Home Posts tagged "Arm Care"

Why I’ve Gotten Away from the “No Money” Drill (Video)

I first came across the "No Money" drill for scapular control and rotator cuff activation/strength back around 2008, and introduced it to a lot of people when I included it in my first book, Maximum Strength.

At the time, I was working heavily in the general population segment and hadn't gotten as entrenched in the baseball world as I am now. So, like a carpenter who only had a hammer, I started thinking everything was a nail - and logically applied the No Money Drill with all our baseball athletes.

The more time I spent around baseball players, though, the more I realized that the No Money Drill was actually feeding into the negative adaptations we saw in them: a loss of scapular upward rotation, lat stiffness, lumbar extension syndrome, etc. As a result, we've gotten away from the drill with most of our overhead athletes (depending on what we see in an evaluation). Check out this video to learn more:

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

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Exercise of the Week: Quadruped 1-arm Trap Raise to Swimmer Hover

I recently started implementing the quadruped 1-arm trap raise to swimmer hover with some of our baseball guys, and it’s quickly become one of my favorites.

This drill addresses several important needs in a throwing population:

1. scapular posterior tilt

2. scapular upward rotation

3. tissue extensibility of the long head of the triceps and lat

4. the quadruped (all fours) position really reaffirms the good convex-concave relationship between the scapula and rib cage

You should not feel this at all in the front or top of the shoulder. Rather, the movement should be felt in the lower traps (mid back) and serratus anterior (add a full exhale at the top of each rep to intensify that activation). Some individuals will feel a good stretch through the triceps.

To learn more about how we assess, program, and coach at the shoulder girdle, be sure to check out Sturdy Shoulder Solutions.

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Strength and Conditioning Stuff You Should Read: 11/9/18

I hope you've had a good week. To kick off your weekend on the right foot, I've got some good reading from around the strength and conditioning world.

First, though, I just wanted to give you a heads-up that I'll be speaking at Pitchapalooza near Nashville in early December as part of an awesome lineup. You can learn more HERE.

Maximum Strength Training for Tennis: Why You Should Do It - Matt Kuzdub authored a great guest post for EricCressey.com a few months ago, and this was another recent post of his in the tennis world. Much it it could be applied to other sports as well.

Your Glutes Probably Aren't to Blame for Sore Knees, but They Could Still Be Stronger - Here's a solid dose of reality with some actionable strategies from Dean Somerset.

5 Great Analogies for Training Baseball Players - A big part of getting results is clearing communicating with athletes, and analogies are an invaluable way of doing so. This article outlines some of my favorites for working with a baseball population.

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5 Reasons for the Increase in Lat Strains in Baseball Pitchers

There have been some noteworthy lat strains in MLB this year, and this trend isn't showing any signs of letting up. Here are a few reasons why they're occurring at such an alarming rate.

1. Better Diagnosis

Any time a diagnosis becomes more "accepted," doctors know to look for it more immediately. In 2011, Jake Peavy was the first player to actually tear the lat off the humerus and have surgery on it, but now we're actually seeing 1-2 of these each year in guys who come to Cressey Sports Performance for consultations (on top of guys who have lower grade lat strains). In the past, a lot of doctors would mistake lat strains for rotator cuff injuries or biceps tendon issues (because the lat attaches on the front of the humerus). Sometimes, lat injuries would be missed on MRIs because the attachment is far enough down the humerus that a regular shoulder MRI wouldn't cut wide enough. In short, better identification and subsequent diagnosis are always a big reason why a class of injuries "surges."

2. Harder Throwers

Lat recruitment during acceleration is substantially higher in high level throws than it is in amateur pitchers. In particular, as lot of elastic energy is put into lat during the lay-back phase of throwing while it works as an anterior stabilizer of the shoulder as it prepares to unleash that energy into powerful internal rotation and horizontal adduction.

Sprinters who run fast pull hamstrings more often. Basketball players who jump high increase their risk of Achilles ruptures. It shouldn't be a surprise that harder throwers have a higher incidence of lat strains.

3. Inappropriate Strength Training

With each passing day, weight training gets more and more "accepted" in baseball populations, and I absolutely love it. Unfortunately, that means a lot of inferior programs get implemented, and nothing is more inferior in a baseball strength and conditioning setting than programs that are way too lat dominant. If you're doing pull-ups, bench presses, heavy deadlifts, farmer's walks, walking dumbbell lunges - and then coaching all your rows and arm care exercises to be very lat dominant, you're really just exacerbating all the negative adaptations we see in throwers. If you look around your weight room and see a ton of guys with limited shoulder flexion, that should be a red flag.

