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If You Could Only Pick One…

Each time I run a Q&A, I get questions along the lines of:

If you could only pick one hip mobility assessment, what would it be?

If you could only pick one exercise to build pitching velocity, what would it be?

If you could only pick one shoulder exercise to fix my shoulder pain, what would it be?

You know what's awesome? With respect to all of these questions - and many more - I've NEVER in my entire career had to choose just one.

There may be no such thing as a stupid question, but there are stupid lines of thinking - and this reductionist approach to solving health and human performance problems is a big issue in our industry. In my experience, we see far more chronic issues develop because individuals fail to see the synergy among many factors, as opposed to their inability to hone in on the most important one. I'll give you an example.

Earlier this year, we saw a pitcher with a cranky ulnar nerve. He'd had mixed results with anti-inflammatory medications.

As it turns out, he had a subluxating ulnar nerve, which would predispose him to this issue during a motion like pitching that involves repeated flexion/extension, especially when combined with valgus stress (which stretches the nerve).

He did some extensive manual therapy with my business partner, massage therapist Shane Rye, who treated everything from his neck down to his forearm. This alone gave him a ton of relief - and he even commented that he felt a lot better with respect to some shoulder and neck issues he'd had previously.

In his movement screen, we'd noticed a lot of glaring scapular control issues. At rest, he sat in considerable anterior tilt and depression. Upon initiation of overhead reaching, he pulled into retraction instead of initiating smooth upward rotation. Most of his "external rotation" was actually scapular retraction and lumbar extension. In short, he was getting a lot of motion in the wrong places during several upper extremity assessments - and when we went to watch his arm care exercises, they were reaffirming all these faulty patterns. As an example, he was pulling down with the lat on horizontal abduction work, going into forward head posture on a lot of lifts, and banging out push-ups that looked a lot like this. 

Morever, the exercise selection in his strength and conditioning programs were contributing to these aberrant patterns. His program was very lat dominant, and he wasn't doing enough work above 90 degrees of shoulder elevation to drive better patterns of upward rotation with good scapular posterior tilt. And, if that wasn't enough, he was using blood flow restricted training on his upper arm regularly in hopes of optimizing recovery. In reality, the compression was probably "snagging" his nerve even more.

We made a bunch of changes - picking lots of very easy, low-hanging fruit - and he hasn't had issues with the nerve all season. I can't tell you exactly which ONE of these interventions had the biggest impact on him staying healthy - but the good news is that it doesn't matter. Success is a function of over a dozen assessments and several interventions from multiple people.

With that mind, quit looking for a quick, easy, reductionist answer. It's not about a single assessment, exercise, or coaching cue any more than it is about a magic pill. Rather, it's about how all the pieces fit together. If you look around at the best coaches and rehabilitation specialists in the industry today, they're usually very well rounded in terms of their knowledge base, skill sets, and referral network. As a result, they can appreciating multiple disciplines and provide comprehensive care to the athletes, clients, and patients they serve.

Looking for a diversified educational experience? Be sure to check out our 7th Annual Cressey Sports Performance Fall Seminar. It'll take place on October 14 at our Hudson, MA location. You can learn more HERE.

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Random Thoughts on Sports Performance Training – Installment 31

It's time for this month's installment of my random thoughts on sports performance training. In light of this week's $50 off sale (ending tonight) on Mike Boyle's outstanding resource, Complete Youth Training, I thought I'd focus this edition on the training of young athletes.

1. Puberty changes everything.

The best players at age 11 usually aren't always the best players at age 18 for two reasons:

a. They're usually the ones that get heavily overused by an overzealous coach who wants to win now - and end up injured, missing crucial developmental time periods.

b. Puberty changes absolutely everything. The hormonal and biomechanical changes that kick in during adolescence massively impact how one controls the center of mass within the base of support.

Prepubescent training is all about having fun and establishing solid foundations of movement that set young athletes up for future success.

2. Some training practices are more about establishing routines as they are about creating adaptation.

All our athletes begin their training sessions with self-myofascial release work: foam rolling, lacrosse ball trigger point work, the FMR Stick, and the Acumobility Ball. This includes younger athletes who honestly probably don't really need it.

Why do these youngsters do it, too? Because I want it to become a habit. I want them to realize that the gym isn't just about lifting heavy stuff, throwing med balls, and running fast. Rather, it's also a place where you can go to take care of soreness and actually leave feeling better than when you arrived. This proactive approach at age 13 helps us tremendously when they're age 18 and have more legitimate stresses on their bodies.

