After my recent presentation at Pitchapalooza in Nashville, I received the following question from a college coach who was in attendance:
Q: "My question revolves around pitchers landing with an open foot position. From your experience and from a biomechanical standpoint what have you seen regarding this landing/stride position in regards to why it occurs and how you have gone about correcting it? And, how have you seen it impact knee and back health. My experience has been that there is either some underlying knee or back history, or something is about to occur. In the recruiting process, I've spoken with several coaches and scouts who won’t consider someone who has this issue (open foot strike) regardless of velocity, due to concerns over long term health."
A: This answer can go in a lot of directions, so I decided to film a video:
In terms of a real-world example, take a look at Cressey Sports Performance athlete and Astros pitcher, Josh James. Josh has a slightly more retroverted hips presentation, and you can see that he lands a bit open. This is his normal alignment and he controls his body well, so it works for him (to the tune of consistent 100mph+ velocity).
More often that not, though, the pitchers who are winding up in this open foot position are getting there because of mechanical faults or physical limitations.
[bctt tweet="It's imperative to have a thorough assessment process for pitchers; you never want to try to take a mechanical fix to a movement problem."]
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Today, I've got a video post for you, and it builds on the Joint-by-Joint approach that's been popularized by Gray Book and Mike Boyle. In the video, I discuss how we can apply the joint-by-joint theory to the elbow, particularly in the context of pitching injuries. Check it out:
If you're looking to learn more about the elbow, I'd encourage you to check out my presentation on the topic, Everything Elbow.
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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.
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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Trying to build rotator cuff strength and scapular control while optimizing range of motion while you're still throwing is like trying to change the tire on a car that's still moving. Take advantage of periods of low/no throwing volume to build your foundation on this front.
It's been quite some time since I published an update to this series, but some recent professional baseball initial offseason evaluations have had me thinking more and more about how important it is to take a look at lateral flexion.
In the picture above, I'd say that the athlete is limited in lateral flexion bilaterally, but moreso to the left than right. You'll also notice how much more the right hip shifts out (adducts) as he side bends to the left; he's substituting hip fallout for true lateral flexion from the spine. The most likely culprit in this situation is quadratus lumborum on the opposite side (right QL limits left lateral flexion).
As you can see from the picture below, the triangle shaped QL connects the base of the rib cage to the top of the pelvis and spine.
Stretching out the QL isn't particularly challenging; I like the lean away lateral line stretch (held for five full exhales). This is a stretch that can be biased to target the lat, QL, or hip abductors.
That said, the bigger issue is understanding why a QL gets tight in the first place. As Shirley Sahrmann has written, whenever you see an overactive muscle, look for an underactive synergist. In this case, the right glutes (all of them) are likely culprits. If the gluteus maximus isn't helping with extending the hip, the QL will kick on to help substitute lumbar extension. And, if the gluteus medius and minimus aren't doing their job as abductors of the hip, the QL will kick in to "help out" in the frontal plane. This double whammy has been termed a Left AIC pattern by the good folks at the Postural Restoration Institute, and they've outlined many drills to not only address the apical expansion (which creates length through the QL), but also bring the pelvis back to neutral.
Taking this a step further, typically, those with very overactive QLs will also present with limited thoracic rotation (in light of the QL attachment on the inferior aspect of the ribs), so you'd be wise to follow up this stretch with some thoracic mobility work. The athlete in the example at the top of this article had the most limited thoracic rotation (both active and passive) that I've seen in any pitcher this offseason.
That said, here's a good rule of thumb:
If you have a flat thoracic spine athlete with limited thoracic rotation, look at pectoralis major, latissimus dorsi, and quadratus lumborum. If horizontal abduction (pec) and shoulder flexion (lat) both check out well, go right for QL tissue extensibility (as measured by lateral flexion). It will be absolute game changer - particularly in rotational sport athletes.
If you're looking to learn more about how we assess, program, and coach at the shoulder girdle, be sure to check out my new resource, Sturdy Shoulder Solutions.
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It's often been said that anything can be fixed with duct tape and WD-40. And, as a guy with extremely limited handyman skills, I really like this flowchart.
