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Exercise of the Week: Bent-over T-Spine Rotation with Hip Hinge

I wanted to introduce you to a new exercise we've been playing around with lately. I created the bent-over thoracic spine rotation with hip hinge because I was looking for a way for athletes to avoid compensatory movements as we worked on thoracic spine mobility in the standing position. Essentially, you'll often see folks with limited thoracic spine mobility move East-West with the hips or laterally flex through the spine as they try to find motion in spite of their limitations. By pushing the butt back to the wall, we effectively block off compensatory hip motion (and work on a better hip hinge pattern at the same time).

Key coaching points:

1. By having the eyes follow the hand, you get some cervical rotation to help things along.

2. Make sure the upper back is moving and you aren't just "hanging out" on the front of the shoulder. This is especially true in a throwing population who may have acquired anterior shoulder laxity.

3. We'll usually do eight reps per side. This can be included as a single set during a warm-up, or for multiple sets as fillers during a training session (we'll often plug it in between medicine ball sets).

4. This is a better option for those who have active range-of-motion limitations to thoracic spine rotation, as opposed to passive limitations. In the case of the passive limitations, athletes are better off with things like side-lying windmills, where they have assistance from gravity (instead of having to compete against it).

To learn more about how we assess, program, and coach around the thoracic spine (and entire shoulder girdle), be sure to check out Sturdy Shoulder Solutions.

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Strength and Conditioning Stuff You Should Read: 11/3/18

I hope your weekend is off to a good start. It's been a while since I published a compilation here, so there was quite a bit to sift through. Here's a little recommended reading and listening from around the 'net.

10 Tips for Better Sleep - This solid article from the crew at Examine.com includes a lot of strategies that are easy to implement.

Kelly Starrett on Building the Mobility WOD Empire - I'm a big fan of both Kelly and Mike Robertson (who interviewed him), so this podcast was a win/win for me.

How Environment Shapes Training Success - An interaction with a client earlier this week reminded me of this post I wrote up last year.

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Assessments You Might Be Overlooking: Installment 6

It's been quite some time since I published an update to this series, but some recent professional baseball initial offseason evaluations have had me thinking more and more about how important it is to take a look at lateral flexion.

In the picture above, I'd say that the athlete is limited in lateral flexion bilaterally, but moreso to the left than right. You'll also notice how much more the right hip shifts out (adducts) as he side bends to the left; he's substituting hip fallout for true lateral flexion from the spine. The most likely culprit in this situation is quadratus lumborum on the opposite side (right QL limits left lateral flexion).

As you can see from the picture below, the triangle shaped QL connects the base of the rib cage to the top of the pelvis and spine.

Stretching out the QL isn't particularly challenging; I like the lean away lateral line stretch (held for five full exhales). This is a stretch that can be biased to target the lat, QL, or hip abductors.

That said, the bigger issue is understanding why a QL gets tight in the first place. As Shirley Sahrmann has written, whenever you see an overactive muscle, look for an underactive synergist. In this case, the right glutes (all of them) are likely culprits. If the gluteus maximus isn't helping with extending the hip, the QL will kick on to help substitute lumbar extension. And, if the gluteus medius and minimus aren't doing their job as abductors of the hip, the QL will kick in to "help out" in the frontal plane. This double whammy has been termed a Left AIC pattern by the good folks at the Postural Restoration Institute, and they've outlined many drills to not only address the apical expansion (which creates length through the QL), but also bring the pelvis back to neutral.

Taking this a step further, typically, those with very overactive QLs will also present with limited thoracic rotation (in light of the QL attachment on the inferior aspect of the ribs), so you'd be wise to follow up this stretch with some thoracic mobility work. The athlete in the example at the top of this article had the most limited thoracic rotation (both active and passive) that I've seen in any pitcher this offseason.

That said, here's a good rule of thumb:

If you have a flat thoracic spine athlete with limited thoracic rotation, look at pectoralis major, latissimus dorsi, and quadratus lumborum. If horizontal abduction (pec) and shoulder flexion (lat) both check out well, go right for QL tissue extensibility (as measured by lateral flexion). It will be absolute game changer - particularly in rotational sport athletes.

If you're looking to learn more about how we assess, program, and coach at the shoulder girdle, be sure to check out my new resource, Sturdy Shoulder Solutions.

Sign-up Today for our FREE Baseball Newsletter and Receive Instant Access to a 47-minute Presentation from Eric Cressey on Individualizing the Management of Overhead Athletes!

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3 Random Thoughts on Rotator Cuff Readiness

Both Cressey Sports Performance facilities are booming with baseball players coming back to start their offseason training, so it's the time of year when athletes are working hard to get their rotator cuff control back before they start up their offseason throwing programs. With that said, I've been thinking about some big principles on the rotator cuff readiness front.

