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.
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.”
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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A while back, 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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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?
Realtime MRI vs traditional static MRI - seems you can learn different things from a dynamic scan? Here's my neck last week. @KingsImagingpic.twitter.com/xB8fvOciPv
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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The prone horizontal abduction - also known as a "T" - is well known as a popular arm care exercise that has been around for decades. Unfortunately, it's commonly performed incorrectly. In today's video, I cover the most common mistakes - and then add a progression I like to use with folks once they've mastered the technique. Check it out:
Keep in mind that these cues also apply to "T" drills you perform with bands, TRX, or any other implements as well.
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I didn't get in a May installment of this series, but the good news is that it gave me two months to gather my thoughts for a big June! Here goes...
1. Athleticism is doesn't have to be max effort if you have a strength and power "reserve."
Cressey Sports Performance athlete Logan Morrison is currently second in Major League Baseball in homeruns. I came across this video of #22 on Twitter and it immediately got me thinking:
Hitting bombs in the big leagues - particularly on 95mph sinkers - is really challenging, but that looked absurdly easy. He put some force into the ground, got himself in a good position to succeed, and athleticism "happened."
The only reason this is possible is that he's developed a strength and power "reserve." LoMo is strong - and more importantly, he's a powerful dude. When he throws a medicine ball, in many cases, the entire gym stops and watches because it sounds like he's going to knock the wall down. When you've got a foundation of strength and know how to use it quickly, this kind of easy athleticism happens. It does not, however, happen if you're a) weak or b) strong and not powerful. I'd call LoMo a nice blend on the absolute strength-to-speed continuum.
2. If you're struggling to feel external rotation exercises in the right place, try this quick and easy fix.
One of the reason some throwers struggle to "keep the biceps" quiet during external rotation drills is that they start too close to the end-range for external rotation. A quick strategy to improve this is to simply build a little success in a more internally rotated position. This video goes into more depth:
3. Be cautiously optimistic with new surgical advances.
On a pretty regular basis, we hear about remarkable sports medicine breakthroughs that will revolutionize the way we prevent and treat both acute and chronic diseases and injuries/conditions. Unfortunately, they usually don't live up to the hype. Most of the time, we're talking about a "miracle" supplement or drug, but sometimes, we have to ponder the benefits of a new surgical procedure.
In the mid 1990s, the thermal capsulorrhaphy procedure was introduced to attempt to treat shoulder instability. It gained some momentum in the few years that followed, but the outcomes didn't match the hype in spite of the fact that the initial theory seemed decent (heat can shorten capsular tissues, which would theoretically increase shoulder stability). Failure rates were just too high.
Conversely, in 1974, Dr. Frank Jobe revolutionized the way elbow pain was treated in baseball pitchers - and saved a lot of careers - when he performed the first successful ulnar collateral ligament reconstruction (better known as Tommy John Surgery). More than 1/4 of MLB pitchers have had Tommy John, so you could say that this procedure revolutionized sports medicine even though it's taken decades to fine-tune it.
More recently, a new surgery - the UCL repair with internal brace - has been gaining some steam as an alternative to Tommy John surgery. The initial results have been very promising, particularly in situations where the patient is a good match (depending on age, activity level, and location and extent of the UCL tear). I've actually seen two of these surgeries in the past week myself. One pitcher (Seth Maness) was able to successfully return to the Major Leagues after having it - but we still have a long way to go to determine if it might someday dramatically reduce the number of Tommy John surgeries that take place. Why?
Right now, we only have statistics on a limited number of these cases, and they're usually in the high school and college realms. All that is reported on is return to previous level of competition (e.g., varsity baseball). We don't know whether a kid that has it at age 16 is still thriving with a healthy elbow at age 22 during his senior year of college.
Additionally, Seth Maness has really been an 88-90mph pitcher throughout his MLB career. We don't know if this same level of success will be seen with 95-100mph flamethrowers.
