Home Posts tagged "Arm Care"

Exercise of the Week: Prone External Rotation End-Range Lift-off to Internal Rotation

If you're involved in any sport that requires a lot of precise control of the extreme external rotation position (as in throwing), here's an advanced progression that you could benefit from trying. Many rotator cuff exercises focus on building strength/motor control/timing in positions that aren't specific to the throwing motion, but this one forces athletes to be proficient in positions that really matter.

If you're looking to learn more about how I assess, program, and coach at the shoulder, be sure to check out my popular resource, Sturdy Shoulder Solutions.

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CSP Elite Baseball Development Podcast: Should Pitchers Take Time Off From Throwing?

For this week's podcast, I'm flying solo as I tackle a commonly debated question in the world of developing pitchers: should pitchers take time off from throwing? This is something I've pondered a lot over the years, and my position on it has evolved considerably.

A special thanks to this show’s sponsor, Athletic Greens. Head to http://www.athleticgreens.com/cressey and you’ll receive a free 10-pack of Athletic Greens travel packets with your first order.

Sponsor Reminder

This episode is brought to you by Athletic Greens. It’s an all-in-one superfood supplement with 75 whole-food sourced ingredients designed to support your body’s nutrition needs across 5 critical areas of health: 1) energy, 2) immunity, 3) gut health, 4) hormonal support, and 5) healthy aging. Head to www.AthleticGreens.com/cressey and claim my special offer today – 10 FREE travel packs – with your first purchase. I use this product daily myself and highly recommend it to our athletes as well. I’d encourage you to give it a shot, too – especially with this great offer.

Podcast Feedback

If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.

And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.

Thank you for your continued support!

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An Overlooked Function of Serratus Anterior

Serratus anterior gets:

1. A lot of love as a scapular protractor

2. Some love as a scapular upward rotator

3. Even less love as a posterior tilter of the scapula

4. Just about zero love for its impact on rib internal/external rotation.

Most importantly, you'll see that the upper fibers of the serratus anterior attach on the first rib - the very bone that's removed during thoracic outlet surgery.


Images by Anatomography - en:Anatomography (setting page of this image), CC BY-SA 2.1 jp, https://commons.wikimedia.org/w/index.php?curid=27010000

When the serratus fires, it depresses the first rib and clears space under the clavicle for important nerve and vascular structures to pass.

If you take a second to think about it while looking at the anatomy charts below, you'll appreciate that this attachment effectively makes serratus anterior an antagonist to the scalenes and subclavius, which both elevate the first rib.

This is one reason why a lot of the thoracic outlet syndrome cases you'll encounter aren't your classic kyphotic (hunchback) posture, but actually a lot of flat thoracic spine, heavy scapular downward rotation/depression, and horizontal clavicle presentations.

Getting serratus anterior going favorably impacts scapular upward rotation (which brings the clavicle up), first rib positioning, and the ideal convex-concave relationship between the rib cage and scapula.

Fun fact: serratus anterior also indirectly impacts contralateral thoracic rotation, but that's a post for another day!

If you're looking to learn more about how I assess, coach, and program for the upper extremity, be sure to check out Sturdy Shoulder Solutions.

 

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Exercise of the Week: Half-Kneeling Wall-Press 1-Arm J-Band Trap Raise

Today's guest post comes from Cressey Sports Performance - MA coach, Ethan Dyer.

The Half-Kneeling Wall-Press 1-Arm J-Band Trap Raise is a new variation we’ve been using a lot with our more hypermobile (loose jointed) and/or younger athletes here at CSP. We get the same value as a traditional J-Band trap raise, but with a small tweak that can be a huge difference maker for certain athletes.

Important Coaching Cues:

Make sure we nail our half-kneeling position. Any postural issues down the chain will create interference up the chain. Undue lumbar extension and/or "hip hike" on one side needs to be taken care of before we can worry about the rest of the exercise.

Our wall press needs to be aggressive enough to make a difference. This is what separates this exercise from a standard J-Band trap raise or "Y." By actively reaching with our off hand, we push our rib cage back - allowing for better scapulothoracic (shoulder blade on rib cage) congruency and ideally more effective retraction/upward rotation. Reaching against a hard surface gives us even more stability in that position, and this is particularly useful for our looser, floppier guys (you know who you are).

