Here are a few recommended reads for the week:
Shoulder Pain vs. Neck Pain - This old post highlights a simple, but very accurate observation from Mark Comerford.
28 Synergistic Factors for Success - I wrote this article at T-Nation back in 2005, but it still holds water and will make you appreciate how many differen factors are impacting your progress.
Too Much Vitamin D? - This great Q&A from Brian St. Pierre addresses this new question that seems to be popping up quite a bit.
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Here are a few good reads from the archives for you for today:
Things I Learned from Smart People: Installment 1 - This features some stuff Bill Hartman taught me about the diagnosis of disc herniations.
Shoulder Range-of-Motion Norms - What's normal - if there is such a thing?
Avoiding the Workout Routine Overhaul - This piece talks about the problem with people that jump completely from one workout routine to another at the drop of the hat - and outlines a better strategy.
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This weekend is going to be one of very mixed emotions for our entire family, as we'll lay my grandfather to rest Saturday morning; he passed last Thursday morning. Gramp had been the center of our family for my entire life, and he was a huge part of making me the man that I am. Were it not for Gramp, I never would have developed the passion for baseball that eventually led to me finding a career that focuses on the game. On one hand, it's going to be hard to say goodbye to him, but on the other hand, we're happy to celebrate his life and take solace that he's finally at peace after a long illness.
That said, in his final weeks, Gramp requested a Saturday funeral because - as a former high school principal - he didn't want any teachers to have to miss school to attend. To that end, he'd want the show to go on at this blog, too - so that's what we'll do with some random thoughts today.
1. I got a mention in the USA Today on Wednesday in a very interesting article on the biceps tenodesis surgery, as this procedure could become the "next big thing" in SLAP repairs. I was mentioned alongside the likes of Curt Schilling, James Andrews, Brett Favre, Jake Peavy, and Bud Selig...pretty good company! Check out the article: For Pitchers, Shoulder Surgery Cuts Both Ways.
2. Speaking of pitchers, here's yet ANOTHER study showing that resistance training (with throwing) improves throwing velocity significantly more than throwing alone. Meanwhile, we still have some old-school coaches saying that kids shouldn't lift. Ugh.
3. How's this for some solid feedback on just the first two months of Show and Go: High Performance Training to Look, Feel, and Move Better?
"Hey Eric, Just wanted to keep you updated with the results I've had from Show and Go, as well as ask a quick question regarding this. I started the program at 10% body fat (measured with AccuMeasure callipers) and am now down to about just over 7% body fat! This is the lowest I've ever gone."
For more information, check out www.ShowandGoTraining.com.
4. Here's some interesting research that shows that vitamin D deficiency doubles stroke risk in Caucasians. Deficiency incidence is lower (6.6%) in whites than African-Americans (32.3%), though. Beyond just cardiovascular health, though, vitamin D is one of the first things we look at in those with chronic soft tissue problems, especially in Northern climates where folks don't get enough sunshine during the winter months.
5. Today is the last day to get Joel Marion's Cheat Your Way Thin Holiday Edition at the introductory discount; check it out HERE, if you're interested.
6. Here's a great video from Mike Robertson on "Conquering the Chin-up:"
7. And your weekly dose of puppy...
Have a great weekend!
Hey Eric,
Just wanted to keep you updated with the results I've had from Show and Go, as well as ask a quick question regarding this. I started the programme at 10% body fat (measured with AccuMeasure callipers) and am now down to about just over 7% body fat! This is the lowest I've ever gone.
This Sunday, my fiancee Anna and I officially tie the knot.
Also this Sunday, the major league baseball season officially ends - which means my buddy Mike Reinold (head athletic trainer and rehabilitation coordinator of the Boston Red Sox) is going to have some time to do some marriage "maintenance" of his own after lots of long days and travel since the season began in February.
So, in honor of the weekend, Mike and I decided that we'd run a sale on our Optimal Shoulder Performance DVD Set. From now through midnight on Sunday, just head to www.ShoulderPerformance.com, add the DVD set to your cart, and get $30 off the price of the DVD set by entering the coupon code "HITCHED" (no quotation marks) at checkout.
For those of you who may be on the fence about the product, be sure to check out the testimonials and product information on the website - as well as the following:
13 Fun Facts about Optimal Shoulder Performance
Video: Should Pitchers Overhead Press?
I've seen a few acromioclavicular (AC) joint impingement cases at our facility in the last couple of weeks and thought it'd be good to do a quick blog to talk about how different they are from "regular" (external) shoulder impingement cases. And, it is a very important differentiation to make.
I've already written at length about AC joint issues in Getting Geeky with AC Joint Injuries: Part 1 and Part 2. And, I kicked out a two-part series called The Truth About Shoulder Impingement; here are Part 1 and Part 2.