Dr. Jeffrey Dugas has become known as "the guy" when it comes to these procedures, and I loved the fact that he reiterated "cautious optimism" in his webinar at the American Sports Medicine Institute Injuries in Baseball course earlier this year. If this gets rolled out too quickly and in the wrong populations, the failure rate could be significantly higher and give an otherwise effective surgery a bad name. I think it's important for all of us to stay on top of sports medicine research to make sure we don't miss out on these advancements, but also so that we know to be informed consumers so that we don't jump behind new innovations without having all the information we need.
Speaking of the ASMI Injuries in Baseball Course, it's on sale for $100 off through this Sunday, June 24, at midnight. I've enjoyed going through this collection of webinars, and I'm sure you will, too. You can check it out HERE.
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Happy Memorial Day! I hope you're enjoying the long weekend with friends and family and, more importantly, honoring those we celebrate today. Here are some good reads from the fitness industry over the past week:
EC on the ABCA Calls from the Clubhouse Podcast - I was on a podcast interview with Jeremy Sheetinger, Alan Jaeger, and Kyle Boddy to discuss arm care and the long-term development of pitchers.
Hit Makers - I just finished this audiobook from Derek Thompson up and really enjoyed it. I found the following quote to be really logical, yet insightful: "A reader's favorite subject is the reader."
It's time for part 2 of "things you aren't doing - but SHOULD be doing - with a Jaeger Band." In case you missed it, be sure to check out Part 1, too. Also, be sure to pick up a J-Band HERE, if you haven't already done so.
Without further ado, here are five more exercises to try with the oh-so-versatile J-Bands!
6. Core-Engaged Dead Bugs
In this core stability drill, we use the tension from the band to build some extra core stiffness to resist lumbar extension (lower back arching) and (to a lesser extension) rotation during leg lowering. Add a big exhale at the bottom to fire up the anterior core and reaffirm good positioning.
7. J-Band Assisted Leg Lowering
This builds on our previous drill from a core stability challenge standpoint (straight leg is harder than bent-knee), but also helps individuals improve their hip mobility. Make sure to double up the band to get sufficient resistance, - and don't do this with cleats on!
Here's a Functional Movement Systems inspired drill we'll use with those athletes who have very limited active thoracic mobility into extension. In other words, they passively rotate well (with the assistance of the assessor), but can't get to that same range of motion actively. The band assistance reduces the gravity challenge against which an individual has to extend and rotate.
9. Band-Assisted Overhead Squat
I've traditionally done this drill with a TRX, but one day, I had an athlete try using the J-Band on the road when he didn't have a TRX handy. His immediate response was that it was "frying" his lower traps. Maintaining continuous tension in scapular posterior tilt and thoracic extension really takes this squat pattern assistance drill up a notch.
10. Side Bridge with Horizontal Abduction
Once an individual gets a solid feel for arm care, I'm all for integrating core stability with scapular control and rotator cuff challenges. This is one advanced progression along those lines. I say "advanced" because many individuals struggle to get a true "T" positioning on horizontal abduction; instead, they'll yank down with the lats (more on that HERE). That said, I recommend athletes perform this on video or with a coach watching the first time, as they'll usually be in the wrong pattern. The goal is 90 degrees of arm elevation, and you should feel this predominantly in the mid-traps.
That wraps up this two-part series - but it's certainly just the tip of the iceberg when it comes to innovative exercises you can integrate with a versatile piece of equipment like Jaeger Bands. With that in mind, if you don't already have a set in your training bag, I'd highly recommend you pick up a J-Band. Your arm - and the rest of your body - will thank you for the investment!
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Go to just about any baseball field in America, and you'll find Jaeger Bands (J-Bands). They're well established as great tools for getting in some quality arm care - and doing so conveniently.
What you might not realize, though, is just how many exercises you can do beyond the traditional J-Band sequence. With that in mind, I thought I'd introduce ten exercises our guys often do with J-bands when they're looking to step up their training while on the road. Today, we'll cover the first five.
