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We see a lot of baseball players, so a lot of these guys come to use with elbow problems. In most cases, the doctors they’ve seen have said, flat-out, “NO LIFTING WEIGHTS.” This drives me nuts for a variety of reasons:
1. They’ve still got two good legs, one good arm, and a bunch of core musculature that needs to be strong and functional.
2. This recommendation implicitly means “Stay away from personal trainers and strength coaches.” It’s probably due to the fact that there are a lot of bonehead personal trainers out there who could do more harm than good, but the truth is that these services comprise more than just lifting weights. We do a lot of mobility and activation work and self-myofascial release on the foam roller.
Collectively, #1 and #2 demonstrate that this blanket recommendation includes an insanely ignorant omission, as the majority of elbow problems can be attributed to mobility and strength deficits at the shoulder. You can train a shoulder a thousand different ways without even involving elbow motion – let alone challenging it sufficiently to cause a problem. In fact, I'd estimate that you could prevent 90% of elbow problems in baseball guys if we simply taught all of them how to sleeper stretch in their early teenage years:
I'd strongly encourage you to check out this article I wrote, where I go over the common mistakes folks make when performing the sleeper stretch.
3. This recommendation flat-out ignores the specific nature of the overwhelming majority of elbow problems in throwing athletes. Let me elaborate..
In my estimation, 95% of baseball players with elbow pain couldn’t elicit their pain in a weight room if they wanted to; seriously! The reason is that this elbow pain is typically mechanical in nature; that is, it’s only aggravated by specific activities (in their case, throwing).
Believe it or not, I have had guys do everything from pull-ups, to dumbbell bench presses, to rows, to push-ups, to grip work just days out from elbow surgery. It isn’t true in every case, but it’s definitely the majority. And, they can all get diesel in the lower body during this time period.
Some great related reading for you:
Inefficiency vs. Pathology
Lay Back to Throw Gas
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| Q: A trainer at my gym was telling me that the best way for a bodybuilding competitor to perform lateral raises was to execute them in or slightly behind the frontal plane and in the "empty-can" hand position (he said this is good for long-term shoulder health since he claimed it would strengthen the supraspinatus) while leaning slightly forward.
Do you think this recommendation is conducive to long-term shoulder health, or would it lead to excessive wear and tear and potentially create impingement problems? Or is it a case of this being perfectly acceptable for some populations and a nightmare for others? If it is the latter, who can perform them this way and who should avoid them?
A: I disagree wholeheartedly. The empty can is a provocative test; it's what we do when we want to see just how angry an injured supraspinatus is.
If you want to keep the supraspinatus healthy, you don't need to make a dedicated effort to strengthen it. You need to strengthen the muscles that position the scapula so that there is more clearance through which that tendon can pass under the acromion process. These would include lower trapezius and serratus anterior. Strengthening the muscles of the rotator cuff will help to depress the humeral head as well.
There is also a definite role for thoracic spine mobility (as I wrote about in a previous newsletter) in this situation, as it helps dictate the positioning of the scapulae.
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| Q: Eric, I know you see a ton of baseball pitchers, so I wanted to ask you if there are particular flexibility restrictions you notice. I am guessing that because it is such a "lopsided" sport that imbalances tend to be magnified. Thanks.
A: Absolutely! The "money" flexibility issues we aim to address are:
-Throwing shoulder glenohumeral internal rotation deficit (GIRD)
-Lead leg hip internal rotation deficit (HIRD)
-Lead leg hip extension deficit
-Lead leg knee flexion deficit
-Trailing leg hip flexion deficit (tight hamstrings)
-Pec minor
-Sternocleidomastoid
-Long head of triceps
-Throwing elbow extension deficit (secondary to length issues with brachialis and other elbow flexors)
Some of these are attacked with more dynamic flexibility, while others are addressed with 30s static stretching and/or prolonged holds. We're also always working on thoracic mobility and ankle mobility, although I look at these issues more as gross mobility deficits than specific muscles that are short.
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| In a 2007 study, Ellenbecker et al. compared hip internal and external rotation range-of-motion in elite baseball pitchers and elite tennis players. They noted the following:
An analysis of the number of subjects in each group with a bilateral difference in hip rotation greater than 10 degrees identified 17% of the professional baseball pitchers with internal rotation differences and 42% with external rotation differences. Differences in the elite male tennis players occurred in only 15% of the players for internal rotation and 9% in external rotation. Female subjects had differences in 8% and 12% of the players for internal and external rotation, respectively.
