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Cryotherapy and Exercise Recovery: Part 2

Today's guest post is the second installment in a series on cryotherapy from Tavis Bruce. In case you missed Part 1, you can check it out HERE. -EC

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In Part 1 of this two-part series on cryotherapy, I summarized the literature to-date on the short- and long-term effects of post-exercise cryotherapy.

To briefly recap:

• Cryotherapy, particularly cold water immersion (CWI) seems to reduce perceptions of fatigue and muscle soreness and increase perceptions of recovery which may benefit performance in the short-term.

• However, chronic use of cryotherapy is contraindicated due to the detrimental effects on long-term training adaptations.

Today, in Part 2, I’m going to discuss more of the practical side of cryotherapy—basically, how to make the most of it, if and when you choose to use it.

But first, I thought I would discuss some baseball-specific research that may be of interest to the baseball players and coaches out there who are reading this article.

Should Pitchers Ice?

As a pitcher, my relationship with ice is definitely what I would describe as hot n’ cold (pun intended). When I was younger, slapping an ice pack on my arm was somewhat of a post-game ritual. But, by the time I got to college, I found myself questioning how much icing my arm actually “helped”. I eventually stopped icing altogether, save maybe a few times when I was particularly sore. Suffice to say, I’ve always been curious what the research had to say about icing after throwing, so I was pretty stoked to find a few studies that looked at exactly that. (If you don’t care about baseball, go ahead and skip to the next section.)

In a study of “highly skilled”* amateur baseball players, Yanagisawa et al. found that light shoulder exercise (20 minutes on an arm ergometer at a low-intensity) was more effective than ice at restoring internal and external shoulder strength and range of motion (ROM) 24 hours after a 7-inning, 98-pitch simulated outing (38,89). However, improvements in shoulder strength, ROM, and muscle soreness were greatest when ice and light shoulder exercise were combined. These results indicate that active recovery (such as light shoulder exercise) may be an effective recovery strategy between pitching appearances, and that ice may provide some additional benefits, particularly relating to the management of delayed-onset muscle soreness (DOMS) in the throwing shoulder after pitching.

*The participants were college-aged, but the authors did not explicitly state if they were college or recreational baseball players, nor did they state average velocities.

Two studies (90,91) looked at the effects of icing the throwing arm between innings of a simulated game. Interestingly, both studies found that pitchers’ velocities dropped off less when they iced their throwing arms between innings compared to when they didn’t. In addition, icing between innings decreased perceived exertion and increased perceived recovery (91) as well as increased the number of innings and the total number of pitches pitchers threw when pitchers threw to volitional fatigue (90).

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While these findings are intriguing, I wouldn’t go icing my arm between innings just yet. It’s certainly possible that cooling the pitchers’ throwing arms modified perceptions of effort and fatigue in a way that allowed for a greater output as the game went on. But, as I alluded to earlier in this article, cooling can disrupt both neuromuscular drive as well as proprioceptive feedback from the arm, both of which have important implications for throwing a baseball fast, accurately, and (perhaps) “safely”. This may be less problematic in low velocity pitchers (with an average fastball of about 70 miles per hour, the pitchers in these two studies weren’t exactly lighting up the radar gun!) but we have no idea how pitchers with elite-level fastball velocities would respond to this kind of protocol.

There is no direct evidence that suggests that ice is detrimental to pitching performance. In particular, ice combined with active recovery strategies such as light shoulder exercise may help reduce DOMS and restore shoulder strength and range of motion between pitching appearances. However, these findings need to be interpreted with caution as the effect of icing after throwing in the elite-level pitcher has not been quantified nor are there any longitudinal studies assessing the long-term effects of icing after throwing on functional or morphological adaptations to a comprehensive, periodized throwing program. Given the detrimental effects of CWI on resistance training adaptations, regular icing of the shoulder is not recommended in the off-season.

Does Cooling Method Matter?

It turns out that how you choose to cool down after exercise may be important. A 2013 meta-analysis by Poppendieck et al. found that CWI was more effective than ice packs and cryogenic chambers for performance recovery in trained athletes (92). This findings may be biased due to the large majority of studies that use CWI as their cooling intervention but there’s a reason for this: CWI is by far the most effective method for cooling the body (93) and, as such, it has become the gold standard in both research and athletic settings.

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Whole-body cold water immersion also appears to be more effective than cooling only the exercised limb(s) (92). This may be due to a greater reduction in core temperature with whole body cooling than with partial-body cooling (94) in addition to the (potentially) therapeutic effects of hydrostatic pressure experienced during water immersion10. If CWI isn’t available, compression wraps can enhance the intramuscular cooling effects of ice packs (95,96) in addition to providing a compression effect (albeit to a far lesser degree than water immersion), although it’s not quite clear what effect (if any) this might have on recovery.

Whole body CWI is not only the most effective way to cool the body, it may also have the greatest therapeutic benefit, due to the temperature-independent effects of water immersion.

Is There an Optimal Temperature or Duration?

There is no definitive evidence on an “optimal” temperature or duration for cryotherapy; however, the available research provides some insight.

In their meta-analysis, Poppendieck et al. concluded that water temperatures of 12-15ᵒC are sufficient to elicit positive effects on post-exercise recovery in trained athletes and that cooler temperatures are not likely to produce any additional benefit (92).

As for duration, 10 minutes of whole body CWI at 12-15ᵒC is more than enough to elicit a reduction in intramuscular temperature (93) and 20 minutes seems to be the upper limit of what is used in the literature (with the exception of warmer immersions, of course). Logically, the less body mass that is exposed to cold, the longer the exposure needs to be to elicit a similar reduction in core body temperature (94). Similarly, colder temperatures require shorter exposures (97).

Further evidence suggests that CWI for longer durations (30 minutes) may exacerbate the inflammatory response to exercise (64) and there are several documented cases of peripheral nerve injury when ice packs are left on for too long (98,99). Don’t be the guy that falls asleep with an ice pack on!

A 10-minute, whole body immersion at 12-15ᵒC is more than enough to reap the benefits of CWI. Cooler temperatures or longer durations are unnecessary and potentially harmful, so always be sure to err on the side of caution.

What About Placebo Effects?