1. Chops and Lifts - Popularized by the innovative rehabilitation specialists at Functional Movement Systems, these exercises are awesome for teaching core stability as it relates to resisting excessive rotation through the lower back. Depending on the height of the band, too, they can also challenge an athlete's ability to resist extension (too much arching of the lower back).
2. 1-arm Rotational Row w/Weight Shift - I absolutely love this drill for guys who have poor extension down the mound and need to learn to accept force on the front leg. The goal is to get in and out of the front hip - and also learn how to "sync" this loading/unloading up with proper movement of the thoracic spine, scapula, and arm.
3. Lateral Lunge w/Band Overhead Reach - Similar to the chops and lifts from above, you get great core recruitment in resisting extension and rotation, but in this drill, we also add some additional upper body and hip mobility challenges.
4. Serratus Wall Slides w/J-Band - I love me some serratus activation drills - and the J-Band is a great way to progress these exercises. Before you try it with a J-Band, though, give it a shot with a foam roller using these cues:
Then, grab your J-Band and go to town on a dugout wall. If you don't feel "cleaner" scap movement at ball release, I'll be stunned.
5. Side Bridge w/Band-Resisted Hip Extension - Side Bridges are some of the best lateral core exercises there are - but some folks will do them with incomplete hip extension, thereby falling into a faulty stabilization pattern that overrelies on the hip flexors. I like using the band to teach that terminal hip extension. To make this challenging, do them "high-tension" style: brace as hard as you can, squeeze the glutes together like you're trying to crush walnuts between your buttcheeks, and exhale as hard as you can. If you're doing them correct, you should be struggling by the end of five breaths - and you'll probably gain some hip internal rotation in the process.
That does it for part 1! I'll be back in a few days with five more creative uses for a J-Band. In the meantime, you can pick up a J-Band at http://www.jaegersports.com/J-Bands-Cressey/.
*A big thanks to Marlins pitcher Tyler Kinley for the help with demonstrations for this article!
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After a week in Massachusetts for Thanksgiving, the Cressey family is back in Florida. While up there, we celebrated our twin daughters' second birthday. I'm not sure they're fans of the cold yet...
With that said, let's get to the recommended reading!
30 Days of Arm Care Updates - You can see all these videos (currently on day 17) via the hashtag #30DaysOfArmCare on both Twitter and Instagram.
Settling the Great Grain Debate - Here's some great stuff on the nutrition front from Precision Nutrition's Brian St. Pierre.
Jim Harbaugh's Circle of Friends Is Even Cooler Than You Think - I often say that successful people find value in unexpected places. I love the discussion about how Harbaugh pries to ask questions and elicit deeper responses in his conversations with friends from all walks of life. The best coaches I know are always looking outside their fields to find ways to improve.
Top Tweet of the Week
No bigger injury risk than a 150lb pitcher w/a 90+ mph arm & a Dad who loves showcasing. Sometimes you have to say "no" to help development.
Today's guest post comes from physical therapist, Eric Schoenberg. Eric is an integral part of the Elite Baseball Mentorships team.
A thought came to mind as I was considering how we can work towards reducing the incidence of injury in baseball: we need more specialists.
If we use the field of medicine as a model, the Total Knee Replacement has pretty much been mastered. Of course, there is room for improvement, but over the past 25 years, this surgery has become a massive success. The biggest reason for this is a progression of specialization:
If you need a knee replacement, you don’t go to your primary care physician. Instead, you schedule an appointment with an Orthopedic Surgeon that specializes in TKR. So, if you are a baseball player, why does it make sense to work with a “general” strength coach or physical therapist?
[bctt tweet="Every profession matures into a state of “super-specialization” as it develops."]
Strength coaches and physical therapists have a great opportunity ahead of us to move our professions forward in this manner.
The current entry point for a strength coach is minimal. Most commonly, entry into the field falls somewhere between a fitness certification and a 4-year degree. In some cases, you will see dual degrees, Master’s degrees, and the occasional PhD.
