It's time for this month's installment of my random thoughts on sports performance training. In light of my ongoing sale on my Sturdy Shoulder Solutions resource, I thought I'd focus this edition on the shoulder.

1. If you want a healthy shoulder, getting tobacco products out of your life is a good place to start.

The research is pretty clear: smoking is a bad idea (and an independent risk factor) if you're looking to stay healthy from a musculoskeletal standpoint, or have a good outcome in rehabilitation (whether conservative or post-surgical) . Here's an excerpt from a recent study with an excellent review of the literature:

"Cigarette smoking adversely affects a variety of musculoskeletal conditions and procedures, including spinal fusion, fracture healing, surgical wound healing, tendon injury and knee ligament reconstruction. More recently, smoking has been suggested to negatively impact rotator cuff tear pathogenesis and healing. Tobacco smoke contains nicotine, a potent vasoconstrictor that can reduce the blood supply to the already relatively avascular rotator cuff insertion. Furthermore, carbon monoxide in smoke reduces the oxygen tension levels available for cellular metabolism. The combination of these toxins may lead to the development of attritional rotator cuff tears with a decreased capacity for healing."

Many times, we're looking for the best exercise, rehabilitation protocol, soft tissue treatment, or volume amounts - but we really ought to be looking at lifestyle factors.

With a large baseball readership on this site, the logical next question: are these harmful effects also noted with smokeless tobacco (i.e., dip/chew)? The research is somewhat sparse, as it's harder to study a younger, active population than a bunch of middle-aged post-operative rotator cuff patients. However, it's hard to believe that the aforementioned carbon monoxide implications would cause 100% of the issues and that the nicotine would serve as just an innocent bystander. So if you're looking to check every box in your quest to stay healthy, it's not a bad idea to lay off the dip.

And, if healthy tendons aren't enough to convince you, do yourself a favor and read this article by Curt Schilling.

2. The 1-arm, 1-leg landmine press isn't a mainstay in your training programs, but can be a perfect fit in a few circumstances.

This looks like kind of a wussy exercise, but I actually really like it in two circumstances.

a. It's awesome in a post-surgery period when you can't load like crazy, but still want folks to be challenged in their upper extremity progressions. The single-leg support creates a more unstable environment, which means that antagonist activity is higher and there is more work going to joint stability than actual movement. In other words, it makes pressing safer.

b. Once we get to the inseason period, it allows us to check two boxes with a single exercise: single-leg balance and upper body strength (plus serratus activation/scapular upward rotation).

3. Posterior pelvic tilt increases lower trap activation.

I've written about it a lot in the past: core positioning has an incredibly important impact on shoulder function. Check out this study on how reducing anterior pelvic tilt increases lower trapezius activation during arm elevation and the return from the overhead position.

In my experience working with extension-rotation athletes (particularly baseball players), one of the biggest risk factors for shoulder injury is when the lower trapezius can't keep up with the latissimus dorsi. Just consider the attachment points of the lat in the picture below; as you can imagine, if you posteriorly tilt the pelvis, the lat is inhibited, making it easier for lower trap to get to work.

The lower trapezius is very important for providing posterior tilt (slight tipping back) of the scapula and assisting in upward rotation. These two functions are key for a pitcher to get the scapula in the correct position during the lay-back phase of throwing.

By contrast, the lat has more of a "gross" depression effect on the scapula; it pulls it down, but doesn't contribute to posterior tilting or upward rotation. This might help with an adult rotator cuff pain patient who has an aggressive scapular elevation (shrug) substitution pattern, but it's actually problematic for a thrower who is trying to get his scapula up and around the rib cage to make sure that the ball-on-socket congruency is "flush" when it really matters: the maximal external rotation position.

As such, you can say that the lat and lower trap "compete" for control of the scapula - and the lat has a big advantage because of its cross-sectional area and multiple attachment points. It's also much easier to train and strengthen - even if it's by accident. Upper body work in faulty core positioning (in this case, too much anterior pelvic tilt and the accompanying lumbar extension) shifts the balance to the lats.