While I talk a lot about the symptoms for both, several provocative tests for these issues, and training modifications to avoid exacerbating pain under these conditions, there was one important "differential assessment that I missed." Mike Reinold actually taught me it as we were planning the Optimal Shoulder Performance DVD set.
Just paying close attention to (and asking about) where folks have their pain during overhead motion can tell you quite a bit. In an external impingement - where we're talking about the rotator cuff tendons and bursa rubbing up against the undersurface of the acromion - you'll usually get pain as folks approach 90 degrees of abduction (arm directly out to the side). That pain will persist as they go further overhead, and in my experience, start to die off as they get to the top.
Conversely, for those with AC joint impingement - what is essentially bone rubbing up against bone - you see a "painful arc" only at the last portion of abduction:
You can usually confirm your suspicions on this front with direct palpation of the AC joint and checking to see if folks have pain when reaching across the chest.
Much of the training modifications will be the same for these two conditions, but there are also going to be several key things that should be managed completely differently. For instance, front squatting someone with an AC joint issue would not be a good idea due to the direct pressure of the bar on the AC joint; it would, however, be just fine for most cases of external shoulder impingement. In another example, some serious AC joint issues are exacerbated even by just doing the end-range of a rowing motion (to much shoulder extension/horizontal abduction) - whereas even folks with full-blown rotator cuff tears can generally do rows pain-free.
In the same grain as Monday's post on lower back pain, today, I thought I'd highlight some of the common findings in diagnostic imaging of the shoulder, as these findings are just as alarming.
Do you train loads of overhead throwing athletes (especially pitchers) like I do? Miniaci et al. found that 79% of asymptomatic professional pitchers (28/40) had "abnormal labrum" features and noted that "magnetic resonance imaging of the shoulder in asymptomatic high performance throwing athletes reveals abnormalities that may encompass a spectrum of 'nonclinical' findings." Yes, you can have a torn labrum and not be in pain (it depends on the kind of labral tear you have; for more information, check out Mike Reinold's great series on SLAP lesions, starting with Part 1).
This isn't just limited to baseball players, either; you'll see it in handball, swimming, track and field throwers, and tennis as well. And, it isn't just limited to the labrum. Connor et al.found that eight of 20 (40%) dominant shoulders in asymptomatic tennis/baseball players had evidence of partial or full-thickness cuff tears on MRI. Five of the 20 also had evidence of Bennett's lesions.
The general population may be even worse, particularly as folks age. Sher et al. took MRIs of 96 asymptomatic subjects, finding rotator cuff tears in 34% of cases, and 54% of those older than 60 - so if you're dealing with older adult fitness, you have to assume they're present in more than half your clients!
Also, in another Miniaci et al. study, MRIs of 30 asymptomatic shoulders under age 50 demonstrated "no completely 'normal' rotator cuffs." People's MRIs are such train wrecks that we don't even know what "normal" is anymore!
As is the case with back pain, these issues generally only become symptomatic when you don't move well - meaning you have insufficient strength, limited flexibility, or poor tissue quality. For more information on how to screen for and prevent these issues from reaching threshold, check out Optimal Shoulder Performance from Mike Reinold and me.
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Q: I recently opened up my own place to train athletes, and wanted to thank you for all of the knowledge you have passed along, as it has been a big factor in designing my own training philosophy. The majority of my athletes are baseball and football players in the high school and collegiate level, and I had question for you regarding my baseball players specifically.Nearly every player I work with (and for the most part every pitcher I have worked with), has tight shoulders due to over-use, being imbalanced, and weak. I have them performing a ton of upper back work in comparison to pressing movements, rotator cuff work, sleeper stretches, and myofascial release. It helps greatly, but they still seem to never get back to a full range of motion or an actual natural throwing motion. Because of this, I was wondering what you thought about adding in shoulder dislocations using a dowel rod or broomstick to help with shoulder mobility.Because the players I work with are either in college because of their ability to play baseball, or have a chance at being drafted or getting a good college scholarship from their arms, I want to make sure that everything I do makes them better instead of hurting them in the long run for what looks like a quick fix when they are with me.I'd love to hear any thoughts you might have on helping increase shoulder mobility and the shoulder dislocation exercise, in particular.
A: First off, thank you very much for your kind words and continued support.
Unfortunately, to be blunt, I think it would be a terrible idea and you would undoubtedly make a lot of shoulders (and potentially elbows) worse.
Most pitchers will have increased external rotation (ER) on their dominant side, and as such, increased anterior instability. If you just crank them into external rotation and/or horizontal abduction, you will exacerbate that anterior instability. Think about what happens in the apprehension-relocation test at the shoulder; the relocation posteriorly pushes the humerus to relieve symptoms by taking away anterior instability.