So, in other words, baseball pitchers were more likely to be asymmetrical than tennis players. While they both serve/pitch with one arm and push off the same-side leg. Tennis players, move a lot more in various directions. And, just as importantly, they hit backhands - so the asymmetries you see at the shoulder are less pronounced as well.
Who would have thought: moving more and doing the opposite of what you normally do is a good way to stay healthy? Yes, I'm being sarcastic. Regardless of your sport, you need to get out of your comfort zone more often if you want to stay healthy.
To learn more about the common asymmetries affecting overhead athletes and how to manage them, definitely check out the Optimal Shoulder Performance DVD set.
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| One of the things that we are constantly working to address with our baseball guys is the loss of range-of-motion following an extended period of throwing (i.e., a pitching appearance). There's some good research out there showing that the marked eccentric stress on the elbow flexors (biceps, etc) and glenohumeral external rotators (posterior rotator cuff) can lead to an acute (and potentially chronic) loss of elbow extension and humeral internal rotation range-of-motion. Pitching with a loss of ROM over the course of a competitive season is a recipe for disaster - both in terms of velocity reductions and risk of injury.
Interestingly, previous research has shown that post-exercise ROM is reduced more with eccentric muscle actions than concentric muscle actions. Since virtually every resistance training sessions comprise some form of eccentric exercise, post-training stretching for the involved musculature is really valuable. And, if you're doing a lot of eccentrics in that training sessions, it's even more important.
A lot of athletes get bored really quickly with static stretching, so one thing I've done a bit (especially with kids who really need to work on their mobility) is to simply repeat our dynamic flexibility warm-ups - but integrate a bit longer of a hold on each rep.
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| When TC asked me to outline a recent training program, he was probably expecting to get something powerlifting-oriented, as that's probably the style of training people associate with my name around these parts.
Truth be told, I'm at a bit of a crossroads in my training career. I still consider myself an athlete first, meaning that lifting (while competitive in itself) has always been a means of becoming more athletic or displaying the athleticism I have.
To take it a step further, I work almost exclusively with athletes, particularly baseball guys. This past off-season at Cressey Performance, we saw 96 baseball players from 32 high schools, 16 colleges, and 8 MLB organizations.
As such, it's really important for me to not only look like an athlete (and not like a blocky, immobile powerlifter), but also be able to lift, jump, and sprint alongside these guys. Hell, I even caught bullpens for four of the pros!
Continue Reading...
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| Q: You don't like back squats for overhead throwers, is this because of anterior instability or some other reason?
A: In a word, yes; anterior stability is so crucial for a pitcher that I’m not tempted to push it. Then again, that’s the short version – and it also assumes that the lifter is using a closer-grip, which mandates more external rotation.
So, to the casual observer, the solution to this would be to simply bring the hands out and squat with a wider grip, which requires less external rotation. Unfortunately, this logic is flawed, too, as you have to abduct (elevate) your humerus another 15-20 degrees to get to that position. In the process, you bring it further into the “classic” impingement zone. This not only compromises the rotator cuff, but perhaps more significantly, the long head of the biceps, which is an extremely common nuisance in both powerlifters and overhead throwing athletes.
All that said, while I’d never do it with a pitcher, you can probably get away with it with position players because they have better upward rotation. I wouldn’t go near it if thoracic spine range of motion is subpar – or the athlete had a history of shoulder or elbow issues.
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| Q: There have been a few quadriceps pulls in MLB this year. Have you seen these before in baseball players? What gives?
A: This is why I love baseball; it's probably one of the most at-risk sports you'll ever see (particularly in pitchers). Here's a little excerpt from a slide in a recent presentation I gave on training for overhead athletes:
-Very Long Competitive Season
>200 games as a pro?
>100 College/HS?
-Unilateral Dominance/Handedness Patterns
Asymmetry is a big predictor of injury
Switch hitters – but no “switch throwers!”
-The best pitchers – with a few exceptions – are the tallest ones. The longer the spine, the tougher it is to stabilize.