As we perform the trap raise we need to be careful not to lose our initial posture. If we allow compensatory movement in the lower extremity or the torso, we are no longer isolating the desirable posterior tilt and upward rotation and end up performing what is essentially a full-body exercise.

To progress this, stand the athlete up (short-split or split-stance). Removing the wall will make this more difficult but may dramatically change the stimulus depending on the athlete.

We love the J-Band "Junior" resistance for this exercise; the traditional resistance J-Bands will bury a lot of people here. As with other J-Band drills, we get a lot of value without asking our athletes to grip anything (think high throwing volume or return-to-throw).

This variation is probably most useful in the 8 to 12 rep range, with a varying number of sets depending on its location in a program (part of a warm-up or movement day, or accessory work during a lift).

About the Author

Ethan Dyer serves as a Strength & Conditioning coach at Cressey Sports Performance. He started as a client at CSP and eventually went on to intern at CSP-MA. Following another internship at Indianapolis Fitness and Sports Training, Ethan joined the CSP-MA team. He was a pitcher at the College of the Holy Cross before transferring to Endicott College to complete his undergraduate work with a major in Exercise Science and minor in Psychology. A Certified Strength and Conditioning Coach through the National Strength and Conditioning Association, Ethan has been a volunteer with both the Miracle League and Special Olympics, and has a passion for working with young athletes to help them fall in love with training while avoiding injury. You can follow him on Instagram at @Ethan___Dyer.

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Exercise of the Week: Bowler Squat to J-Band Y

This week's exercise of the week is the brainchild of physical therapist Eric Schoenberg, who works out of Cressey Sports Performance - Florida. When I first saw him implementing it with a patient, I immediately thought, "How have I never thought of it?" You see, this drill actually combines two of my favorite exercises: the bowler squat and the J-Band Y. In doing so, we get an awesome arm care exercise that integrates single-leg balance and hip mobility.

The bowler squat component delivers a triplanar challenge to the glutes, as you have to eccentrically control hip flexion, adduction, and internal rotation on the way down - and it's actually overloaded in the transverse plane by the pull of the band. Here are some coaching cues and notes:

1. The upper arm should be at about a 135-degree angle to the torso so that it's in the line of pull of the lower traps. The upper extremity action should actually be driven by scapular movement into posterior tilt.

2. Most athletes should start with a J-Band Jr. before proceeding to a regular thickness J-Band.

3. As the athlete approaches the bottom of the movement on the lowering phase, he should try to get more hip motion than upper back motion. Although both are necessary, we've seen a lot of athletes who jump dump over into thoracic kyphosis (rounding) when they start to struggle. In other words, use the hips to deliver the hands.

4. The head should remain in line with the body to preserve a neutral cervical spine.

5. I generally prefer this to be done barefoot or in minimalist sneakers, like I'm wearing. It can be helpful to cue the athlete into "tripod foot" or tell them to "grab the ground like you're trying to picking a basketball with your foot."

6. We like this as a warm-up exercise or "filler" between sets of medicine ball work. We'll program it for sets of 8-10 reps on each side.

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Taking Proteus Motion for a Spin

Today’s guest post comes from former Cressey Sports Performance intern and current physical therapist, Tanner Allen. I asked Tanner to take the lead on our work with Proteus this offseason, and he does a great job of summing up our initial experiences below. Enjoy! -EC

In December, we brought in a Proteus Motion unit to Cressey Sports Performance – Florida to try out for the offseason. It goes without saying that we found some excellent benefits, and I thought I’d use today’s blog post to dig in on them. First, however, I think it’s important to appreciate what Proteus is.

Proteus Motion uses electromagnetic brakes to produce resistance that the user must overcome to move the arm or beam. This futuristic cannon packs a heavy punch of technology. Utilizing biofeedback and tracking technology, Proteus enables athletes to optimize their movement patterns and power development. It allows you to train within the freedoms of your own movements while providing resistance continuously in a manner different than you'd experience with cable machines, barbells, dumbbells and kettlebells - because the impact of both gravity and specific planes of motion are reduced and eliminated, respectively.

