A while back, I published a blog called Making the Case for Training in the Post-Surgery Period. In short, it discussed how we are almost always dealing with athletes who are training during their rehabilitation periods. In many cases, this is strictly working around the issues while they're going through physical therapy.
In writing these programs, one recognizes that it's actually far easier to write a program for a post-op lower body issue than it is for a post-op upper body scenario. Very simply, because most strength and conditioning exercise selections work "from the ground up," there are many more ways that lower extremity exercises can impact upper body drills than vice versa. Today, I'll outline some examples.
1. Grip work.
There is grip involvement in deadlifts, various dumbbell single-leg exercises, and even squatting exercises that require an athlete to grasp the bar. Particularly in the case of elbow issues, too much grip work can become a real problem. For example, in the 4-8 month period after Tommy John surgery, it's not uncommon for athletes to experience discomfort in the common flexor tendon region - and it usually has to do with the cumulative stress of gripping during strength training and rehab work on top of the intensification of the throwing program. Some doctors have surgical approaches that are a bit "rougher" on the flexor tendon, too. In these scenarios, you're best off working predominately with lower body drills that don't involve a lot of grip work.
2. Front rack position with acromioclavicular (AC) joint issues.
When you want an AC joint issue to calm down, there are really three big rules:
a. Avoid reaching across the body (horizontal adduction, like a cross-body stretch)
b. Avoid reaching behind the body (full extension, like in a dip)
c. Avoid direct pressure to the area (particularly because it has very little muscle mass to cushion it)
With respect to "C," the front squat set-up is an absolute no-no. The pressure on the bar across the shoulder girdle can really take an upset AC joint and make it markedly worse. And, since this is in many cases an injury that we’re just “waiting out,” simply training through it will only makes things worse long-term.
Therefore, deadlift variations, single-leg variations, and back squats (assuming no other related problems) are likely better bets. That said, we generally use the safety squat bar and giant cambered bar exclusively with those who present with AC joint problems.
3. Back squat position with internal impingement.
Internal impingement (also known as posterosuperior impingement) is a broad diagnosis most common in overhead throwing athletes. In the late cocking phase of throwing (or swimming, tennis, etc.) - which involves external rotation and abduction - the humeral head tends to translate superiorly (up) and anteriorly (forward) relative to the scapula.
These issues are magnified by poor scapular control, weakness of the rotator cuff, insufficient thoracic mobility, loss of tissue extensibility around the shoulder girdle, and in some cases, structural changes. The end result is that the biceps tendon, labrum, rotator cuff, glenohumeral ligaments, or nerves that pass the anterior aspect of the shoulder get irritated. The term "internal impingement" really just explains the pain-provoking position, not the specific diagnosis. Generally speaking, the pain is purely mechanical in nature; it won’t bother an athlete unless the “apprehension” position (full external rotation at 90+ degrees of abduction) is created.
Just about every overhead athlete is constantly "flirting" with internal impingement problems, so my feeling is that it's best to just avoid this "at-risk" position in the weight room - and that's why we don't back squat any of our overhead throwing athletes. And, we certainly wouldn't use a back squat with anyone with symptomatic internal impingement.
4. Giant cambered bar with scapular anterior tilt, humeral anterior glide, and forward head posture.
The giant cambered bar is an awesome option for avoiding the "at-risk" abducted, externally rotated position that often gives overhead athletes problems, but it can create a problem with athletes who are prone to scapular anterior tilt, humeral anterior glide, and/or forward head posture. Because of the positioning of the hands, the elbows are driven a bit behind the body, which can cause the shoulder blade to dump forward and "ball" to glide forward on the socket. You may also see the head shoot forward.
That said, these faults can be easily minimized with good cueing. However, I wouldn't recommend using this bar with an athlete who has a big predisposition toward any of the three issues.
5. Scapular depression from holding heavy weights in the hands.
The deadlift can be an awesome exercise for improving poor posture - but not in all cases. Specifically, whenever we have an athlete who sits in too much scapular depression and downward rotation (more info on that HERE), we'll avoid holding really heavy weights in the hands for lower body training.
Our goal is to teach the shoulder blades to sit a little higher at rest, and functionally get higher when the arms need to go overhead. We don't want all our lower body work competing against that. During this time period, it's best to go with squatting variations, barbell supine bridges/hip thrusts, DB/KB goblet set-ups, sled work, the front squat grip, glute-ham raises, and anything else your imagination yields - as long as it doesn't tug the shoulder blades down.