-Short off-season + Long in-season w/daily games = tough to build/maintain strength, power, flexibility, and optimal soft tissue quality
Specific to the quad pulls, I'd add to this list that baseball guys rarely hit top speed; all of their sprint work is done in acceleration, where the quads are dominant. Factor in that they spend a lot of time sitting on airplanes/buses, and it's no surprise that they'd get tight anteriorly. It's why it's so important to really hammer on hip mobility in any population that sits a lot.
The stop and go nature of the sport also dictates that strains would be common, whether they are groins, hip flexors, hamstrings, or quads (likely rectus femoris, which is a hip flexor that can get overactive, particularly alongside poor psoas function).
So, all that said, before anyone jumps to conclusions and tries to criticize some strength coach, it's important to consider:
a) the certain amount of happenstance that occurs with any baseball player due to the nature of the game and the season
b) what that athlete does on his own in the off-season
In terms of "b," I’ve seen some pretty bad stuff, unfortunately. For many guys, it becomes a leg extensions and curls off-season if they're on their own - or they do nothing.
I'd like to think that our success in working with baseball guys is not just in the fact that we've made the programming good, but also in the fact that we've changed the culture a bit in our guys: they appreciate what lifting is doing for them and look forward to getting after it in the gym.
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| A New Model for Training Between Starts: Part 1
By: Eric Cressey
The management of pitchers between starts is one of the most debated topics in the world of baseball training. Some pitching coaches want multiple throwing sessions between starts, while others insist that a single bullpen is sufficient. Athletic trainers debate on whether or not a pitcher should ice after a throwing session. And, specific to my realm of expertise, there are differing opinions on what kind of running programs are appropriate for pitchers between bouts of throwing.
Not to toot my own horn, but I'm a pretty well-read guy - and I can honestly say that I've never read anything along the lines of a truly logical argument for or against a specific running program for pitchers. So, I guess that's where I come in with this piece.
With that in mind, I'll be very blunt with you: I despise distance running for pitchers (and the overwhelming majority of other athletes, for that matter). While many pitching coaches are probably reading this and cursing my name already for going against the norm, I'd encourage you all to hear me out on this. Below, I'll outlined NINE reasons why distance running is not the correct course of action - and then, in my next installment, outline a new model for training between starts that we've used with great success at the professional, collegiate, and high school levels.
Why Distance Running is Not the Answer
Reason #1: Immunity Concerns
As a strength and conditioning coach, my number one priority in working with athletes is to keep them healthy. This refers not only to musculoskeletal health, but also general health. In an outstanding 2006 review, Gleeson wrote that "postexercise immune function depression is most pronounced when exercise is continuous [and] prolonged." Interestingly, this review also noted that many of these symptoms are "attributable to inflammation of the upper respiratory tract rather than to infectious episodes (1)." In other words, distance running between starts is more likely to cause and spread sickness in your clubhouse than that tramp in the right field bleachers who wants to hook up with every guy in your bullpen. Strike 1.
Reason #2: Endocrine Concerns
Here's a little excerpt from an email I got from a minor league guy I work with in the off-season:
Yesterday might have been the roughest day of my career. It started by getting back from our game Sunday night at 11:30PM. I couldn't fall asleep until at least 12:30AM, and then we had a 3:30AM wake up call to catch a bus to the airport for our flight at 6:15AM. We had a layover for an hour and a half, then got to the next city at 11AM. We drove to our hotel and I got to my stinky room at the Sleep Inn and tried to catch some sleep - except we had to be at the field at 4PM.
Days like this are the norm for many professional (and particularly, minor league) pitchers: late nights, early wake-up calls, red-eye flights, long bus rides, and - as a result - completely warped sleeping patterns. And, as I'm sure you can imagine, the diet that accompanies these travels is less than stellar, particularly when clubhouse food isn't exactly gourmet or healthy. And, let's just say that a lot of ballplayers at the collegiate and pro levels far too much alcohol, and that has direct negative consequences in terms of sleep and tissue quality.
So, basically, we've got absurd sleeping hours, terrible dietary habits, too much alcohol - and one of the longest seasons in sports. Effectively, we've done everything we possibly can to reduce lower testosterone and growth hormone output, creating a mess of a hormonal environment. Frankly, you could get this same hormonal response by forcing pitchers to watch Golden Girls reruns while sitting on bicycle seats and downing estrogen tablets - and you wouldn't have any incidences of plantar fasciitis.
