Okay, this subject line was undoubtedly the worst of all time, but I promise that the information that follows will be worth reading.
A lot of you were probably hoping that you were out of the woods after I told you how bad your lower backs and shoulders look on diagnostic imaging such as MRIs. I'm sorry to say that these "normal" structural disasters also apply to the knees.
A 2010 review from Flanigan et al. looked at studies that collectively examined the (1,862) knees of 931 athletes (40% of whom were professional athletes) using MRI and arthroscopy. They found that 36% of these knees had full-thickness chondral defects, but 14% of these subjects had no symptoms when diagnosed. The researchers concluded that "Over one-half of asymptomatic athletes have a full-thickness defect."
Years earlier, Cook et al. screened 134 elite junior basketball players (268 total knees) for patellar tendinopathy. At the time, only 19 (7%) of the 268 tendons presented with symptoms (pain) of tendinopathy. Interestingly, though, under diagnosis with ultrasound, researchers actually found that 26% of all the tendons could be labeled tendinopathy based on the degenerative changes observed. In other words, for every one that actually presents clinically with symptoms, more than three more go undiagnosed because people either haven't reached threshold, or they move well enough to keep symptoms at bay. Or they are Kurt Rambis and can just look so awkward that nobody even pays attention to their knee sleeve.
On the "move well enough" side of things, check out this study from Edwards et al. They showed that these athletes with asymptomatic patellar tendinopathy actually land differently - both in terms of muscle recruitment and sequencing - than asymptomatic athletes without tendinopathy. Fix that movement pattern neurally and strengthen the right muscles, and those issues never reach threshold. Leave it alone, and they'll be presenting with knee pain sooner than later. Mike Robertson does a great job of outlining ways to improve knee health via movement retraining in his Bulletproof Knees Manual.
This is just the tip of the iceberg. You'll see loads of chronic ACL and meniscus tears that folks never realize they have. I could go on and on. The take-home messages? Yet again, diagnostic imaging is just one piece of the puzzle, and how you move is far more important.
Related PostsThe Importance of Ankle MobilityHealthy Knees, Steady Progress
In place of our normal "Random Friday Thoughts" blog, I just wanted to use today as an announcement of something I think is really cool, convenient, and forward-thinking.
Anthony Renna has done a great job with the Strength Coach Podcasts, and now he's taken it a step further with the introduction of the Strength and Conditioning Webinars. As the name implies, a webinar is a seminar done on the web. So, you view a speaker's Powerpoint presentation while he does the voice-over on it.
It's super-convenient for presenters because we don't have to travel anywhere to give it, and we can deliver it while in our boxer shorts and beat-up old t-shirts. And, it's convenient for the audience for that exact same reason, but also because it's a bit of a lower price point (no facility rental fees to cover) and because it's convenient as heck. You can watch it at your convenience and don't have to be there "live" - and you can rewind to listen to it again if there is something that doesn't quite make sense.
Essentially, Anthony has addressed a lot of the shortcomings of traditional seminars - yet still brings together a bunch of great minds. Thus far, he's recorded webinars with Mike Boyle, Alwyn Cosgrove, Tim Vagen, and Tim Yuhas. In the future, you'll see folks like Gray Cook, Mike Robertson, Mike Reinold, Lee Burton, me, and a whole bunch of other super-talented and smart strength and conditioning coaches, physical therapists, aned athletic trainers.
If you look around, most webinars are going for $25-30 each. Conversely, Anthony is only charging $29.99/month for a membership to StrengthandConditioningWebinars.com. It's even cheaper if you pay up front for the year!
Even better, if you sign up before Monday, June 8, you can get an unbelievable deal- only $19.99 a month for as long as you are a member, or again, even cheaper if you sign up for the whole year- only $199.
You'll get two webinars a month guaranteed from the world's top coaches, bonus webinars, and access to presenter forums, all for $19.99 a month.
This is seriously a great deal and it is truly a one-time offer. After June 8, the price goes up.
So go to StrengthandConditioningWebinars.com, sign up for the Special Pre-Launch Offer before June 8 and start watching webinars right away.
Let's get right to it.
1. First up, a few quick congratulations are in order for some Cressey Performance ballplayers. Justin Quinn (Lincoln-Sudbury) and Sahil Bloom (Weston) were named Dual County League Large and Small Players of the Year, respectively. They are also two of the three finalists for the MA Gatorade Player of the Year award. LS won the DCL Large, and Weston won the DCL - thanks in large part to the efforts of these two guys. Both were selected as league all-stars, as were CP athletes Garrett Moore (LS), Ryan Wood (LS), Derek Lowe (LS), Chris Conlon (Weston), Reed Chapman (Weston), Alex Hill (Wayland), and Scott Lueders (Newton-South). Congratulations, guys!