The only other place on earth an individual can experience this 3D resistance is in water. In fact, the machine was named after Proteus, the son of the sea god Poseidon in Greek mythology. The quality that links water and the Proteus machine is the ability for an individual to move fluidly throughout every movement that they may perform. The main handle attachment of Proteus is unlike traditional grips and enables the user to sync multiple movements together in a natural and organic way. As soon as you step up to the machine for the first time, you can move the arm in any direction to get a feel for the continuous resistance which is unlike any other resistance training you have ever done before.

Currently, we are using Proteus as an adjunct to conventional training involving our Arm Care and Med Ball programming. This gives our clients variable training environments to aid in motor learning, control, and carryover between common exercises and movement patterns. Below, I’ll demonstrate a few examples of exercises that we are performing with our clients:

Arm Care/Scapula Stabilizer strengthening, consisting of: D2 Flexion and Extension, Horizontal Abduction, External Rotation while simultaneously transitioning into Internal Rotation and lead arm stability during swing.

Med balls and Rotational Core Variations: Rotational Chops, Chop and Lift, Rotational Shotput, Split Stance Anti Rotation Chops as well as many others.

One of the foundational principles coached regardless of training method is the appropriate activation of your core during extremity movements for optimal stability and force transfer. Something that we notice with first-time users is the lack of awareness that they have throughout rotational control and power, which typically causes the athlete to lose their balance backwards during their first couple repetitions. Once an athlete’s neuromuscular system kicks in and maximizes full-body engagement, they make the needed adjustments to maintain balance appropriately during exercises. This challenge to the neuromuscular system eventually improves the client’s ability to properly sequence movements and create/transfer force, which subsequently improves the power production numbers Proteus tracks.

The sky is truly the limit with Proteus as the potential for possible exercises and movements is endless, making this exercise machine a potential one-stop-shop for workouts. This machine can be utilized for sports-performance training due to decreased restrictions on natural movement patterns or for an extremely effective total body routine, as you can seamlessly flow from one exercise to the next. This machine also allows easy resistance adjustments during a workout through Bluetooth controls for on-the-fly changes. The weight ranges from 1-35lbs, making it versatile for warm-up routines prior to powerlifts, sport-specific skill drills or training peak power production in multi-planar movements. The Proteus can also be extremely beneficial during rehabilitation due to visual feedback and tracking capabilities.

The Proteus also offers a wide range of metrics that can be tracked for each individual user to assess progress. This is helpful for re-assessments following an individual’s program, tracking improvements throughout the off-season, following an injury during rehabilitation or assessing fatigue during a periodization period. You can track power output (Watts), Acceleration, Deceleration, Endurance, and Consistency looking at the client’s ability to reproduce a specific movement. The pictures below provide you with a visual of what a post-test report might look like.

The report provides you with an in-depth analysis of your performance, comparing movement patterns or exercises bilaterally. It allows you to determine specific trends an athlete might have in fatigue or recovery management, helping the provider make necessary changes to programming. Results can be determined based on a single repetition, or a 3D graph can be created overlaying multiple repetitions. A cool feature included is the visual feedback of an entire motion throughout the length-tension curve, allowing you to assess strengths and weaknesses along the total path of motion pictured above. Moving forward, from a testing standpoint, we see ourselves using it extensively with:

a. objective measurement of shoulder strength tests in a standing (and therefore more functional) position

b. measuring rotational power - but peak and in terms of side-to-side comparisons

On this second point, there's a lot to be said for the ability of Proteus to slide into a relatively untapped portion of the force-velocity curve. Looking at this old video from EC, you can see that it could fit anywhere in the speed-strength to strength-speed aspect of this continuum - almost like a medicine ball that you can load more - but have to apply force over a greater distance. And, because it's concentric dominant action in nature, it could be trained frequently without making athletes really sore.

As you can see, Proteus is a versatile machine with broad application in peak performance training as well as rehabilitation and testing. It measures and tracks data on hard-to-measure patterns to assess an athlete’s progress, provide biofeedback, and train rotational sport athletes along the force-velocity curve in a safe way. We look forward to diving into the Proteus system’s capabilities even more in the future. We have only just begun to tap into the potential and vast capabilities of Proteus with testing and programing at our CSP-FL.