1. In a broad sense, just above every rotator cuff exercise can be categorized in one of five ways:

a. Strength - this consists of manual resistance work and anything with cables at dumbbells; it needs to be loaded up and challenging.

b. Timing - this consists of drills like 90/90 holds and rhythmic stabilizations.

c. Endurance - this builds on what we see in Option A (some of the same exercises), but the resistance is a bit lower and it's done for higher reps or a longer time. The goal is less about strength and more about training the ability to hold the humeral head on the glenoid fossa for a lengthier period of time. I'd call it more important for a sport like swimming than for baseball or tennis athletes.

d. Irradiation - this can refer to just about any exercise, as your rotator cuff fires reflexively any time your arm moves. That said, certain exercises - bottoms-up kettlebell variations, for instance - are particularly useful for challenging this category of drills.

e. Patterning - these are just drills that take the humerus through its full range-of-motion. Of particular importance is end-range external rotation, which we train with drills like this:

2. I prefer near-daily exposures rather than exhaustive, less frequent programs.

If you look at our training programs, most of our pro guys are doing some kind of targeted training for the rotator cuff 5-6 days per week. Twice per week, we'll push more strength and irradiation work, and twice per week, we'll cover more timing drills. Just about every day, though, there will be some kind of patterning exercise so that we're reminding the cuff of what it's supposed to do.

This approach is a stark contrast to what you usually see in the baseball world, which is notorious for handing out the 2x/week arm care routines that take 45-60 minutes each. They're usually about 15 exercises for multiple sets, and leave an athlete hanging by the end of the session. I think this approach has more to do with the fact that it lines up with what's convenient for 2-3x/week physical therapy sessions than because it's truly optimal. I'm of the belief that you don't need (or want) to exhaust the cuff to get it to where it needs to be.

And, while we're at it, if the cuff is going to get abused on a daily basis with throwing, lifting, and activities of daily living, why not give it some more frequent exposure to build a little tissue resiliency?

3. Posterior deltoid shouldn't be lumped in with infraspinatus and teres minor.

Many times, the reason we have discomfort or the "wrong" feeling with drills is that athletes are paying close attention to the osteokinematics - gross movements of internal/external rotation, flexion/extension, adduction/abduction - of the joint in question, but not paying attention to the arthrokinematics of that same joint. In other words, the rolling, rocking, and gliding taking place needs to be controlled within a tight window to ensure ideal movement.

In shoulder external rotation variations, as we externally rotate the arm, the humeral head (ball) likes to glide forward on the glenoid fossa (socket). The glenohumeral ligaments (anterior shoulder capsule), rotator cuff, and biceps tendon are the only things that can hold it in the socket. In a throwing population, the capsule is usually a bit loose and the cuff is a bit weak, so the biceps tendon often has to pick up the slack - which is why some folks wind up feeling these in the front, thereby strengthening a bad pattern. There are also a bunch of nerves at the front of the shoulder that can get irritated.

Now, here's where things get a bit more complex. The infraspinatus and teres minor are both rotator cuff muscles that have attachments right on the humeral head, so they can control the arthrokinematics (posterior glide) during external rotation work. Conversely, the posterior deltoid (blue, in the image below) runs from the posterior aspect of the spine of the scapula to further down the arm on the deltoid tubercle. In other words, it completely bypasses control of the humeral head.


By Anatomography - en:Anatomography (setting page of this image), CC BY-SA 2.1 jp, https://commons.wikimedia.org/w/index.php?curid=22835985

With this in mind, the posterior deltoid actually creates a gliding forward of the humeral head as it externally rotates and horizontally abducts the arm. For this reason, you need to make sure the arm doesn't come back (horizontal abduction) as it externally rotates during your arm care drills. This video should clarify things, if you're a visual learner:

Looking for more insights like these? Be sure to check out my new resource, Sturdy Shoulder Solutions.

 

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Strength and Conditioning Stuff You Should Read: 10/19/18

It's been pretty quiet here on the blog of late, as we've been really crazy with the CSP Fall Seminar, our Business Building Mentorship, loads of pro baseball guys starting up their offseason, and us moving the family down to Florida for the offseason. While there hasn't been a lot of time for new content, I do have some good recommendations from around the 'Net for you:

CSP Fall Seminar Live Tweet Stream - Andrew Lysy (one of our coaches at CSP-MA) live Tweeting bits and pieces of the presentations from this past weekend, and there are some great nuggets in there. You can follow along with them at https://twitter.com/hashtag/CSPFS2018?src=hash

How to Build an Aerobic Base with Mobility Circuits - I wrote this blog three years ago, and it seemed like a good time to reincarnate it, as this is the time of year when we're incorporating these strategies with a lot of our MLB guys as they get back in action in the weight room.

EC on the Robby Row Show - If you're interested in baseball development, check out this podcast I did with Robby Rowland.

3 Loading Types You've Likely Never Heard Of - This was an awesome guest post from Chris Merritt for Mike Robertson's website.