Despite the placebo effect being well-documented in sports (see Beedie et al. [100] for review), there hasn’t really been an attempt to quantify its role in the positive outcomes we (sometimes) see with cryotherapy. Sugar pills are one thing, but it’s not exactly easy to convince someone they’re taking an ice bath—without actually having them take an ice bath! So, when Broatch et al. published their placebo study in 2014 there was a lot of hype on the internets. And for good reason: it was the first study that compared CWI to, what I consider to be, a pretty decent shot at a placebo condition.

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In the study, participants in the placebo group performed 15 minutes of thermoneutral immersion but were led to believe it contained a special “recovery oil” that was just as effective as CWI. And the results were pretty compelling: the thermoneutral placebo was just as effective as CWI at restoring quadriceps strength (MVC) up to 48 hours post-exercise and both groups recovered significantly better than the thermoneutral control group. In addition, both the CWI and the thermoneutral placebo group reported similar subjective ratings of recovery.

Now, we can’t generalize these results to all scenarios because the study looked at recovery of quadriceps strength following four 30-second maximal sprints on a cycle ergometer. We have no idea to what extent placebo effects are involved in recovery from, say, resistance training, endurance exercise, or team sports. I think it’s pretty safe to say they likely play a role, though.

So how do we interpret these results?

Well, we could throw the ice out with bathwater. After all, cold water immersion is no better than placebo, right? But I don’t think that’s necessary. As a coach, I think it’s always important to consider the preferences of your athletes. And I think this study supports the use of CWI with athletes who believe it to have a recovery benefit (e.g., Cook & Beaven found that repeat sprint performance following CWI was related to how much athletes “liked” it [67]). Said differently, there’s not enough solid evidence to encourage your athletes to use CWI, but I see no reason to discourage an athlete who sees value in it either.

This last point comes with one major caveat: as long as an athlete’s use of CWI does not impede on your training goals for that athlete. In this sense, it may be valuable to educate athletes who regularly use CWI on its potentially detrimental effects on long-term training adaptations and explain to them it is best used sparingly throughout the competitive season.

Placebo effects almost certainly play a role in the recovery benefits of cryotherapy, but it’s not clear to what extent. Coaches should pay attention to the preferences of their athletes, and not necessarily discourage an athlete who perceives cryotherapy to be beneficial from using it sparingly, and in a manner that is congruent with their training goals.

Practical Recommendations

If you’re an athlete (or if you coach an athlete) that likes using ice or ice baths for recovery, that’s great! Keep doing what you’re doing. But to make the most of it, I suggest you following my recommendations below:

• Use ice baths over ice packs or other forms of local cooling whenever possible.

• Make sure the water temperature is between 10-15 degrees Celsius but not any colder. Colder does not mean better. Warmer temperatures (up to 20 degrees Celsius) for longer durations can also be used.

• Ice baths should last between 5-15 minutes. The colder the water, the shorter the ice bath should be.

• Submerge your whole body (up to your neck/shoulders), or as much of your body as you can.

• After the ice bath, allow time for rewarming and ensure an adequate warm-up before your next game, event, or training session. Avoid using ice baths immediately (<1 hour) prior to exercise, particularly before training or events involving high-intensity or explosive efforts such as sprinting, jumping, or weightlifting. The exception to this rule would be if you’re competing in an endurance event in warm or hot weather. In this case, precooling may enhance subsequent performance.

• Use ice baths sparingly. Regular ice baths kill strength and muscle mass gains! They’re best saved for strategic use during the competitive season when you’re trying to recover performance within a few hours to a few days.

• Important: Be careful! Cryotherapy does not come without its dangers. Exposing your body to cold temperatures for too long can have potentially dangerous effects. (E.g., don't fall asleep with an ice pack on your shoulder. I used to do this. It’s moronic!) Set yourself a timer and stick to it. And if things start to feel sketchy before the timer goes off, call it quits!

Note: the references for this entire article will be posted as the first comment below.

About the Author

A native of the Great White North, Tavis Bruce (@TavisBruce) is no stranger to the effects of cold on athletic performance. He holds a Bachelor of Kinesiology and Health Science from the University of British Columbia, where he pitched for the Thunderbirds baseball team for three seasons. Tavis is currently the Director of Education for the Baseball Performance Group, where he integrates his passion for sports science with his love of baseball. He can be contacted at tavis.bru@gmail.com.

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Cryotherapy and Exercise Recovery: Part 1

Today's guest post comes from Tavis Bruce. A while back, I asked Tavis to pull together an article examining the literature on cryotherapy with athletes, and as you'll see below, he really overdelivered. Enjoy! -EC

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Sports and ice go together like peanut butter and jelly (or steak and eggs, if you’re into Paleo). From ice packs to ice baths, various forms of “cryotherapy” have long held a sacred place in sports medicine to treat acute injuries and facilitate recovery from training or competition. But despite its popularity and widespread use, the evidence in support of cryotherapy remains equivocal.

More recently, cryotherapy—particularly the use of ice baths, or cold water immersion—has come under increasing scrutiny from both the scientific community and the strength and conditioning industry at large...and rightfully so! However, in the process, we may be swinging the pendulum too far in the other direction, indicated by those who have come to the conclusion that “ice baths are a complete waste of time for every athlete in every sport in every possible situation.” Now, others may disagree with me on this one; but, the evidence (or lack thereof) for cryotherapy appears to be a little more nuanced than that.

I guess what I’m trying to say is: I’m not so sure I’m ready to throw the ice out with the bathwater just yet. Perhaps, instead of pondering black-and-white questions like, “to ice or not to ice?” we should be asking:

                         “When is ice appropriate?”

I’d like to examine why.

A quick note before we get started: this article will not discuss the use of cryotherapy for the management and/or rehabilitation of acute soft tissue injuries. I am NOT a medical professional; I just play one on Facebook.

As such, this article will only cover the efficacy of cryotherapy as a post-exercise recovery strategy.

Is there a Physiological Rationale for Cryotherapy?