Just shorten that rolling series up and get right to the good stuff!

3. Youth training should be all about linear progress for the first two years of organized strength training.

It drives me crazy when kids have to re-gain initial strength. As an example, let's say a kid comes in at age 15 and takes his trap bar deadlift from 135 to 225 over the course of three months. His technique is pristine and he's learned how to put force into the ground.

Then, his sports season starts and he disappears for six months. At the end of the season, he comes back in and starts all over at 135 pounds. Sure, this time around, there's a bit of a technical foundation, and he makes those gains a little bit faster than the first time around. Really, though, we're talking about a situation where he wasted 1/8 of his high school development window.

We've all seen this graphic in the performance realms before, but the truth is that the image on the right applies to intermediate and experienced athletes. The goal is to never have setbacks in beginners because the positive adaptations are so easy to come by with consistent training, even if it's only two days per week of in-season work.

This is one reason why I've added a new component to every young athlete evaluation I do: a discussion about expectations and timelines. Every kid who walks in our facility will say that they want to play Division 1 sports. Very few truly appreciate the consistency and work ethic it will take to get to that point.

4. Make sure your medicine balls are the right weights.

I'm often asked what weight medicine balls we use for our training - and I always respond with a range: 4-8lb for our rotational work, and 4-12lb for our overhead work.

This range accounts not only for the type of exercise, but also the size of the athlete. A 13-year-old athlete will do best with a 4-pound ball for rotational med ball scoop tosses, whereas a 250-pound MLB player will handle a 8lb ball much better.

This, however, might be the most impressive med ball video you'll ever see from a 13-year-old, regardless of weight!

5. With skinny young male athletes, competition works amazingly on the nutrition front.

If you're training teenage male athletes who want to gain weight, nothing works better than having weekly weigh-ins that are charted for everyone to see. We've done it two years in a row with our college development program, and it's also proven extremely successful in our high school athletes. These quantifiable changes not only help to evaluate progress, but they also drive camaraderie among your athletes. Since we starting doing this, we see more guys going out to meals together, chatting each other up on the nutrition front, and discussing what has been working well for them.

Another interesting observation on this front: young athletes are often very out-of-touch with huge swings in body weight. As an example, earlier this week, I had an athlete tell me that he was 145 pounds during an evaluation. When we actually weighed him in, he was 133 pounds. That's an 8.3% loss of body weight! I'm 183 pounds, and if you dropped me by 8.3% to 167.8 pounds, I'd feel absolutely miserable. Young athletes aren't in-tune enough with their bodies to recognize this, though. It's up to us to make them consciously aware of how big swings in body weight are bad for not only performance, but also health and academic performance (dehydration has a massive impact on brain function).

Wrap-up

I could go on and on about lessons learned in training young athletes (and I might, at a later date), but in the meantime, I'd strongly encourage you to check out Mike Boyle's new resource, Complete Youth Training. I loved this product as both a strength and conditioning coach and a parent. Mike did a tremendous job of outlining the problems in the current youth sports landscape while also including practical solutions to these concerns. You can learn more - and get $50 off through tonight at midnight - HERE.


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Why Rhomboids Probably Aren’t Your Best Friend

Today, I've got an excerpt from my new course, Sturdy Shoulder Solutions. I discuss the functional anatomy of the rhomboids, a commonly misunderstood muscle group with big implications.

For a lot more functional anatomy insights like these - as well as a comprehensive look at shoulder assessment, programming, and coaching - be sure to check out Sturdy Shoulder Solutions.

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2018 CSP Elite Baseball Development T-Shirts Now Available!

I’m excited to announce that the 2018 edition of the Cressey Sports Performance Elite Baseball Development t-shirts (powered by New Balance Baseball) are now available for sale.  Here's the design:

These shirts are insanely comfortable and run true to size.

Each shirt is $24.99 + S&H. Click the links below to add shirts to your cart:

XXL

Extra Large

Large

Medium - sold out!

These usually sell very quickly, so don’t delay if you’re interested in picking one up. Enjoy!

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5 Reasons for the Increase in Lat Strains in Baseball Pitchers

There have been some noteworthy lat strains in MLB this year, and this trend isn't showing any signs of letting up. Here are a few reasons why they're occurring at such an alarming rate.

