On Monday night, Josh Hamilton put on an amazing show with 28 homeruns in the first round of the MLB Homerun Derby. While he went on to lose to Justin Morneau in the finals of the contest, Hamilton did smash four 500+ ft. shots - and stole the hearts of a lot of New York fans. It's an incredible story; Hamilton has bounced back from eight trips to rehabilitation for drugs and alcohol to get to where he is today.

Geek that I am, though, I spent much of the time focusing on the incredible hip rotation and power these guys display on every swing. According to previous research, the rotational position of the lead leg changes a ton from foot off to ball contact. After hitting a maximal external rotation of 28° during the foot off “coiling” that takes place, those hips go through some violent internal rotation as the front leg gets stiff to serve as a “block” over which crazy rotational velocities are applied.

How crazy are we talking? How about 714°/s at the hips? This research on minor leaguers also showed that stride length averaged 85cm - or roughly 380% of hip width. So, you need some pretty crazy abduction and internal rotation range-of-motion (ROM) to stay healthy. And, of course, you need some awesome deceleration strength – and plenty of ROM in which to apply it – to finish like this.

Meanwhile, players are dealing with a maximum shoulder and arm segment rotational velocities of 937°/s and 1160°/s, respectively. All of this happens within a matter of 0.57 seconds. Yes, about a half a second.

These numbers in themselves are pretty astounding – and probably rivaled only by the crazy stuff that pitchers encounter on each throw. All these athletes face comparable demands, though, in the sense that these motions take a tremendous timing to sequence optimally. In particular, in both the hitting and pitching motions, the hip segment begins counterclockwise (forward) movement before the shoulder segment (which is still in the cocking/coiling phase). Check out this photo of Tim Hudson (more on this later):

Many of you have probably heard about a “new” injury in major league baseball – oblique strains – which have left a lot of people looking for answers. In fact, the USA Today published a great article on this exact topic earlier this season. Guys like Hudson, Chris Young, Manny Ramirez, Albert Pujols, Chipper Jones and Carlos Beltran (among others) have dealt with this painful injury in recent years. You know the best line in this entire article? With respect to Hudson:

“After the 2005 season, he stopped doing core work and hasn't had a problem. Could that be the solution?”

I happen to agree with the mindset that some core work actually contributes to the dysfunction – and the answer (to me, at least) rests with where the injury is occurring: “always on the opposite side of their throwing arm and often with the muscle detaching from the 11th rib.” If I’m a right-handed pitcher (or hitter) and my left hip is already going into counter-clockwise movement as my upper body is still cocking/coiling in clockwise motion – both with some crazy rotational velocities – it makes sense that the area that is stretched the most is going to be affected if I’m lacking in ROM at the hips or thoracic spine.

I touched on the need for hip rotation ROM, but the thoracic spine component ties right into the “core work” issue. Think about it this way: if I do thousands of crunches and/or sit-ups over the course of my career – and the attachment points of the rectus abdominus (“abs”) are on the rib cage and pelvis – won’t I just be pulling that rib cage down with chronic shortening of the rectus, thus reducing my thoracic spine ROM in the process?

Go take another look at the picture of Tim Hudson above. If he lacks thoracic spine ROM, he’s either going to jack his lower back into lumbar hyperextension and rotation as he tries to “lay back” during the late cocking phase, or he’s just going to strain an oblique. It’s going to be even worse if he has poor hip mobility and poor rotary stability – or the ability to resist rotation where you don’t want it.

Now, I’m going to take another bold statement – but first some quick background information:

1. Approximately 50-55% of pitching velocity comes from the lower extremity.

2. Upper extremity EMG activity during the baseball swing is nothing compared to what goes on in the lower body. In fact, Shaffer et al. commented, “The relatively low level of activity in the four scapulohumeral muscles tested indicated that emphasis should be placed on the trunk and hip muscles for a batter's strengthening program.”

So, the legs are really important; that 714°/s at the hips has to come from somewhere. And, more importantly, it’s my firm belief that it has to stay within a reasonable range of the shoulder and arm segment rotational velocities of 937°/s and 1160°/s (respectively). So, what happens when we give a professional baseball player a foo-foo training program that does little to build or even maintain lower-body strength and power? And, what happens when we have that player run miles at a time to “build up leg strength?” How many marathoners do you know who throw 95mph and need those kind of rotational velocities or ranges of motion? Apparently, bigger contracts equate to weaker, tighter legs…

Meanwhile, guys receive elaborate throwing programs to condition their arms – and they obviously never miss an upper-body day (also known as a “beach workout"). However, the lower-body is never brought up to snuff – and it lags off even more in-season when lifting frequency is lower and guys do all sorts of running to “flush their muscles.” The end result is that the difference between 714°/s (hips) and 937°/s and 1160°/s (shoulders and arms) gets bigger and bigger. Guys also lose lead-leg hip internal rotation over the course of the season if they aren’t diligent with their hip mobility work.

So, in my opinion, here’s what we need to do avoid these issues:

1. Optimize hip mobility – particularly with respect to hip internal rotation and extension. It is also extremely important to realize the effect that poor ankle mobility has on hip mobility; you need to have both, so don’t just stretch your hip muscles and then walk around in giant high-tops with big heel-lifts all day.

2. Improve thoracic spine range of motion into extension and rotation.

3. Get rid of the conventional “ab training/core work” and any yoga or stretching positions that involve lumbar rotation or hyperextension and instead focus exclusively on optimizing rotary stability and the ability to isometrically resist lumbar hyperextension.

4. Get guys strong in the lower body, not just the upper body.

5. Don’t overlook the importance of reactive work both in the lower and upper-body. I’ve read estimates that approximately 25-30% of velocity comes from elastic energy. So, sprint, jump, and throw the medicine balls.

