Home Posts tagged "Elbow Pain"

Strength and Conditioning Stuff You Should Read: 8/6/19

Today, I've got a list of recommended reading to get you through the week. Before we get to it, though, just a quick heads-up that we're doing a pre-sale on Cressey Sports Performance bucket hats. If you're interested in buying one, you can do so at THIS LINK. They'll be available for shipment in early-mid September.

As for the reading recommendations, check out the following:

Is It Really "Biceps Tendonitis?" - In light of a recent Instagram post I made on a related topic, this video blog deserves a reincarnation this week.

10 Habits that are Just as Important as Tracking KPI - My business partner, Pete Dupuis, wrote this article that examines some of the overlooked areas in which you can evaluate fitness business success.

Professional and Amateur Pitchers' Perspective on the Ulnar Collateral Ligament Injury Risk - This was an interesting study on a number of fronts. It was surprising to see how many pro guys think UCL injuries are unavoidable, but not at all surprising to hear that 55% of those who have UCL injuries in pro ball had a previous history of elbow injury in their youth baseball days. The biggest risk factor for an injury is...shocker...a previous injury.

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The Best of 2018: Baseball Articles

With baseball athletes being the largest segment of the Cressey Sports Performance athletic clientele, it seems only fitting to devote a "Best of 2018" feature to the top baseball posts from last year. Check them out:

1. When Pitching Goes Poorly: 5 Strategies for Righting the Ship - Pitchers can struggle for many reasons beyond just mechanics. Here are five factors to take into account.

2. Is It Really Biceps "Tendonitis? - One of my biggest pet peeves is when all anterior shoulder pain is given a "blanket diagnosis" of biceps tendonitis. With that in mind, this webinar excerpt from my Sturdy Shoulder Solutions resource delves into the topic in greater detail.

3. How to Apply the Joint-by-Joint Approach to the Elbow - In this video blog, I discuss how we can apply the concept of regional interdependence to the elbow, particularly in the context of pitching injuries.

4. How to Win 99% of High School Baseball Games - I've haven't coached a high school baseball game in my life. I know a lot about adaptation to training in youth athletes, though, and that puts me in a unique position to comment on how to win high school baseball games.

5. Why Injuries are Highest Early in the Baseball Season (Video) - Major League Baseball Injuries are highest during Spring Training and early in the regular season. Surely, some of this has to do with the fact that some players had lingering issues from the previous season that never went away - but it definitely goes further than this.

We've got one last "Best of 2018" list running tomorrow, so stay tuned for the closer!

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How to Apply the Joint-by-Joint Approach to the Elbow

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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Strength and Conditioning Stuff You Should Read: 6/15/18

It's been a quiet week here on the blog because I'm still recovering from last week's Sturdy Shoulder Solutions product launch and the barrage of college athletes who are all starting up at CSP at the same time. Luckily, I do have some good content from around the 'net for you:

Pat Rigsby on Building Your Ideal Fitness Business - Pat Rigsby is the man. I got this email from Mike Robertson in my inbox this morning and cleared time in my schedule to listen to this podcast right away. He always has great business insights for fitness professionals.

10 Strength and Conditioning Lessons from Friends, Mentors, and Colleagues - This is a great compilation from my buddy Todd Hamer, who's been a mainstay in the college strength and conditioning field for as long as I can remember.

Lessons Learned from a Bum Elbow - I posted this story on my Facebook page the other day, and there are a lot of lessons in here for fitness professionals and rehabilitation specialists, especially those who deal with throwing athletes.

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Random Thoughts on Sports Performance Training – Installment 19

It's time for the June installment of "Random Thoughts on Sports Performance Training."  With the introductory sale on Functional Stability Training: Optimizing Movement ending on Sunday at midnight, I'm going to use this post as an opportunity to highlight one of the key concepts that resounds throughout the product: relative stiffness.