There are many more considerations for how lower body work impacts upper body function, but these are definitely the five I most frequently encounter that you should keep in mind. If you're interested in learning more, I'd encourage you to check out my popular resource, Sturdy Shoulder Solutions.
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We had a great staff in-service on strength and conditioning programming yesterday, and it really got the wheels turning in my brain. The end result was this video, which is especially timely, given that many professional baseball players are about to begin their off-season training.
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Here's a question I recently received from a reader:
Q: I've been training a couple college guys this month before they go back to school and I had a few questions regarding rhythmic stabilizations. I started implementing them with my pitchers recently and they say they don't feel anything. Should they be? Is there any extra coaching points I'm missing here? Thanks for your time.
A: This video!
To learn more about how I assess, program, and coach at the shoulder, be sure to check out my popular resource, Sturdy Shoulder Solutions.
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It's time for the August installment of this popular series, and with the Olympics in full swing, MLB season in the home stretch, and the NFL season rapidly approaching, there's plenty of material rattling around my brain.
1. Don't criticize what you don't understand.
Maybe it's just because all the aforementioned sporting events are taking simultaneously and we're on sports social media overload right now, but it seems like a lot of people are ranting and raving about high-level athletes' preparation. They're cranky about Usain Bolt's hamstrings issue and how it's being managed. They're shocked the Kerri Walsh Jennings has had so many shoulder surgeries. They're flustered about Michael Phelps using cupping. They're floored by Prince Fielder's retirement after a second cervical fusion surgery. And they're cranky because they're confident that they can do a better job in spite of the fact that they have exactly ZERO knowledge of any of these situations.
If there's one thing I've learned from a lot of work with professional and Olympic athletes over the years, it's that nothing is ever as simple as it seems. What you read in the media is usually a partial truth (if that). For instance, I know of pitchers who have gone on the disabled list with calf strains or neck stiffness when they just needed to iron out mechanics or rest up from a high workload. I've also known athletes whose performance has suffered tremendously as they tried to plow through nagging injuries. They're getting blown up on Twitter when they should be getting commended for putting the team's needs ahead of their own personal health.
The point is that if you don't have any knowledge of the unique situations, blindly criticizing athletes and their sports medicine teams is a cheap shot. And, in my eyes, it makes you look incredibly unprofessional.
I'd also add that it's important to remember that you never know who is reading your criticism. Burning that bridge because you "just had to get it off your chest" could interfere with future job possibilities, or even the opportunity to work with the athletes in question.
So, sit back, chill out, and just be a sports fan, but not a Monday Morning Quarterback. You can't rehab someone on Twitter.
2. Use the bottoms-up get-up to remind hypermobile athletes to avoid elbow hyperextension - and cue "grabbing"the floor.
I love using Turkish Get-ups with athletes for a host of reasons; this drill really trains whole-body mobility and stability and delivers a great training effect without insane external loading. That said, one thing you have to be really careful of with using get-ups is that hypermobile (loose jointed) individuals will often wind up with elbows hyperextended - both on the support and overhead arms.
With that in mind, I like the idea of using a bottoms-up Turkish get-up because it's more grip intensive and strictly mandates a more neutral wrist position. This activation of the flexors of the fingers, wrist, and elbow gets the muscles that prevent elbow hyperextension a little more "pre-tensioned," so it's a lot harder to slip into bad patterns.
The bottom arm is a bit trickier, but I have had some success with the cue, "grab the floor as if you're trying to palm a basketball." That same activation of the flexors can help to keep a slight flex in the elbow.
3. A training effect prepares you, but an education sustains you.
This morning, I woke up to this article about Cubs pitcher Jason Hammel "reinventing himself" this past offseason. Part of that process involved getting started up with Cressey Sports Performance, and we've be really cheering him on as he's put forth a career year to be a big part of the Cubs' success. As the article details, one of Jason's biggest struggles was fading in the second half of the season. This was something he and I discussed at length during his initial evaluation last November. Even though it was 8-9 months away, we started talking about in-season training approaches and how to sustain performance well into the second half of the long MLB season. Thus far, he's done a great job of it; in five starts since the All-Star Break, he's 5-0 with a 1.16 ERA.
