To say that I’m a baseball fan would be an understatement. I essentially taught myself to read with baseball cards; I knew the players’ faces, so it was just a matter of sounding out the words on the cards with the names I knew. Now, some 23 years later, I’m older and wiser (I can even read complete sentences now) – but still a huge baseball fan, and far more than just a casual observer to the game.  I spend my days training tons of baseball guys and am pretty much inundated in the game; in fact, as I type this, I am following two minor league games online, as two Cressey Performance athletes are pitching tonight elsewhere in the U.S. At risk of sounding overconfident, I know baseball players: demeanors, attitude toward lifting, imbalances, performance enhancement, you name it.  I feel very strongly that we’ve created a system that not only knows how to get guys to perform at high levels, but also stay/fet healthy in the process.  That said, the past two days have been pretty big on the local publicity front for Cressey Performance:

• Boston Globe: Baseball Players Train for On-Field Results at Hudson Gym
• Metrowest Daily News: Ostrander, Scanlan Get Northern Exposure

So, with that in mind, it seemed like a good day to reprint an interview Mike Robertson did with me for his newsletter. An Interview with Eric Cressey

By: Mike Robertson (robertsontrainingsystems.com)

MR:  Eric, believe it or not you’ve never done an interview for the site before!  If you don’t mind, please explain to people that we AREN’T the same person. (Yes, people actually thought this for a while!)

EC: I’m actually just the president of the Mike Robertson Fan Club; he’s the real thing.

MR:  You’ve recently opened your own facility, Cressey Performance.  What kind of people are you training on a day-to-day basis?  How is the gym going?

EC:  It’s going very well and we’ve having a blast.  In fact, as I type this, we’re in the process of arranging a move into a new facility; it should take place within two weeks and double our space.

We get a little bit of everything in terms of client variety, but the overwhelming majority of my athletes are baseball players.  This past off-season, we saw 96 baseball guys from 32 high schools, 16 colleges, and 8 major league organizations.  Throw in some football, hockey, triathlete, track and field, soccer, bobsled, skeleton, rowing, and regular ol’ weekend warriors, and it keeps life interesting.

MR:  I’m willing to admit, you know a ton about shoulder.  Couple this with the fact that you work with a ton of baseball players daily, and that pretty much makes you a shoulder guru in my book.

Where are most people missing the boat with regards to training overhead throwing athletes?

EC:  Wow, there is a loaded question.  Here are a few thoughts – speaking specifically to a baseball population to keep it more focused.

People spend too much time looking at the rotator cuff.  It’s like focusing on the oars when there is a hole in your rowboat.  The truth is that when someone’s shoulder goes, the rotator cuff (and labrum) are just the place where someone becomes symptomatic; it’s poor soft tissue quality and faulty movement patterns elsewhere (and in many cases rotator cuff weakness) that cause the problem. So what are these problems?

First off, the very nature of baseball is an issue.  It’s a long competitive season (>200 games as a pro, potentially, and more than half that in high school/college): Short off-season + Long in-season w/daily games = tough to build/maintain strength, power, flexibility, and optimal soft tissue quality.

You’ve got unilateral dominance and handedness patterns, too; when was the last time you saw someone throw the first inning right-handed and then toss the second inning as a southpaw?  We know that asymmetry is a big predictor of injury.

Let’s take it a step further.  The best pitchers – with a few exceptions – are the tallest ones. In chatting with one MLB scout this off-season, he noted that only 14% of major league pitchers are under 6-feet tall.  The longer the spine, the tougher it is to stabilize.  I’ve worked with eleven guys 6-9 or taller since 2003, so I can definitely speak to this from experience.  They were all basketball guys; I can’t imagine how jacked up they’d be if they were throwing baseballs, too!

And, to be more blunt, there is absolutely nothing even remotely healthy about throwing a baseball.  Do a MRI of a pitcher’s shoulder and you’re going to find labral fraying: big deal!  That’s just what happens when you go through 7,500°/second of internal rotation during acceleration – or the equivalent of 20 full revolutions per second!  Some guys are symptomatic and some aren’t; it’s the other “stuff” that’s going on that dictates whether they’re hurting or playing pain-free.