Note: I’m not going to spend much time discussing the physiological rational (the “why”) behind cryotherapy for two reasons. First, the mechanisms are still quite hypothetical. Second, and more importantly, it’s a bit outside the scope of this article to convey practically relevant and actionable information for my fellow coaches and athletes. We can debate the mechanistic stuff until the cows come home, but in my humble opinion, the gold standard measurement for post-exercise recovery is the measurement of performance variables. And, I like to think that most athletes, coaches, and sports scientists would agree with me. That being said, I do think it’s always a good idea to establish if there is at least a physiological rationale for any method we may use with ourselves and/or our athletes. With that said…

Cryotherapy results in various physiological changes (most of which are temperature-dependent) that have long been proposed to exert a therapeutic effect post-exercise. Although the most cited physiological change is a blunted inflammatory response, there exists a range of other effects through which cooling the body after exercise may accelerate the recovery process. Of note, cryotherapy may:

• Improve tissue oxygenation1 and removal of metabolic waste (2) by reversing exercise-induced muscle edema (3,4).
• Reduce reactive oxygen species (ROS)-mediated muscle damage (5) by reducing local metabolism (1).
• Induce analgesia by decreasing nerve conduction velocity (6) in addition to directly activating sensory afferents (7).
• Restore parasympathetic tone by increasing vagal tone (8,9).

In addition, cold water immersion (or “ice baths”), a popular form of cryotherapy, may have additional benefits resulting from the compressive forces experienced during water immersion, but I won’t be covering them in this article (see Wilcock et al. [10] for a good review). For more information on the physiological effects of cold water immersion and other forms of cryotherapy, I encourage you to check out this (open access!) review by White and Wells.

The Effects of Cryotherapy on Recovery from Sport or Exercise

Perceptual Measures of Recovery

Cold water immersion reduces perceptions of fatigue (11-16) and increases perceptions of recovery (17,18) and physical readiness (19) between training sessions; however, it doesn’t seem to have much of an effect on ratings of perceived exertion (RPE) during subsequent training bouts (20-23).*

*Except for when CWI is used as a precooling strategy before exercise. (More on precooling later.)

Delayed-Onset Muscle Soreness

Though it’s pretty well accepted that cooling injured tissue can temporarily reduce or relieve pain (24), it’s not really clear if post-exercise cooling has any effect on delayed-onset muscle soreness (DOMS): the type of soreness you feel in the days following a bout of intense or novel exercise.

There is some evidence that cold water immersion (CWI) alleviates DOMS better than passive recovery (25), particularly when CWI is used following exercise that involves a large degree of metabolic stress (26) (e.g., running, cycling, or team sports). However, this effect is less clear when CWI is compared to warm (27), thermoneutral1 (4,28), or contrast (27,29,30) immersion, and recent evidence suggests that CWI may be no more effective than a placebo (19) for relieving DOMS. Collectively, these findings highlight the perceptual nature of muscle soreness and the importance of athletes’ perceptions of cryotherapy (or any recovery method, for that matter).

Icing and cold water immersion may help reduce delayed-onset muscle soreness after running or team sports, but the effect likely depends on the athlete’s belief in cryotherapy as a method of recovery.

Range of Motion

There is conflicting data on the effect of cooling on range of motion (ROM). Cooling alone does not appear to improve ROM (28,31-38), but it may enhance the effects of stretching (39-43) by increasing stretch tolerance (44). On the one hand, this increased tolerance to stretch does not appear to translate into long-term improvements in ROM (45-47). On the other hand, heat combined with stretching may have more lasting effects than stretching alone (44).

If your goal is to restore lost ROM following exercise, combine heat (not cold!) with stretching.

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Strength

The short-term effects of post-exercise cooling on recovery of strength characteristics are mixed and seem to depend on the type of exercise stress from which you’re trying to recover before you hit the weights.

There is some evidence that CWI may reduce or recover losses in maximal voluntary contraction (MVC) following simulated team sports (48-50) or intermittent sprint exercise (51-53), but not after downhill running (54) or cycling (55,56). And, in the only study of its kind, Broatch et al. found that CWI following high-intensity sprint intervals recovered MVC no better than a thermoneutral placebo (19).

Roberts et al. demonstrated that CWI was effective for restoring submaximal (but not maximal) strength between two lower body training sessions within the same day (57). Vaile et al. found both cold and contrast water immersion were effective at restoring strength up to three days after heavy eccentric strength training (27)*, but most studies show no or non-significant improvements over this time period (28,58-62). However, it’s important to note that all of these studies used (potentially) “less effective” cooling methods (such as when only the exercised muscle is cooled) compared to more therapeutic methods such as whole-body CWI.

*I highlight the study by Vaile et al. because it is the only study that compared multiple hydrotherapy modalities in trained males, and in a cross-over design with a “washout” period between treatments of sufficient duration to eliminate any residual effects of the repeated bout effect. Thumbs up for study quality!

Cold water immersion may help recover muscle contractile properties following running or team sports. Benefits following resistance training are less clear and may require the use of cold water immersion over local cooling of exercised tissue.

Jump Performance

Most studies show significant recovery of jump performance within 24-48 hours post-exercise with no clear additional benefits to CWI (18,49,53,63,64). Furthermore, CWI may impair jump performance within the first two hours (57) possibly due to the acute effects of cold exposure on force production (65).

Here’s the deal: jump performance seems to recover just fine on its own. However, there is some evidence that CWI may maintain jump performance in scenarios of accumulated fatigue, such as during tournament play in team sports. One study of basketball players found that the CWI maintained jump performance better in players who saw more playing time throughout a 3-day tournament (66).

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Sprint Performance

Like jump performance, many studies report that sprint performance returns to baseline within 24 hours after exercise, regardless of treatment intervention (18,49, 61). Accordingly, most studies do not find a benefit in favor of CWI compared to other recovery interventions because the initial exercise bout was not sufficiently intense to elicit a significant 24-hour performance decrement.

However, when exercise was sufficiently intense to affect 24-48 hour sprint performance, CWI maintained repeat-sprint performance (a measure of speed-endurance) better than thermoneutral immersion (67), contrast water therapy (12,13,48), and passive recovery (12,13,48,67).

The effect of CWI on absolute speed is less clear. Of the two studies I found, one found no benefit to CWI over passive recovery on immediate and 24-hour recovery of 50-m dash time (68), while the other showed that CWI maintained 20-m speed better than compression or stretching over a 3-day simulated basketball tournament (66).