Sign-up Today for our FREE Baseball Newsletter and Receive a 47-Minute Presentation on Individualizing the Management of Overhead Athletes!

I’ll be making my Fenway Park debut on Saturday. I know it’s hard to believe, but it won’t be for my catching abilities, base-stealing prowess, or 95-mph two-seam fastball. Rather, I’ll be speaking on a panel at the annual Fenway Park Fantasy Day to benefit The Jimmy Fund. And, if people don’t give a hoot about listening to me, they’ve got a skills zone with batting cages, a fast-pitch challenge, and accuracy challenge on top of loads of contests and tours. I’ll be sure to snap some photos for you.

This is an absolutely great cause, and while I know most of you won’t be in attendance, I’d highly encourage you to support the cause with a donation to the Jimmy Fund. What they are doing is something very special, and I’m honored to be a part of it.

A: Thanks for the email.  It really depends on whether you're dealing with someone who just has an accentuated kyphotic curve or someone who actually has some sort of clinical pathology (e.g. osteoporosis, ankylosing spondylitis, Cushing’s Syndrome) that's causing the "hump."  In the latter case, you obviously need to be very careful with exercise modalities and leave the “correction” to those qualified to deal with the pathologies in question.

In the former case, however, there’s quite a bit that you can do. You mentioned using a foam roller as a “prop” around which you can do thoracic extensions:

Thoracic Extensions on Foam Roller

While some people think that tractioning the thoracic spine in this position is a bad idea, I don’t really agree. We’ve used the movement with great success and absolutely zero negative feedback or outcomes.

With most of these exercises, you’re using motion of the humerus to drive scapular movement and, in turn, thoracic spine movement.

The importance of t-spine rotation again rang true earlier this week when I had lunch with Neil Rampe, director of corrective exercise and manual therapy for the Arizona Diamondbacks. Neil is a very skilled and intuitive manual therapist, and he had studied extensively (and observed) the effect of respiration. He made some great points about how we can’t get too caught up in symmetry. Neil noted that we’ve got a heart in the upper left quadrant, and a liver in the lower right. The left lung has two lobes, and the right lung has three – and there’s some evidence to suggest that folks can usually fill their left lung easier than their right. The right diaphragm is bigger than the left –and it can use the liver for “leverage.” The end result is that the right rib winds up with a subtle internally rotated position, which in turns affects t-spine and scapular positioning. Needless to say, Neil is a smart dude – and once I got over how stupid I felt – I started scribbling notes. I’m going to be looking a lot more at breathing patterns as a result of this lunch.

Additionally, it’s very important to look at the effects of hypomobility and hypermobility elsewhere on thoracic spine posture. If you’re stuck in anterior pelvic tilt with a lordotic spine, your t-spine will have to compensate by rounding in order to keep you erect. And, if you’ve shortened your pecs and pulled the scapulae into anterior tilt and protraction, you’ll have a t-spine that’s been pulled into flexion. Or, if you’ve done thousands and thousands of crunches, chances are that you’ve shortened your rectus abdominus so much that your rib cage is depressed to the point of pulling you into a kyphotic position.

On the hypermobility front, poor rotary stability at the lumbar spine can lead to excessive movement at a region of the spine that really isn’t designed to move. It’s one reason why I like Jim Smith’s Combat Core product so much; he really emphasize rotary stability with a lot of his exercises. Lock up the lumbar spine a bit, and you’ll get more bang for your buck on the t-spine mobilizations.

As valuable as all the t-spine extension and rotation drills can be, they are – when it really comes down to it – just mobility drills. And, to me, mobility drills yield transient effects that must be sustained and complemented by appropriate strength and endurance of surrounding musculature. Above all else, strength of the appropriate scapular retractors (lower and middle trapezius) is important. You can be very strong in horizontal pulling – but have terrible posture and shoulder pain – if you don’t row correctly.

Not being cognizant of head and neck position can lead to a faulty neck pattern:

Cervical hyperextension (Chin Protrusion) Pattern

Here, little to no scapular retraction takes place. And, whatever work is done by the scapular retractors comes from the upper traps and rhomboids – not what we want to hit.

Then, every gym has this guy. He just uses his hip and lumbar extensors to exaggerate his lordotic posture and avoid using his scapular retractors at all costs.

Another more common, but subtle technical flaw is the humeral extension with scapular elevation. Basically, by leaning back a bit more, an individual can substitute humeral extension for much of the scapular retraction that takes place – so basically, the lats and upper traps are doing all the work. This can be particularly stressful on the anterior shoulder capsule in someone with a scapula that sits in anterior tilt because of restrictions on pec minor, coracobrachialis, or short head of the biceps. Here is what that issue looks like when someone is upright like they should be. A good seated row would like like this last one – but with the shoulder blades pulled back AND down. We go over a lot of common flaws like these in our Building the Efficient Athlete DVD series.

Finally, don’t overlook the role that soft tissue quality plays with all of this. Any muscle – pec minor, coracobrachialis, short head of the biceps – that anteriorly tilts the scapulae can lead to these posture issues. Likewise, levator scapulae, scalenes, subclavius, and some of the big muscles like pec major, lats, and teres major can play into the problem as well. I’ve always looked at soft tissue work as the gateway to corrective exercise; it opens things up so that you can get more out of your mobility/activation/resistance exercise.

Hopefully, this gives you some direction.

“Forget avocado, evening primrose oil or other exotic ingredients, the latest facial to hit New York is a mask made with bird excrement. The Geisha Facial, available at Shizuka New York for $180, about $100 more than the shop's other facials, contains nightingale excrement.”

The message is that you can sell people on any kind of crap (pun intended) that you want.