1. Better Diagnosis

Any time a diagnosis becomes more "accepted," doctors know to look for it more immediately. In 2011, Jake Peavy was the first player to actually tear the lat off the humerus and have surgery on it, but now we're actually seeing 1-2 of these each year in guys who come to Cressey Sports Performance for consultations (on top of guys who have lower grade lat strains). In the past, a lot of doctors would mistake lat strains for rotator cuff injuries or biceps tendon issues (because the lat attaches on the front of the humerus). Sometimes, lat injuries would be missed on MRIs because the attachment is far enough down the humerus that a regular shoulder MRI wouldn't cut wide enough. In short, better identification and subsequent diagnosis are always a big reason why a class of injuries "surges."

2. Harder Throwers

Lat recruitment during acceleration is substantially higher in high level throws than it is in amateur pitchers. In particular, as lot of elastic energy is put into lat during the lay-back phase of throwing while it works as an anterior stabilizer of the shoulder as it prepares to unleash that energy into powerful internal rotation and horizontal adduction.

Sprinters who run fast pull hamstrings more often. Basketball players who jump high increase their risk of Achilles ruptures. It shouldn't be a surprise that harder throwers have a higher incidence of lat strains.

3. Inappropriate Strength Training

With each passing day, weight training gets more and more "accepted" in baseball populations, and I absolutely love it. Unfortunately, that means a lot of inferior programs get implemented, and nothing is more inferior in a baseball strength and conditioning setting than programs that are way too lat dominant. If you're doing pull-ups, bench presses, heavy deadlifts, farmer's walks, walking dumbbell lunges - and then coaching all your rows and arm care exercises to be very lat dominant, you're really just exacerbating all the negative adaptations we see in throwers. If you look around your weight room and see a ton of guys with limited shoulder flexion, that should be a red flag.

4. Poorly Executed Arm Care Programs

Lats are sneaky, as they'll find a way to creep into a lot of arm care exercises. You'll see people "tug down" (extension/adduct) the humerus (upper arm) during external rotation exercises using the lat when it should be relaxing to allow the arm to externally rotate.

You'll see hands creeping toward the midline (shoulder internal rotation) during wall slide variations - when the lat should be relaxing to allow "clean" overhead motion to take place.

You'll see individuals lock the scapula down into depression during prone trap raises instead of allowing it to posterior tilt.

And, in the most commonly butchered exercise by every lat strain pitcher I've ever seen, you'll see the humerus tugged down during the prone horizontal abduction (when it should be at 90 degrees).

These examples should help to demonstrate that we've had a lot of success bringing lat strain injuries back to full function not only because of our quality manual therapy, but also because we know how to prescribe and meticulously coach the exercises that are so important for these individuals to master.

5. Weighted Balls

Weighted ball programs increase external rotation quickly (particularly in hypermobile throwers) and the lat - as one of the anterior stabilizers of the shoulder - is one structure that takes on the brunt of the load. When external rotation increases quickly and high speeds are involved, the lat at lay-back is analogous to the Achilles tendon of a basketball player that lands on a heavy dorsiflexed ankle; it just can't "give" any more. If you're a visual learner (and don't have a weak stomach), check out the 1:40 mark in this video to see what crazy eccentric stress at the end-range of a joint can do.

Now, imagine he's an untrained 14-year-old working at these speeds and you put a 100-pound weight vest on him; do you think it'll turn out well?

Weighted balls are awesome - when they're integrated at the right times, at the right loads, in the right dosages, with the right athletes who have earned the right to use them.

Closing Thoughts

If you look at these five contributing factors - and exclude the one (better diagnosis) that's actually a good thing - you'll realize that we have three that are completely in our control. Coach exercises correctly, prescribe strength and conditioning exercises appropriately, and integrate weighted baseball work the right way. If we do these three things correctly - and make sure to take care of tissue quality and length in our throwers - I firmly believe we can completely prevent lat strains, and that's been verified by our experience at Cressey Sports Performance.

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Strength and Conditioning Stuff You Should Read: 7/6/18

I hope you all had a great holiday week. Here's some recommended reading and listening from around the 'net over the past week:

The Best Team Wins - This was an awesome recommendation from my buddy Josh Bonhothal. Adrian Gostick and Chester Elton provide some outstanding strategies for both sports team settings and businesses alike. The section on Baby Boomers vs. Generation Xers vs. Millenials was particularly fascinating.