Instead, you know what's done instead? Distance running! Yes, the same distance running that is responsible for the markedly lower testosterone levels and higher cortisol levels in endurance athletes. It's like putting a new engine in a car with square wheels: studying for the wrong test.
It almost makes you wonder if some guys used performance-enhancing drugs just to counteract the negative effects of their running programs!
Strike 2.
Reason #3: Mobility Concerns
As I wrote in a previous newsletter, one of the issues with distance running is that it doesn't allow for sufficient hip flexion to truly activate all the hip flexors. Specifically, we get a lot of rectus femoris recruitment, but not much activation of psoas, which predominately is active above 90 degrees of hip flexion. Likewise, you really aren't getting much hip extension at all.
So, on the whole, by using a repetitive motion like jogging for an extended period of time, pitchers are losing mobility in their hips - and that's the very mobility they depend on so much to generate stride length and, in turn, velocity.
Frankly, runners are the athletes I see with the most marked lower extremity dysfunctions due to the lack of range-of-motion in the jogging stride - and the fact that they pile so much mileage on this faulty movement pattern. I am a firm believer that we were made to sprint, not jog.
Strike 3. The batter's out!
Reason #4: Negative Effects on the Stretch-Shortening Cycle
Here, I need to get a bit geeky for a second so that I can explain the stretch-shortening cycle (SSC). The easiest analogy I can use is that when you want to shoot a rubber band at someone, you pre-stretch it before you release your shot. Muscles work the same way; pre-stretching them (eccentric action) prior to shortening them (concentric action) stores elastic energy and helps that muscle generate more force. Anecdotally, I've heard estimates that as much as 25-30% of pitching velocity is attributed to elastic energy - or how effectively someone makes use of the stretch-shortening cycle.
Where we're different from rubber bands is that we can actually train those elastic qualities to make our tendons more efficient at collecting, temporarily storing, and releasing that elastic energy to help us run faster, jump higher, and throw harder. It's why doing plyos, sprinting, and throwing medicine balls can do wonders for a player's performance.
With the stretch-shortening cycle, we need three things, according to Komi (2):
1. a well-timed muscle preactivation before the eccentric phase
2. a short, fast eccentric component
3. immediate transition (minimal delay) between stretch (eccentric) and shortening (concentric) phases. This period is known as the amortization phase, and the shorter it is, the less elastic energy we lose (as heat).
To be honest, #1 takes care of itself. For #2 and #3, though, we are definitely working against ourselves with distance running, as the importance of the SSC rapidly diminishes as exercise duration continues. In fact, the vertical jump only predicts sprinting performance up to 300m (3).
In other words, the longer exercise goes, the more we "muscle" it instead of being relaxed. What do we know about guys who try to muscle the ball to the plate? They don't throw hard because it impairs pitching specific mobility and they don't let the arm whip through.
I will take a guy with a good vertical jump over a guy with a high VO2max anyday. Distance running conditions guys to plod instead of bounce - and this definitely has implications in terms of chronic overuse conditions.
Strike 1.
Reason #5: Strength and Power Reductions
As just one example of how stressful the pitching motion is on the body, the humerus internally rotates at 7,500°/second during the acceleration phase of throwing. It takes a lot of strength and power to generate this kind of velocity, but just as importantly, it takes a lot of strength and power - and in a timely fashion - to decelerate it. We need to not only be able to generate enough force to resist and control this acceleration at end-range, but also be able to generate this force quickly (power). To that end, you would think that conditioning for pitchers would be similar to that of strength and power athletes, who avoid distance running altogether.
Instead, most pitchers run several times a week. When was the last time you saw a marathoner throw 95mph?
Additionally, in many cases, coaches encounter Latin American players who have never had access to weight-training equipment - and this is a huge window of untapped potential. Using distance running when these athletes could be devoting more time to getting stronger is a huge hindrance to these players' development, as it conditions them to go longer instead of faster. At some point, you have to put more horsepower in the engine instead of just changing the oil.