Research on the repeated exposures effect in marketing shows that the more people see something (to a point of limited returns), the more they accept it as not only as fact, but as convenience – or even gospel – as well. It’s the reason so many people “Xerox” rather than photocopy – or grab a Kleenex rather than a tissue. While making some photocopies, blowing your nose, or even rubbing bird crap on your face is a far cry from lifting heavy stuff, you’d be surprised at the messages you can glean from this introduction.

If I told you in a Monday T-Nation article that my nightingale excrement protocol would add 50 pounds to your squat in two weeks, would you buy it? Probably not. But, if Christian Thibaudeau chimed in on Tuesday and said that he’d added one inch to his biceps over the course of a month by simply massaging bird poo onto his upper arms, you’d probably raise an eyebrow and read on.

Then, Mike Robertson chimes in on Wednesday to tell you that, “as demonstrated by an independent laboratory study” (which, incidentally, was funded by the American Society for the Advancement of Bird S**t), nightingale dung reduces knee pain in arthritis patients. Thursday, Chad Waterbury tells you that ten sets of three minutes of bird s**t on your face works better than three sets of ten minutes. Friday, TC admits he sniffs nightingale doo-doo to gain inspiration for each Atomic Dog column.

You’re sold.

There are no peer-reviewed studies displaying quantifiable results, or even a good amount of anecdotal, subjective evidence to support the aforementioned notions.

A few years ago, I wrote a series called “Debunking Exercise Myths.” In hindsight, I probably should have called it “Stupid Stuff You Shouldn’t Believe” – especially since I’m a few years older and a bit more cynical now. These were two of my more popular articles to-date, so I thought I’d throw it out there to get some reader input: would you like to see more?

And, if so, feel free to drop us an email with your suggestions on topics to cover. You can send an email to ec@ericcressey.com with the subject line “Debunking Exercise Myths Suggestion.” I’ll either cover it in future newsletters and/or blogs, or make a new article out of it altogether.

I had a new article published there yesterday; check out First Person: Cressey .

And, speaking of blogs, check out some of our latest content – including two recent audio interviews with me:

EC on Superhuman Radio

Random Friday Thoughts

Maximum Strength Feedback from the Medical Community

EC on The Fitness Buff Show

All the Best,

EC

Symptoms may come on traumatically (contact injury) or insidiously (overuse, genetic predisposition, or rapid bone growth during puberty). Pain is typically more lateral to the spine than it is centralized.

We have had quite a few athletes come to us with the condition because we work with a ton of athletes in rotational sports, predominantly baseball. In my humble opinion, "spondies" are the new ACL epidemic. Don't believe me? Check out these numbers from a 2000 study from Soler and Calderon (1):

-highest prevalence (27%) in those in track & field throws

-17% of rowers, 14% of gymnasts, and 13% of weightlifters had spondylolysis

-L5 most common (84%), followed by L4 (12%).

-Multiple levels of involvement in only 3% of cases

-Bilateral 78% of the time

-Only 50-60% of those diagnosed actually reported low back pain

-Males and females affected equally (although associated spondylolisthesis - or vertebral "slippage" was higher in females)

-Presence of spondylolysis is estimated at 15-63%, with the highest prevalence among weightlifters.

-Poor bone mineral density (*)

-Poor lower limb alignment and foot structure (*)

-Faulty muscular recruitment patterns (*)

-Height - Taller (non-modifiable)

-Rapid growth (non-modifiable)

-Body Type - muscle mass, longer spine (* to a degree, some non-modifiable)

-Poor conditioning/muscular fatigue (*)

-Bone pathologies (refer out)

-Menstrual/hormonal irregularities (refer out)

-Genetic predisposition: Inuit > Caucasian > African-American (non-modifiable)

-Inappropriate training regimen or surface (*)

-Sporting discipline: Sports demanding repetitive lumbar hyperextension, trunk rotation, and/or axial loading (*short-term, potentially modifiable long-term)

-Footwear (*)

-Cigarette smoking (*)

-Insufficient nutrition - calories, calcium, vitamin D (*)

Now, to get to the question at-hand, return-to-play after a period of bracing is a different story. Believe it or not, we've trained guys through their entire 12-16 week bracing protocols. When they're in the brace, aside from axial loading, there isn't much that can "get them" - meaning that they're completely protected from rotation and extension problems.

In fact, the brace does so much of the work for them that you need to make sure they're seeing a physical therapist at least 1-2 times a week during that protocol to get them out of it to entire that they don't detrain the deep core stabilizers. The brace also restricts full hip extension and flexion - and thoracic spine ROM, to a degree - so mobility work is very important. If I had to briefly summarize our training programs during bracing protocols, it would be "upper body, single-leg movements, pull-throughs, rotary stability training, mobility work, low-level linear plyos and medicine ball throws."

And, you know what? That would summarize my recommendations for the short-term when they get out of the brace - because it's what all athletes need! However, post-spondy athletes are different in several regards:

With respect to the athlete in question, if he is still having residual flare-ups (which do happen relatively frequently), he simply isn't ready for more aggressive loading - presumably because he has some degree of instability in one or more directions. When this is the case, we work around the issue - but check to see if there is a specific deficit that needs to be addressed. It may be as simple as poor breathing patterns or a lack of hip rotation - or it could be something that takes longer to address.

1. Soler T, Calderon C. The prevalence of spondylolysis in the Spanish elite athlete. Am J Sports Med. 2000 Jan-Feb;28(1):57-62.

Somehow in conversation, we got on the topic of the alarming rates of youth sports injuries – everything from ACL ruptures, to stress fractures, to Tommy John surgeries – at hand today. He asked very simply, “Why has it gotten so bad – and seemingly so fast?”

My response was, “Well, there are a lot of reasons. First – and most significantly – when I was young…”

I nearly swallowed my tongue when I caught myself saying that, but continued on.

