
Of course, if you get a freestyle swimmer, thinks get a bit interesting. You have to go a bit more by end-feel, and mandate that they have at least 25° degrees of total internal rotation.
That said, in a "normal" weight training population, I like to have at least 90° of external rotation and 50+° of internal rotation. I wouldn't consider those "good" measurements, but they would be workable (assuming symmetrical total motion).
Now, you are going to have situations here and there where someone has lost total motion in the non-dominant side. My experience has been that this occurs in athletes who spend too much time in computers and those who get "100% shut down" after an injury.
Believe it or not, I once saw a pro pitcher with only 6° (yes, single digits) of internal rotation on his throwing shoulder, and the medical staff's conclusion was to give him a cortisone shot and make him rest completely - no lifting, sprinting, stretching, anything (I wonder if they assigned an intern to him to help him wash his hair in the shower). He basically just charted pitches for two months. This guy lost total motion bilaterally, so the fact that he was forced into inactivity actually made his subsequent evaluation a bit more complex. The good news is that these guys can generally be recognized by their terrible thoracic spine posture and increased body fat levels!
It's been a while since my last dose of Friday Randomness, but when you're got so much intern hazing going on, it's hard to even imagine topping that kind of content!
1. I recently contributed to another T-Muscle feature; check out Advice You Don't Want to Hear: Volume 2 for a little dose of tough love. I'm the last one down.
2. I have to say, I'm pretty proud of myself. My fiancee's been out of town since Monday morning, and while the fridge is just about empty and I'm down to one pair of clean underwear, the place didn't burn down, and I didn't put an eye out.
3. Here's a quick takeaway from a great Elbow Biomechanics talk by Mike Reinold earlier this week...
Obviously, in dealing with loads of baseball guys, I see a lot of elbow issues come through my door. The overwhelming majority of those folks are medial elbow pain, but we also see a fair amount of lateral elbow pain - even though we program for these individuals very similarly, as their inefficiencies are pretty much identical. I've seen it in practice, but never actually gotten the numbers on the forces involved.
The same medial tensile force that can wreak havoc with an ulnar collateral ligament or ulnar nerve also applies approximately 500N on the radioulnar joint during the late cocking (maximum external rotation) phase of throwing; that's about one-third of the total stress on the elbow. This lateral area also takes on about 800N of force at the moment arm deceleration begins (elbow extended out in front). As always, a picture is worth a thousand words:
I always knew it was going on, and always worked to prevent problems in the area, but suffice it to say that it was nice to get some numbers on this. If you see these issues, you've obviously got to look at mechanics, but more importantly, tissue quality, all the common flexibility deficits we see in pitchers, and overall strength of the rotator cuff, scapular stabilizers, core, lower body, and muscles acting at the elbow to provide valgus stability. For more information, I highly recommend you check out the 2008 Ultimate Pitching Coaches Boot Camp DVD set.
4. Bill, Mike, and I film our new DVD next weekend out in Indianapolis, so I'm going to end this one here and get to work on finishing up the script. Stay tuned on this front; we are excited about how thorough this is.
Have a great weekend!
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used by Cressey Performance Pitchers after they Throw!
I've written previously about the many flexibility deficits we see in baseball players (particularly pitchers). One of the biggest issues we face is a loss of elbow extension range-of-motion. This adaptive change most likely occurs because of the insane amounts of eccentric muscle action required to decelerate the 2,500 degrees/second of elbow extension that occurs during pitching. You'll find some serious shortness/tissue restrictions in biceps brachii, brachioradialis, brachialis, and all the rest of the muscles acting at the elbow and wrist.
Unfortunately, it's not an area you can really work on with the foam roller or baseball, as it's in a tough spot. For that reason, we prefer using The Stick - and hold it in place with the j-hooks in a power rack. Here is how it works when rolling out the anterior forearm musculature (this same technique can be utilized on the elbow flexors):
Follow that up with some longer duration holds of this stretch, and you'll get that elbow extension back in no time.
For the entire Cressey Performance foam roller series, click HERE.