If you're interested in learning more, check them out at www.ProteusMotion.com.

About the Author

Tanner Allen received his Doctorate of Physical Therapy from the University of St. Augustine in 2019. After graduating, he completed an Internship at CSP-FL in the Fall of 2019. Tanner enjoys working with athletes of all ages and backgrounds on a continuum from rehabilitation following injury through sports performance training. He graduated from Valdosta State University in 2015 with a degree in Exercise Physiology and is a Certified Exercise Physiologist (ACSM-EP) as well as a Certified Strength and Conditioning Specialist (CSCS).

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Arm Care: Why Are We Still Talking About “Down and Back?”

Today's guest post comes from Eric Schoenberg, the physical therapist at Cressey Sports Performance - Florida and a great resource to the entire CSP team. Enjoy! -EC

To get right to the heart of what I'm covering today, I think it's best that we start with a video:

So, as you can infer, the reason we're still talking about "down and back" is because we need to! Athletes are coming into the gym every week after multiple surgeries or drops in performance with postures and movement patterns that are faulty and easily correctible.

Obviously, the down and back concept is not the only reason for this, but the idea of driving our scapulae into maximal adduction (retraction), downward rotation, and depression is certainly something that we can control and improve upon.

To set the record straight, the only time an athlete should receive this cue is when their arms are by their side (Deadlifts, farmer’s walks, heavy dumbbell holds for lower body lifts). Once the humerus starts to move away from the side more than 20-30 degrees, the scapula needs to start moving in the appropriate direction to keep ball on socket congruency and reduce mechanical stress to the neighboring soft tissue structures (labrum, rotator cuff, neurovascular structures).

On the performance side of things, the “down and back” posture (scapular adduction, downward rotation, and depression) limit the ability to get the hand out in front or overhead. This has obvious implications in overhead athletes.


 In the case of throwers, the difference in extension at ball release can vary by 3-4 inches depending on the position of the scapula. (as you can see in the comparison pics above and the video below).

When we don’t get full extension at ball release, any variety of downstream stresses can occur (aggressive elbow extension, lack of full pronation through the baseball) that result in increased injury risk and decreased performance.

As mentioned in the introduction video, we are bringing bad cues to good programming and it continues to result in faulty movement and injury. Even worse is when this “down and back” cue is brought into the rehabilitation setting and athletes that have already had surgery continue to experience symptoms similar to their pre-surgery presentation.

In conclusion, let’s continue to look at our cues and consider where the arm is in relation to the body when we decide to cue down and back. When the arms are by the side, then go ahead and cue the scaps down and back. However, when the arm is abducted to the side, overhead, layed back into ER, or out in front at ball release, we need to cue a degree of upward rotation and elevation to make sure the joint is aligned for success.

About the Author

Eric Schoenberg is a Physical Therapist and Strength Coach and the Owner of Diamond Physical Therapy located inside Cressey Sports Performance – Florida. Eric’s approach is to help athletes move more efficiently to reduce injury and improve performance. You can follow him on Twitter and Instagram at @csp_physicaltherapy, or email him at eric@diamondphystherapy.com.

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CSP Elite Baseball Development Podcast: February 2020 Q&A with Eric Cressey

For this week's podcast, in lieu of a guest, I'm going to do a Q&A on a collection of baseball training questions that were submitted by listeners.

A special thanks to this show's sponsor, Athletic Greens. Head to http://www.athleticgreens.com/cressey and you'll receive a free 20-pack of Athletic Greens travel packets with your first order.

Show Outline

  • Why pitch counts are important, and how that importance relates to the SAID (specific adaptation to imposed demand) principle
    ● What coaches should consider when incorporating vertical pulling exercises with athletes who have a history of lat injury
    ● What the best exercises are for strengthening the deceleration muscles of the throwing motion
    ● What professionals should assess in an athlete when personalizing an arm care program

Sponsor Reminder

This episode is brought to you by Athletic Greens. It’s an all-in-one superfood supplement with 75 whole-food sourced ingredients designed to support your body’s nutrition needs across 5 critical areas of health: 1) energy, 2) immunity, 3) gut health, 4) hormonal support, and 5) healthy aging. Head to www.AthleticGreens.com/cressey and claim my special offer today - 20 FREE travel packs (valued at $79) - with your first purchase. I use this product daily myself and highly recommend it to our athletes as well. I'd encourage you to give it a shot, too - especially with this great offer.