There’s not a lot of data on the effects of CWI on same-day recovery of sprint performance, but one study showed no significant differences in repeat-sprint performance between CWI and passive recovery immediately and up to two hours after intermittent sprint exercise in the heat (61). This ties in well with the research in sprint cycling that shows neutral—or even detrimental—effects on 30-second Wingate performance following CWI when sufficient re-warming does not occur (69,70). This makes sense: reduced muscle temperature will negatively affect muscle contractile properties (71), impair energy metabolism (72), and slow nerve conduction velocity (6,73), which collectively will negatively affect the force- and power-generating capabilities of muscle. Thus, caution should be taken when using CWI between or prior to exercise that requires a high-degree of muscular force (sprinting, jumping, etc.). Athletes should allow sufficient time to rewarm following CWI and make sure to include a dynamic warm-up before their next event, which has been shown to offset the negative effects of cold exposure on power production in the vertical jump (65).

When exercise is sufficiently intense, CWI may help restore short-term (<48 hour) sprint and jump performance. However, reduced muscular temperatures negatively affect the force-generation capacities of muscle. Thus, when using ice baths between two training sessions or events within the same day, it is important to allow the body sufficient time to re-warm and/or to include an extensive dynamic warm-up.

Endurance Performance

Given the number of endurance athletes that use ice baths to recover between workouts or events, it was somewhat surprising that very few studies looked at endurance performance following recovery periods of 24 hours or longer. Two of those studies showed that CWI improves endurance performance following a 24-hour recovery period (17,74), and two other studies demonstrated similar recovery benefits across 3-day (75) and 5-day (23) training blocks.

Paula_Radciffe_NYC_Marathon_2008_cropped

Most studies that looked at the effects of CWI on recovery from endurance exercise utilized recovery periods of <60 minutes between exercise bouts. But here’s the thing: When an athlete takes an ice bath between two bouts of exercise with a short (<1 hour) duration between bouts that ice bath creates a “precooling” effect for the second bout. Precooling is proposed to increase performance (particularly in hot conditions) by increasing heat storage capacity, reducing thermal strain, and decreasing perceived exertion by reducing core body temperature prior to exercise (76).* And, based on the abundance of data showing a benefit to precooling on endurance performance** (particularly in hot conditions), this is probably why we see such an immediate recovery of endurance performance following CWI (56,77-81). This effect diminishes with longer recovery periods (82), presumably as core body temperature returns to baseline.

*If you’re interested in learning more about precooling check out this (open-access!) systematic review as well as the results of two recent meta-analyses here and here.

**Just to reiterate: the beneficial effect of precooling likely does not hold true for short-duration, maximal efforts (see above).


Ice baths may be useful for recovering endurance performance, particularly when an athlete has to compete in multiple games or events in one day.

The Effect of Regular Cold Water Immersion on Long-Term Training Adaptations

Very few studies have looked at the effects of ice baths on long-term training adaptations. But, the evidence-to-date paints a pretty clear picture:

Strength Training

The evidence is pretty clear on this one: regular use of CWI impairs long-term gains in muscle mass and strength (83-86) at least in part by blunting the molecular response to resistance exercise (84). This seems to apply to both trained (84) and untrained (85,86) individuals.

Ice baths blunt the acute molecular response to resistance training and impair long-term gains in muscle mass and strength. Athletes should reconsider using ice baths after strength training, particularly in the off-season or preparatory period when the focus is on adaptation rather than performance.

Endurance Training

The evidence for the effects of CWI on adaptations to endurance training is not so clear. One study in competitive cyclists found that regular CWI neither enhanced nor interfered with cycling performance over a three-week training block (87). Furthermore, recent evidence suggests that regular CWI may actually enhance molecular adaptations to endurance training (88). However, it’s important to interpret these results with caution, as molecular adaptations do not always reflect functional outcomes and the study did not measure changes in performance. Of note, there is some evidence that regular CWI at very cold temperatures (5ᵒC) for very long durations (>30 minutes) may disrupt local vascular adaptations and attenuate improvements in VO2max to endurance training in untrained subjects (85).

There is no direct evidence to suggest that ice baths enhance nor interfere with endurance training adaptations. In trained athletes, ice baths can be used sparingly after endurance training, but regular use is not recommended, particularly during the preparatory period when the focus of training is on adaptation. Finally, ice baths of excessive duration or at extremely cold temperatures should be avoided.

Major Take-Aways

The evidence for cryotherapy is pretty mixed, but there are some patterns that seem to emerge from the literature:

• Cold water immersion and other forms of cryotherapy reduce exercise-induced inflammation.
• This reduction in inflammation may lead to reduced perceptions of fatigue and muscle soreness and increased perceptions of recovery which may benefit performance in the short-term.
• Importantly, the short-term recovery benefits of cryotherapy may depend considerably on the mode exercise (i.e. the type of stress), the physiological and perceptual qualities one is trying to restore, and (as I will discuss further in Part 2) the athlete’s belief in cryotherapy as a recovery modality.
• Meanwhile, a growing body of evidence indicates that inflammation is a necessary process for tissue regeneration and, as such, regular use of cold water immersion may impair long-term muscular and vascular adaptations to exercise.
• As such, cryotherapy should be used sparingly, particularly in the off-season when the goal is to maximize training adaptations.

In Part 2, I will address:

• whether baseball pitchers should ice their arms
• whether there an optimal cooling method, temperature, or duration
• whether cryotherapy is just one big fat placebo
• practical recommendations for athletes and coaches

Stay tuned for Part 2!

Note: the references for this entire article (including the upcoming part 2) will be posted as the first comment below.

About the Author

A native of the Great White North, Tavis Bruce (@TavisBruce) is no stranger to the effects of cold on athletic performance. He holds a Bachelor of Kinesiology and Health Science from the University of British Columbia, where he pitched for the Thunderbirds baseball team for three seasons. Tavis is currently the Director of Education for the Baseball Performance Group, where he integrates his passion for sports science with his love of baseball. He can be contacted at tavis.bru@gmail.com.
 

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10 Ways to Remain Athletic as You Age

Back in my early-to-mid-20s, my focus shifted into powerlifting and away from a "traditional" athletic career. While I got a ton stronger, I can't say that I felt any more athletic. In hindsight, I realize that it was because I trained strength at the exclusion of many other important athletic qualities. Since then, I've gone out of my way to include things that I know keep me athletic, and as a result, into the latter half of my 30s, I feel really good about taking on anything life throws my way. With that in mind, I thought I'd pull together some recommendations for those looking to remain athletic as they age.

1. Stay on top of your soft tissue work and mobility drills.

Without a doubt, the most common reason folks feel unathletic is that they aren't able to get into the positions/postures they want. As I've written in the past, it's much easier to do a little work to preserve mobility than it is to lose it and have to work to get it back. Some foam rolling and five minutes of mobility work per day goes a long way in keeping you athletic.