2. Padres prospect and CP athlete Will Inman jumped up to AAA from AA on Wednesday. If you're anywhere near Portland, OR, get out to watch him make his first start tonight (Friday) at 7PM. Will is 4-1 with a 3.05 ERA in eight starts on the year, having given up only 33 hits and eight walks in 44.1 innings pitched. Congratulations to Will on taking the next step in his baseball journey.
3. Check out this great video content today from Dr. John Berardi about The Key to Accidental Fitness. I can tell you that this is 100% spot on from my own experiences - and the thousands of clients and athletes I've seen over the years.
4. I got a question the other day about who I thought were the most important individuals to add to one's network in the field of strength and conditioning. My first response was "anyone who is smart, openminded, and willing to share ideas."
That said, I realize this individual was probably looking for a list of occupations in this regard, so here goes: doctors, physical therapists, chiropractors, massage therapists, athletic trainers, other strength coaches/trainers, radiologists, sports coaches, researchers, sports psychologists, equipment manufacturers/distributors, and loads others that I have probably forgotten. Basically, you're just trying to find people who have different areas of specialization to either add to, refute, or confirm your existing knowledge.
5. Had some car and computer issues earlier this week, so I got a bit sidetracked on the writing side of things this week. I submitted the third installment of Lower Back Savers a bit late, so it didn't run this week. For those who missed Parts 1 and 2, you can check them out HERE and HERE.
6. Just finished up my powerpoint for the Distinguished Lecture Series in Sports Medicine at Northeastern on June 5-6. This is an awesome event featuring guys like Dr. Stuart McGill, Mike Boyle, Dr. David Tiberio, and others (including some schmuck named Cressey). It's very affordable, and I can tell you that the last two years have been fantastic. Check it out HERE for more details.
7. Can we please get over this swine flu stuff, people? They are closing schools left and right in Boston - and as a result, ASYMPTOMATIC kids are having to FORFEIT games/matches - and now, potentially playoff games.
8. I'm most likely getting a new car tonight. I've never been a "car guy," so it's more of a chore than anything. Let's hear some of your favorite strategies for bargaining with car dealers (particularly when you've got a trade-in)...
I turn 28 today, so in hopes of distracting myself from the painful realization that I'm starting to go bald, I thought I'd focus on the positives of my existence in contexts that would appeal to you. Below, you'll find 28 of my favorite things - most of which are at least loosely related to fitness, nutrition, strength and conditioning, and sports.
1. Favorite Nickname: Power Alleys. This seemed like a good starting point, as power alleys are bald spots. Credit for this one goes to Mets pitching prospect Tim Stronach.
2. Favorite Thing About Cressey Performance: The camaraderie among the athletes/clients. I think the hard thing to appreciate about our facility without experiencing it first-hand and being there on a regular basis is that it's as much about the environment and attitude as it is about the expertise and programming. I'm psyched that we've not only created an environment where clients can improve physically, but one in which they can thrive socially, too.
3. Favorite Book I've Read Related to Fitness:Diagnosis and Treatment of Movement Impairment Syndromes, by Shirley Sahrmann. This book got me thinking more about dysfunction and less about pathology. Quality of movement is often far more important than anything a MRI or x-ray can ever tell you.
4. Favorite Book I've Read Unrelated to Fitness: This is a top-up between The Tipping Point and A Prayer for Owen Meany. They might be taken over, however, by one of the gifts I just got for my birthday from CP Client Steph Holland-Brodney.
5. Favorite DVD I've Watched:The Indianapolis Performance Enhancement Seminar DVD Set. Bill Hartman's presentation on "Stiff vs. Short" alone makes this a fantastic resource, and the rest is just gravy. I reviewed it HERE.
6. Favorite DVD I've Co-Created: The Building the Efficient Athlete DVD set. I think I'm most proud of this resource because it's something that provided something I so desperately wanted - but couldn't get - during my college education. Effectively, it's a resource that blends book memorization with real-world practice with a focus on functional anatomy, assessments, and troubleshooting common exercises.
7. Favorite Seminar I've Attended:The Perform Better 3-Day Functional Training Summit. Each year, they get better and better. Check out Chicago or Long Beach this year if you missed Providence.
8. Favorite Athlete of All Time: Barry Sanders. I can't imagine an guy with better kinesthetic awareness, body control, or ability to turn a complete disaster of a play into a 90-yard touchdown run - while carrying two defensive linemen on his back.