Over the next few minutes, I talked a bit about what my buddies and I did every day after school when I was growing up. I lived next door to a church that had a big grass parking lot that was only used on Sundays. The rest of the week, it was a football/baseball/wiffleball/soccer/dodgeball/any-other-ball-you-can-think-of extravaganza. We played until our mothers called us home to dinner. There were days when I was so dirty when I got home that my parents just threw my clothes away rather than try to wash them.

In terms of organized sports, we never played a sport for more than six months consecutively – and even that time period would be a stretch. I can remember being involved in organized soccer, basketball, flag football, tennis, and baseball around fourth grade.

You know what’s wild? From that little churchyard in little Kennebunk, Maine came six eventual NCAA athletes and seven NCAA coaches (four in lacrosse, two in strength and conditioning, and one in football). There was a D1 All-American/professional lacrosse player, 500-pound raw bench press, and world record in the deadlift. There were no ACL tears, stress fractures, ulnar collateral ligament ruptures, or cases of plantar fasciitis. I didn’t even know what an athletic trainer was until I was a sophomore in high school.

The point – which may be hackneyed to many of my newsletter subscribers by now – is that we stayed healthy and came into some athletic success by playing a lot at a young age, but participating a little. And, personally, it wasn’t until I specialized more and started playing tennis nine months out of the year (November-August) that I started dealing with chronic shoulder problems. Had I known then what I know now, it would have been manageable – especially with my diverse athletic background.

So, this brings me to several points…

First, there are more opportunities than ever to participate year-round and without restrictions. Most sport coaches know only tactics and not physiology, so at a time when recognizing the warning signs of injury and burnout is most important, those supervising the system are the least prepared.

Third, in spite of the fact that kinesiology, exercise science, biomechanics, and related health and human performance fields are actually courses of study at academic institutions and beyond – and all the information on training young athletes is out there, if you know where to look – there really aren’t many people doing it correctly. Thanks to some wretched attempts at franchising youth sports training, we’ve been left with a lot of parents and kids that think “running cones” is where it’s at. Many others have just written the idea of youth performance training off altogether because they’ve had bad experiences in these situations. Kids can run cones on their own; they need to be taught how to run, jump, land, lift, and throw.

So, what to do to remedy the situation?

First off, I wish more people would read Brian Grasso’s stuff at DevelopingAthletics.com. Brian’s at the forefront of youth fitness training and really gets it.

Second, while I’d like to think that it’s possible to “undo” the specialization trend, it’s simply not going to happen, folks. The best we’re going to do is learn to recognize the symptoms of burnout/injury early on – and encourage kids to hold off until later in high school before choosing one specific sport. Kirk Fredericks, head coach of the Lincoln-Sudbury High School varsity baseball team (Massachusetts State Champs in 2005 and 2007), is the single-best coach with whom I have worked at any level. I was at his team’s award banquet two weeks ago to hear Kirk credit the success of his only three sophomores on the varsity squad to playing multiple sports and focusing on getting stronger. He didn’t rave about how they took batting practice 365 days of the year – or all the time they spent running cones. Versatility, athleticism, and strength were what differentiated them from their peers.

Third, kids need to move – and be taught how to move. Call me biased, but organized strength and conditioning settings are, in my opinion, the best way to provide young athletes with the favorable outcomes and fun through the inherent variety featured in any appropriate S&C program. You can train mobility, activation, strength, stability, reactive ability, sprint mechanics, you name it – all in a single session.

Fourth, I would like to see physicians become more proactive with encouraging young athletes to seek out effective training. Having communicated with some excellent physicians myself, I’ve come to realize that the best doctors know that their recommendations to young athletes go beyond simply protecting sutures. It is also about setting an athlete up for future health and success.

Fifth, those training young athletes have to not only get more in-tune with how to do it well, but also structure their business models to accommodate leveraging this knowledge. I can only speak to what I have practiced with Cressey Performance:

1. Grow slowly and hire extremely carefully.

2. Know every bit of each athlete’s health history.

3. Program individually.

4. Put young athletes in an environment in which they can thrive on each other’s energy.

5. Provide specific, quantifiable markers of progress to foster further motivation.

6. Communicate regularly with sport coaches, parents, and the athletes themselves.

7. Appreciate that young athletes are not simply smaller adults.

8. Recognize the imbalances inherent to particular sports.

9. Treat every athlete as if he/she is your own son/daughter (assuming you are not a psycho parent).

10. Keep it FUN.

Audio Interview with EC

About a month ago, I did a phone interview with Kaiser Serajuddin on the topic of the business of personal training. You can listen to it HERE.

Maximum Strength: Working Around Equipment Limitations

Heavy Lifting to Wussy Music: Why Not?

Ignorance is Bliss

A special thanks goes out to Chris Poirier, the entire Perform Better staff, and all the attendees from this year’s PB Summits. Thanks for making them such great events!

I’ll be at the 2^nd Annual Distinguished Lecture Series in Sports Medicine this Friday at Northeastern University – and hopefully have some newsletter tidbits for you from it next week. It’ll be nice to do the listening instead of the lecturing this time – although I may be available for guest shadow puppet and magic trick exhibitions in the lobby on request!

All the Best,

EC

An Interview with EC, by Mike Robertson (continued)...

MR:  You also recently released an e-book called The Art of the Deload.  What prompted you to write a manual all about taking time off training?

MR: Without giving away the farm, what are some of the different scenarios you outline? I know that I talk to people and they think of a deload week as one of two things:

2 – The typical 60% volume approach with a slight reduction in intensity.