I often tell our athletes that the training effects we deliver in the off-season gets them through the first half of the season, but it's the education we impart that should sustain them through the second half of the year. The MLB calendar spans from mid-February (spring training) all the way to early October (and even longer if a team makes the playoffs). Nothing we can do in the offseason is guaranteed to last for eight months, but education certainly can. We need to work hard to help athletes understand what is unique about their bodies so that they can be advocates for themselves - and their own best coaches.
Jason's success has been a good reminder:
[bctt tweet="Coaching isn't just about building athleticism; it's also about educating."]
4. I still don't like Olympic lifts for baseball players.
By this point, most of you have probably heard (or seen) an Armenia Olympic lifter end up with a gruesome elbow injury on the jerk portion of a clean and jerk. It was a combination valgus stress - elbow hyperextension injury - which just so happens to be the exact same kind of stresses that lead to most pitching injuries at the elbow. Keep in mind that this was on a jerk - and the valgus stress is actually magnified on a snatch because of the bar path and distance traveled prior to the attempted catch.
I've written previously at length on my feelings about the topic: Should Baseball Players Olympic Lift? I think there are much better ways to train power in a specific context and with less injury risk.
Some coaches will argue, "But this is a max attempt in the Olympics! Our technique is much better than this and we aren't taking those kind of chances!" The truth is that video doesn't lie; you see a lot of ugly Olympic lifting technique all over the 'net. And, athletes will always want to push the limits and hit personal records. Moreover, baseball players have a lot more funky presentations (valgus carrying angle, medial elbow instability, and joint hypermobility) that muddy the waters further.
Perhaps more importantly, I know of very few high level arms who Olympic lift. We've demonstrated over and over again that you can build huge arm speed without snatches, jerks, and cleans, so why take the chance?
I should reiterate: I think the Olympic lifts are absolutely fantastic for other athletes. Baseball is just a different beast.
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I'm wrapping up my California trip tonight, but didn't want to leave you hanging on this week's recommended strength and conditioning reading/listening. Here are some good ones to check out:
EC on "The Impact Show" with Jim Kielbaso - This might have been my favorite podcast I've ever done, as I feel like Jim and I covered a lot of ground on the business and coaching sides of the equation. He's got some quality stuff in the archives of this podcast, too, so I'd encourage you to check some of his previous episodes out as well.
Invisible Influence - I've become a big fan of Jonah Berger's writing in a similar way to how Malcolm Gladwell won me over years ago. If you're interested in the factors that govern behavior and decision-making, Berger's stuff will be right up your alley. His commentary on "social facilitation" has immediate utility for those in the fitness industry.
Softball and Humeral Anterior Glide - If you like my baseball writing, you'll also enjoy CSP coach Nancy Newell's blogs on training softball players. This is one such example.
Over the years, on several occasions, I've made a trip to Long Beach, CA for the New Balance Area Code Games. This event brings together the top 230 high school baseball players in the country. In 2016, I spoke as part of the opening ceremonies.
I wanted to be succinct with my message, and with that in mind, I chose to emphasize the importance of differentiating between processes and outcomes. This is something I try to hammer home with all our in-person athletes at Cressey Sports Performance, but I feel it's an important differentiation for all players to make.
An outcome is - for lack of a better term - a result. It's going 4-for-4 at the plate, getting selected for an all-star team, or getting an "A" on a final exam. It may also be negative: going 0-for-4, getting left off the team, or flunking that final exam. There is never growth in an outcome alone; it's just something that happens after all the work is done. Unfortunately, it's been my experience that far too many people - and particularly young athletes who have had considerable success at a young age - become very outcome-oriented. They devote too much time and energy to celebrating their successes instead of recognizing the processes that got them to that end (good or bad).
Conversely, a process constitutes all the habits and actions that lead to an outcome. It's the hours you spent in the cage fine-tuning your swing before those four at-bats. It's your efforts and attitude that predated that all-star selection decision. And, it's your study habits that culminated in your final exam preparedness (or lack thereof).
[bctt tweet="There is growth in every process, but not in ANY outcome."]
Not surprisingly, there's evidence to suggest that outcome-oriented parenting is an inferior approach to process-oriented parenting. You're far better off praising efforts than you are outcomes, because it's those efforts that remind your kid to bust his or her butt in everything the future holds. Your work ethic and demeanor from tee ball can sustain for decades to help you in your job as an accountant when tax season is upon you, but don't expect your 20-year-old trophies to help you out when the going gets tough in adulthood.