We'll often hear throwers cued "down and back" during arm care drills. The intention - improving posterior tilt via lower trap activation - is admirable, but the outcome usually isn't what's desired. Unless athletes are actually put in a position of posterior tilt where they can actually feel the lower traps working, they don't get it. Instead, they pull further down into scapular depression, which feeds the lat-dominant strategy. This is why we teach almost all our throwers to differentiate between depression and posterior tilt early on in their training at Cressey Sports Performance.

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. Learn more at www.SturdyShoulders.com.

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6. Here's a great video from Mike Robertson on "Conquering the Chin-up:"

7. And your weekly dose of puppy...

Have a great weekend!

Click here for more information on the Cressey Performance Elite Baseball Development Program. Have a great weekend!

Q: I read your blog here the other day about your "ideal competitive year" for a baseball player.  What's your take on showcases and college camps?  They always occur during the "down periods" you mentioned: fall ball and the early winter.  How do these fit in to a baseball player's development?

A: To be blunt, while there are some exceptions to the rule, they rarely fit into development. In reality, they usually feed into destruction - at least in the context of pitchers.  I openly discourage all our young athletes and parents from attending them almost without exception.

I know of very few showcase directors and college baseball coaches who legitimately understand anatomy, physiology, the etiology of baseball injuries, the nature of adolescent development, or motor skill acquisition.

Showcase directors specialize in promoting and running showcases.  College coaches specialize in recruiting players, developing talent, planning game and practice strategy, and winning games.  To my knowledge, understanding scapulohumeral rhythm and the contributions of a glenohumeral internal rotation deficit (GIRD) to SLAP lesions via the peel-back mechanism isn't all in a day's work for these folks.

The fundamental issue with these events is their timing.  As you noted, they almost always occur in the fall and winter months.  Why?

1.  It's the easiest time to recruit participants, as they aren't in-season with their baseball teams.

2. It's not during the college baseball season - so fields and schedules are open and scouting and coaching man-power is free.

You'll notice that neither #1 or #2 said "It's the time of year when a pitcher is the most prepared to perform at a high level safely."  It is just profitable and convenient for other people - and that occurs at the expense of many young pitchers' arms.

In 2006, Olsen et al. published a fantastic review that examined all the different factors associated with elbow and shoulder surgeries in pitchers by comparing injured pitchers (those who warranted surgery) with their non-injured counterparts.  Some of the findings of the study:

-Pitchers who eventually required surgery threw almost EXACTLY twice as many pitches as the control group (healthy pitchers) over the course of the year...from a combination of pitches per outing, total outings, and months pitched per year.  For those of you who think your kid needs to play on multiple teams simultaneously, be very careul; add a team and you instantly double things - at least acutely.

-The injured pitchers attended an average of FOUR times more showcases than non-injured kids.

-Interesting aside:  injured pitchers were asked what their coaches' most important concern was: game, season, or athlete's career.  In the healthy group, they said the coach cared about the game most in only 11.4% of cases. In the injured group, it was 24.2%!  These crazy little league coaches are often also the ones running the showcases...

The big problem is that these issues usually don't present until years later.  Kids may not become symptomatic for quite some time, or pop NSAIDs to cover up the issues.  They might even go to physical therapy for a year before realizing they need surgery.  It's why you see loads of surgeries in the 16-18 year-old population, but not very often in 15 and under age groups.

So why are appearances like these in the fall and winter months so problematic?  Well, perhaps the best way I can illustrate my point is to refer back to a conversation I had with Curt Schilling last year.

Curt told me that throughout his career, he had always viewed building up his arm each year as a process with several levels.

Step 1: Playing easy catch
Step 2: Playing easy catch on a line
Step 3: Building up one's long toss (Curt never got onto a mound until he'd "comfortably" long-tossed 200 ft.)
Step 4: Throwing submaximally off a mound
Step 5: Throwing with maximum effort off a mound
Step 6: Throwing with maximum effort off a mound with a batter
Step 7: Throwing with maximum effort off a mound with a batter in a live game situation
Step 8: Opening day at Fenway Park in front of 40,000+ people

Being at a showcase in front of college coaches and scouts with radar guns is Step 8 for every 14-16 year old kid in America.  And, it comes at the time of year when they may not have even been throwing because of fall/winter sports and the weather.  Just to be clear, I'll answer this stupid question before anyone asks it: playing year-round and trying to be ready all the time is NOT the solution.