2. Do a small amount of pre-training plyos.

I think it's important to preserve the ability to effectively use the stretch-shortening cycle (SSC). That's not to say that every gym goer needs to be doing crazy depth jumps and sprinting full-tilt, though. A better bet for many folks who worry about tweaking an Achilles, patellar tendon, or hamstrings is to implement some low-level plyometric work: side shuffles, skipping, carioca, and backpedaling. Here's a slightly more advanced progression we use in The High Performance Handbook program:

The best bet is to include these drills right after the warm-up and before starting up with lifting.

3. Emphasize full-body exercises that teach transfer of force from the lower body to the upper body.

I love cable lift variations to accomplish this task in core exercises, but push presses, landmine presses, and rotational rows are also great options.

4. Emphasize ground-to-standing transitions.

Turkish Get-ups are the most well-known example of this challenge, but don't forget this gem:

5. Get strong in single-leg.

Squats and deadlifts will get you strong, no doubt, but don't forget that a big chunk of athletics at all levels takes place in single-leg stance. Lunges, 1-leg RDLs, step-ups, and split squats all deserve a place in just about everyone's training programs.

6. Use core exercises that force you to resist both extension and rotation.

Efficient movement is all about moving in the right places. The lower back isn't really the place to move, though; you should prioritize movement at the hips and upper back. With that in mind, your core work should be focused on resisting both extension (too much lower back arching) and rotation. Here are a few favorites:

7. Train outside the sagittal plane.

It's important to master the sagittal (straight ahead) plane first with your training programs, but once you get proficient there, it's useful to progress to a bit of strength work in the frontal place. I love lateral lunge variations for this reason.

8. Chuck medicine balls!

I'm a huge fan of medicine ball drills with our athletes, but a lot of people might not know that I absolutely love them for our "general population" clients as well. I speak to why in this article: Medicine Ball Workouts: Not Just for Athletes. Twice a week, try adding in four sets at the end of your warm-up and prior to lifting. Do two sets of overhead stomps and two sets of a rotational drill, starting with these two variations in month 1:

In month 2, try these two:

Trust me; you'll be hooked by the "8-week Magic Mark."

9. Be fast on your concentric.

If you want to stay fast, you need to keep a fast element in your strength training program. This can obviously entail including things like Olympic lifts, jump squats, and kettlebell swings. Taking it a step further, though, you can always just make a dedicated effort to always accelerate the bar with good speed on the concentric (lifting) portion of the movement. 

10. Play.

In a given week, on top of my normal lifting, I might catch bullpens, sprint or condition with my athletes, play beach volleyball, or run a few football receiving routes at the facility. The old adage, "Variety is the spice of life" applies to fitness and athleticism, too. Don't be afraid to have some fun.

The longer you've been training, the more you realize that your strength and conditioning programs have to be versatile enough to preserve your athleticism and functional capacity while still keeping training fun. If you're looking for a flexible program that's proven effective across several populations, I'd encourage you to check out my flagship resource, The High Performance Handbook, especially since it's on sale for $50 off through Sunday at midnight. The discount is automatically applied at checkout at www.HighPerformanceHandbook.com.

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Strength and Conditioning Stuff You Should Read: 2/12/16

Happy Friday, everyone! Here are three good reads from the strength and conditioning world to kick off your weekend on the right foot:

Would I Be Healthier If I Quit Drinking? - Camille DePutter takes a close look into how alcohol and fitness can co-exist, and what tradeoffs the choice to drink may entail. As usual, Precision Nutrition delivers excellent content.

Resume Building 101 for Fitness Professionals - My business partner, Pete, reviews well over 300 resumes each year for both CSP internships and jobs. Suffice it to say that if you're looking to strengthen your resume in the fitness industry, this is must-read material!

EC on the Physical Preparation Podcast with Mike Robertson - I was a guest on Mike's show last week, and we talked a lot about baseball development.

Also, just a friendly reminder that the $30 off sale on The High Performance Handbook ends this Sunday at midnight. Be sure to take advantage of this discount on my most popular resource of all time!

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Random Thoughts on Sports Performance Training – Installment 15

This is my first installment of this series since October, so hopefully I can atone for that with a solid January performance. Here goes!

1. On several occasions, I've written that if you are going to include an exercise in a program, you absolutely have to be able to justify how it's going to create the training effect you want. In particularly, this is a question that should be asked constantly during sprinting and agility progressions. The end goal is obviously to (safely) put a lot of force into the ground as quickly as possible to create powerful athletic movements in all three planes of motion. Sometimes, I feel like we get very caught up in just programming drills for the sake of programming drills. There are a million different types of skipping drills, for instance, and we use a lot of them. Athletes certainly ought to be able to skip, but at the end of the day, we have to ask ourselves if making a skip more advanced and elaborate is really going to make an athlete move better. Or, would we be better off devoting that training volume to actual sprint work? There isn't really a "correct" answer to these questions, but I do think it's important to critically analyze our programs to see if the carryover from drills to actual athletic performance is really that good.

2. Earlier today, I was discussing outfield "jumps" with a few of our Cressey Sports Performance clients, including Sam Fuld, an Oakland A's outfielder who is well known for making some pretty crazy plays in center field. We were talking about lower-body movement (hip turn, crossover run, etc.) during the initial break as he reads a ball off a bat, but as we went to actually find some video online, my attention went elsewhere. Check out this play where Sam traveled 58 feet to make a diving catch:

What I noticed was the fact that he never actually got upright. He stayed in acceleration mode the entire time. If you replay the video from above, watch the :08 through :11 second interval. You'll rarely see a player cover more ground in the field.

This is yet another reason why I think a 30-yd (or home-to-first) time is more appropriate for assessing baseball-specific speed than a 60-time. Baseball players rarely get to top speed, whether it's in running the bases or playing the field. And, more importantly, they'd never do it in a straight line. I'm beginning to think that a 60-time is about as useful for a baseball evaluation as the 225lb bench press test is for NFL players...