Interestingly, though, this message actually has significant parallels to some conversations I've had with respect to the fitness industry over the years. In fact, I can remember covering it in detail when I delivered a shoulder seminar to a room of 105 trainers, strength and conditioning coaches, and rehabilitation specialists in Chicago that same summer.
At the conclusion of the event, I had several young trainers inquire about how I wound up where I am. In fact, one even asked, "What do I need to do to be you in ten years?" I always find these inquiries challenging to answer because I rarely reflect on success, and frankly don't consider myself successful because it's too early in my career (age 35) to determine that. Perhaps more significantly, though, I can't vividly describe where I plan to be in five (let alone ten) years. If I can't be sure of exactly where I'm headed, who am I to tell an up-and-coming fitness professional how he should get to where he thinks he wants to be a decade from now?
With that in mind, my answer is usually necessarily vague:
[bctt tweet="Embrace processes, but let outcomes take care of themselves."]
The problem is that the fitness industry is unique in that none of these processes are clearly defined. In other words, there is no strict foundation upon which a large body of work in the field is entirely based. There aren't many industries like this.
For example, my wife is an optometrist, and she had four years of undergraduate education, followed by four years of optometry school (including clinical rotations), and then board exams before she could become a doctor. There was a set curriculum, and then measures to determine competency in the areas emphasized in that curriculum. And, even after that proficiency was established, Anna did an additional year of residency where she specialized in cornea and contact lens. You can't just declare yourself an optometrist one day and start a career - but individuals do that all the time in personal training because the barrier to entry is completely non-existent.
So, how do we take this lesson and apply it to our fitness professionals who really want to be great? I think the first step is to heavily emphasize a minimum standard of education: a foundation upon which a career can be built.
While the skill sets needed to be a successful NFL strength and conditioning coach are obviously different than what one would need to do cardiac and pulmonary rehabilitation in a clinical exercise physiology setting, there are surely many commonalities across these domains (and everything in between). Here are a few things I think everyone in the fitness field needs to know to create a solid foundation:
1. Anatomy, Kinesiology, and Biomechanics - Structure dictates function, and you have to know what good movement (function) is before you can structure a program to create, preserve, or reestablish it.
2. Physiology - I'm not saying that you need to be able to recite the Krebs cycle by heart, but you should have a clear understanding of energy systems development, the endocrine response to exercise, how various disease states impact exercise, the role of various medications your clients may be taking and a host of other physiological considerations.
3. Coaching Approaches - I'll be blunt: I don't think that anyone should be allowed to train someone unless they've first completed internships under multiple other credentialed coaches. Massage therapists need to complete hundreds (and sometimes thousands) of hours before they can go out on their own, and I'd argue that a bad fitness professional can hurt people a lot faster than a bad massage therapist. Good coaches understand how to not only deliver effective coaching cues, but also do so in the most efficient manner possible. The only way to get to this point is to get out and coach individuals from all walks of life - and then fine-tune when things don't work the way you expected.
4. Interpersonal relations - I've always been surprised at how little formal training in psychology the aspiring fitness professional gets in the typical exercise science curriculum. And, honestly, I think that the psychology lessons taught in a classroom by a "typical" college PhD (and I don't mean that disparagingly at all) are likely a lot different than ones you might learn from successful personal trainers who've had clients for decades, or strength and conditioning coaches who've thrived in college weight rooms for generations. Motivation is a very complex topic. Multiple times in my career, I've had a client walk in and start the session with (paraphrased), "So, I'm getting a divorce." Maybe deciding between a reverse lunge and Bulgarian split squat just became a little secondary?
What These Meant for Me
As I look at these four foundational educational processes, I feel like I was really well prepared on both #1 and #2 when I entered the industry. Having a class in gross anatomy during my undergraduate experience was a game-changer, and I was also fortunate to have some excellent kinesiology, biomechanics, and exercise physiology professors that went above and beyond simple memorization challenges.
Early on, though, I struggled with my coaching approaches. I spoke too quickly, blurted out too many cues, and likely confused a lot of athletes. It wasn't until I got to watch some great coaches at the University of Connecticut do their thing that I learned to be more clear and concise, and make the complex seem simple for our athletes.