4. Poorly Executed Arm Care Programs

Lats are sneaky, as they'll find a way to creep into a lot of arm care exercises. You'll see people "tug down" (extension/adduct) the humerus (upper arm) during external rotation exercises using the lat when it should be relaxing to allow the arm to externally rotate.

You'll see hands creeping toward the midline (shoulder internal rotation) during wall slide variations - when the lat should be relaxing to allow "clean" overhead motion to take place.

You'll see individuals lock the scapula down into depression during prone trap raises instead of allowing it to posterior tilt.

And, in the most commonly butchered exercise by every lat strain pitcher I've ever seen, you'll see the humerus tugged down during the prone horizontal abduction (when it should be at 90 degrees).

These examples should help to demonstrate that we've had a lot of success bringing lat strain injuries back to full function not only because of our quality manual therapy, but also because we know how to prescribe and meticulously coach the exercises that are so important for these individuals to master.

5. Weighted Balls

Weighted ball programs increase external rotation quickly (particularly in hypermobile throwers) and the lat - as one of the anterior stabilizers of the shoulder - is one structure that takes on the brunt of the load. When external rotation increases quickly and high speeds are involved, the lat at lay-back is analogous to the Achilles tendon of a basketball player that lands on a heavy dorsiflexed ankle; it just can't "give" any more. If you're a visual learner (and don't have a weak stomach), check out the 1:40 mark in this video to see what crazy eccentric stress at the end-range of a joint can do.

Now, imagine he's an untrained 14-year-old working at these speeds and you put a 100-pound weight vest on him; do you think it'll turn out well?

Weighted balls are awesome - when they're integrated at the right times, at the right loads, in the right dosages, with the right athletes who have earned the right to use them.

Closing Thoughts

If you look at these five contributing factors - and exclude the one (better diagnosis) that's actually a good thing - you'll realize that we have three that are completely in our control. Coach exercises correctly, prescribe strength and conditioning exercises appropriately, and integrate weighted baseball work the right way. If we do these three things correctly - and make sure to take care of tissue quality and length in our throwers - I firmly believe we can completely prevent lat strains, and that's been verified by our experience at Cressey Sports Performance.

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Strength and Conditioning Stuff You Should Read: 5/18/18

Happy Friday! I'm a few days late with this post in light of our spring sale as well as some speaking-related travel I had this week. The good news is that the travel gave me some time to do some reading/viewing/listening and come up with some additional recommendations for you. Check them out:

Complete Youth Training - This is Mike Boyle's great new resource for those who work with young athletes. He touches on everything from the problems with early specialization to age-specific training stages. It's a good investment for parents and coaches alike. I loved how his perspective as a parent coalesced with his commentary as a strength and conditioning coach and business owner. It's on sale for $50 as an introductory discount.

The Best Team Wins - This was a recommendation from my buddy Josh Bonhotal, who's spent the past several years at the Purdue basketball strength and conditioning coach. Whether you're a coach or involved in a business in any way, this is a great book that'll teach you a lot about your interactions with athletes, fellow coaches, employees, and co-workers.

Prioritization and Success for Strength and Conditioning Success - I was reminded of this older post of mine this week when chatting with an up-and-coming strength and conditioning coach about how I've approached career development since I entered the industry.

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I think the long head of the triceps is a really overlooked structure in the development of both shoulder and elbow pain in throwers. Many people forget that it crosses the shoulder joint - and therefore effectively links the scapula to the lower arm. 🤔 In the late cocking phase of throwing, it's working eccentrically to prevent excessive elbow flexion while storing elastic energy that can be released on the subsequent elbow extension of the delivery. In other words, you can view the long head of the triceps as somewhat of a "mini-lat," as the lat serves this similar store-release function (albeit with different functions) - and they both work as shoulder extensors. 💪 It's also interesting in that it's one of the few muscles where the trigger point referral patterns can work up and down, as opposed to just down. I've seen some throwers where treating triceps has been a game changer in terms of everything from elbow, to shoulder, to neck pain. 👇 The long story short is that you have to give the triceps some love with quality self-myofascial release/manual therapy and make sure that you preserve tissue length (by stretching into shoulder flexion and elbow flexion simultaneously). Swipe right for some ideas. Thanks to @andrewmillettpt for the dry needling and manual therapy and @oneilstrength and @sooo_deep for the exercise demos. #cspfamily

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Strength and Conditioning Stuff You Should Read: 3/10/18

Here's a special Saturday edition of Stuff to Read!