However, there is no direct path available to niche into a “baseball specialist.” Instead, we have private sector, college, and even some professional strength coaches that may have seen baseball players by chance, but have no more experience with them than any other sport. It’s not a criticism of them, though; there simply isn’t an established “curriculum” they can pursue. As a result, in most cases, highly “specialized” baseball players are being managed by “general” strength coaches.
I have to believe that this is as much of a contributing factor as any to the high incidence of injury in the baseball world. By the time these athletes make it far enough in their careers to have access to “baseball specialists,” they are often too damaged for even the experts to manage.
Here are five tips to establish yourself as a trusted resource in the baseball community:
1. Watch baseball.
Don’t just watch it for entertainment value. Study the movements. Use slow motion and rewind on your TV. Watch video online and gain a better understanding of the actions and positions unique to the sport. Once you think you have it figured out, you are only just scratching the surface. Keep studying! Start to recognize why faulty mechanics can lead to improper distribution of stress and ultimately injury. By doing this, you can pair this knowledge with your individual assessment of the athlete to create a more optimal training program.
2. Spend time on a field.
Baseball players are unique in their habits and tendencies. Gain a “feel” for the game. Understand the culture of the game. Learn how to identify with and communicate with athletes that are much younger than you. Understand that most of their time on the field is spent standing around and waiting. Educate your players on how to optimize this time to prepare mentally, hydrate, properly warm up, etc. It is not enough to say you used to play baseball 20 years ago; nobody cares. My credibility and effectiveness in managing baseball players increased 10x once I started spending time at the field as part of a team. Create an angle to quickly establish trust and common ground with the athlete and watch your results dramatically improve.
3. Understand the unique physical characteristics and demands of baseball players.
Baseball players have physical characteristics that differ from other sports. Educate yourself for the benefit of your athletes. Learn about humeral retroversion, gross extension patterns, laxity, valgus stress, dynamic stability, rotator cuff timing, etc. Work towards understanding the importance of stability of the landing leg, proper hip hinge pattern, and the importance of tri-planar single leg balance. Don’t “stretch” a guy that is already too loose. Instead, give him some stability and watch his pain go away. The baseball player’s anatomy is a long way from “neutral.” Do your best to bring them closer to the middle and not further away. For example, your ability to recognize that a baseball player should not be cued to pull their shoulder blades “down and back” because their shoulder blades are ALREADY down and back may save dozens of careers.
4. Master functional anatomy and human movement.
Understand the critical role of the scapula. Train the rotator cuff in the throwing position through the entire range of motion (especially end-range external rotation). Learn how the kinetic chain applies specifically to baseball. Hitting and throwing are highly coordinated, precisely timed, multidirectional movements. Don’t train your athletes with single joint exercises that only occur in the sagittal plane. Learn about hip/trunk separation to maximize power and explosiveness. Be able to educate the athlete on what it means to have a labral tear or understand the specifics of an ulnar nerve transposition. If you can’t explain these pathologies, then how can you minimize risk when working with these athletes? Take pride in your job on this front.
5. Be willing to respectfully challenge the “institution of baseball.”
CSP coach Tony Bonvechio wrote a blog post a while back where he warned about the dangers of the phrase “this is how I’ve always done it.” I find myself observing on a daily basis that regardless of level – little league, high school, college, pro ball – at least 80% of the player’s warm up routine is exactly the same. How can that be? We have progressed as a profession; however, kids on baseball fields across the world are all doing the same useless warm-up routine.
An example of progress is Joe Maddon and the Chicago Cubs. He softened the traditional stance of getting to the ballpark at 1pm for a 7pm game. Instead, they have created a culture that emphasizes more sleep, nutrition, and recovery and his players love him for it.
If we want different results, we have to continue to move towards a different approach. The efforts of strength coaches and physical therapists to move towards becoming baseball specialists will go a long way in helping to reach this goal.
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