Matej Hocevar on the Physical Preparation Podcast - Matej is an absolutely awesome guy with a wealth of information to share, and this podcast is an excellent example. He was also an amazing host to my wife and me when we visited Slovenia a few years ago.

7 Ways to Increase Your Training Density - I reincarnated this post from the archives earlier in the week and it was a hit, so I wanted to give it a mention here as well.

Top Tweet of the Week

Top Instagram Post of the Week

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Random Thoughts on Sports Performance Training – Installment 31

With summer training in full swing at both Cressey Sports Performance facilities, I've had all sorts of thoughts rattling around my head on a daily basis, so it set the stage for a new installment of this series on sports performance training.

1. Where an athlete feels an exercise is important, but not on all exercises.

I recently put up two Instagram posts that would appear to contradict one another, to the naked eye.


On one hand, you should always ask athletes where they feel an exercise. And, on the other hand, you sometimes don't want to feel it in one specific place. The answer (as is almost always the case) is "it depends."

When motion is actually taking place, muscles are working concentrically to create that motion. When a muscle shortens, you'll usually develop that "feel" in a certain spot.

Conversely, on an isometric exercise like a carry, there isn't a chance in tissue length, so you won't usually get that same sensation.

Also, keep in mind that the position you're in plays into this as well. If you're squatting, don't expect to "feel" your glutes, hamstrings, or quads specifically in the bottom position or mid-range - but you definitely could feel them a lot at the top as you approach the end of knee and hip extension, as the muscles shorten fully.

In short, "feel" matters - but not all the time.

2. Consider an athlete's age when you're trying to determine why they have a mobility restriction.

One-size-fits-all mobility approaches rarely work because of the way the body changes over the course of the lifespan.

Early on in life, kids are very hypermobile, so you don't really see mobility restrictions. If something seems out of whack, it's probably because they lack adequate motor control at an adjacent joint.

As they hit growth spurts, bones lengthen faster than muscles and tendons can keep up, so restrictions often become more musculotendinous in nature.

As the athletic lifespan continues, those muscular restrictions - in combination with the stress of sports participation or faulty postural habits - can lead to bony blocks and cemented joints. In the years that follow, capsular stiffness can emerge as a problem.

Over time, ligamentous laxity falls off and arthritis becomes more common, limiting range-of-motion even further.

Beyond a lifelong focus on preserving mobility, this knowledge of ROM "regressions" can remind to look to different places at different times. That 14-year-old athletic probably doesn't have capsular stiffness, nor is arthritis a concern. And, that 64-year-old client with the cranky hip probably isn't *only* dealing with muscular problems.

3. Strong guys need longer to train.

Imagine two lifters. Lifter A has one year of training experience and has a personal record deadlift of 315 pounds. Lifter B has 15 years of lifting under his belt and deadlifts 700 pounds. Let's assume both lifters are working up to ~90% of their 1RM in a training session.

Lifter A Warm-up

135x8
185x5
225x3
255x1
275x1
Work sets at 280-285

Lifter B Warm-up

135x8
225x5
315x3
405x3
455x1
495x1
545x1
585x1
605x1
Work sets at 630

Lifter A can get to his working weight in five warm-up sets while lifter B needs nine sets to do so. And, this is just the tip of the iceberg. Lifter B will take more time to unload his plates after finishing his work sets - and he'll probably need an additional warm-up set or two on subsequent assistance exercises. Additionally, chances are that given his time "under the bar" over the years, he'll be a bit older and more banged up (especially at those strength levels), so he'll need to devote more time to the general warm-up before he even gets to deadlifts. Lifter B will also be far more neurally efficient and therefore need more rest between heavy sets than Lifter A even if they've got similar aerobic capacity to facilitate recovery. You're really comparing apples and oranges.

The list goes on and on, and we arrive at the realization that every lifter will have a different optimal training time. This is why I always disagree when I hear things like, "You're working against yourself if you train for longer than 60 minutes." Meanwhile, just about every accomplished strength sport athlete on the planet trains for longer than 60 minutes in just about every training session. And, many of them are extremely lean and muscular.

Don't waste time in the gym, but don't try to race the clock in every session, either. Do what you need to get to get your work in to deliver a quality training effect.