Interpersonal relations seemed to come more naturally to me, likely because I worked at a tennis club for eight summers while I was growing up; I was constantly interacting with members across multiple age groups. However, this has actually been my biggest area of study over the past 3-4 years (particularly because I now have employees), and I always have an audiobook in progress with respect to leadership, communication, motivation, and related areas.
What These Mean for You
Everyone in the fitness field has unique preparation. Some folks are very good technical coaches, but not great communicators. Some trainers have a knack for making movements look good even if they don't know the exact anatomy governing that clean movement. Some professionals have delivered outstanding results even if they can't explain the underlying physiological changes that occurred. These successes (outcomes) don't mean that they shouldn't constantly be seeking out ways to improve (processes), so I'd encourage you to do a "self audit" to determine your biggest growth areas.
You can shore up a lot of these knowledge gaps with books, DVDs, and online mentorship programs, but I'm of the belief that the fastest way to learn will always be in-person, as you can pick up information on all four components and see how the fit together. Internships and mentorships are phenomenal in this regard; there is real-time application and feedback. Seminars are also be fantastic, particularly when you have both lecture and practical (hands-on) components.
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It's hard to believe that we're 20 installments deep on this series, but I'm glad they've been so well received and definitely plan to continue to write them. Here goes!
1. Tall athletes are usually longer term projects.
When you have a 15-year-old 6-6, 150-pound kid with size 17 shoes, you have your work cut out for you.
These athletes are challenging for a number of reasons:
a. Their bone growth has usually outpaced their flexibility (except in kids - usually those who haven't finished puberty - who have preserved their childhood joint laxity). This often means that they have to do a fair amount of "preliminary" work just to get into good positions to benefit from big bang exercises.
b. Their center of mass has rapidly shifted up away from their base of support, creating a constantly unstable state.
c. A longer spine is a lot harder to stabilize than a shorter one.
d. You can put 20 pounds on one of these athletes and barely notice. As a frame of reference, in the picture below, the 6-6 athlete on the left added 31 pounds between September and February (when this picture was taken) to get to approximately 200 pounds. Meanwhile, Greg Robins (the CSP coach in the middle) actually weighs more than him even though his about eight inches shorter.
e. Even if you put that 20 pounds on them, it might not be enough to have a "grounding" effect on the athlete. Unless an athlete is very gifted in terms of reactive ability (as you might see with lighter weight NBA players), you might need to add a lot more weight for them to learn how to properly load the lower extremity to create athletic movement using the stretch-shortening cycle.
f. At younger ages, they're often put in positions that don't require as much movement (first base, DH, or pitcher in baseball; center in basketball; goalie in soccer; etc.). This may rob them of crucial exposure to movement "education."
The take home points?
[bctt tweet="In tall athletes, push patience, consistency, calories, and perfect technique on fundamentals."]
2. It's not your job to have all the answers.
Earlier this week, I sent along a nutrition question to Cressey Sports Performance's first employee, Brian St. Pierre. Brian is now Director of Performance Nutrition for Precision Nutrition and a tremendous resource we have at our fingertips on everything relating to nutrition and supplementation. Within 24 hours, Brian had sent along a 244-word reply that covered his anecdotal experiences on the topic in question, along with some recommended reading in case I was interested in what the peer-reviewed evidence demonstrated.
I'd love to have all the answers, but I simply don't. As such, I refer out all the time - whether it's a question like this on the nutrition front, or sending a client to a physical therapist. Your job is to deliver the best possible outcomes for your athletes/clients, and referring out regularly usually leads to those ends - and creates learning opportunities for you via the collaborative efforts that occur during the referral.
It's not your job to have all the answers; it's your job to know where you can find them.
3. It's important to understand how much relative strength an athlete needs - and that is sport and position specific.
I'll use my experience with baseball to make this point.
Pitching is a combination of absolute and relative strength and power. From an absolute standpoint, more body weight equates to more force to push off the mound, and more momentum moving downhill; that's why gaining weight can have such a profound impact on pitching velocity.
On the other hand, from a relative strength and power standpoint, you eventually have to "accept" all the force you create. We know that there are substantial ground reaction forces taken on by the front leg, and research has demonstrated that they are (not surprisingly) directly impacted by body weight. Additionally, according to 1998 research on professional pitchers from Werner et al., at ball release, the distraction forces on the shoulder are approximately 108% of body weight. You could also make the argument that these forces are even higher now, as average fastball velocity has crept up significantly since 1998, and the subjects in that study averaged only 89mph. As is the case with body weight increases, as arm speed rises, so do shoulder distraction forces.