3. Remember that not all your anterior core work has to be slower tempo drills like rollouts and fallouts, or low-level isometrics like prone bridges. Rather, remember that any time you go overhead while maintaining a neutral spine, you're working to resist excessive extension at your lumbar spine. In other words, overhead med ball drills can be great anterior core progressions - and here's a way to take them to the next level:

4. Resistance bands are awesome on a number of training fronts. They can be used to accommodate the strength curve, making the movements more challenging at the points in the range of motion where we are strongest. They can also be used to deload certain movements at positions where we are weakest.

In sports performance training, though, I'd say that their biggest value is in teaching direction - and subsequently loading it. As an example, I like band-resisted broad jumps because they allow us to produce force in a path that would be challenging to load in any other way. And, we need to produce force in this path during everyday athletic endeavors:

This is an area where Lee Taft really excels. When I watch experienced coaches teaching and coaching, I look for patterns that stand out: strategies that they return to frequently. In his new Certified Speed and Agility Coach course, Lee uses a band a ton to teach direction of force application and create appropriate angles for acceleration. It made me realize that we can get more efficient in some of our coaching strategies by busting out the band a bit more.

leeband

Speaking of Lee, the early-bird $100 discount on his new certification wraps up this Friday at midnight. I'm finishing it up myself and really benefited on a number of fronts - and our entire Cressey Sports Performance staff will be going through the resource as well. You can learn more about the course HERE.

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Preventing Baseball Injuries: Actions Speak Louder Than Words

We're at a point in time where just about everyone knows that throwing a baseball year-round is a bad idea. Moreover, we know that it's best for kids to avoid early sports specialization. 

Dr. James Andrews has been outspoken against early specialization and year-round throwing for roughly a decade.

John Smoltz devoted a big chunk of his Hall-of-Fame acceptance speech in Cooperstown to discouraging kids and parents from early specialization and year-round baseball.

JohnSmoltz

Seahawks coach Pete Carroll recently referred to the trend of kids playing only one sport as "an absolute crime."

USA Baseball launched their Pitch Smart campaign - featuring an advisory board of many MLB team doctors and athletic trainers - to prevent overuse in youth baseball.

All the way back in 2006, a landmark study by Olsen et al. clearly demonstrated strong associations between injuries requiring surgery and pitching "more months per year, games per year, innings per game, pitches per game, pitches per year, and warm-up pitches before a game" as well as showcase appearances during adolescence. Overuse is the one factor that predicts injury over and over again in the research.

A 2011 study demonstrated that players in warm weather climates had less shoulder strength and more problematic range-of-motion adaptations than those in cold weather climates. And, speaking from personal experience from having Cressey Sports Performance facilities in both states, it's been far more challenging to develop players in Florida than it is in Massachusetts. There is simply too much baseball competing with general athletic development.

These are just a few examples, too. Hundreds of professional athletes have spoken out against early sports specialization. College coaches have in some cases refused to recruit one-sport athletes. And, there are more anti-specialization posts and websites freely available on the Internet than one could possibly imagine. Yet, the problem isn't even close to going away, and injuries still at all-time highs.

Now, I can understand how some players, parents, coaches, and scouts don't stay on top of the American Journal of Sports Medicine and might have missed this important information. What I can't understand is how they'd miss it when the world's most recognized orthopedic surgeon is speaking out against it. Or how they can miss it when one of the most accomplished pitchers of the last century devotes the biggest media spotlight of his life to bashing early sports specialization. Or how they'd overlook one of the premier coaches in the NFL so vehemently putting down the practice. Or how a governing body like MLB would devote time, money, and resources to a problem that they think will have a significant negative impact on the future of the game beyond just the billions of dollars that are already being wasted on players on the disabled list.

The problem is not a lack of knowledge; the problem is a lack of action and consequences.

When you were a little kid and stole a cookie from the cookie jar - even after your mother told you it was off limits - you got punished for doing so. If you didn't have consequences, you'd keep stealing cookies. Unfortunately, this isn't an option with youth baseball. Really, the only consequence is injury, and it's surprisingly not that great a teacher.

elbows

A lot of kids and parents continue to make the same mistakes even after an arm surgery and extended layoff. They've been brainwashed to think that the only way kids can succeed in baseball is to play year-round to keep up with other kids and get exposure to college coaches and pro scouts. There are too many coaches, showcase companies, and scouting services lining their pockets by lobbying hard to make these false assumptions stick. 

If knowledge ("eating too many cookies is bad for you") isn't working, and it's hard to deliver consequences, what's the next step? You've got to make it really hard to get to those cookies - and they better taste like crap if you do manage to do so. 

Stepping away from this analogy, the big governing bodies that matter need to step up their game. Here are six quick changes that I personally feel could have a profound impact on reducing injury rates across all levels:

1. Major League Baseball needs to implement a high school scouting "dead period" from October 1 through January 1. It is entirely hypocritical for MLB to push PitchSmart, but turn a blind eye when literally hundreds of scouts are showing up for October-December showcases and tournaments that directly compete with the PitchSmart initiative. Most of the highest-profile players aren't even attending these events anymore (advisors know it's an unnecessary injury risk), and there is absolutely nothing a scout would see in November that they can't see in the spring during the regular season.

2. MLB should also mandate that no pitcher can throw in more than three consecutive games - including "getting hot" (throwing in the bullpen, but not entering the game). Some might criticize me for this, but after extensive interaction with relievers at this level, I firmly believe that bullpen mismanagement is one of the biggest problems in MLB pitching injuries. Fans and the media only see the actual number of appearances, but when you factor in the number of times a pitcher "gets hot" without entering the game, you have relievers who are literally throwing over 120 times in a season.

3. The NCAA needs to implement innings limits on freshman and sophomore pitchers. Keep freshman pitchers to 120 innings and sophomore pitchers to 140 (combining the college season and summer ball). Additionally, any pitcher who throws more than 120 innings during the spring/summer should have a mandatory 60-day period of no throwing prior to starting fall ball.

4. The NCAA should also implement a conservative pitch count limit for college starters. I think 130 is a good place to start, and while I still think it's unnecessarily high, it reins in those coaches who'll leave a guy in for 150+ pitches. Sadly, this happens far too often in college baseball these days, and there are zero repercussions (although I do commend ESPN's Keith Law for always calling these coaches out on Twitter).

5. State athletic associations in warm weather climates need to structure high school seasons to allow for athletes to compete in multiple sports. As an example, in Massachusetts, the high school baseball season begins on the third Monday in March, while the first basketball practice is November 30. If a high school basketball player wants to play baseball, he might only have a 1-2 week overlap during that month - and it only happens if his team goes deep into the playoffs.