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Is It Really Biceps “Tendonitis?”

One of my biggest pet peeves is when all anterior shoulder pain is given a "blanket diagnosis" of biceps tendonitis. With that in mind, today, I've got a webinar excerpt from my Sturdy Shoulder Solutions resource that delves into the topic in greater detail. Check it out:

For more information, check out www.SturdyShoulders.com.

Also, if you're looking for an in-person shoulder course that discusses these topics in greater detail, be sure to look into my November 11 course in Indianapolis. You can learn more HERE.

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Exercise of the Week: Knee to Knee Rollover Medicine Ball Stomps

If you've followed my writing for any length of time, you'll know that I'm a big fan of using medicine ball training for power development with our athletes. We have both rotational and overhead variations - and sometimes, we have drills that combine the two. Enter the knee-to-knee rollover medicine ball stomp.

Key Coaching Points:

1. Don't rush the back hip rotation; rather, sit into that hip for what seems like an uncomfortable long time. This allows hip-shoulder separation to occur.

2. Minimize lower back arching.

3. Be firm into the ground on the front leg. Some individuals will stiffen up on that front leg with more knee extension, while others will be slightly more flexed.

4. Perform 3-4 reps per side.

5. We utilize this exercise several months into the offseason after we've had a chance to optimize overhead and rotational medicine ball technique with less complex drills. Athletes have to earn this one.

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Exercise of the Week: 1-leg Side Bridge

A lot of people write off side bridges as “too easy” without considering that there are actually a lot of progressions one can employ to make them more advanced. To that end, I really like the one-leg side bridge with the top leg on a bench as a great way to "own" the frontal plane.

A few notes:

1. Make sure the body creates a straight line from the head to the heel.

2. If you feel any discomfort on the inside of the knees, it's because you've set up incorrectly or just aren't strong enough to do this movement.

3. Imagine the weight distribution being 50/50 between the two points of contact (forearm and foot).

4. I’ll usually program this as 3-5 breaths (with a full exhale) per side in each set.

5. Typically, I'll include this as part of a D1/D2 pairing at the end of a training session. Usually, it'll be preceded by some kind of anti-extension core exercise like a rollout or fallout.

Enjoy!

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Indianapolis Seminar Announcement: November 11, 2018

I just wanted to give you a heads-up on one-day seminar with me in Indianapolis, IN on Sunday, November 11, 2018.

Cressey scapula

We’ll be spending the day geeking out on shoulders, as the event will cover Shoulder Assessment, Corrective Exercise, and Programming.  The event will be geared toward personal trainers, strength and conditioning professionals, rehabilitation specialists, and fitness enthusiasts alike.

Agenda

9:00AM-9:30AM – Inefficiency vs. Pathology (Lecture)
9:30AM-10:15AM – Understanding Common Shoulder Injuries and Conditions (Lecture)
10:15AM-10:30AM – Break
10:30AM-12:30PM – Upper Extremity Assessment (Lab)
12:30PM-1:30PM – Lunch
1:30PM-3:30PM – Upper Extremity Mobility/Activation/Strength Drills (Lab)
3:30PM-3:45PM – Break
3:45PM-4:45PM – Upper Extremity Strength and Conditioning Programming: What Really Is Appropriate? (Lecture)
4:45PM-5:00PM – Q&A to Wrap Up

Location

Indianapolis Sports and Fitness Training
9402 Uptown Drive
Suite 1600
Indianapolis, IN 46256

Continuing Education Credits

The event has been approved for 0.7 CEUs (7 contact hours) through the National Strength and Conditioning Association (NSCA).

Cost: $199.99 

Click here to register using our 100% secure server!

Note: we'll be capping the number of participants to ensure that there is a lot of presenter/attendee interaction - particularly during the hands-on workshop portion - so be sure to register early, as previous offerings of this evan have sold out well in advance of the early-bird registration deadline.

Looking forward to seeing you there!

Questions? Please email ec@ericcressey.com.

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Strength and Conditioning Stuff You Should Read: 9/21/18

I missed a week of this weekly recap in light of the big Sturdy Shoulder Solutions sale last week, so I've had a chance to stockpile some good stuff for you. Before we get to it, a friendly reminder that tonight at midnight is the early-bird registration deadline for the Cressey Sports Performance Fall Seminar. You can learn more HERE.

With the fall seminar in mind, I want to highlight some content from our presenters:

45 Lessons I've Learned Along the Way - Pat Rigsby is our keynote speaker at the fall event, and this was an outstanding post he just published on his 45th birthday.

How to Cultivate Intrinsic Motivation in Young Athletes - CSP-MA Director of Performance John O'Neil wrote up this article shortly after his 2014 internship with us, but the lessons still go strong today.

The Biggest Challenge in Offering Semi-Private Training - and How to Solve It - This was an awesome post on the business of fitness from my CSP-MA business partner, Pete Dupuis.

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