We know that when we first get young athletes started with weight training, there is a huge transformation to make them more athletic in the 8-10 weeks that follow. You would be surprised at what good training can do for many advanced pitchers in the initial phases, too. The reason is that, unlike position players, many pitchers are (to be blunt) one-trick ponies. They know how to throw a nasty cutter, a crazy 12-to-6 curveball, or a slider with a funny arm-slot. So, it's always been "okay" for them to be completely unathletic outside of their delivery. They might get guys out, but they're long-term gambles teams because of their increased risk of injury; weak, immobile bodies break down the fastest - just like distance runners. Additionally, being able to quickly recruit muscles (and do so powerfully) is crucial for rapidly stiffening joint complexes to create stability and prevent acute injuries like ankle sprains and ACL ruptures. Strength and power athletes are much better off in this regard than endurance athletes.
Strike 2.
Reason #6: Inappropriate Intensities
In what was - at least in my eyes - a landmark study, McCarthy et al. (1995) looked at "compatibility" of concurrent strength training and endurance training. Traditionally, the attenuation of strength and power gains has been a big issue when endurance exercise is added to a strength training program. As I noted in Cardio Confusion, these researchers found that strength and power loss was only an issue when the intensity of the endurance exercise was greater than 75% of heart-rate reserve (HRR) (4). I can guarantee you that the majority of pitchers who are running distances are doing so at well over 75% HRR.
As I'll note in my recommendations at the conclusion of this article, I strongly feel that the secret is to stay well above (circa-maximal sprinting, in other words) or below (70% HRR, to play it safe) when implementing any kind of running. The secret is to avoid that middle area where you don't go slow and don't go fast; that's where athletes get SLOW! And, ideally, the lower-intensity exercise would be some modality that provides more mobility benefits.
Strike 3. The batter's out!
Reason #7: Nobody likes to babysit.
Simply put, running is babysitting. Catcher is actually the position that requires the most endurance in baseball, but we don't run catchers extra, do we? Nope - and it's because we have bullpens for them to catch, batting practice for them to take, and all the other responsibilities associated with handling a pitching staff and being a pseudo coach on the field.
My business partner actually was a division 1 pitcher almost ten years ago, and when I brought up this argument, he smiled and nodded, replying with, "When I was a pitcher, all we did was shag fly balls and run poles." Meanwhile, 57% of pitchers suffer a shoulder injury during a competitive season (5) - and that doesn't even include elbow, lower back, or lower-extremity injuries! At the major league level, pitchers are 49% of the players, but they account for 68% of the time on the disabled list league-wide (6). Running isn't going to prevent these problems; it's going to exacerbate them.
Strike 1.
Reason #8: Distance running ignores existing imbalances.
Baseball is an at-risk sport for a number of reasons. You've got an extremely long competitive season, overhead throwing, and - possibly most significantly - unilateral dominance. Switch hitters and guys who bat right and throw left (or vice versa) tend to be a bit more symmetrical, but the guys who bat and throw on the same side tend to have the most glaring issues. Many really smart dudes - most notably, Gray Cook - note that asymmetry is quite possibly the best predictor of injury. When we get pitchers after a long season, our first goals are to address range of motion deficits in:
1. lead leg hip extension (tight hip flexors)
2. lead leg hip internal rotation (tight external rotators)
3. lead leg knee flexion (tight quads)
4. Throwing arm shoulder internal rotation (tight posterior rotator cuff and capsule)
5. Scapular posterior tilt (tight pec minor and levator scapulae)
6. Throwing arm elbow extension (tight elbow flexors)
I knocked back some caffeine, splashed some water on my face, and really put my thinking cap on to see if I could come up with a rationale for how distance running addresses any of these issues. In the end, I had nothing. I came to the realization that jogging negatively affects the majority of them - and pitchers would be better off just shagging fly balls instead of splitting time between that and long runs. At least they move side-to-side when they're chasing fly balls.
Strike 2.
Reason #9: It's really boring!
I am a firm believer that the best coaches are the ones who engage their athletes. The best coaches I had in my athletic career were the ones who made me look forward to each training session. With that said, the only people who look forward to distance running are - you guessed it - distance runners!
Most of the ballplayers you're coaching have always seen running as a form of punishment for doing something wrong; they hate it as much as I do (okay, maybe not that much). And, truth be told, they'd hate it even more if they realized it is limiting their development as athletes.
Strike 3. The batter's out - and the side is retired.
