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Strength and Conditioning Stuff You Should Read: 12/17/18

I hope you had a great weekend. We're getting back on an every Monday schedule with this recommended reading. Before I get to it, just a quick reminder that I just announced a new date for my one-day shoulder course. It'll be taking place near Dallas, TX on January 27. You can learn more HERE.

How Rib Cage Positioning Impacts the Pitching Delivery - CSP-MA pitching coordinator Christian Wonders wrote this up last year, and in light of a recent conversation on pitching mechanics, I wanted to bring it back to the forefront.

Fergus Connolly on Winning and Success at Every Level - Fergus is one of the most insightful guys in the sports science world, and this podcast with Mike Robertson is a great example.

The 7 Keys to Longevity with Dr. Jonny Bowden - Jason Ferruggia interviewed Dr. Bowden on his up-to-date thoughts on a variety of topics: nutrition, sleep, stress, and several other factors.

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Here is an awesome cadaver photo to demonstrate just how little wiggle room there is when dealing with the shoulder. The glenohumeral (ball and socket) joint is maintained in such a small window that it’s possible to say that impingement is a physiological norm. These challenges are even more extreme in the case of structural adaptations and pathology. In other words, we can’t leave any stones unturned in our quest for shoulder health, particularly when one’s sport demands involve high forces and extreme ranges of motion. Anatomy never lies. #cspfamily #Repost @chicagosportsdoc with @get_repost ・・・ Rotator cuff anatomy - A tear into one of these tendons is a common cause of pain and disability among adults. Each year, almost 2 million people in the United States visit their doctors because of a rotator cuff problem.

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4 Yoga Push-up Progression Strategies

We use yoga push-ups a lot in our training programs, but one challenge with incorporating them over the long-term with more advanced athletes is that they're hard to load up. You can't use bands or chains as external resistance because they slide over the course of the set. And, weight vests really can't provide enough external resistance without getting too bulky and cumbersome. Luckily, there are a few other ways to progress the drill:

1. Slideboard Yoga Push-ups

2. 1-leg Feet-Elevated Yoga Push-ups

3. Feet-Elevated Spiderman Yoga Push-ups

4. Yoga Push-up with Opposite Arm Reach

5. Controlled Tempo

Last, but not least, you can simply slow down the tempo at which the yoga push-up variations are performed. I like adding a full exhale at the top position, too.

Speaking of upper extremity progressions, if you're looking for some more information on how we assess, coach, and program for the shoulder girdle, be sure to check out my resource, Sturdy Shoulder Solutions.

 

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Performance Programming Principles: Installment 3

It's been a while since I updated this series on program design, so I figured it'd be a good time to throw some new material at you on this front.

1. Ground-to-standing transitions are invaluable, but it's challenging to know where to put them in programming.

I'm a big fan of exercises like Turkish get-ups and kneeling overhead hold-to-stands, as they're awesome for "syncing up" the lower and upper body to teach force transfer through a stable core. Yesterday, I posted a video of one of my new favorites - half-kneeling offset kettlebell get-ups - and I got a question about how we'd incorporate this in a program.

The challenge is that these could be considered extended warm-up drills, core work, upper body work, and even lower body work (depending on what variation you're using) once the load gets heavy enough. A kettlebell windmill can even be viewed somewhat similarly.

With that said, I find myself programming these first thing in an upper body training session. My experience has been that they are a good "transition" from the medicine ball work into more conventional rows, presses, push-ups, etc. They also generally pair really well with most upper body pulling exercises, as they aren't super grip intensive (gravity helps to hold the KB in the hand).

Later in the offseason, when guys transition to three days per week strength training, we'll plug these in as part of a full-body session because...well...they're about as full-body as you can get.

2. Complex training won't ever be "perfect" when you're working on power development in the frontal and transverse planes.

We like to work in post-activation potentiation in our offseason programs around December/January. I covered this in a lengthy article, The Stage System, at T-Nation in the past, but a quick synopsis of one benefit is that when you do heavy stuff before lighter stuff, your lighter stuff feels much faster. As a result, complex training - using a heavy strength(high load, lower velocity) exercise right before a movement that's lower force, higher velocity (e.g., jumps, throws) can be helpful for eliciting greater power output.

Here's where it gets a bit challenging when dealing with rotational sport athletes. We know that power is relatively plane specific. In other words, just using sagittal plane power exercises like broad and vertical jumps won't necessarily have great carryover to power in the frontal and transverse planes. Instead, we need to do more things like Heidens (skaters) and rotational medicine ball work. Unfortunately, though, it's really hard to load people up on the first exercise in the frontal and transverse planes; you can only go so heavy with a lateral lunge.

With that in mind, we'll often use a more traditional heavy sagittal plane exercise - deadlift, squat, or axial-loaded single leg exercise - for lower reps, but then do the power exercise in the frontal/transverse plane. An example might be:

A1. Safety Squat Bar Squats: 4x3, 30s rest
A2. Heidens: 4x4/side, 120s rest

3. We use more direct forearm work with our pitchers than we have in the past.

For a long time, we really didn't use any direct forearm work with our baseball players. My feeling had always been that they got plenty of grip work in their regular strength training. Two things changed my mind on this.