MR: So what’s this “other stuff” of which you’re speaking?

If you want to keep a pitcher healthy, your job is to make him more athletic.  I have seen professional pitchers who couldn’t broad jump 80 inches or front squat 135, yet they could throw 94 mph.  I’m proud to say that we had two pitchers vertical jump over 35” and broad jump over 115” at their spring training testing this year.

Baseball is a population who – believe it or not – still doesn’t understand a) what good strength and conditioning is and b) what that solid training can do for them. I am a firm believer that much of the abuse of performance enhancing drugs in professional baseball is a direct result of players wanting a shortcut to make up for the fact that they really have no clue how to train for peak performance or sustain it for the long haul of a professional career. And, more sadly, there aren’t many good performance enhancement coaches out there who know how to show them the way. I’m strongly believe that our success in working with these guys is directly related to the fact that we show them direct, tangible results of their training, educate them on the “why” of what they’re doing, and make it fun in the process.

That said, in terms of athleticism, my goal is symmetry – or at least bringing guys closer to it in the off-season.  To that end, we address the following to keep shoulders healthy:

•Scapular stability – In Particular, we need to focus on lower trap and serratus anterior.  I know it’s hackneyed by now, but you can’t shoot a cannon from a canoe!  It’s important to get pec minor, levator scapulae, and rhomboids loosened up to make this happen.  The problem is that the research has shown that pitchers have less scapular upward rotation than position players, specifically at humeral elevations of 60 and 90 degrees – the “zone” in which the humerus sits during throwing.

•Thoracic extension and rotation range of motion – If you don’t have thoracic extension and rotation, you won’t be able to get sufficient “lay back” during the cocking phase, so there is a greater stress on both the humerus and elbow to achieve this range of motion.

•Rotator cuff strength/endurance – You need a strong posterior cuff for decelerating all that internal rotation, but you also need a very strong subscapularis to both depress the humeral head during overhead work and prevent anterior translation of that head. The subscapularis takes on an even bigger role when you realize how many overhead athletes have chronic anterior-inferior laxity and posterior-inferior capsular contracture: adaptations that favor anterior translation of the humeral head (which the subscapularis must resist).

•Soft tissue quality – Pay close attention to lats, pec minor, levator scapulae, posterior cuff/capsule, forearms (flexor carpi ulnaris, FC ulnaris, pronator teres), rhomboids, and subscapularis.

•Opposite hip and ankle – 49% of arthroscopically repaired SLAP lesion patients also have a contralateral hip abduction ROM or strength deficit.  Lead leg hip internal rotation range of motion is extremely important for pitchers and hitters alike.

•Core stability/force transfer – If you can’t transfer force from the lower extremity through the core effectively to the upper body, you shouldn’t be throwing a baseball.  Period.

•Glenohumeral (shoulder) ROM – Over time, the dramatic external rotation during the cocking phase can lead to a loss of internal rotation ROM; this is known as glenohumeral internal rotation deficit (GIRD).  The posterior capsule and cuff stiffness leads to a superior and posterior migration of the humeral head during the late cocking phase.  You also get some osseous changes to the humeral head itself. This commonly presents as medial elbow issues – including UCL injuries and ulnar nerve irritation.

To fix this, we use posterior cuff/capsule soft tissue work, sleeper stretches/cross body mobilizations/doorway capsular mobilizations, and then subscapularis isolation work (prone internal rotation, cable internal rotation at 90 degrees of abduction).  Little league elbows get chewed up more by the varus torque (think transition from cocking to acceleration) and present more laterally with pain.  Adolescent elbows are a bit more skeletally mature and break down medially from the valgus-extension overload that takes place during acceleration.   Little leaguers just need to get stronger.  Adolescents need to get stronger and work on posterior cuff flexibility (more internal rotation).  College and pro guys need to start incorporating capsular mobilizations because of the actual structural changes that take place to the capsule.  Back and Goldberg provide an excellent series of photos for each situation HERE.