• how to deload to make sure old injuries don’t resurface
• how to know when to drop intensity instead of volume
• how to effectively incorporate a testing day at the end of a deload week
• why beginners don’t need to deload
• what active rest means to me
• how to deload on reactive training (particularly important for guys like me who have crazy supinated feet)

Plus, there is some nuts and bolts about how to individualize deload frequency.

To say that I’m a baseball fan would be an understatement. I essentially taught myself to read with baseball cards; I knew the players’ faces, so it was just a matter of sounding out the words on the cards with the names I knew. Now, some 23 years later, I’m older and wiser (I can even read complete sentences now) – but still a huge baseball fan, and far more than just a casual observer to the game.  I spend my days training tons of baseball guys and am pretty much inundated in the game; in fact, as I type this, I am following two minor league games online, as two Cressey Performance athletes are pitching tonight elsewhere in the U.S. At risk of sounding overconfident, I know baseball players: demeanors, attitude toward lifting, imbalances, performance enhancement, you name it.  I feel very strongly that we've created a system that not only knows how to get guys to perform at high levels, but also stay/fet healthy in the process.  That said, the past two days have been pretty big on the local publicity front for Cressey Performance:

• Boston Globe: Baseball Players Train for On-Field Results at Hudson Gym
• Metrowest Daily News: Ostrander, Scanlan Get Northern Exposure

So, with that in mind, it seemed like a good day to reprint an interview Mike Robertson did with me for his newsletter. An Interview with Eric Cressey

By: Mike Robertson (robertsontrainingsystems.com)

MR:  Eric, believe it or not you’ve never done an interview for the site before!  If you don’t mind, please explain to people that we AREN’T the same person. (Yes, people actually thought this for a while!)

EC: I’m actually just the president of the Mike Robertson Fan Club; he’s the real thing.

MR:  You’ve recently opened your own facility, Cressey Performance.  What kind of people are you training on a day-to-day basis?  How is the gym going?

EC:  It’s going very well and we’ve having a blast.  In fact, as I type this, we’re in the process of arranging a move into a new facility; it should take place within two weeks and double our space.

We get a little bit of everything in terms of client variety, but the overwhelming majority of my athletes are baseball players.  This past off-season, we saw 96 baseball guys from 32 high schools, 16 colleges, and 8 major league organizations.  Throw in some football, hockey, triathlete, track and field, soccer, bobsled, skeleton, rowing, and regular ol’ weekend warriors, and it keeps life interesting.

MR:  I’m willing to admit, you know a ton about shoulder.  Couple this with the fact that you work with a ton of baseball players daily, and that pretty much makes you a shoulder guru in my book.

Where are most people missing the boat with regards to training overhead throwing athletes?

EC:  Wow, there is a loaded question.  Here are a few thoughts – speaking specifically to a baseball population to keep it more focused.

People spend too much time looking at the rotator cuff.  It’s like focusing on the oars when there is a hole in your rowboat.  The truth is that when someone’s shoulder goes, the rotator cuff (and labrum) are just the place where someone becomes symptomatic; it’s poor soft tissue quality and faulty movement patterns elsewhere (and in many cases rotator cuff weakness) that cause the problem. So what are these problems?

First off, the very nature of baseball is an issue.  It’s a long competitive season (>200 games as a pro, potentially, and more than half that in high school/college): Short off-season + Long in-season w/daily games = tough to build/maintain strength, power, flexibility, and optimal soft tissue quality.

You’ve got unilateral dominance and handedness patterns, too; when was the last time you saw someone throw the first inning right-handed and then toss the second inning as a southpaw?  We know that asymmetry is a big predictor of injury.

Let’s take it a step further.  The best pitchers – with a few exceptions – are the tallest ones. In chatting with one MLB scout this off-season, he noted that only 14% of major league pitchers are under 6-feet tall.  The longer the spine, the tougher it is to stabilize.  I’ve worked with eleven guys 6-9 or taller since 2003, so I can definitely speak to this from experience.  They were all basketball guys; I can’t imagine how jacked up they’d be if they were throwing baseballs, too!

And, to be more blunt, there is absolutely nothing even remotely healthy about throwing a baseball.  Do a MRI of a pitcher’s shoulder and you’re going to find labral fraying: big deal!  That’s just what happens when you go through 7,500°/second of internal rotation during acceleration – or the equivalent of 20 full revolutions per second!  Some guys are symptomatic and some aren’t; it’s the other “stuff” that’s going on that dictates whether they’re hurting or playing pain-free.

MR: So what’s this “other stuff” of which you’re speaking?

If you want to keep a pitcher healthy, your job is to make him more athletic.  I have seen professional pitchers who couldn’t broad jump 80 inches or front squat 135, yet they could throw 94 mph.  I’m proud to say that we had two pitchers vertical jump over 35” and broad jump over 115” at their spring training testing this year.

Baseball is a population who – believe it or not – still doesn’t understand a) what good strength and conditioning is and b) what that solid training can do for them. I am a firm believer that much of the abuse of performance enhancing drugs in professional baseball is a direct result of players wanting a shortcut to make up for the fact that they really have no clue how to train for peak performance or sustain it for the long haul of a professional career. And, more sadly, there aren’t many good performance enhancement coaches out there who know how to show them the way. I’m strongly believe that our success in working with these guys is directly related to the fact that we show them direct, tangible results of their training, educate them on the “why” of what they’re doing, and make it fun in the process.

That said, in terms of athleticism, my goal is symmetry – or at least bringing guys closer to it in the off-season.  To that end, we address the following to keep shoulders healthy:

•Scapular stability – In Particular, we need to focus on lower trap and serratus anterior.  I know it’s hackneyed by now, but you can’t shoot a cannon from a canoe!  It’s important to get pec minor, levator scapulae, and rhomboids loosened up to make this happen.  The problem is that the research has shown that pitchers have less scapular upward rotation than position players, specifically at humeral elevations of 60 and 90 degrees – the “zone” in which the humerus sits during throwing.