First, I saw what a game-changer is it to strengthen throwers closer to end-range external rotation in the 90/90 position. In other words, rather than just expecting arm care work with the elbow at the sides to magically carry over to the positions where guys threw, we actually trained guys at those positions. Novel concept, huh?

Second, thanks to the higher quality slow-motion video we have at our fingertips these days, we can better appreciate that throwers' forearms get into considerably more supination and pronation throughout the throwing delivery than we were training in the weight room. While we were doing a lot to preserve those ranges-of-motion, we weren't doing anything to provide good strength throughout those ranges-of-motion.

With that in mind, we attack our direct forearm work in two particular ways: supination/pronation and ulnar deviation. Here are some Instagram posts that'll walk you through the why: 

Nowadays, we'll work in some of this direct forearm work 1-2x/week at the end of our upper body training sessions with our throwers.

I'll be back soon with another programming strategy brain dump. Have a great week!

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Exercise of the Week: Quadruped 1-arm Trap Raise to Swimmer Hover

I recently started implementing the quadruped 1-arm trap raise to swimmer hover with some of our baseball guys, and it’s quickly become one of my favorites.

This drill addresses several important needs in a throwing population:

1. scapular posterior tilt

2. scapular upward rotation

3. tissue extensibility of the long head of the triceps and lat

4. the quadruped (all fours) position really reaffirms the good convex-concave relationship between the scapula and rib cage

You should not feel this at all in the front or top of the shoulder. Rather, the movement should be felt in the lower traps (mid back) and serratus anterior (add a full exhale at the top of each rep to intensify that activation). Some individuals will feel a good stretch through the triceps.

To learn more about how we assess, program, and coach at the shoulder girdle, be sure to check out Sturdy Shoulder Solutions.

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How to Apply the Joint-by-Joint Approach to the Elbow

Today, I've got a video post for you, and it builds on the Joint-by-Joint approach that's been popularized by Gray Book and Mike Boyle. In the video, I discuss how we can apply the joint-by-joint theory to the elbow, particularly in the context of pitching injuries. Check it out:

If you're looking to learn more about the elbow, I'd encourage you to check out my presentation on the topic, Everything Elbow.

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Making Sense of Rotational Medicine Ball Progressions

If you've followed our work at Cressey Sports Performance for any length of time, you know that we're big fans of training rotational power with medicine ball variations. With that in mind, I wanted to use today's blog to outline some of our strategies for introducing and progressing these exercises in our programs.

Step 1: Stationary Anti-Rotation - These exercises teach bracing on the front leg and emphasize thoracic (upper back) rotation. The split-stance anti-rotation medicine ball scoop toss is a good example.

Step 2: Stationary Rotation: These exercises emphasize hip loading, force transfer, and thoracic rotation delivering the arm, but the base of support doesn't change much (if at all). The rotational medicine ball shotput is an example.

Step 3: Momentum Rotation - These exercises teach athletes to create and utilize momentum as they work into the front hip (imagine riding a bike into a curb). The step-behind rotational medicine ball shotput is an example.

Step 4: Eccentric Pre-Loading Rotation: These exercises teach athletes to get in and out of the back hip while better making use of the stretch-shortening-cycle (think of keeping the head behind the belly button as long as possible). The step-back rotational medicine ball scoop toss is an example.

Step 5: Eccentric Pre-Loading with Momentum Rotation: These exercises combine the previous two categories to try to make things as athletic as possible. The 2-hop to rotational medicine ball scoop toss is a good example.

With this progression in mind, it's important to recognize that athletes need to earn the right to move from one step to the next. Steps 3-5 are far to advanced for 13-15-year-old athletes who have very little body awareness or foundational strength. And, aggressive progressions may be potentially harmful in even advanced athletes if they aren't prepared for the extensive hip-shoulder separation that takes place. Even with our professional athletes, I'll start athletes with the earliest stages in the progression during their initial off-season training programs.

Also, whenever I post about medicine balls, I invariably get the question: what brand do you prefer? I'm a fan of the Perform Better Extreme Soft Toss medicine balls, as they provide the right blend of durability and rebound. The overwhelming majority of our rotational medicine ball work is in the 4-8lb range.

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Holiday Shopping, CSP-Style

With the holidays approaching, here are a few options for holiday gifts with CSP logos.

Cressey Sports Performance Elite Baseball Development T-Shirt: $24.99 + S&H

Click the links below to add shirts to your cart:

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Royal Blue CSP Camo t-shirt: $24.99 + S&H

Click the links below to add shirts to your cart:

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CSP Tank Top: $24.99 + S&H

Click the links below to add tank tops to your cart (men's sizes):

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Hats

CSP baseball caps can be purchased for 24.99 + S/H. These are of the Flex Fit variety, which means that they’re ultra-comfortable and one size fits all (unless you have an absolutely GIANT head or are a petite female who will wear a fitted cap, in which case, you’ll want to let us know). Click here to add one to your cart.

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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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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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