9. Favorite Athlete of All-Time that you've probably never heard of: Jerry Sichting. He played for the Celtics from 1985 to 1988, and I'll always remember the night Sichting - at a heigh of 6-1 - got in a fight with 7-4 Ralph Sampson during the 1986 NBA Finals. At the time, I was a five-year old shadow boxing in my living room yelling at the top of my lungs.
10. Favorite Place to Visit: Fenway Park
11. Second Favorite Place to Visit: Gampel Pavilion at the University of Connecticut. It's an incredible environment in which to watch college basketball, and it's also where I spent just about all my time from 2003 to 2005.
12. Favorite Exercise: was this ever in question?
13. Favorite Sites I Visit Just About Every Day: T-Nation.com, MinorLeagueBaseball.com, ESPN.com, Sports.Yahoo.com, WilliamInman.com, 38Pitches.com, ShawnHaviland.Blogspot.com, MetrowestDailyNews.com, StrengthCoach.com, MikeReinold.com, RobertsonTrainingSystems.com, BillHartman.net, AlwynCosgrove.Blogspot.com, DieselCrew.com, PrecisionNutrition.com, BrianStPierreTraining.com, Tony Gentilcore's Blog, Boston.com, BarstoolSports.com, Facebook.com, EricCressey.com.
14. Favorite Kind of Injury to See (weird category, I know): Labral Tears (SLAP lesions), or really any kind of shoulder or elbow pain in pitchers. You've got so many potential causes that it's kind of fun (for me, not the athlete) to go through a process of elimination to see what combination of factors caused it. There are all the classic flexibility deficits in pitchers, plus scapular instability, poor thoracic spine mobility, plus faulty mechanics, plus inappropriate training volumes, plus weak lower bodies. It's kind of like peeling back the layers on an onion to see what shakes free. It's also a great scenario to illustrate what I talked about with respect to diagnostic imaging in #3 from above. All of these guys will have labral fraying and rotator cuff partial thickness tears at the very least; it's our job to fix them up and make them work efficiently in spite of these structural deficits in situations where surgery isn't warranted.
15. Favorite Class I Took in School: Gross Anatomy. Yes, I cherished the semester I spent with a bunch of cadavers.
16. Favorite Healthy Food: Apple-Cinnamon Protein Bars from John Berardi's Gourmet Nutrition Cookbook. Admittedly, I often just eat the batter before it ever gets cooked. Not good, I know.
17. Favorite Piece of Equipment We Have at CP: Giant Cambered Bar. Along with the safety squat bar and front squat set-up, this bad boy has allowed me to keep squatting even though my right shoulder decided a long time ago that traditional back squats weren't a good idea. It's also a great asset for working with overhead throwing athletes who should avoid the externally rotated, abducted position under load.
18. Favorite Thing About Having a Blog: I can write a lot more casually than in my newsletter, which tends to be more geeky. And, I can post videos of this kid rocking out:
19. Favorite Mobility Drill: Walking Spiderman w/Overhead Reach. I love this drill because you're covering so many things at once. You'll get thoracic spine extension and rotation from the reach, and hip flexor and adductor length in the lower body from the lunge angle. Keep an eye out for more new movements along these lines in the months to come as we film the sequel to the Magnificent Mobility DVD.
20. Favorite Pastime I Had to Give Up: Fantasy Baseball/Basketball. During my sophomore year of undergrad, I finished fourth in the world in NBA.com's Virtual GM contest. Long story short, if you want to be really good at fantasy sports with that kind of set-up, you've got to put a lot of time into it - and realize that it won't make girls like you. You'll also find yourself watching games in which you'd otherwise have absolutely no interest. I couldn't do it half-ass (aside from the CP Fantasy Football League), so I gave it up.
21. Favorite Inedible Toy: Rubber Steak.
Suffice it to say that Fire & Ice wouldn't allow us to eat a birthday cake inside their restaurant on Saturday night in celebration of my awesomeness. So, in celebration of their suckiness, none of us (16 in all) will ever eat again - and I was reduced to gnawing on dog toys.
22. Favorite Birthday Excitement: Apparently, it's going to be taking my car in to get work done, buying a new laptop, and then coaching 'em upat CP. There will also be a dominant upper body lift at CP that will undoubtedly feature Kevin Larrabee missing 300...again...and again).