•Thoracic extension and rotation range of motion – If you don’t have thoracic extension and rotation, you won’t be able to get sufficient “lay back” during the cocking phase, so there is a greater stress on both the humerus and elbow to achieve this range of motion.

•Rotator cuff strength/endurance – You need a strong posterior cuff for decelerating all that internal rotation, but you also need a very strong subscapularis to both depress the humeral head during overhead work and prevent anterior translation of that head. The subscapularis takes on an even bigger role when you realize how many overhead athletes have chronic anterior-inferior laxity and posterior-inferior capsular contracture: adaptations that favor anterior translation of the humeral head (which the subscapularis must resist).

•Soft tissue quality – Pay close attention to lats, pec minor, levator scapulae, posterior cuff/capsule, forearms (flexor carpi ulnaris, FC ulnaris, pronator teres), rhomboids, and subscapularis.

•Opposite hip and ankle – 49% of arthroscopically repaired SLAP lesion patients also have a contralateral hip abduction ROM or strength deficit.  Lead leg hip internal rotation range of motion is extremely important for pitchers and hitters alike.

•Core stability/force transfer – If you can’t transfer force from the lower extremity through the core effectively to the upper body, you shouldn’t be throwing a baseball.  Period.

•Glenohumeral (shoulder) ROM – Over time, the dramatic external rotation during the cocking phase can lead to a loss of internal rotation ROM; this is known as glenohumeral internal rotation deficit (GIRD).  The posterior capsule and cuff stiffness leads to a superior and posterior migration of the humeral head during the late cocking phase.  You also get some osseous changes to the humeral head itself. This commonly presents as medial elbow issues – including UCL injuries and ulnar nerve irritation.

To fix this, we use posterior cuff/capsule soft tissue work, sleeper stretches/cross body mobilizations/doorway capsular mobilizations, and then subscapularis isolation work (prone internal rotation, cable internal rotation at 90 degrees of abduction).  Little league elbows get chewed up more by the varus torque (think transition from cocking to acceleration) and present more laterally with pain.  Adolescent elbows are a bit more skeletally mature and break down medially from the valgus-extension overload that takes place during acceleration.   Little leaguers just need to get stronger.  Adolescents need to get stronger and work on posterior cuff flexibility (more internal rotation).  College and pro guys need to start incorporating capsular mobilizations because of the actual structural changes that take place to the capsule.  Back and Goldberg provide an excellent series of photos for each situation HERE.

Now, there is some debate over whether the loss of internal rotation in experienced throwers is due to posterior capsule tightness. Burkhart and Morgan insisted that there was posterior capsule tightness involved via what they called the “peel-back” mechanism, which causes the humeral head to translate posteriorly and superiorly during the late cocking phase. They picked up on these posterior capsule contracture issues during surgeries of a large number of pitchers with type II SLAP lesions.

Wilk, Meiser, and Andrews (2002) countered that it was simply related to the posterior muscular tightness and the aforementioned humeral head adaptations. They therefore recommend primarily cross-body and sleeper stretch drills with the scapula fixed – but don’t pay much attention to the role of the capsule.

I’m not too handy with an arthroscope (I prefer samurai swords for all my impromptu operations), so I keep my mouth shut and do both capsular and soft tissue mobilizations, as they’re all means to the same end. They’re all brilliant guys, but are really debating on which one will get you from point A to point B faster – and how to perform surgeries once you are FUBAR. I’m more concerned with preventing the surgeries in the first place!

Interestingly, there appears to be a “threshold” of internal rotation deficit at which a pitcher becomes symptomatic. In the aforementioned Burkhart and Morgan study, all the surgery cases had an internal rotation deficit of greater than 25°. Myers et al. pinned that “don’t cross this line” number at about a 19° deficit. The research on non-symptomatic throwing shoulders was in the 12-17° range – so every little bit matters. Horizontal adduction (cross-body range of motion) is understandably impaired as well, and the common compensation pattern is for pitchers to substitute extra protraction for this lost ROM during the follow-through. This is where pec minor grows barnacles and the lower traps simply can’t handle the load alone.

•Breathing Patterns – Guys who breath into their bellies have much better shoulder function than those who breath into their chests.

•Cervical Spine ROM – Levator scapulae and sternocleidomastoid have significant implications in terms of shoulder health, but very few people pay attention to them.  Levator scapulae helps to downwardly rotate the scapula, so if it’s tight, overhead motion will be compromised.  SCM attaches to the mastoid process of the skull as well as the sternum and clavicle; it might be the latissimus dorsi of the head and neck.  Suboccipitals can be hugely important as well.  Get ‘em all worked on by a good manual therapist. Forward head posture is associated with too much scapular anterior tilt and too little upward rotation.

•Reactive Ability – We test all our guys on a single-leg triple jump to determine their reactive ability and look for unilateral discrepancies.  Typically, pitchers will have a better score on their lead leg, not their push-off leg.  It sounds backwards, but if you think about it, that front leg is more trained for deceleration and reactive ability (they have to land, and immediately swivel into fielding position).  The back foot is much more geared toward propulsion, so it doesn’t decelerate so well.

Interestingly, you can look at callus patterns and pick up on this.  Check out the base of the 1st and 5th metatarsals on a pitcher’s push-off leg and you’ll typically find calluses that indicate more of a supinator.  Check the lead leg, though, and you’ll find more thickening at the base of the 2nd and 3rd toes, indicating more pronation.  These won’t be as noteworthy in people who throw right and bat left (or vice versa); switch-hitting is actually really valuable for symmetry.