Podcast Feedback

If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.

And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.

Thank you for your continued support!

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Random Thoughts on Sports Performance Training – Installment 35

In this installment of Random Thoughts on Sports Performance Training, I want to hone in on shoulder stuff because, well, that's what I talk about a lot!

Let's get to the new content:

1. The neck is the easiest place to start with cleaning up shoulder movement.

I've written a lot in the past about how our arm care programs work proximal to distal, meaning that we focus on the center of the body before the extremities. Usually, the right proximal changes yield immediate distal improvements both via reducing protective tension and reducing stiffness in the muscles we're trying to "overpower" to create good movement. Usually, though, when it comes to proximal changes, folks look at the thoracic spine and rib cage only. In reality, the cervical spine ought to take precedence over both of them - particularly because all the nerve of the upper extremity originate from the brachial plexus, which ranges from C5 to T1.

Fortunately, while it might be anatomically correct, coaching optimal positioning in the neck is actually very simple in the context of weight training and arm care drills: get it to neutral and keep it there. In 99% of cases, that means getting people out of upper cervical extension, which fires up the levator scapulae (which competes against all the scapular upward rotation we want). Here's a video that walks you through what you need to know:

The thoracic spine and rib cage are sexy right now, but the cervical spine is an older, reliable option for cleaning up movement quickly in just about everyone.

2. Whenever possible, get core control integrated in your arm care drills.

I often come across arm care protocols that literally have athletes laying on a table for 30 minutes worth of "exercise." This not only leads to a disengaged athlete, but also overlooks the fact that the entire kinetic chain needs to be synced up to keep a shoulder healthy. We'll often use predominantly table-based exercises in month 1 to make sure athletes are picking up the technique in a controlled environment, but in almost all scenarios, these table drills are actually "fillers" between sets of strength training exercises that have the athletes up and around in the gym.

More importantly, after that first month, I try to make sure that at least half of our arm care exercises are done separate from the table. Maybe we do our horizontal abductions in a side bridge position, or integrate more bottoms-up carries or bear crawls for serratus activation. Perhaps the prone trap raises take place on a stability ball, or we shift to a TRX Y instead. Or, we could move the athlete to half-kneeling, split-stance, or in a rear-foot elevated position for their 90/90 external rotation holds.

Regardless of what we choose, the buy-in from athletes is definitely better - and just as importantly, the resulting training effect has a more specific carryover to sporting success.

3. Yet another study reminds us that GIRD is a measurement and not an actual pathology.

Glenohumeral internal rotation deficit (GIRD) was all the rage in the baseball sports medicine community for decades. Unfortunately, what many practitioners fail to appreciate is that GIRD can be a completely normal finding as long as an individual's total motion is symmetrical between throwing and non-throwing shoulders. We expect to see less internal rotation and more external rotation in a throwing shoulder because of retroverion in the throwing shoulder; the arc is just shifted. Here's a glimpse at what it looks like:

 

Today is Day 12 of #30DaysOfArmCare. Thanks to #Tigers pitcher @adamrav12 for the assist! Key takeaways: 1. Retroversion is a common finding and throwing shoulders. It gives rise to greater lay-back at max external rotation. 2. The more passive range of motion you have, the more consistently you must work to maintain active stability of that ROM. ROM without stability is injury risk. 3. Perform your cuff work in the positions that matter - and keep in mind that individual differences in passive ROM may be present. 4. Don't stretch throwers into external rotation, especially if they already have this much lay-back! Follow #30DaysOfArmCare and @cresseysportsperformance for more tips to keep throwing arms healthy. #cspfamily #armcare #baseball #mlb

A video posted by Eric Cressey (@ericcressey) on

Anyway, we are now at a point in time where more and more research on GIRD is out there, and it's pretty resounding: it doesn't predict injury as well as we once thought. And, more importantly, the opposite seems to be true: a loss of external rotation (usually from a combination of less retroversion and soft tissue limitations) equates to a greater injury risk. We need to get more of the "GIRD? So What?" literature into the hands of doctors who aren't familiar with the latest research, as many are still making "GIRD" diagnoses when they really are just range-of-motion measurements. I delve into this in great detail in the Sturdy Shoulder Solutions product, but figured another study reiterating the point can't hurt. This one - Relationship Between Glenohumeral Internal Rotation Deficit and Medial Elbow Torque in High School Baseball Pitchers - just found that GIRD wasn't associated with medial elbow torque in high school pitchers.