In hitting, "accepting" force on the front side isn't as stressful because we don't hit downhill on a mound. However, batters have to run the bases, and that's a significant relative strength challenge.
With all this in mind, you it's important to realize that some athletes need to gain weight, some athletes need to lose weight, and some athletes are good right where they are. Obviously, body composition plays into this as well, but speaking in general terms, understanding strength-to-bodyweight ratios in sport-specific contexts is really important for all strength and conditioning coaches.
4. Use upper body drivers in your lower body mobility work.
This video from Mike Robertson got me thinking a lot:
We've done quite a bit of upper body reaching in our warm-ups with drills like the lateral lunge with overhead reach, but typical, this motion has really only occurred in the sagittal plane:
Conversely, if you look at the bowler squat, the upper body reach drives hip internal rotation, adduction, and flexion on the support leg.
Moving forward, I plan to get a lot more creative with using reaching to challenge folks in the transverse and frontal planes during our warm-ups.
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Today's guest post comes from physical therapist, Eric Schoenberg. Eric is an integral part of the Elite Baseball Mentorships team.
A thought came to mind as I was considering how we can work towards reducing the incidence of injury in baseball: we need more specialists.
If we use the field of medicine as a model, the Total Knee Replacement has pretty much been mastered. Of course, there is room for improvement, but over the past 25 years, this surgery has become a massive success. The biggest reason for this is a progression of specialization:
If you need a knee replacement, you don’t go to your primary care physician. Instead, you schedule an appointment with an Orthopedic Surgeon that specializes in TKR. So, if you are a baseball player, why does it make sense to work with a “general” strength coach or physical therapist?
[bctt tweet="Every profession matures into a state of “super-specialization” as it develops."]
Strength coaches and physical therapists have a great opportunity ahead of us to move our professions forward in this manner.
The current entry point for a strength coach is minimal. Most commonly, entry into the field falls somewhere between a fitness certification and a 4-year degree. In some cases, you will see dual degrees, Master’s degrees, and the occasional PhD.
However, there is no direct path available to niche into a “baseball specialist.” Instead, we have private sector, college, and even some professional strength coaches that may have seen baseball players by chance, but have no more experience with them than any other sport. It’s not a criticism of them, though; there simply isn’t an established “curriculum” they can pursue. As a result, in most cases, highly “specialized” baseball players are being managed by “general” strength coaches.
I have to believe that this is as much of a contributing factor as any to the high incidence of injury in the baseball world. By the time these athletes make it far enough in their careers to have access to “baseball specialists,” they are often too damaged for even the experts to manage.
Here are five tips to establish yourself as a trusted resource in the baseball community:
1. Watch baseball.
Don’t just watch it for entertainment value. Study the movements. Use slow motion and rewind on your TV. Watch video online and gain a better understanding of the actions and positions unique to the sport. Once you think you have it figured out, you are only just scratching the surface. Keep studying! Start to recognize why faulty mechanics can lead to improper distribution of stress and ultimately injury. By doing this, you can pair this knowledge with your individual assessment of the athlete to create a more optimal training program.
2. Spend time on a field.
Baseball players are unique in their habits and tendencies. Gain a “feel” for the game. Understand the culture of the game. Learn how to identify with and communicate with athletes that are much younger than you. Understand that most of their time on the field is spent standing around and waiting. Educate your players on how to optimize this time to prepare mentally, hydrate, properly warm up, etc. It is not enough to say you used to play baseball 20 years ago; nobody cares. My credibility and effectiveness in managing baseball players increased 10x once I started spending time at the field as part of a team. Create an angle to quickly establish trust and common ground with the athlete and watch your results dramatically improve.
3. Understand the unique physical characteristics and demands of baseball players.
Baseball players have physical characteristics that differ from other sports. Educate yourself for the benefit of your athletes. Learn about humeral retroversion, gross extension patterns, laxity, valgus stress, dynamic stability, rotator cuff timing, etc. Work towards understanding the importance of stability of the landing leg, proper hip hinge pattern, and the importance of tri-planar single leg balance. Don’t “stretch” a guy that is already too loose. Instead, give him some stability and watch his pain go away. The baseball player’s anatomy is a long way from “neutral.” Do your best to bring them closer to the middle and not further away. For example, your ability to recognize that a baseball player should not be cued to pull their shoulder blades “down and back” because their shoulder blades are ALREADY down and back may save dozens of careers.