We are extremely careful with who we select for exercises to increase external rotation, and it is in the small minority. Most pitchers gain ~5 degrees of external rotation over the course of the competitive season, as it is. If we are going to have them do mobilizations to increase ER, it's only after we've measured their total motion (IR+ER) as asymmetrical and determined that they need ER (a sign is ER that is less on the dominant shoulder). And, any exercises we provide on this front are done in conjunction with concurrent scapular stabilization and thoracic spine extension/rotation - as you'd see in a side-lying extension-rotation drill.
Here, you've got supination of the forearm, external rotation of the shoulder, scapular retraction/posterior tilt, and thoracic spine extension/rotation occurring simultaneously on the "lay back" component. And, the opposite occurs as the athlete returns to the starting position. Again, to reiterate, this is NOT a drill that is appropriate for a large chunk of throwing shoulders who already have crazy external rotation; it's just one we use with specific cases of guys we discover need to gain it.
With the broomstick dislocation, you're going to be throwing a lot of valgus stress on the elbow - and as I noted in my recent six-part series on elbow pain, pitchers already get enough of that. To read a bit more, check out Part 3: Throwing Injuries.
While we're on the topic, be careful about universally recommending sleeper stretches. There is going to be a decent chunk of your baseball players that don't need it at all. In particular, if you have a congenitally lax (ultra hypermobile) athlete (high score on Beighton laxity test), a sleeper stretch will really irritate the anterior shoulder capsule and/or biceps tendon.
These players don't really need to be stretched into IR; they just need loads of stability training. You'll find that these guys become more and more common at higher levels, as congenital laxity serves as a sort of "natural selection" to succeed for some people. So, universally prescribing the sleeper stretch becomes more and more of a problem as you deal with more and more advanced players and could be jacking up multi-million dollar arms. You'll even find guys who can gain 10-20 degrees of internal rotation in a matter of 30 seconds - without any shoulder mobilizations - just with the appropriate breathing patterns. It just doesn't work for everyone. Honestly, the only way to know is to assess; each pitcher is unique.
The obvious question then becomes "why are you seeing shoulder "tightness.?" Is it postural? Is it an actual range of motion you've assessed? Is it guarding/apprehension in certain positions? And, what is a "natural throwing motion?" They said Mark Prior had "perfect mechanics" and he has been injured his entire career.
What is "natural" is not what is "effective" in many cases, so you have to appreciate that throwing is an unnatural motion that may be necessary for generating velocity, creating deception, and optimizing movement on a certain pitch.
It might seem like shameless self-promotion, but I would highly recommend that you pick up the DVD set Mike Reinold and I recently released: Optimal Shoulder Performance.
It covers all of this information in great detail, plus a ton more. Baseball players - and particularly pitchers - are a unique population as a whole, and within that population, each one is unique.
I'd also strongly encourage you to check out Mike Reinold's webinar, "Assessing Asymmetry in Overhead Athletes: Does Asymmetry Mean Pathology?" It's available through the Advanced CEU online store.
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used by Cressey Performance Pitchers after they Throw!
On the recommendation of Mike Reinold, my co-creator of the Optimal Shoulder Performance DVD set, we've been using forearm wall slides as part of our warm-ups and shoulder health programs for the past year or so. A variation is also featured on our Assess & Correct DVD as both an assessment and corrective drill.
With this exercise, the goal is to get to about 135 degrees of shoulder flexion without shrugging. In other words, you're checking just how well you upwardly rotate the scapulae. A good progression for this is the forearm wall slides with band, where you simply wrap a band around the wrists. The pull of the band forces your shoulder into internal rotation, so the external rotators (posterior rotator cuff and posterior deltoid) have to work isometrically to resist that movement. As I learned from physical therapist Tim Tyler at the MGH/Harvard Med Sports Medicine 2010 conference recently, it also improves recruitment of the lower trapezius while decreasing anterior deltoid and upper trapezius activity. In other words, it's one of the best bang for your buck scapular stability and rotator cuff exercises out there:
We just received this great feedback on Optimal Shoulder Performance:
"I just recently finished the Optimal Shoulder Performance DVD's. Without a doubt, that was the best $100 I've spent on a home based CEU opportunity.
The material was very well presented, the talks cut to the chase, and provided tons of practical ideas that I have already put into practice with my baseball and softball players."In addition to the downloadable PowerPoint slides PDF, I took tons of notes because both of you offered up such great information.
"I would highly recommend this to anyone who wants a quality shoulder DVD to add to their professional library.
"Thanks, guys, for a very high quality practical product!"-Kevin Collins, MS, ATC