24. Favorite Strength and Conditioning Coach Who is Having Surgery on my Birthday: Josh Bonhotal, Chicago Bulls. I talked with Josh yesterday and he informed me that he was finally having his ACL fixed today in celebration of my birthday. Nothing says "Happy Birthday, Buddy" like taking a chunk out of your patellar tendon and turning it into an anterior cruciate ligament. It's kind of like planting a tree on Earth Day. What a nice gesture.
25. Favorite Article Series I've Written:A New Model for Training Between Starts (Part 1and Part 2). These articles were actually picked up by Collegiate Baseball Magazine as front-page features, and I received a lot of great feedback about them. If there is one thing I do before I retire, it's convincing the world of the evils of distance running for pitchers. I'd put the Shoulder Savers series in a close second
26. Favorite Supplement: Fish Oil. It's followed closely by Vitamin D. You need both - and probably a lot more than you think. I'm a simple guy when it comes to this stuff.
27. Favorite Random Website a Buddy Texted to Me Last Week: www.EasyCurves.com. This thing is hilarious. A special thanks goes out to Jesse Burdick for making me just a little bit dumber with that.
28. Favorite Sign of Athlete Dedication for the Month: We have two college pitchers up here fromPennsylvania for the month to work on getting bigger, stronger, faster, and more flexible in hopes of a nice velocity jump on the mound, and the obvious injury prevention benefits of such training. That's all well and good - until you hear that they got an unfurnished apartment in Hudson, MA. These guys are sleeping on mattresses on the floor, and all they brought were a few lamps, a TV, some books, and a whole lot of enthusiasm and motivation. That's committment to training - and just the kind of guys we like to have around Cressey Performance.
What kind of sacrifices are you making to get better and move closer to your goals? I'm not sure that sleeping on a mattress on the floor is necessary, but it says a lot.
With that in mind, I'm not taking today off. There is work to be done and I love to do it, birthday or not.
I got this email over the weekend from a recent finisher of the Maximum Strength Program:
"Eric,
Here are my results on the Maximum Strength program.
Packing Day
Standing Broad Jump: 80 inches
Bench Press: 225 lbs
Box Squat: 295 lbs
Deadlift: 385 lbs
------------------------
905 lbs total for the big 3
3-Rep Max Chins: BW (230) +10 lbs total of 240 lbs
------------------------------------------
Moving Day
Standing Broad Jump: 90.25 inches (+10.25 inches)
Bench Press: 275 lbs (+50 lbs)
Box Squat: 365 lbs (+70 lbs)
Deadlift: 405 lbs (+20 lbs)
-------------------------------------------
1045 lbs total for the big 3 (+140 lbs)
3-rep Max Chins:BW (220) +35 lbs total of 255 lbs (+15 lbs)
"Thoughts on the program:
"This is the first program I have ever completed from start to finish in the few years that I have been lifting. I always got burned out or got training A.D.D. and did something else. Not with yours.
"This program was incredible. Not only did it feel great to do a specifically designed program, but it felt great to see my progress as I was doing the program. The gym I worked out in didn't have a power rack-only a squat rack- so I had to do some McGuyver rigging for rack pulls and pin presses. I wasn't able to do the Anderson Front squats and had to go light on the floor presses, but all in all, I was able to stick with the program 100%.
"I missed about a week total of workouts due to a couple serious, family emergencies, but I didn't use that as an excuse to fall off the wagon. I pushed through and loved my results.
"Thanks for such a great program, and I look forward to the sequel.
"David"
5o pounds added to a bench press in 16 weeks? Not too shabby!
I got a phone call this morning around 7:30AM. I knew it was coming, but was just a matter of time. So, when I saw Curt Schilling's name on the Caller ID, I figured that he was ready to call it a career - and a brilliant career at that. You can read his official retirement statement on his blog.
We had the radio on today, and the commentators talked quite a bit about his impressive career stats, fantastic post-season record, and three World Series rings. It's safe to say that all of these factors are going to come up time and time again in discussions over the next few years about whether or not Curt ought to go to Cooperstown. He's got over 3,000 career strikeouts, and a career ERA of under 3.46. Throw in six all-star game appearances, three Cy Young runner-up seasons, and a World Series MVP. He's also got the highest strikeout-to-walk ratio of all time. Those factors alone - plus the subjective fact that he is probably the single-best post-season pitcher of all time - ought to get him in.
To me, though, there are two more factors that make this a sure thing.