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Risk-Reward in Training Athletes and Clients
This week, approximately 1,500 players will be drafted in the 2009 Major League Baseball Draft. Historically, a whopping 2-3% of these players will ever actually make it to the big leagues. In fact, only about 2/3 of all first-round draft picks - seemingly the most qualified candidates - ever make it to the major leagues.
For this reason, many have labeled competing in the professional baseball ranks a "War of Attrition." High-round picks get preferentially escorted through the minor leagues, while a lot of the late-round picks fight for their positions in the minors - especially since they know a brand new class of 40-50 draft picks and a bunch of free agent signees will line up to take their jobs each year. Along the way, loads of guys incur career-ending injuries.
Here, we come to several decisions in how to train athletes.
First, all athletes have unique movement inefficiencies, so we screen these issues and address them individually. Nothing remarkable there.
Second, some athletes have bigger contracts, so you have to be more conservative with their programming. Sure, they might get benefits out of more aggressive programming, but it also increases the likelihood that you'll mess up an athlete with multi-million dollar contracts in his immediate future.
Take, for instance, Cressey Performance athlete Shawn Haviland. Shawn was drafted out of Harvard by the Oakland A's in the 33rd Round of the 2008 Draft after being named Ivy League Pitcher of the Year. As Shawn himself has said, he "would have signed for a plane ticket to Arizona." In other words, he didn't get an $8 million signing bonus; he's a very low-risk investment. Life goes on for his organization if he doesn't work out because they can just draft another 50 guys the following year. After all, he's just another 6-0 right-hander in the system - a dime a dozen, if you will.
This is the exact conversation Shawn and I had last October when we first met up. He'd been 86-88mph on the radar gun most of last year, and that really isn't going to earn you a long stay in professional baseball. So, we decided to be more aggressive with his off-season programming than we would with someone who'd just become a first-round pick.
All off-season, he lifted, sprinted, accumulated 80-120 medicine ball throws three times a week, did some extreme long-toss, threw the weighted balls around, and consistently worked on his flexibility and tissue quality. It flies in the face of the conventional wisdom that says: a) we shouldn't long toss more than 120 feet, b) weighted balls are the devil, c) only distance running and steady-state cardio will "build leg strength" in pitchers, d) lifting will ruin flexibility, and e) medicine ball throwing will cause oblique strains (yes, I've really heard that one). However, it worked.
Now, seven months later, Shawn was just named a Midwest League All-Star. He is consistently 91-94mph and has completely changed his body. In short, he took a chance, worked his butt off, and got better.
Shawn's program wasn't "unsafe;" it was just "less conservative." It was at a different point on the continuum on which every strength and conditioning coach and personal trainer works on a daily basis. This program was obviously different than what I'd do with, say, a 40-year-old marathon runner, but it's also different than I'd do with a first-round pick with Shawn's exact build, competitive demands, and inefficiencies. And, if I had a pitcher with those exact same characteristics and an extensive injury history, we'd be even more conservative. Otherwise, the risk: reward would be completely out of whack.
Often, in our industry, we get far too caught up in numbers - whether it's the weight one lifts or his/her body fat percentage. In reality, I look at what I do as a means to an end. People train with us first and foremost to stay healthy, whether they're pitching in the professional baseball ranks or just carrying their kids around. What you do in the gym should improve quality of life first and foremost, and any activity that carries a high likelihood of injury is very rarely worth the risk.
Why pick up a stone - which demands compression and lumbar flexion - when you're not a strongman competitor and could just as easily do a more controlled trap bar deadlift?
Why behind-the-neck overhead press - which puts the shoulder at one of its most at-risk position - when you've already had four shoulder surgeries and still have hunchback posture?
When it really comes down to it, you have to fit the program to the athlete, and not the athlete to the program. For more information, a few resources I'd recommend:
1. My article, 6 Mistakes: Fitting Round Pegs into Square Holes
2. The Building the Efficient Athlete DVD Set
3. The 2008 Indianapolis Performance Enhancement DVD Set
4. For those of you interested in a bit of what we did with Shawn, check out this Athlete Profile on him.
New Article at T-Nation
For those who missed it, Part 3 of my "Lower Back Savers" series was posted at T-Nation last week. You can check it out HERE (and be sure to check out Part 1 and Part 2 if you missed them in previous weeks).