Conversely, the high school baseball season here in Florida begins on January 18, while the last regular season basketball game doesn't occur until January 30. The state championship games take place February 23-27 - which is roughly halfway through the baseball season! There is absolutely no reason for a high school baseball season (in which teams play about 30 games) needs to start prior to March 1.

CSP-florida-021

That extra six weeks would make a huge difference in getting more baseball players to also participate in winter sports and help to get a baseball out of young hands a bit longer. And, you'd see a lot more players well prepared on day 1 of baseball tryouts because they'd have more off-season preparation under their belts. It would simply force teams to play three games per week instead of two; this is exactly what's done in Northern states (and they'll sometimes play four, if weather interferes).

6. Similar to point #4, state athletic associations should also have regulations on permissible pitch counts for high school arms. I think 115 pitches is a good number.

Closing Thoughts

I should note that I actually think Little League Baseball does a solid job of disseminating information and including specific regulations within the game and between games. The changes - at least in my eyes - should rest with high school athletic associations, the NCAA, and Major League Baseball. Impact will come from the top down.

As you can see, with only two exceptions, I'm much more about managing the competitive year than I am about micromanaging pitch counts. And, the two pitch count recommendations I put out are remarkably conservative and just reaffirm common sense (which, unfortunately, isn't so common anymore). Pitch counts alone haven't proven to be tremendously effective, but do have a place when implemented alongside guidelines for managing the overall baseball calendar.

There is absolutely no reason for skeletally immature middle and high school baseball players to have longer competitive seasons than professional players.

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The Best of 2015: Baseball Articles

With baseball athletes being the largest segment of the Cressey Sports Performance athletic clientele, it seems only fitting to devote a "Best of 2015" feature to the top baseball posts from last year. Check them out:

1. Common Arm Care Mistakes - Installment 6 - In this article, I talk about how important it is to select arm care exercises that truly appreciate the functional demands placed on the shoulder and elbow during throwing.

2. Changing Baseball Culture: A Call to Action - Physical therapist Eric Schoenberg makes a call to action to step away from four baseball traditions so that we can more easily prevent baseball injuries.

manual_therapy_page-300x206-2 

3. What is a "Big League Body?" - Big leaguers come in all shapes and sizes. Your baseball strength and conditioning programs need to appreciate that.

4. 6 Physical Attributes of Elite Hitters - Here are six physical characteristics that elite hitters seem to share.

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5. Projecting the Development of High School Pitchers -  Cressey Sports Performance Pitching Coordinator Matt Blake shows what a difference a year can make in projecting high school pitchers for college baseball success.

If you're interested in learning more about how we assess, program for, and train baseball players, I'd encourage you to check out one of our Elite Baseball Mentorships. The next course will take place January 17-19, 2016 at our Hudson, MA facility. You can learn more HERE.

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The Best of 2015: Strength and Conditioning Videos

With my last post, I kicked off the "Best of 2015" series with my top articles of the year. Today, we'll highlight the top five videos of the year. These videos only include instructional videos, not quick exercise demonstrations.

1. Avoid this Common Wall Slide Mistake - I'm a huge fan of wall slides for teaching good scapular upward rotation. Check out this video to see if you're making a common mistake on this front:

2. Steer Clear of this "Shoulder Health" Exercise - Continuing with the shoulder theme, here's a drill I don't particularly like. The good news is that I propose a suitable alternative. 

3. Serratus Anterior Activation: Reach, Round, and Rotate - This video covers some of our common coaching cues for a different variation of wall slides than featured in video #1.

4. 3 Back to Wall Shoulder Flexion Cues - This drill is both a great training exercise and an assessment. With the right cueing, you can clean the pattern up pretty quickly, in most cases.

5. Exercise of the Week: Split-Stance Anti-Rotation Medicine Ball Scoop Toss - This is one of my favorite medicine ball exercises for early on in training progressions. 

I'll be back soon with the top guest posts of 2015!

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Coaching Cues to Make Your Strength and Conditioning Programs More Effective – Installment 13

It's time for another installment of my series on coaching cues we utilize at Cressey Sports Performance on a daily basis. Today, I'll feature some of my favorite medicine ball coaching cues:

1. "Keep the head behind the belly button a bit longer."

Creating good "separation" is absolutely essential for producing power in rotational sports. This separation occurs when the pelvis rotates toward the target as the torso continues to rotate (or at least stay back) in the opposite direction. In the example of a right-handed pitcher, the pelvis rotates counter-clockwise toward the plate while the torso is still rotating clockwise toward second base. This separation stores elastic energy - but can also predispose athletes to injuries (as I wrote in 2008) if the motion doesn't come from the right places. 

med ball

In this regard, one of the biggest mistakes we see is the athlete "leaking" forward at the torso. This is a bad habit to get into in terms of power production (loss of separation), injury risk (can make a pitcher's arm "late" and subject the elbow and shoulder to undue stress), and effectiveness (hitters can't stay back to adjust on pitches, pitchers make struggle with "catching up" to find a consistent release point, etc.). 

My feeling is that the head goes where the torso tells it to go, so trying to keep the head back a bit longer will force the torso to stay back long enough for the athlete to get sufficient hip rotation to create the ideal stretch. 

2. "Make your front leg and back legs work like a slingshot."

Throwing a medicine ball - whether it's an overhead or rotational variation - is all about putting good force into the ground on the back leg and then accepting it on the front leg. In the analogy of a slingshot, if the back leg doesn't create enough eccentric preloading and subsequent force production, it's like not pulling back hard/far enough on the elastic portion of the slingshot. Athletes usually "get" this really quickly.

What they often fail to recognize is that the front foot has to stiffen up to accept force and - particularly in the case of overhead variations - help to create an effective downhill plane. One of the things I watch for on the front foot is whether athletes "spin out" of their shoes; you'll actually see some guys roll right over the sides of the sneakers if they don't stiffen up enough on the front leg to accept all the force that's being delivered. This is just like having a "limp" front arm when using a slingshot.

In over ten years of coaching these drills, CSP athletes and Royals pitcher Tim Collins is probably the absolute best example of effective "slingshot" force transfer on medicine ball work. He's got excellent reactive ability and absolute strength/power to create force, but is equally proficient at knowing how to stiffen up at the right time on his front side. I firmly believer that this proficiency plays a big role in his ability to create a great downhill plane and throw one of the best curveballs in baseball even though he's only 5-7. 