First, while I'm a huge Red Sox fan and - like millions others - will be eternally grateful for the two championships he helped bring to Boston, I have to say that what he did in Arizona from 2001-2003 was nothing short of incredible. At a time when the use of performance-enhancing drugs was off the charts - and guys were destroying home run records - Schilling was a dominant pitcher. It didn't matter how much hitters cheated; they still couldn't put runs on the board against him. Curt's been extremely outspoken against the use of these performance-enhancing drugs, but to me, his numbers during that time period are proof to kids everywhere that you don't have to cheat to get ahead.
Second, Curt's career spanned a time period where it seemed like every day, a new athlete was getting into trouble with the law. We've heard about athletes making bad decisions and getting busted for drunk driving, bar fights, spousal abuse, drug abuse, gambling, adultery, and even murder. Meanwhile, Curt was raising millions of dollars for various charities, being a devoted husband and father, contributing as a valuable member of communities in PA, AZ, and MA, and mentoring up-and-coming pitchers.
I watched first-hand this winter as he took time out of his busy schedule to talk pitching with my minor leaguers and high school athletes. You could tell that it was an interesting blast of emotions for them. On one hand, they were starstruck and amazed that he would actually care enough to share his wisdom with them - and do so with so much passion. On the other hand, they were all frantically trying to understand and memorize all the great ideas they were hearing from a guy with decades of experience in the big leagues.
Say what you want about Curt being outspoken, but make no mistake about it: at a time when baseball needed good citizens off the field as much as it needed stars on the field, Curt filled both those roles. Unfortunately, none of the folks with whom Curt interacted at Cressey Performance will get a vote in the Hall of Fame balloting in a few years. However, if we did, I can say without wavering that everyone in this group would vote him as a person - and that's independent of his impressive baseball resumé.
Congratulations on a great career, Curt. I'm damn proud to have been even just a little part of it.
Q: I'm a baseball pitcher who was diagnosed with a posterior labral tear. Since I was young and the doctor didn't feel that the tear was too extensive, he recommended physical therapy and not surgery. I'm still training the rest of my body hard, but am finding that I can't back squat because it causes pain in the shoulder. Any idea why and what I can do to work around this?
A: It isn't surprising at all, given the typical SLAP injury mechanism in overhead throwing athletes. If there is posterior cuff tightness (and possibly capsule tightness, depending on who you ask), the humeral head will translate upward in that abducted/externally rotated position. In other words, the extreme cocking position and back squat bar position readily provoke labral problems once they are in place. The apprehension test is often used to check for issues like this, as they are commonly associated with anterior instability. Not surprisingly, it's a test that involves maximal external rotation to provoke pain:
The relocation aspect of the test involves the clinician pushing the humeral head posteriorly to relieve pain. If that relocation relieves pain, the test is positive, and you're dealing with someone who has anterior instability. So, you can see why back squatting can irritate a shoulder with a posterior labrum problem: it may be the associated anterior instability, the labrum itself, or a combination of those two factors (and others!).
On a related note, most pitchers report that when they feel their SLAP lesion occur on a specific pitch, it takes place right as they transition from maximal external rotation to forward acceleration. This is where the peel-back mechanism (via the biceps tendon on the labrum) is most prominent. That's one more knock against back squatting overhead athletes.
If you're interested in reading further, Mike Reinold has some excellent information on SLAP lesions in overhead throwing athletes in two great blog posts:
Top 5 Things You Need to Know about a Superior Labral TearClinical Examination of Superior Labral Tears
The solutions are pretty simple: work with front squats, single-leg work (dumbbells or front squat grip), and deadlift variations. If you have access to specialty bars like the giant cambered bar and/or safety squat bar, feel free to incorporate work with them.
And, alongside that, work in a solid rehabilitation program that focuses not only on the glenohumeral joint, but also scapular stability and thoracic spine mobility.
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used by Cressey Performance Pitchers after they Throw!
One of the pro baseball guys I work with from afar is in town this week for a check-in, and he bought ten protein bars for $10 in anticipation of eating out of airports. He was munching on one of them at the facility yesterday, and it was labeled as a "Triple Threat" for a) great taste, b) energy, and c) nutrition.
Now, you're talking to a guy who spent two years at business school before deciding to go the exercise science route, so I've got a little marketing analyst in me. We all know that lots of stuff can have double meanings - so I check out the first three ingredients:
1. Corn Syrup
2. Soy Crisps
3. "Chocolatey" Coating
Yes, it really had a "Y" on the end of the word. So, you not get a candy bar with crap ingredients, but also are treated like a child with words like "chocolatey."
Joking aside, the best protein bars available are the ones you make yourself. John Berardi has some awesome recipes in Gourmet Nutrition Cookbook (also available as part of the Precision Nutrition package).
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Best Wishes,
The EricCressey.com Team