New Blog ContentRandom Friday ThoughtsBogus Workouts and the Official Blog of...Building Vibrant Health: Part 2Friday Night Journals
Have a great week!
EC
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Q&A: Hip Injuries in Baseball
Q: On Sunday, The New York Times published this article that discusses the dramatic increase in hip injuries in Major League Baseball in recent years. I know you work with a ton of baseball players and was curious about your thoughts on the article. Do you agree with their theories?
A: As always, my answer is "kind of" or "maybe." I think they make some great points in the article, but as is the case with mainstream media articles, they're written by reporters with word count limits, so a lot of the most important points get omitted. For example, with respect to the hips, it isn't as simple as "weak or strong." You can have guys with ridiculously strong adductors that are completely overused, balled up, and short - but terribly weak hip extensors and abductors. So, part of the problem is that journalists don't even qualify as casual observers to exercise physiology, so the public only gets part of the story.
(Sorry, but that digression was totally worth it.)
First, I agree that one of the reasons we are seeing more of these issues is because doctors have become better at diagnosing the problems. The "corollary" to this would be that the issues are perceived as more severe because so few physical therapists, athletic trainers, and strength and conditioning coaches are comfortable treating and preventing the problems. That's not to say that hip issues aren't serious in nature; it simply implies that there is a divide between diagnostic capabilities and treatment/prevention strategies.
Second, I agree wholeheartedly that early specialization at the youth levels can lead to injuries down the road. We're dealing with some significant rotational velocities at the hips. In previous analyses of professional hitters, the hips rotated at a velocity of 714°/second. This same velocity isn't the same with little leaguers, but with skeletally immature children, it doesn't take as much stress to impose the same kind of damage. So, I don't see it as at all remarkable that some pro ballplayers have hip problems after they may have played baseball year-round from age 9 all the way to the time they got drafted. They also have bad shoulders, elbows, knees, and lower backs that have taked years to reach threshold. It just so happens that folks are getting better at diagnosing these problems, so we now have an "epidemic," in some folks' eyes.
What I can tell you, though, is that it's borderline idiocy to think that strength training is responsible for these problems. Injuries don't occur simply because you enhance strength. In fact, muscular strength reduces the time to threshold for tendinopathies, and takes stress off passive restraints such as ligaments, menisci, labrums, and discs. Making this assumption is like saying that strength training drills to bolster scapular stability may be the reason we see more shoulder and elbow injuries nowadays. Um, no. Shoulders and elbows crap out because of faulty mechanics, poor flexibility (e.g., shoulder internal rotation ROM), bad tissue quality, and muscular weakness. Granted, the shoulder (non-weight-bearing) and hips (weight-bearing) have different demands, but nobody ever tried to pin the exorbitant amount of arm problems in pitchers on "the advent of strength training."
That said, injuries occur when you ignore things that need to be addressed: pure and simple.
To that end, I can tell you that a large percentage of the baseball players I see - including position players, pitchers, and catchers - have some signficant hip ROM and tissue quality problems. In terms of range of motion, the most common culprints are hip internal rotation deficit (HIRD) and a lack of hip extension and knee flexion (rectus femoris shortness). Pitchers are often asymmetrical in hip flexion, too, with the front leg having much more ROM. In terms of tissue quality, the hip external rotations, hip flexors, and adductors are usually very restricted.
This is has proven true of guys who lift and guys who don't lift. The latter group just so happens to be skinny and weak, too!
Done appropriately, strength training isn't causing the problem - particularly when we are talking about huge contracts that restrict how aggressive programming can be. Trust me; guys with $20 million/year contracts aren't squatting 500 pounds very often...or ever. The risk-reward is way out of whack, and no pro strength coach is going to put his job on the line with programming like that.
However, strength training may be indirectly contributing to the problem by shifting an athlete's focus away from flexibility training and foam rolling/massage. Pro athletes are like everyone else in this world in that they have a limited time to devote to training, but to take it a step further, they have a lot of competing demands for their attention: hitting, throwing, lifting, sprinting, stretching, and soft tissue work. So, they have to pick the modalities that give them the biggest return on time investment and prioritize accordingly in terms of how much time they devote to these initiatives. Some guys make bad choices in this regard, and hip flexibility and tissue quality get ignored.