While this might seem like a dramatic oversimplification with respect the human body, I think there are actually some noteworthy parallels. To prove this, let's take a look at a study my buddy, Mike Reinold, co-authored back in 2008. While they looked at range of motion changes in professional pitchers after an outing, the findings of the study that I always keep coming back to have more to do with the absolute range of motion numbers in the data set (moreso than the changes). Take a look:
Looking at the mean shoulder total motion pre-throwing, MLB pitchers averaged about 191 degrees. However, when you look at the standard deviation of 14.6 degrees, you'll see that there were guys down around 175 degrees (very hypomobile or "tight"), and others up around 206 degrees (very hypermobile or "loose").
Speaking very generally, the tight guys need more WD-40 (range of motion work), and the loose guys need more duct tape (stability training). Now, here's what you make your mark as a coach: identify the exceptions to this rule.
For example, when you have an otherwise "tight" guy who comes back from a long season in with a significant range of motion increase at a joint, it could mean that he's developed instability (e.g., blown out a ligament). Or, maybe you see an otherwise "loose" guy who has lost a considerable amount of range of motion, it could mean that he's really hanging out in a bad pattern, developing musculotendinous shortness/stiffness that "overpowers" his ligamentous laxity. Or, he might be really out of alignment, or have developed a bony block.
Identifying outliers - exceptions to the rules - is a crucial part of evaluation success and subsequent programming. As I've often said, don't just focus on average.
Speaking of lessons to be learned in managing overhead throwing athletes, this will actually be a topic I expand upon at the upcoming fall seminar at Cressey Sports Performance - Massachusetts. We've got a great lineup, and the early bird registration deadline is this Fridya, September 21. You can learn more HERE.
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Last month, I published a blog about the importance of building strength in the teenage years. In case you missed it, you can read it here.
The gist was that strength is foundational to many other athletic qualities: power, stability, endurance, and even mobility. In short, building strength in untrained lifters is low-hanging fruit that can have a massive impact on other domains. However, if you train many of the qualities higher up on this pyramid early in a training career, you don't see very profound changes to athleticism. It's why the kid who just does agility ladders doesn't get much more agile, and the cross-country runner can't go faster just by running slow.
As is always the case with my new articles, I sent it out to my newsletter list - and there are always a dozen or so people who'll reply to the article. One, in particular, stood out for me:
"This reads as an incredible endorsement of multimodal training like Crossfit! Which highlights the very different skills in the article! Thanks for sharing!"
This is an incredibly well-intentioned person, but unfortunately, he could not be any more incorrect. And, it's a nice illustration of the confirmation bias we often encounter in the training world.
This gentleman really loves Crossfit, and that's fine. He can train a bunch of different qualities and have a lot of fun. That does not mean, however, that concurrent training of all these qualities is a way to optimize long-term athletic development in teenagers (or any age of athletes). His confirmation bias leads him to believe that what he enjoys (and likely what has worked for him) will be good for every scenario he encounters.
Sure, you can build a lot of these qualities simultaneously, especially in untrained individuals. However, you are not going to develop a 95mph fastball or run a 10-second 100m dash if you're consistently rowing 1000m, doing sets of 15 power cleans, or rocking kipping pull-ups like they're going out of style. And, you're going to have a much harder time staying healthy as you embark on these goals, as each sport has unique energy systems requirements and position-specific demands. How often do you see aggressive hip-shoulder separation, appreciable single-leg work, and end-range shoulder external rotation in the typical Crossfit program?
Again, if you want to do these things, by all means, go for it and have fun - but don't confuse them with a plan that's optimized for athletes. Random programming might keep training novel, but it delivers random results - and athletic success is much more the result of targeted efforts to meticulously address the growth windows one can identify. In short, you can't take general solutions to specific problems.
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Each time I run a Q&A, I get questions along the lines of:
If you could only pick one hip mobility assessment, what would it be?
If you could only pick one exercise to build pitching velocity, what would it be?
If you could only pick one shoulder exercise to fix my shoulder pain, what would it be?