•STRENGTH – Yes, I put this in all caps because it is important.  If you think doing some rubber tubing external rotations is going to help decelerate a 100mph fastball that involves a total-body effort, you might as well schedule your shoulder or elbow surgery now.  Strength is an important foundation, so strengthen your posterior chain, quads, thoracic erectors, scapular retractors, etc, etc, etc.

MR: Damn that’s a pretty thorough answer! How does overhead pressing fit into all of this?  Some people say you need to do it because they encounter it in their sport.  What do you say?

EC: I stay away from it.  Contraindicated exercises in our program include:

•Overhead lifting (not chin-ups, though)

•Straight-bar benching

•One-Arm Medicine Ball Work

•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

While I'm working on a detailed article on this topic, in a nutshell, it has a lot to do with the fact that overhead throwing athletes (and pitchers in particular) demonstrate significantly less scapular upward rotation – and that makes overhead work a problem.  This is particularly serious with approximation exercises, which leads me to…

Comparing most overhead weight training movements (lower velocity, higher load0 to throwing a baseball is like comparing apples and oranges.  Throwing a baseball is a significant traction (humerus pulled away from the glenoid fossa), whereas overhead pressing is approximation (humerus pushed into the glenoid fossa).  The former is markedly less stressful on the shoulder - and why chin-ups are easier on the joint than shoulder pressing.

Likewise, comparing an overhead-throwing athlete to a non-overhead-throwing athlete is apples and oranges again. Throwing shoulders have more humeral and glenoid retroversion, an adaptation that many believe occurs when pre-pubescent athletes throw when the proximal humeral epiphysis (growth plate) isn’t closed yet. This retroversion gives rise to a greater arc of total rotation range-of-motion. Wilk et al termed this the “total motion concept” (internal rotation + external rotation ROM) and noted that the total arc is equal on the throwing and non-throwing shoulders – yet the composition (IR vs. ER) is different in overhead athletes, who have more less internal rotation in their throwing shoulders.

As I mentioned earlier, a lot of people believe that the internal rotation deficit overhead athletes experience has more do to with the osseous changes than soft tissue and capsular issues alone. We can work with the latter, but can’t do anything with the former. So, when someone says that all their YTWLs and theraband exercises make it okay for an overhead throwing athlete to overhead press, I have to wonder how those foo-foo exercises magically changed bone structure. Additionally, this acquired retroversion allows for more external rotation to generate more throwing velocity. In my opinion, this is why you never see someone just “take up” pitching in their 20s and magically become a stud athlete; the bones literally have to morph to throw heat! Believe it or not, some research suggest that this retroversion actually protects the shoulder from injury by “sparing” the anterior-inferior capsule in from excessive stress during external rotation.

Additionally, as I noted above, just about every overhead throwing athlete you see (and certainly all pitchers) have labral fraying. The labrum deepens the glenoid fossa (shoulder socket) by up to 50% and creates stability. Would you want to build a house on a foundation with chipped concrete?

There may even be somewhat of a congenital component to this. Bigliani et al. found that 67% of pitchers and 47% of position players at the professional level have a positive sulcus sign in their throwing shoulder. One might think that this is simply an adaptation to imposed demand – and that very well might be the case. However, those researchers also found that 89% of the pitchers and 100% of the position players with that positive sulcus sign ALSO came up positive in their non-throwing shoulder. It may very well be that the guys with the most congenital laxity are the ones who are naturally able to throw harder – and therefore reach the higher levels. If you’re dealing with a population that’s “picked the right parents” for laxity, you better think twice about having them press anything overhead.

With respect to the Olympic lifts, I'm not comfortable with the amount of forces the snatch puts on the ulnar collateral ligament, which takes a ton of stress during the valgus-extension overload cycle that dramatically changes the physical shape of most pitchers' elbow joints.  Cleans don’t thrill me simply because I don’t like risking any injury to wrists; surgeons do enough wrist and forearm operations on baseball guys already!  We teach all our guys to front squat with a cross-face grip.

Lastly, here is a frame of reference to deter you from the "Since they encounter is in sports, we need to train it in the weight-room" mindset.  Boxers get hit in the head all the time in matches; why don't we intentionally train that?  Getting hit in the head is not good for you, nor will it make you a better boxer.  It is a part of the sport, but they don't intentionally add it into the training because they can appreciate that it would impair longevity.

Some might ask if I feel that it limits development of the athlete on the whole.  If you’re dealing with a little leaguer, feel free to do some overhead stuff with him; I love one-arm DB push presses with our younger kids.  However, with our 16+ athletes, my glass-is-half-full mentality is that we're avoiding any unnecessary risk because the reward is trivial at best compared to what you can do with effective non-overhead programming.  Like I said, every baseball pitcher you see will have fraying in their labrum - and that means less mechanical stability.

MR: So what do you like to do instead? EC:  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

•Med ball throws

•Specialty squat bars: giant cambered bar, safety squat bar

•Front Squats

MR: Okay, that covers pitchers pretty damn well. Do you follow the same guidelines with position players as well?

EC: At the youth levels, pretty much every kid thinks that he is a pitcher or a shortstop. Next to catchers, these two positions throw more than anyone on the field. At the pro ranks, most guys have developed a lot more of the adaptive changes I outlined earlier, so the name of the game is conservative in terms of exercise selection. So, as far as avoiding the contraindicated exercises I noted above, we’re standard across the board.

I look at my baseball guys as pitchers, catchers, and position players. The big areas in which they’re different are a) initial off-season focus and b) in-season training.

In terms of “a,” I’ve found that we need to spend more time ironing out asymmetries early on in the off-season with pitchers, as they simply don’t move as much as position players. Additionally, with the amount of moronic distance running (can you tell I’m not a fan?) that many pitchers do, we spend a lot of time trying to get back a solid base of strength, power, and reactive ability upon which to build some pitching-specific endurance.