3. "Take your hand to the wall."

This is a cue I blatantly stole from my business partner, Brian Kaplan, who is the best coach I've ever seen when it comes to cleaning up medicine ball technique - and also creating context for our pitchers and hitters so that the drills carry over to what they do on the field.

One of the common issues we see with athletes with scoop toss variations is that they use too much wrist and get around the ball. You'll see the spin on the ball, and it won't sound as firm when it hits the wall. Effectively, what's happening is that the athlete is cutting off hip rotation and using the wrist redirecting the ball to the intended target. This causes the athlete to be around the ball instead of through it - so it's analogous to throwing a bad cutter with a baseball. By encouraging the athlete to take the hand to the wall, the ideal direction of force production is preserved, and we train hip and thoracic rotation more than just compensations at the wrist and hand.

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Understanding Scapular Positioning in the Throwing Motion

Today's guest post comes from Cressey Sports Performance - Massachusetts pitching coordinator, Matt Blake (@Blake_Matt). Matt is an integral part of the Elite Baseball Mentorships team. Enjoy! -EC 

At a recent conference, Eric Cressey gave a presentation that tackled the importance of baseball professionals understanding scapular mechanics and the integral role they play in the throwing athlete’s kinetic chain. Eric Schoenberg also recently showed a great drill to incorporate scapular motion into the kinetic chain of activity. Given that I’m the third member of the Elite Baseball Mentorships team with these two, I figured I might as well chime in to highlight its importance from my perspective as well.

This is an important discussion to have because it can help demonstrate the need for all phases of development to work together to keep the high-level thrower operating on all cylinders. If we’re all speaking the same language, we can work to build the athlete’s awareness for their overall movement and integrate the education from the warm-up through the initial phases of the throwing progression.

If we’re all saying different things to the athlete using our own jargon, it’s easy for them to misinterpret the carryover of certain drills, exercises, and concepts across channels. If we all lay down similar verbiage in our conversations with the athlete regarding their prehab work, dynamic warm-up, strength training and throwing motion, it makes it a lot easier for them to appreciate the importance each piece holds in the puzzle.

In order to get started, let’s look at where the scapula is positioned and introduce its fundamental movements so we can begin to appreciate its role in the kinetic chain.

scaps1scaps2

When looking at the scapula’s position and actions, you have to acknowledge the importance of its relationships with the rib cage and the humerus. These relationships are integral in tying the torso and the arm action together in a high-level throw. These interactions between the thoracic region, scapula and humeral head may be the most overlooked or misunderstood components of the delivery – especially for the average coach who has no anatomical background.

The degree of misunderstanding is mainly because the actions are so subtle and can’t be fully appreciated when the athlete throws with their shirt on. This is why its so vital to have a strength/rehab professional in the mix, who can provide a shirtless scapular screen to give us a baseline on where the scapula lies at rest and how it functions in relation to the movement of the arm.
 

Once you can identify how an athlete presents, you can begin to build a more individualized corrective movement progression. This will serve to help the athlete identify and turn on the appropriate movement patterns to keep the humeral head flush with the scapula through its full range of motion. This is essential in the throw, because of the importance of a “clean” arm action to help alleviate some of the stress involved in the high-level motion. For demonstration sake, here’s an example of a HS pitcher, who throws 88-91, with a relatively efficient arm action for his age.

The ability to create elite levels of hand-speed in a durable manner can be won or lost based on how the humeral head functions in conjunction with the scapula. In my mind, this is the crux of the delivery, where you need to be able to tie the “whip-like” arm action into the sequential actions of the torso.

As the thrower engages his landing position, the kinetic forces of the delivery are beginning to flow up through the chain towards the scapula and arm. It’s crucial at this point for the arm to get set up in a sound position to optimize control of the (glenohumeral) joint in an effort to handle the energy that’s about to drive through that portion of the chain towards release. The “optimal” timing of this set-up will be dictated by how the athlete sequences hip and torso rotation, as well as how much laxity they present with, etc. - but for the sake of discussion, we’ll say landing is a crucial checkpoint.

From here, the key actions that we’re going to break out today are upward rotation and protraction. This isn’t to say that they are more important than the other actions, but throughout the season, throwers tend to lose upward rotation from the stress of the throwing motion. With that in mind, let’s identify what it is and how it works with protraction to aid the durability of the high-level delivery.

This concept is something that EC has written and produced videos about countless times over the years, but it continues to be a point that needs to be reiterated time and again. For those who haven’t seen it, this is a great video to consider in this discussion.

From this video, we’ll take it a step further, so you can visualize how this actually plays out in the throwing motion itself.

As you can see, there is a considerable amount of range of motion and control that needs to be in place if you expect to keep the humeral head “centered” from lay-back through the entirety of the deceleration phase. The challenge here is that we can’t always see how the arm action is working with the shoulder blade. One way to combat this is via communicating with your athletes about where they feel their soreness the day after throwing.

Generally speaking, I like to have guys tell me they’re sore near the medial border of the scapula, in the meat of back, where the scapular retractors are eccentrically controlling the scapula as it moves away from the mid-line. If guys are sore near the back, top, or front portion of the shoulder joint itself, then we’re probably getting too much “joint-play” and the humeral head is gliding and translating away from the center of the socket too much during the throw.

If these other patterns of soreness are presenting somewhere along the line, either the rotator cuff wasn’t doing its job, the scapula wasn’t working in sync with the humeral motion, or the thrower’s motion in general is putting them in positions that aren’t utilizing the correct patterns. In this case, let's assume that we did have a “good” post-throwing stress pattern.

Once we’ve identified that we are using scapular upward rotation and protraction to our benefit to control the socket, now we need to work extremely hard to counteract the eccentric damage associated with these actions. This is where the recovery protocol and the warm-up itself are crucial on a daily basis to make sure we’re getting back both the range of motion that we need, as well as activating it correctly before we begin to throw again.

To learn more about how physical assessment, strength and conditioning principles, video analysis, and drill work for the pitcher fit together, be sure to check out one of our Elite Baseball Mentorships. Our next event will be held January 17-19, 2016 at Cressey Sports Performance in Hudson, MA. The early-bird registration is December 17, 2015. For more information, check out www.EliteBaseballMentorships.com.  

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