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Mobility Exercise of the Week: Supine Banded Shoulder Flexion on Roller

The supine banded shoulder flexion on roller is a new shoulder mobility drill I came up with that is really growing on me quickly. Effectively, it's an alternative to a back to wall shoulder flexion for those who may struggle to "compete against" gravity as they take the arms overhead in the standing position.

In this drill:

1. The foam roller provides feedback for posterior pelvic tilt, thoracic extension, and a more neutral cervical spine posture.

2. Gravity assists the individual into overhead motion to overcome stiffness through the lats, teres major, long head of triceps, inferior capsule, pec minor, etc.

3. The fact that the roller doesn't impede scapular motion (like the wall or floor would) makes it easier to achieve some scapular posterior tilt as the arms go overhead.

4. The supinated grip drives some shoulder external rotation, placing the lats on stretch in the transverse plane so that folks can't "cheat" the movement by letting their hands drift toward the midline.

5. The band creates some posterior rotator cuff recruitment,

I'll take this over a few sets of ugly band pullaparts any day. What's not to like?

Looking for more cutting-edge shoulder strategies like these? Check out my new resource, Sturdy Shoulder Solutions at www.SturdyShoulders.com.

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Stop Thinking About “Normal” Thoracic Spine Mobility

Two years ago, I published a post, Tinkering vs. Overhauling - and the Problems with Average, where I discussed the pitfalls of focusing on population averages, especially in the world of health and human performance. I'd encourage you to give it a read, but the gist is that you have to be careful about overhauling a program because you see someone as being outside a "norm" that might have been established for an entire population when they are unique in so many ways.

Thoracic spine mobility is an excellent example. What would be considered acceptable for an 80-year-old man would be markedly different than what we'd want from a 17-year-old teenage athlete in a rotational sport. This athlete, for instance, had some marked negative postural adaptations that contributed to two shoulder surgeries during his time as a baseball pitcher. If he was far older with different physical demands, though, he might have never run into problems.

Lumbar locked rotation is a great thoracic spine rotation screen I learned from Dr. Greg Rose at the Titleist Performance Institute. Briefly, you put the lumbar spine in flexion (which makes lumbar rotation hard to come by) and the hand behind the back (to minimize scapular movement). This allows you to better evaluate thoracic rotation without compensatory motion elsewhere. Check out the high variability among three athletes who are all roughly the same age:

On the left, we have a professional baseball pitcher. In the middle, we have an aspiring professional golfer. And, on the right, we have a powerlifter who's moved well over 600 pounds on both the squat and deadlift. Adaptation to imposed demand is an incredibly important part of this discussion of "normal." The hypertrophy (muscle bulk) that benefits the powerlifter could possibly make the baseball pitcher and golfer worse, but at the same time, I wouldn't necessarily say that the powerlifter is "lacking" in thoracic rotation because you don't need a whole lot of movement in this area for a successful, sustainable powerlifting career.

I should also note that these are all active measures. If we checked all three of these guys passively, we'd likely see there's even more thoracic rotation present than you can see here. And, that can open up another can of worms, as having a big difference between active and passive range of motion can be problematic, too.

The take-home message is that if you're going to call someone's movement quality "abnormal," you better have a clear designation of what "normal" is for their age and sport, as well as what's required for their athletic demands.

For more information on how we assess and train thoracic mobility, I'd encourage you to check out my new resource, Sturdy Shoulder Solutions.

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Strength and Conditioning Stuff You Should Read: 6/9/18

Happy Saturday! This edition of "stuff to read"is a few days late in light of the Major League Baseball Draft and release of my new resource, Sturdy Shoulders Solutions. As a quick reminder, it's on sale for $50 off through the end of the day tomorrow (Sunday). You can learn more at www.SturdyShoulders.com.

With it being a shoulder product, I figured I'd use this week to "reincarnate" some upper extremity content from my archives:

Are You Packing the Shoulder Correctly? - Most people don't appreciate the relevant anatomy involved in packing the shoulder, so that may actually utilize the wrong muscles to get the job done. This webinar delves into the topic in detail.

3 Tips for Improving Your Back to Wall Shoulder Flexion - This video demonstrates a few quick and easy cues to improve your capacity for overhead reaching.

Exercise of the Week: Standing External Rotation Holds to Wall - This exercise is a great fit for everyday lifters and baseball players alike, as it builds rotator cuff strength without any equipment.

Top Tweet of the Week

Top Instagram Post of the Week

Have a great weekend!

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