Conclusion
I have always disliked it when people criticize the status quo, but fail to offer solutions of their own. With that in mind, the next installment of this series will outline my personal perspective on how to attack the time between pitching outings.
References
1. Gleeson, M. Immune systems adaptation in elite athletes. Curr Opin Clin Nutr Metab Care. 2006 Nov;9(6):659-65.
2. Komi, P.V. Stretch-shortening cycle. In: Strength and Power in Sport (2nd Ed.) P.V. Komi, ed. Oxford: Blackwell, 2003. pp. 184-202.
3. Hennessy L, Kilty J. Relationship of the stretch-shortening cycle to sprint performance in trained female athletes. J Strength Cond Res. 2001 Aug;15(3):326-31.
4. McCarthy JP, Agre JC, Graf BK, Pozniak MA, Vailas AC. Compatibility of adaptive responses with combining strength and endurance training. Med Sci Sports Exerc. 1995 Mar;27(3):429-36.
5. Ouelette, H, Labis J, Bredella M, Palmer WE, Sheah K, Torriani M. Spectrum of shoulder injuries in the baseball pitcher. Skeletal Radiol. 2007 Oct 3.
6. Fleisig, GS. The Biomechanics of Baseball Pitching. Spring 2008 Southeast ACSM Conference.
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| Cressey Performance Athlete, Dede Griesbauer Finishes 10th at Ford Ironman World Championship!
This was Dede's second consecutive podium finish. Awesome job, Dede!
EricCressey.com Subscriber-only Q&A
Q: Could you please explain the rationale for the wall triceps stretch you used in a previous blog post?
A: Here’s a photo of that stretch, for those who missed it:
We find that this stretch can relieve shoulder issue in a lot of the guys who come to us with typical pitcher problems – particularly posterior/superior shoulder pain (and sometimes medial elbow pain – but no glenohumeral internal rotation deficit (GIRD).
Posterior cuff/capsule stiffness will cause the humeral head to translate superiorly and posteriorly during the late cocking phase of throwing. And, this stiffness also has huge implications on humeral head position during the deceleration and follow-through phases of throwing.
Most throwers with shoulder problems will have the most pain at:
a. maximal external rotation/late cocking phase (usually the worst type of problems, SLAP 2 lesions, that warrant a great consideration of surgery)
or
b. follow-through/deceleration (usually something that’s more easily fixed with good posterior cuff/capsule stretching and good scapular stability work, so conservative treatment is the name of the game)
Of course, all this depends on symptoms, degree of mechanical pain, and what the MRI says.
Sometimes, though, if the stiffness isn't present posteriorly, but you're still seeing these kind of symptoms, you have to look to the inferior capsule. The shoulder capsule is large and relatively “loose” to allow for the wide range of shoulder movements present. When tightness kicks in somewhere, you can see some noteworthy problems.
So, the roundabout answer to your question is that the truth is that this is as much an inferior capsular mobilization/stretch as it is a triceps stretch.
As a general rule of thumb, you always migrate opposite capsular tightness. Inferior tightness leads to superior migration. Inferior tightness is the big problem in regular ol' weekend warriors, and definitely moreso in those who have had surgery and been immobilized with the arm at the side
As an aside to this, rarely will someone need JUST inferior capsule mobilizations; they usually need other attention to areas such as thoracic spine mobility work.
Feedback on The Truth About Unstable Surface Training
Here’s a quote from Leigh Peele of avidityfitness.com on my new e-book, The Truth About Unstable Surface Training :
“This e-book, regardless of if they have to break out a dictionary, is for every trainer/coach/physical therapist out there. Period. If you are a trainer or if you plan on being a trainer or physical therapist, then you need to own this manual. This isn’t just about doing things “right,” either; this puts you ahead of the pack. Your teams, clients, and patients will thank you for the increase of knowledge.
“I also feel that this e-book is for those who are really serious about training and applying the best methods to their program. If you don’t have a good coach and you need one, sometimes yourself is all you have. If that is the case, go to the education. Coach yourself.
“In short, if you design programming, be it for yourself or for others, you should get this e-book for a learning resource.”
Click here to purchase The Truth About Unstable Surface Training.
Blog Updates
Detailed Feedback on Maximum Strength
Random Friday Thoughts
A Little Monday Update
Random Friday Thoughts
All the Best,
EC
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