Bought-In - I posted a guest blog from Brett Bartholomew earlier in the week in light of the release of this new coaching resource from him. I've since had a chance to spend some time going through it, and it's been excellent. I'd highly recommend you check it out if you'd like to delve more into the coach-athlete relationship and optimizing adherence from your athletes.

EC on the Physical Preparation Podcast - It's been over a year since I joined my good friend Mike Robertson on his podcast, so we have plenty of good stuff to catch up on.

The Right Way to Stretch the Pecs - I saw someone really cranking on a pec stretch the other day, and it reminded me of this article I wrote for T-Nation nine years ago. The content still applies, even if I'm getting really, really old.

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This #tbt is a video of alternating serratus slides on the @trxtraining suspension trainer, with a great demo from #mets pitcher @nsyndergaard. Some thoughts: 1️⃣One of the things we worked a lot on with Noah this offseason was differentiating between glenohumeral (ball on socket) and scapulothoracic (shoulder blade on rib cage) movement. Most pitchers get too much motion from the upper arm, and not enough from the shoulder blade. Notice how the scapula upwardly rotates around the rib cage - which takes stress off the front of the shoulder. 2️⃣ serratus anterior also helps to drive some thoracic flexion in a throwing population that often presents with a flat/extended thoracic spine (upper back). 3️⃣in a general sense, you could call serratus anterior the “anti-lat.” The latissimus dorsi drives a gross extension pattern and can be heavily overused in throwers; the serratus anterior works in opposition (scapular upward rotation, intimate link with the anterior core, accessory muscle of exhalation). 4️⃣add a full exhale at the “lengthened” position on each rep 5️⃣you could’ve observed the shoulder blades better if he was shirtless, but I figured Thor has already hit his weekly quota for shirtless social media cameos.😜 👍💪#cspfamily

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Strength and Conditioning Stuff You Should Read: 1/24/18

I hope your week is off to a great start. Just in case it isn't, though, here are some recommended reads to turn it around!

10 Nuggets, Tips, and Tricks on Energy Systems Development - Mike Robertson hit a bunch of nails on the head with this excellent article.

When: The Scientific Secrets of Perfect Timing - I just finished up this new book from Daniel Pink, and it was outstanding. He covers everything from nutrition, to exercise, to career success, to economic ups and downs, to sleep quantity/timing. It was a really entertaining read with many applications to the strength and conditioning field.

Organic vs. "Forced" Lay Back in the Pitching Delivery - This mechanics discussion from CSP-MA pitching coordinator Christian Wonders is very important stuff to understand if you work with pitchers.

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Checks and Balances in the Shoulder of the Throwing Athlete

For today's guest post, I've collaborated with physical therapist Eric Schoenberg, one of my co-presenters at the Elite Baseball Mentorship. Enjoy! -EC

The #1 reason why a player or team does not succeed in baseball is injury. Today, there is a surplus of information, but at the same time a lack of basic understanding of how to keep a baseball player healthy. When in doubt, you can never go wrong by understanding and relying upon anatomy and quality human movement.

One key principle to understand in this regard is that there is a tremendous system of checks and balances working at the shoulder girdle to make sure that we control both the big movements (osteokinematics) and subtle joint movements (arthrokinematics) in a small window for health and performance. If we look to anatomy, we can appreciate a very important concept by looking at the attachment points for the deltoid, latissimus dorsi, and pectoralist major: your three biggest prime movers in the upper extremity. You'll notice that all three attach on the shaft of the humerus, not the humeral head. Take a look at their attachment sites on this anatomical chart, and then compare them to where the rotator cuff (supraspinatus, subscapularis, teres major, and teres minor) attach further up on the humeral head.

Source: http://howtorelief.com/humerus-anatomy-bony-landmarks-muscle-attachment/

You can appreciate that all these big muscles attach on the anterior (front) aspect of the humerus, which means that they have powerful pulls into internal rotation that have to be counteracted by fewer, smaller muscles that attach on the posterior (back) aspect of the shoulder.