You know what's awesome? With respect to all of these questions - and many more - I've NEVER in my entire career had to choose just one.
There may be no such thing as a stupid question, but there are stupid lines of thinking - and this reductionist approach to solving health and human performance problems is a big issue in our industry. In my experience, we see far more chronic issues develop because individuals fail to see the synergy among many factors, as opposed to their inability to hone in on the most important one. I'll give you an example.
Earlier this year, we saw a pitcher with a cranky ulnar nerve. He'd had mixed results with anti-inflammatory medications.
As it turns out, he had a subluxating ulnar nerve, which would predispose him to this issue during a motion like pitching that involves repeated flexion/extension, especially when combined with valgus stress (which stretches the nerve).
He did some extensive manual therapy with my business partner, massage therapist Shane Rye, who treated everything from his neck down to his forearm. This alone gave him a ton of relief - and he even commented that he felt a lot better with respect to some shoulder and neck issues he'd had previously.
In his movement screen, we'd noticed a lot of glaring scapular control issues. At rest, he sat in considerable anterior tilt and depression. Upon initiation of overhead reaching, he pulled into retraction instead of initiating smooth upward rotation. Most of his "external rotation" was actually scapular retraction and lumbar extension. In short, he was getting a lot of motion in the wrong places during several upper extremity assessments - and when we went to watch his arm care exercises, they were reaffirming all these faulty patterns. As an example, he was pulling down with the lat on horizontal abduction work, going into forward head posture on a lot of lifts, and banging out push-ups that looked a lot like this.
Morever, the exercise selection in his strength and conditioning programs were contributing to these aberrant patterns. His program was very lat dominant, and he wasn't doing enough work above 90 degrees of shoulder elevation to drive better patterns of upward rotation with good scapular posterior tilt. And, if that wasn't enough, he was using blood flow restricted training on his upper arm regularly in hopes of optimizing recovery. In reality, the compression was probably "snagging" his nerve even more.
We made a bunch of changes - picking lots of very easy, low-hanging fruit - and he hasn't had issues with the nerve all season. I can't tell you exactly which ONE of these interventions had the biggest impact on him staying healthy - but the good news is that it doesn't matter. Success is a function of over a dozen assessments and several interventions from multiple people.
With that mind, quit looking for a quick, easy, reductionist answer. It's not about a single assessment, exercise, or coaching cue any more than it is about a magic pill. Rather, it's about how all the pieces fit together. If you look around at the best coaches and rehabilitation specialists in the industry today, they're usually very well rounded in terms of their knowledge base, skill sets, and referral network. As a result, they can appreciating multiple disciplines and provide comprehensive care to the athletes, clients, and patients they serve.
Looking for a diversified educational experience? Be sure to check out our 7th Annual Cressey Sports Performance Fall Seminar. It'll take place on October 14 at our Hudson, MA location. You can learn more HERE.
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Today, I've got an excerpt from my new course, Sturdy Shoulder Solutions. I discuss the functional anatomy of the rhomboids, a commonly misunderstood muscle group with big implications.
For a lot more functional anatomy insights like these - as well as a comprehensive look at shoulder assessment, programming, and coaching - be sure to check out Sturdy Shoulder Solutions.
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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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Today, I wanted to introduce you to a mobility exercise we're utilizing a lot these days at Cressey Sports Performance. Here's a great demonstration from Cressey Sports Performance coach Frank Duffy :
Speaking of Cressey Sports Performance, as part of my spring sale, I'm putting Cressey Sports Performance Innovations on sale for 40% off through Tuesday at midnight. This resource features webinars on a variety of topics that will help coaches and fitness enthusiasts improve their training, programming, and coaching. Just enter the coupon code SPRING (all CAPS) at checkout to apply the discount. You can add it to your cart HERE.
About the Author
Frank Duffy is the Coordinator of Strength Camps at Cressey Sports Performance-Massachusetts. He is a Functional Range Conditioning Mobility Specialist (FRCms) and Kinstretch Instructor. You can contact him via email at frankduffyfitness@gmail.com, check out his website, and follow him on Instagram.
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