Now, there is some debate over whether the loss of internal rotation in experienced throwers is due to posterior capsule tightness. Burkhart and Morgan insisted that there was posterior capsule tightness involved via what they called the “peel-back” mechanism, which causes the humeral head to translate posteriorly and superiorly during the late cocking phase. They picked up on these posterior capsule contracture issues during surgeries of a large number of pitchers with type II SLAP lesions.

Wilk, Meiser, and Andrews (2002) countered that it was simply related to the posterior muscular tightness and the aforementioned humeral head adaptations. They therefore recommend primarily cross-body and sleeper stretch drills with the scapula fixed – but don’t pay much attention to the role of the capsule.

I’m not too handy with an arthroscope (I prefer samurai swords for all my impromptu operations), so I keep my mouth shut and do both capsular and soft tissue mobilizations, as they’re all means to the same end. They’re all brilliant guys, but are really debating on which one will get you from point A to point B faster – and how to perform surgeries once you are FUBAR. I’m more concerned with preventing the surgeries in the first place!

Interestingly, there appears to be a “threshold” of internal rotation deficit at which a pitcher becomes symptomatic. In the aforementioned Burkhart and Morgan study, all the surgery cases had an internal rotation deficit of greater than 25°. Myers et al. pinned that “don’t cross this line” number at about a 19° deficit. The research on non-symptomatic throwing shoulders was in the 12-17° range – so every little bit matters. Horizontal adduction (cross-body range of motion) is understandably impaired as well, and the common compensation pattern is for pitchers to substitute extra protraction for this lost ROM during the follow-through. This is where pec minor grows barnacles and the lower traps simply can’t handle the load alone.

•Breathing Patterns – Guys who breath into their bellies have much better shoulder function than those who breath into their chests.

•Cervical Spine ROM – Levator scapulae and sternocleidomastoid have significant implications in terms of shoulder health, but very few people pay attention to them.  Levator scapulae helps to downwardly rotate the scapula, so if it’s tight, overhead motion will be compromised.  SCM attaches to the mastoid process of the skull as well as the sternum and clavicle; it might be the latissimus dorsi of the head and neck.  Suboccipitals can be hugely important as well.  Get ‘em all worked on by a good manual therapist. Forward head posture is associated with too much scapular anterior tilt and too little upward rotation.

•Reactive Ability – We test all our guys on a single-leg triple jump to determine their reactive ability and look for unilateral discrepancies.  Typically, pitchers will have a better score on their lead leg, not their push-off leg.  It sounds backwards, but if you think about it, that front leg is more trained for deceleration and reactive ability (they have to land, and immediately swivel into fielding position).  The back foot is much more geared toward propulsion, so it doesn’t decelerate so well.

Interestingly, you can look at callus patterns and pick up on this.  Check out the base of the 1st and 5th metatarsals on a pitcher’s push-off leg and you’ll typically find calluses that indicate more of a supinator.  Check the lead leg, though, and you’ll find more thickening at the base of the 2nd and 3rd toes, indicating more pronation.  These won’t be as noteworthy in people who throw right and bat left (or vice versa); switch-hitting is actually really valuable for symmetry.

•STRENGTH – Yes, I put this in all caps because it is important.  If you think doing some rubber tubing external rotations is going to help decelerate a 100mph fastball that involves a total-body effort, you might as well schedule your shoulder or elbow surgery now.  Strength is an important foundation, so strengthen your posterior chain, quads, thoracic erectors, scapular retractors, etc, etc, etc.

MR: Damn that’s a pretty thorough answer! How does overhead pressing fit into all of this?  Some people say you need to do it because they encounter it in their sport.  What do you say?