4. Master functional anatomy and human movement.
Understand the critical role of the scapula. Train the rotator cuff in the throwing position through the entire range of motion (especially end-range external rotation). Learn how the kinetic chain applies specifically to baseball. Hitting and throwing are highly coordinated, precisely timed, multidirectional movements. Don’t train your athletes with single joint exercises that only occur in the sagittal plane. Learn about hip/trunk separation to maximize power and explosiveness. Be able to educate the athlete on what it means to have a labral tear or understand the specifics of an ulnar nerve transposition. If you can’t explain these pathologies, then how can you minimize risk when working with these athletes? Take pride in your job on this front.
5. Be willing to respectfully challenge the “institution of baseball.”
CSP coach Tony Bonvechio wrote a blog post a while back where he warned about the dangers of the phrase “this is how I’ve always done it.” I find myself observing on a daily basis that regardless of level – little league, high school, college, pro ball – at least 80% of the player’s warm up routine is exactly the same. How can that be? We have progressed as a profession; however, kids on baseball fields across the world are all doing the same useless warm-up routine.
An example of progress is Joe Maddon and the Chicago Cubs. He softened the traditional stance of getting to the ballpark at 1pm for a 7pm game. Instead, they have created a culture that emphasizes more sleep, nutrition, and recovery and his players love him for it.
If we want different results, we have to continue to move towards a different approach. The efforts of strength coaches and physical therapists to move towards becoming baseball specialists will go a long way in helping to reach this goal.
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Monday, Fun day! I hope you all had a great weekend. Here's some recommended strength and conditioning reading to kick the week off for you:
4 Tips for Stronger Client Connections- Todd Bumgardner provides some excellent tips for anyone - especially the personal trainer - who is in the business of dealing with people.
I thought I'd use today's post to throw out some thoughts on training the shoulders.
1. In the upper extremity, the assessments are often the solutions, too.
Imagine you're assessing an athlete, and their squat pattern is absolutely brutal. Usually, the last thing you're going to do is go right to a squat as part of their training. In other words, simply coaching it differently usually won't improve the pattern immediately. Rather, you typically need "rebuild" the pattern by working with everything from ankle and hip mobility to core control, ultimately progressing to movements that replicate the squatting pattern.
Interestingly, the upper extremity is usually the opposite in that the assessment might also be the drill you use to correct the movement. For instance, an aberrant shoulder flexion pattern like this...
...might be quickly corrected with some of these three cues on a back to wall shoulder flexion pattern.
This is also true of push-up assessments and shoulder abduction and external rotation tests we do; funky patterns are usually cleaned up quickly with some subtle cueing. This just isn't the case as much in the lower body, though. Why the difference?
My theory is that because we're weight-bearing all day, the lower extremity is potentially less responsive to the addition of good stiffness in the right places. Conversely, a little bit of stiffness in serratus anterior, lower trap, or posterior cuff seems to go a long way in quickly improving upper extremity movement. My experience with the Postural Restoration Institute also leads me to believe that creating a good zone of apposition can have lead to a more pronounced transient movement in the upper extremity than it does in the lower extremity. This is likely because the rib cage is directly involved with the shoulder girdle, whereas the relationship with the lower extremity (ribs --> spine --> pelvis) is less direct.
These differences also seem to at least partially explain why upper extremity posture is much easier to change than lower extremity positioning. It's far more common to see a scapular anterior tilt change markedly than it is to see an anterior pelvic tilt substantially reduced.
Just thinking out loud here, though. Fun stuff.
2. Anterior shoulder pain usually isn't "biceps tendinitis."
First off, true tendinitis is actually quite rare. In this landmark paper, Maffulli et al. went to great lengths to demonstrate that the overwhelming majority of the overuse tendon conditions we see are actually tendinOSIS (degenerative) and not tendinITIS (inflammatory). It may seem like wordplay, but it's actually a very important differentiation to make: if you're dealing with a biceps issue, it's probably tendinosis.