Baseball is a sport that doesn't permit ignorance, unfortunately, and this is one of many reasons why it has one of the highest injury rates in all of professional sports. We are talking about an extremely long competitive season with near daily games - a schedule that makes it challenging to maintain/build strength, flexibility, and tissue quality. Throwing a baseball is also the fastest motion in all of sports. Rotational sports have the pelvis and torso rotating in opposite directions at the same time. And, as I noted in Oblique Strains and Rotational Power, most professional ballplayers have a stride length of about 380% of hip width during hitting. It is really just a matter of which joint will break down first: hip, knee, or lower back. Taking immobile hips with poor tissue quality out into a long season with these demands is like doing calf raises in the power rack when someone is around with a video camera: you are just asking for a world of hurt.
So, what to do? Well, first, get cracking on tissue quality with regular foam rolling and massage (the more an athlete can afford, the better). Here is the sequence all Cressey Performance athletes go through before training.
In many of our guys, we also add in extra adductor rolling on the stretching table.
Second, you've got to hammer on flexibility. We spend a ton of time with both static stretching and dynamic flexibility. Here are a few of the static stretching favorites (the first to gain hip internal rotation, and the second to gain hip extension and knee flexion ROM):
Third, as Dr. Eric Cobb has written, you use resistance training to "cement neural patterns." This includes all sorts of lower-body lifting variations - from single-leg movements, to glute-ham raise, to deadlifting and squatting variations - and multi-directional core stability drills. And, often overlooked is the valuable role of medicine ball training in teaching good hip (and scap) loading patterns:
For more information, check out my previous newsletter, Medicine Ball Madness, which describes our off-season medicine ball programs in considerable detail.
All taken together, my take is that the increase in hip injuries at the MLB level has everything to do with early baseball specialization and improved diagnostic capabilities. However, when you examine hip dysfunction under a broader scope, you'll see that this joint breaks down for many of the same reasons that lower backs and knees reach threshold: inattention to tissue quality and targeted flexibility training. Strength training works synergistically with these other components of an effective program just like it would at any other joint.
*A special thanks goes out to Tony "Explosive Calves" Gentilcore for being a good sport in the videos in this newsletter.
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Q: My son pitches for a Division II baseball program - well, at least, until recently. Since he began his strength training regimen one year ago, his pitches have gained velocity, but he no longer has control over the ball. Is it possible that his training has changed the mechanics in his arm so much that he has no idea where the ball is going after it leaves his hand? He's frustrated - we are talking about one of the best and strongest in collegiate baseball and now they won't even put him on the mound. I asked some baseball veteran friends about it and they suggested he has to retrain his arm since he has become so much stronger. What are your thoughts?
A: I've definitely seen guys who have gained muscle mass and lost velocity because they didn't train the right way, and it can absolutely go in the opposite direction as well and affect control.
I agree with your pitching coaches that he probably needs to retrain his mechanics with the added weight, but to be honest, it's something that should have been happening with a gradual weight gain anyway. I would be more inclined to look to address any range of motion (ROM) deficits he may have acquired through the process of gaining weight.
For instance, if he lost some hip rotation ROM, it could markedly affect control. A guy without enough hip internal rotation will fly open early on his front leg and, as a result, the arm lags behind (and out of the scapular plane, which can also lead to arm problems). A guy who loses external rotation tends to stay closed, which means he either throws more across his body (increased arm stress) or miss high and inside frequently (in the case of a RHP vs. right-handed batter, or LHP vs. left-handed batter).
Likewise, a pitcher who bench presses until he's blue in the face can lose both external rotation and horizontal abduction ROM. These ROM factors are two (of many) predictors of velocity, and while a decrease in one or both normally equates to a drop in velocity, it could also cause a pitcher to change his arm slot. I actually wrote more about this in an old newsletter: Lay Back to Throw Gas.
These are just some thoughts. I'd need to do some ROM tests and see some videos of him throwing to know for sure if any of my impressions are on the money.
For more information, I'd definitely recommend you check out the 2008 Ultimate Pitching Coaches Bootcamp DVD Set.
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