EC: I stay away from it.  Contraindicated exercises in our program include:

•Overhead lifting (not chin-ups, though)

•Straight-bar benching

•One-Arm Medicine Ball Work

•Upright rows

•Front/Side raises (especially empty can – why anyone would do a provocative test as a training measure is beyond me)

•Olympic lifts aside from high pulls

•Back squats

While I’m working on a detailed article on this topic, in a nutshell, it has a lot to do with the fact that overhead throwing athletes (and pitchers in particular) demonstrate significantly less scapular upward rotation – and that makes overhead work a problem.  This is particularly serious with approximation exercises, which leads me to…

Comparing most overhead weight training movements (lower velocity, higher load0 to throwing a baseball is like comparing apples and oranges.  Throwing a baseball is a significant traction (humerus pulled away from the glenoid fossa), whereas overhead pressing is approximation (humerus pushed into the glenoid fossa).  The former is markedly less stressful on the shoulder – and why chin-ups are easier on the joint than shoulder pressing.

Likewise, comparing an overhead-throwing athlete to a non-overhead-throwing athlete is apples and oranges again. Throwing shoulders have more humeral and glenoid retroversion, an adaptation that many believe occurs when pre-pubescent athletes throw when the proximal humeral epiphysis (growth plate) isn’t closed yet. This retroversion gives rise to a greater arc of total rotation range-of-motion. Wilk et al termed this the “total motion concept” (internal rotation + external rotation ROM) and noted that the total arc is equal on the throwing and non-throwing shoulders – yet the composition (IR vs. ER) is different in overhead athletes, who have more less internal rotation in their throwing shoulders.

As I mentioned earlier, a lot of people believe that the internal rotation deficit overhead athletes experience has more do to with the osseous changes than soft tissue and capsular issues alone. We can work with the latter, but can’t do anything with the former. So, when someone says that all their YTWLs and theraband exercises make it okay for an overhead throwing athlete to overhead press, I have to wonder how those foo-foo exercises magically changed bone structure. Additionally, this acquired retroversion allows for more external rotation to generate more throwing velocity. In my opinion, this is why you never see someone just “take up” pitching in their 20s and magically become a stud athlete; the bones literally have to morph to throw heat! Believe it or not, some research suggest that this retroversion actually protects the shoulder from injury by “sparing” the anterior-inferior capsule in from excessive stress during external rotation.

Additionally, as I noted above, just about every overhead throwing athlete you see (and certainly all pitchers) have labral fraying. The labrum deepens the glenoid fossa (shoulder socket) by up to 50% and creates stability. Would you want to build a house on a foundation with chipped concrete?

There may even be somewhat of a congenital component to this. Bigliani et al. found that 67% of pitchers and 47% of position players at the professional level have a positive sulcus sign in their throwing shoulder. One might think that this is simply an adaptation to imposed demand – and that very well might be the case. However, those researchers also found that 89% of the pitchers and 100% of the position players with that positive sulcus sign ALSO came up positive in their non-throwing shoulder. It may very well be that the guys with the most congenital laxity are the ones who are naturally able to throw harder – and therefore reach the higher levels. If you’re dealing with a population that’s “picked the right parents” for laxity, you better think twice about having them press anything overhead.

With respect to the Olympic lifts, I’m not comfortable with the amount of forces the snatch puts on the ulnar collateral ligament, which takes a ton of stress during the valgus-extension overload cycle that dramatically changes the physical shape of most pitchers’ elbow joints.  Cleans don’t thrill me simply because I don’t like risking any injury to wrists; surgeons do enough wrist and forearm operations on baseball guys already!  We teach all our guys to front squat with a cross-face grip.

Lastly, here is a frame of reference to deter you from the “Since they encounter is in sports, we need to train it in the weight-room” mindset.  Boxers get hit in the head all the time in matches; why don’t we intentionally train that?  Getting hit in the head is not good for you, nor will it make you a better boxer.  It is a part of the sport, but they don’t intentionally add it into the training because they can appreciate that it would impair longevity.

Some might ask if I feel that it limits development of the athlete on the whole.  If you’re dealing with a little leaguer, feel free to do some overhead stuff with him; I love one-arm DB push presses with our younger kids.  However, with our 16+ athletes, my glass-is-half-full mentality is that we’re avoiding any unnecessary risk because the reward is trivial at best compared to what you can do with effective non-overhead programming.  Like I said, every baseball pitcher you see will have fraying in their labrum – and that means less mechanical stability.