I can honestly say that in all my years of training baseball players, I've only seen one kid who was "discovered" at a showcase.  And, frankly, it occurred in December of his junior year, so those scouts surely would have found him during high school and summer ball; it wasn't a desperate attempt to catch someone's eye.

I'll be honest: I have a lot of very close friends who work as collegiate baseball coaches.  They're highly-qualified guys who do a fantastic job with their athletes - but also make money off of fall baseball camps.  I can be their friend without agreeing with everything they do; there is a difference between "disagree" and "dislike."

Fortunately, the best coaches are the ones who go out of their way to make these events as safe as possible, emphasizing skill, technique, and strategy improvements over "impressing" whoever is watching.  So, it's possible to have a safe, beneficial experience at one of these camps.  I'd encourage you to find out more about what goes on at the events in advance, and avoid throwing bullpens if unprepared for them.

As far as showcases are concerned, I'd encourage you to save your money and go on a family vacation instead.

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Q: I was wondering the other day about why guys often come back from Tommy John surgery pitching better and harder than they did before.  My first thought was they can't do any upper-body strength training for months while they recover from the surgery, so they're forced to work on lower body, core, and mobility - and, in turn, come back as better conditioned athletes with more control and velocity.  Or, do you think their improved velocity and command is just an illusion made possible because we're comparing them to the way they pitched while they were hurt, but not yet "disabled?"  Or, is there another factor I'm missing altogether? I figure there's a sample-size issue -- we're just looking at the guys who make it all the way back, and ignoring the ones who don't.

A: It's an excellent question - and one I actually get quite a bit.   I'd say that it's a combination of all three.

In my eyes, an ulnar collateral ligament tear is usually an injury that speaks to YEARS of dysfunction and accumulated stress.  Guys usually have a history of elbow pain/soreness in their teenage years, some calcification on the UCL, and then it finally goes in their college/pro years.  They may have been managed conservatively (physical therapy) for a long time just because doctors don't like doing surgeries on 16-year-olds.  However, when they're 20, it becomes "acceptable" to do a Tommy John surgery.

In the meantime, many of these injured pitchers will modify their deliveries to avoid the pain and end up with some crazy mechanics that leave the ball all over the place at erratic radar gun readings.  So, that can usually cover the velocity drop and control issues.  This is in stark contrast to what you'll see with serious injuries to the labrum (SLAP2 lesions), which generally give you the quick velocity drop, and eventually, loss of control - even in the absence of pain.  Elbow stuff doesn't usually directly influence velocity as quickly; a lot of guys can throw through it for years.

So, yes, we are comparing them to their pre-injury numbers.  However, there is - at least in my eyes - a better reason.

They are often lazy and inconsistent with their training and arm care before they get hurt.  Quite often, you'll see an ACL reconstruction leg coming back and being stronger than the uninjured side long-term.  The same thing can happen with a Tommy John.  The rehab is crazy long, so guys have time to learn arm care as religion and - as you noted - focus on athletic qualities that are often partially or entirely "squeezed out" by competing demands.

I remember talking with Curt Schilling along these lines - although it was with respect to his shoulder.  He had a shoulder surgery in 1995, and it made him "religious" about arm care.  His best years came years after that even though he'd gotten older.

So, usually, the guys who wind up throwing harder are just the ones who were lazy in the first place and were finally forced into actually taking care of their bodies.  The guys who DO take good care of their arms and wind up tearing UCLs rarely come back throwing harder, and to be frank, probably have a lower chance of returning to their former selves than their lazy counterparts.

Of course, this obviously excludes issues with the graft type (autograft or allograft), graft site (Palmaris longus, hamstrings, or another site), surgeon's abilities, physical therapy, athlete motivation, strength and conditioning, and return-to-throwing progression.

To learn more about assessment and management of the throwing elbow, check out my Everything Elbow In-Service video.

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