Second, if you speak with any forward thinking orthopedic shoulder specialist or rehabilitation expert, they'll tell you that there are a lot of differential diagnoses for anterior (front) shoulder pain. It could be referred pain from further up (cervical disc issues, tissue density at scalenes/sternocleidomastoid/subclavius/pec minor, or thoracic outlet syndome), rotator cuff injury or tendinopathy, anterior capsule injury, a lat strain or tendinopathy, labral pathology, nerve irritation at the shoulder itself, arthritis, a Bankart lesion, osteolysis of the distal clavicle, AC joint injury, and a host of other factors.
3. Thoracic outlet surgery really isn't a shoulder surgery.
Over the past few years, each time a professional pitcher gets thoracic outlet surgery, you see many news outlets call it "shoulder surgery." Sorry, but that really isn't the case unless you have a very expansive definition of the word "shoulder."
With this intervention, the surgeon is removing the first (top) rib to provide "clearance" for the nerves and vascular structures to pass underneath the clavicle.
Additionally, surgeons usually opt to perform a scalenectomy, where they surgically remove a portion of the anterior scalenes, which may have hypertrophied (grown) due to chronic overuse. Again, this is not a "shoulder" procedure.
Finally, more and more surgeons are also incorporating a pec minor release as part of the surgical intervention. This is because the nerve and vascular structures that may be impinged at the scalenes or first rib can also be impinged at the coracoid process of the scapular if an individual is too anterior-tilted. While the coracobrachialis and short head of the biceps both attach here, the pec minor is likely the biggest player in creating these potential problems.
This, for me, is the only time this becomes somewhat of a "shoulder" surgery - and it's an indirect relationship that doesn't truly involve the joint. We're still nowhere near the glenohumeral (ball-and-socket) joint that most people consider the true shoulder.
All that said, many people consider the "shoulder girdle" a collection of joints that includes the sternoclavicular, acromioclavicular, glenohumeral, and scapulothoracic articulations. In this case, though, the media just doesn't have a clue what they're trying to describe. With that in mind, hopefully this turned into somewhat of an educational rant.
4. Medicine ball scoop tosses tend to be a better than shotputs for cranky shoulders.
Rotational medicine ball training is a big part of our baseball workouts, and it's something we try to include as an integral part of retraining throwing patterns even while guys may be rehabilitating shoulder issues. When you compare rotational shotputs with rotational scoop tosses...
...you can see that the scoop toss requires far less shoulder internal rotation and horizontal adduction, and distraction forces on the joint are far lower at ball release. The shotput is much more stressful to the joint, so it's better saved for much later on in the rehab process.
5. Adequate rotator cuff control is about sufficient strength and proper timing - in the right positions.
To have a healthy shoulder, your cuff needs to be strong and "aware" enough to do its job in the position that matters. If you think about the most shoulder problem, there is pain at some extreme: the overhead position of a press, the lay-back phase of throwing, or the bar-on-your back position in squatting. For some reason, though, the overwhelming majority of cuff strength tests take place with the arms at the sides or right at 90 degrees of elevation. Sure, these positions might give us a glimpse at strength without provoking symptoms, but they really don't speak much to functional capacity in the positions that matter.
With that in mind, I love the idea of testing rotator cuff strength and timing in the positions that matter. Here's an example:
Obviously, you can make it even more functional by going into a half-kneeling, split-stance, or standing position. The point is that there are a lot of athletes who can test pretty well in positions that don't matter, but horribly in the postures that do.
6. Pre-operative physical therapy for the shoulder is likely really underutilized.
It's not uncommon to hear about someone with an ACL tear going through a month or so of physical therapy before the surgery actually takes place. Basically, they get a head start on range-of-motion and motor control work while swelling goes down (and, in some cases, some healing of an associated MCL injury may need to occur).
I'm surprised this approach isn't utilized as much with shoulder surgeries. It wouldn't be applicable to every situation, of course, but I think that in some cases, it can be useful to have a pre-operative baseline of range-of-motion. This is particularly true in cases of chronic throwing shoulder injuries where regaining the right amount of external rotation is crucial for return to high level function. Adding in some work on cuff strength/timing, scapular control, and thoracic mobility before hopping in a sling for 4-6 weeks probably wouldn't hurt the case, either. And, as an added bonus, if this was more common, I think we'd find quite a few people who just so happen to become asymptomatic, allowing them to cancel their surgeries. It's probably wishful thinking on my part, but that's what these random thoughts articles are all about.
For more information on approaches to evaluating, coaching, and programming for the shoulder, be sure to check out Sturdy Shoulder Solutions.
Have a great weekend!
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