MR: So what do you like to do instead? EC:  Here’s a small list:

•Push-up variations: chain, band-resisted, blast strap

•Multi-purpose bar benching (neutral grip benching bar)

•DB bench pressing variations

•Every row and chin-up you can imagine (excluding upright rows)

•Loads of thick handle/grip training

•Med ball throws

•Specialty squat bars: giant cambered bar, safety squat bar

•Front Squats

MR: Okay, that covers pitchers pretty damn well. Do you follow the same guidelines with position players as well?

EC: At the youth levels, pretty much every kid thinks that he is a pitcher or a shortstop. Next to catchers, these two positions throw more than anyone on the field. At the pro ranks, most guys have developed a lot more of the adaptive changes I outlined earlier, so the name of the game is conservative in terms of exercise selection. So, as far as avoiding the contraindicated exercises I noted above, we’re standard across the board.

I look at my baseball guys as pitchers, catchers, and position players. The big areas in which they’re different are a) initial off-season focus and b) in-season training.

In terms of “a,” I’ve found that we need to spend more time ironing out asymmetries early on in the off-season with pitchers, as they simply don’t move as much as position players. Additionally, with the amount of moronic distance running (can you tell I’m not a fan?) that many pitchers do, we spend a lot of time trying to get back a solid base of strength, power, and reactive ability upon which to build some pitching-specific endurance.

In-season, it’s not too hard to program for starting pitchers; you know they’re going to throw on a 5-day (pros) or 7-day (college/high school) rotation. Some guys might close games on Mondays and start on Wednesdays, though. Basically, you plan around the starts – and make sure that you get in a solid lower-body-emphasis lift in within 24 hours after a start. Relievers are a bit more challenging – and in many ways have to be treated as a hybrid between position players and starters. You base a lot of what you do on how many pitches they throw and the likelihood of them pitching on a given day.

As a general rule of thumb, I don’t do chin-ups or heavy pressing the day after someone pitches. It’s generally more rowing and push-up variations.

I don’t squat my catchers deep in-season. We’ll do some hip-dominant squatting (paused or tap and go) to a box set at right about parallel, but for the most part, it’s deadlift variations. We get our range-of-motion in the lower-body with these guys with single-leg work.

Position players just need to lift – before or after games. The name of the game is frequency, and as long as you aren’t introducing a lot of unfamiliar exercises or long eccentrics in-season, they won’t be sore.

MR:  This question may be for myself as much as the readers, but what resources can you recommend for someone that wants to learn more about the anatomy and biomechanics of the shoulder and elbow?

EC:  I haven’t seen a really good resource that effectively addresses the need for specialized training in overhead throwing athletes; I’ve actually had a lot of people telling me I should pull something together.  I guess that’ll be a project for the new facility.

That said, there are definitely some great resources available.  First and foremost, I really like all the drills you and Bill outline in Inside-Out – and I’m not just saying that to butter you up (hell, I already got the interview, and I can be a jerk to you whenever I want).

Second, I think Gray Cook’s Secrets of the Shoulder DVD is excellent.

Third is Donatelli’s Physical Therapy of the Shoulder is a classic.  It’s very clinical, and you won’t read it in one sitting, but it’s definitely worth a read.

Fourth is Shirley Sahrmann’s Diagnosis and Treatment of Movement Impairment Syndromes.  Sahrmann really turned me on to looking at things in terms of inefficiency/syndrome rather than pathology.  The way she approaches scapular downward rotation syndrome is great.

Fifth, get over to Pubmed.com and read everything you can from James Andrews – and then search the related articles.  Be sure to check out Throwing Injuries to the Elbow by Joyce, Jelsma, and Andrews as well; it’s important to understand how shoulder dysfunction impacts elbow function.

Blog Update Athletes Aren’t as Smart as We Think All the Best, EC