Here are three specific implications of these anatomical observations that relate to how you manage your throwing athletes:

1. The Deltoid is strong/active enough!

The deltoid works in conjunction with the supraspinatus to form a “force couple.”

Source: www.MikeReinold.com

If the strength, recruitment, or timing of the deltoid is greater than the supraspinatus, then the result will be superior migration of the humeral head in the glenoid. This results in superior humeral head stress (chondral defect), undersurface rotator cuff tear, labral pathology, among other structural injuries to the glenohumeral joint.

Tip: Be sure that athletes feel rotator cuff strengthening exercises in the cuff and not the deltoid or biceps.

2. The lat is strong/active enough!

The lat (as it acts on the scapula) is opposed by the serratus anterior, lower trapezius, and upper trapezius to control scapular rotation. Increased relative stiffness of the lat results in excessive scapular depression and downward rotation at rest.

Additionally, if you have decreased activation or muscle performance of the scapular upward rotators and elevators with overhead motion, the outcome will be inferior migration of the glenoid on the humeral head.

This results in superior humeral head stress (chondral defect), undersurface rotator cuff tear, labral pathology, among other structural injuries to the glenohumeral joint.

Tip: Be sure that the athlete’s programs have a good balance of overhead reaching tasks done with proper mechanics and timing of the glenohumeral and scapulothoracic joints.

3. The pecs are strong/active enough!

Pectoralis major's impact on the anterior glenohumeral joint is opposed by the rotator cuff to prevent anterior humeral glide. Effectively, the pec and lats want to pull the ball forward on the socket as the arm goes through gross movements, and the rotator cuff works hard to prevent this gliding at the joint level.

Dominance of pec major over the rotator cuff muscles (namely subscapularis) will play a role in an athlete presenting with anterior humeral glide. We often hear the athlete report “tightness” in the front of the shoulder and their first option is to "stretch it."

This can lead to anterior shoulder pain and potential structural pathology including anterior joint laxity, biceps tendon pathology, and labral pathology – all common injuries in throwing athletes.

Tip: Rather than trying to decrease the “tightness” in the front of the shoulder by aggressively stretching—instead, focus on improving static alignment, proprioceptive awareness, and recruitment of the cuff. If you couple this with some self-massage work, this approach will yield far more favorable results.

In closing, the shoulder joint is happiest when alignment is optimal. Injury will occur if preferred alignment is altered. Examples of altered alignment at rest or with movement are the humeral head is riding too high in the socket, the socket is riding too low on the humeral head, or the humerus is gliding too far forward. The resultant stress to the active or passive restraints of the shoulder leads to injury and loss of playing time. Do yourself (and the players that you work with) a favor and master the basics to help improve success on the field.

Looking to learn more about our unique approach to assessing and managing throwing athletes? Check out the upcoming Elite Baseball Mentorship Upper Extremity Course on January 14-16, 2018. For more information, click here.  The early-bird registration discount ends tonight at midnight.

About the Co-Author

Eric Schoenberg (@PTMomentum) is a physical therapist and strength coach located in Milford, MA where he is co-owner of Momentum Physical Therapy. Eric is addicted to baseball and plays a part in the Elite Baseball Mentorship Seminars at Cressey Sports Performance. He can be reached at eric@momentumpt.com.
 

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Should You “Balance” Your Pushes and Your Pulls?

Yesterday, I posted on social media about how I think the concept of balancing pushes with pulls in your programming is outdated. It received some hefty debate, so I thought I'd delve into the topic a bit further in today's video.

To learn more about how I assess, program, and coach at the shoulder joint, be sure to check out Sturdy Shoulder Solutions.

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Strength Training Technique: Why Neck Position Matters

A lot of people debate whether neutral neck positioning is important. I don't think it's even a debatable subject, though. Give today's video a watch to learn more:

As additional "ammo," check out this Tweet I came across the other day. Hat tip to Charlie Weingroff for sharing it. Would you want to put your spine in these extended positions while you squat or deadlift?

If you still think that hanging out in cervical extension all day - and then loading it up when lifting - isn't a problem, then I don't know what else to tell you.

I cover this topic in quite a bit of depth in my "Nuances of the Neck" presentation as part of my popular resource, Sturdy Shoulder Solutions. For more information, please visit www.SturdyShoulders.com.

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