It's time to move on from GIRD!

4. If you're about to have shoulder surgery (or any surgery), get your Vitamin D checked.

For years, we've known that having an adequate Vitamin D status was important for a myriad of biologic functions. Perhaps the most well known among observations on this front was a 2015 study of NFL players that demonstrated that players with inadequate preseason Vitamin D levels were more likely to have suffered a lower extremity or core muscle injury. In fact, the likelihood of a hamstrings injury was 3.61 higher in those with inadequate vitamin D levels! As such, it's become a big area of focus in the nutrition and supplementation world for athletes.

However, I've honesty never heard of an orthopedic surgeon looking at it for those who either have chronic pain or are about to undergo a surgical intervention to treat a structural defect. We need to change that, though. A recently published study, Preoperative Vitamin D Deficiency Is Associated With Higher Postoperative Complications in Arthroscopic Rotator Cuff Repair, should help in that goal, though. Patients with pre-operative Vitamin D deficiency were 1.54 times more likely to require a revision surgery and 1.16 times more likely to require manipulation under anesthesia to overcome post-op stiffness.

Clearly, Vitamin D has a huge link to soft tissue health, so don't overlook it!

Wrap-up

I'm a shoulder nerd and could ramble on all day on this stuff, but instead, I'll direct you to check out Sturdy Shoulder Solutions if you'd like to dig in deeper. You can learn more at www.SturdyShoulders.com.

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CSP Elite Baseball Development Podcast: Building a Better Throwing Program with Alan Jaeger

We're excited to welcome highly regarded pitching consultant Alan Jaeger to this week's podcast to discuss long toss and both performance and rehabilitation throwing programs. A special thanks to this show's sponsor, Athletic Greens. Head to http://www.athleticgreens.com/cressey and you'll receive a free 20-pack of Athletic Greens travel packets with your first order.

Show Outline

  • How Alan became known as “the long toss guy”
  • How experience as a young junior college arm led him to developing his throwing strategies
  • How Alan defines long toss and what the specific priorities of a quality long toss session are
  • How long toss facilitates self-organization of the body and intuitive feel for how to throw the ball efficiently
  • How stretching it out and working back to your partner with conviction gives pitchers the variance they need to remain athletic and free on the mound rather than repeatable and robotic
  • What big mistakes Alan sees in athletes’ daily catch play as well as the programming of their throwing sessions
  • How Alan liked to structure throwing for pitchers on 5- and 7-day rotations
  • Where Alan sees room for improvements in rehabilitation throwing programs
  • How the conversation about long toss has evolved over the last 20 years, specifically in professional baseball
  • How some MLB organizations still resist long toss, but why young front office phenoms are playing an influential role in transforming baseball into a more progressive era
  • How understanding a player’s background gives great insight into how they’ll function at a high level
  • How players can learn to respectfully say no to complete overhauls in their abilities and be prepared to stand their ground to preserve the longevity of their career
  • You can follow Alan on Twitter at @JaegerSports  and on Instagram at @JaegerSports.

Sponsor Reminder

This episode is brought to you by Athletic Greens. It’s an all-in-one superfood supplement with 75 whole-food sourced ingredients designed to support your body’s nutrition needs across 5 critical areas of health: 1) energy, 2) immunity, 3) gut health, 4) hormonal support, and 5) healthy aging. Head to www.AthleticGreens.com/cressey and claim my special offer today - 20 FREE travel packs (valued at $79) - with your first purchase. I use this product daily myself and highly recommend it to our athletes as well. I'd encourage you to give it a shot, too - especially with this great offer.

Podcast Feedback

If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.

And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.

Thank you for your continued support!

Sign-up Today for our FREE Baseball Newsletter and Receive Instant Access to a 47-minute Presentation from Eric Cressey on Individualizing the Management of Overhead Athletes!

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