FST-DVD-COVER-OPTIMOVE

1. All successful coaching hinges on relative stiffness - whether you're aware of it or not.

I first came across the concept of relative stiffness in reading Shirley Sahrmann's work. This principle holds that the stiffness in one region (muscles/tendons, ligaments, or joint) has can have a functional impact on the compensatory motion at an adjacent joint that may have more or less stiffness. You'll also hear it referred to as "regional interdependence" and the "joint-by-joint" approach by the FMS/SFMA and Mike Boyle, respectively.

For those who do best with examples, think of lower back pain in someone who has an immobile thoracic spine and hips. They don't move through these regions (excessive stiffness), so the lumbar spine (insufficient stiffness) just compensate with excessive motion. Likewise, a female soccer player with insufficient "good stiffness" in the hip external rotators and hamstrings might be more likely to suffer an ACL injury, as this deficit allows excessive motion into knee valgus and hyperextension.

This is why a knowledge of functional anatomy is so key for strength and conditioning coaches. Every cue you use is an attempt to either increase or decrease stiffness. When you hear Dr. Stuart McGill say, "lock the ribs to the pelvis," he's encouraging more (anterior) core stiffness. When you hear "double chin," it's to increase stiffness of the deep neck flexors. When you ask an athlete to take the arms overhead during a mobility drill, you're looking to decrease stiffness through the lats, thoracic spine, pec minor, etc. - and increase stiffness through the scapular upward rotators, anterior core, deep neck flexors, etc. 

laterallunge

In short, absolutely everything we do in training and in life is impacted by this relative stiffness.

2. Remember that elbow hyperextension doesn't only occur because of joint hypermobility.

I've written frequently about how elbow hyperextension at the top of push-ups is a big problem, especially in hypermobile athletes who may be more predisposed to the issue. Typically, this is simply a technique issue; you tell athletes to stop doing it, and they do.

elbowhyperextension

However, this doesn't mean that they'll automatically correct the tendency on other movements - like catching a snatch overhead, or throwing a baseball. It's when we look at the problem through a larger lens that we realize there is a big relationship to a lack of scapular motion. If you don't have enough good stiffness in serratus anterior to get the scapula to "wrap" around the rib cage and upwardly rotate, you'll have to go elsewhere to find this motion (elbow hypermobility). This is why I'm a huge stickler for getting good scapular movement on the rib cage - and the yoga push-up is a great way to train it. Think "more scap, less elbow."

3. If you want job security, become a hip surgeon.

The other day, I was speaking with a good friend who works with a lot of strength competitors - powerlifting, Olympic lifting, and Crossfit - and he made a comment that really stood out to me: "I'm seeing uglier hips than ever - even with females."

This has some pretty crazy clinical implications. Most females of "strength sport competitor age" have quite a bit of natural joint hypermobility, so they typically present with excellent hip range-of-motion prior to the age of 40. Even females who sit at computers all day rarely present with brutal hip ROM before they're middle-aged. What does this tell us? We have a lot of females who are developing reactive changes (bony overgrowth = bad stiffness) in their hips well too early, and when they later add increased ligamentous stiffness and a greater tendency toward degenerative changes (both normal with aging), we are going to see some really bad clinical hip presentations.

As an aside, it’s widely debated whether those with femoracetabular impingement (FAI) are born with it, or whether it becomes part of “normal” development in some individuals. World-renowned hip specialist Marc Phillipon put that debate to rest with a 2013 study that examined how the incidence of FAI changed across various stages of youth hockey. At the PeeWee (10-12 years old) level, 37% had FAI and 48% had labral tears. These numbers went to 63% and 63% at the Bantam level (ages 13-15), and 93% and 93% at the Midget (ages 16-19) levels, respectively. The longer one played hockey, the messier the hip – and the greater the likelihood that the FAI would “chew up” the labrum.

fai

Source: Lavigne et al.: http://www.ncbi.nlm.nih.gov/pubmed/15043094

So, whether it's strength sport athletes, hockey players, or some other kind of athlete, if you want job security, become a hip surgeon - and expect to do a lot of hip replacements in 2040 and beyond. There's a good chance these folks will need multiple replacements over the course of their life, too, if the longevity of the hardware doesn't improve before then. The same can probably be said for shoulders, too.