In-season, it’s not too hard to program for starting pitchers; you know they’re going to throw on a 5-day (pros) or 7-day (college/high school) rotation. Some guys might close games on Mondays and start on Wednesdays, though. Basically, you plan around the starts – and make sure that you get in a solid lower-body-emphasis lift in within 24 hours after a start. Relievers are a bit more challenging – and in many ways have to be treated as a hybrid between position players and starters. You base a lot of what you do on how many pitches they throw and the likelihood of them pitching on a given day.

As a general rule of thumb, I don’t do chin-ups or heavy pressing the day after someone pitches. It’s generally more rowing and push-up variations.

I don’t squat my catchers deep in-season. We’ll do some hip-dominant squatting (paused or 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.

Position players just need to lift – before or after games. The name of the game is frequency, and as long as you aren’t introducing a lot of unfamiliar exercises or long eccentrics in-season, they won’t be sore.

MR:  This question may be for myself as much as the readers, but what resources can you recommend for someone that wants to learn more about the anatomy and biomechanics of the shoulder and elbow?

EC:  I haven’t seen a really good resource that effectively addresses the need for specialized training in overhead throwing athletes; I’ve actually had a lot of people telling me I should pull something together.  I guess that’ll be a project for the new facility.

That said, there are definitely some great resources available.  First and foremost, I really like all the drills you and Bill outline in Inside-Out – and I’m not just saying that to butter you up (hell, I already got the interview, and I can be a jerk to you whenever I want).

Second, I think Gray Cook’s Secrets of the Shoulder DVD is excellent.

Third is Donatelli’s Physical Therapy of the Shoulder is a classic.  It’s very clinical, and you won’t read it in one sitting, but it’s definitely worth a read.

Fourth is Shirley Sahrmann’s Diagnosis and Treatment of Movement Impairment Syndromes.  Sahrmann really turned me on to looking at things in terms of inefficiency/syndrome rather than pathology.  The way she approaches scapular downward rotation syndrome is great.

Fifth, get over to Pubmed.com and read everything you can from James Andrews – and then search the related articles.  Be sure to check out Throwing Injuries to the Elbow by Joyce, Jelsma, and Andrews as well; it’s important to understand how shoulder dysfunction impacts elbow function.

Blog Update Athletes Aren't as Smart as We Think All the Best, EC

What they’re saying on the internet forums about Maximum Strength…

“Preordered this as soon as I heard about it and I have to say that it is EXCELLENT.

Blog Updates

Q: I had a quick question for you from the Perform Better Summit this past weekend.  I enjoyed your presentation, but was wondering why you do not do any overhead training with your throwing athletes.  Isn't it important to maintain balance in the shoulder musculature and by eliminating that plane of movement are we not putting our athletes at a greater risk for injury?

A: First off, to be clear, I am not opposed to overhead training; that would imply that I don’t like chin-ups, face pulls, long-tossing, or throwing bullpen sessions! I'm actually really surprised at how many people think that I really exclude such training altogether from my programs for non-overhead-throwing athletes. In my presentation, I specifically noted that I was opposed to overhead pressing and the majority of the Olympic lifts in baseball players.

In a nutshell, it has a lot to do with the fact that overhead throwing athletes (and pitchers in particular) demonstrate significantly less scapular upward rotation at 60+ degrees of abduction. Here’s a reference:

Laudner KG, Stanek JM, Meister K. Differences in Scapular Upward Rotation Between Baseball Pitchers and Position Players. Am J Sports Med. 2007 Dec;35(12):2091-5.

From that study: “CLINICAL RELEVANCE: This decrease in scapular upward rotation may compromise the integrity of the glenohumeral joint and place pitchers at an increased risk of developing shoulder injuries compared with position players. As such, pitchers may benefit from periscapular stretching and strengthening exercises to assist with increasing scapular upward rotation.”

Additionally, comparing most overhead weight training movements (lower velocity, higher load) to throwing a baseball is like comparing apples and oranges.  Throwing a baseball is a significant traction (humerus pulled away from the glenoid fossa), whereas overhead pressing is approximation (humerus pushed into the glenoid fossa).  The former is markedly less stressful on the shoulder - and why chin-ups are easier on the joint than shoulder pressing.

With respect to the Olympic lifts, I'm not comfortable with the amount of forces the snatch puts on the ulnar collateral ligament, which takes a ton of stress during the valgus-extension overload cycle that dramatically changes the physical shape of most pitchers' elbow joints. The catch on the clean isn’t something to which I’m going to subject to valuable wrists and hands that go through some serious abuse with every throw and are often injured in diving catches and sliding. I see no problem with high pull variations, though.

To take it a step further, all the research suggests that virtually all baseball players have some degree of labral fraying. The labrum deepens the shoulder “socket” to mechanically provide stability in a joint that is designed for mobility. Without optimal labral function, going to the extreme demands of stability – overhead movements – is not ideal, especially under load.

Lastly, here is a frame of reference to deter you from the "Since they encounter is in sports, we need to train it in the weight-room" mindset.  Boxers get hit in the head all the time in matches; why don't we punch them in the head in the weight room?

The risk outweighs the benefit. Food for thought.

Results Typical

A few weeks ago, I outlined the results my business partner Pete experienced on the four-month Maximum Strength program. One of our clients, Gregg, also completed the entire program; can you start to see a trend?

-Body weight increased by one pound with significant decrease in body fat %

-Broad jump increased by 8 inches

-Vertical jump increased by 2.6 inches

-Box squat increased by 35 pounds

-Deadlift increased by 40 pounds

-Bench press increased by 20 pounds

-Chin-up increased by 25 pounds

For more information, check out Maximum Strength.

Blog Updates Quad Pulls in Baseball Labral Tears and Pitchers All the Best, EC