How does it relate to relative stiffness? Once you've used up all the "bad" stiffness you can acquire - muscles, tendons, ligaments, and joint - there's a good chance that you'll have beaten at least some structure up enough to warrant a surgery.

Wrap-up

I could go on and on with other examples of relative stiffness in action, but the truth is that they are countless - and that's why it's so important to appreciate this concept. To that end, I'd highly recommend you check out Mike Reinold and my new resource, Functional Stability Training: Optimizing Movement. It's on sale at an introductory $30 off discount through this Sunday at midnight.

eric and mike squat

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Preventing Baseball Injuries: Actions Speak Louder Than Words

We're at a point in time where just about everyone knows that throwing a baseball year-round is a bad idea. Moreover, we know that it's best for kids to avoid early sports specialization. 

Dr. James Andrews has been outspoken against early specialization and year-round throwing for roughly a decade.

John Smoltz devoted a big chunk of his Hall-of-Fame acceptance speech in Cooperstown to discouraging kids and parents from early specialization and year-round baseball.

JohnSmoltz

Seahawks coach Pete Carroll recently referred to the trend of kids playing only one sport as "an absolute crime."

USA Baseball launched their Pitch Smart campaign - featuring an advisory board of many MLB team doctors and athletic trainers - to prevent overuse in youth baseball.

All the way back in 2006, a landmark study by Olsen et al. clearly demonstrated strong associations between injuries requiring surgery and pitching "more months per year, games per year, innings per game, pitches per game, pitches per year, and warm-up pitches before a game" as well as showcase appearances during adolescence. Overuse is the one factor that predicts injury over and over again in the research.

A 2011 study demonstrated that players in warm weather climates had less shoulder strength and more problematic range-of-motion adaptations than those in cold weather climates. And, speaking from personal experience from having Cressey Sports Performance facilities in both states, it's been far more challenging to develop players in Florida than it is in Massachusetts. There is simply too much baseball competing with general athletic development.

These are just a few examples, too. Hundreds of professional athletes have spoken out against early sports specialization. College coaches have in some cases refused to recruit one-sport athletes. And, there are more anti-specialization posts and websites freely available on the Internet than one could possibly imagine. Yet, the problem isn't even close to going away, and injuries still at all-time highs.

Now, I can understand how some players, parents, coaches, and scouts don't stay on top of the American Journal of Sports Medicine and might have missed this important information. What I can't understand is how they'd miss it when the world's most recognized orthopedic surgeon is speaking out against it. Or how they can miss it when one of the most accomplished pitchers of the last century devotes the biggest media spotlight of his life to bashing early sports specialization. Or how they'd overlook one of the premier coaches in the NFL so vehemently putting down the practice. Or how a governing body like MLB would devote time, money, and resources to a problem that they think will have a significant negative impact on the future of the game beyond just the billions of dollars that are already being wasted on players on the disabled list.

The problem is not a lack of knowledge; the problem is a lack of action and consequences.

When you were a little kid and stole a cookie from the cookie jar - even after your mother told you it was off limits - you got punished for doing so. If you didn't have consequences, you'd keep stealing cookies. Unfortunately, this isn't an option with youth baseball. Really, the only consequence is injury, and it's surprisingly not that great a teacher.

elbows

A lot of kids and parents continue to make the same mistakes even after an arm surgery and extended layoff. They've been brainwashed to think that the only way kids can succeed in baseball is to play year-round to keep up with other kids and get exposure to college coaches and pro scouts. There are too many coaches, showcase companies, and scouting services lining their pockets by lobbying hard to make these false assumptions stick. 

If knowledge ("eating too many cookies is bad for you") isn't working, and it's hard to deliver consequences, what's the next step? You've got to make it really hard to get to those cookies - and they better taste like crap if you do manage to do so. 

Stepping away from this analogy, the big governing bodies that matter need to step up their game. Here are six quick changes that I personally feel could have a profound impact on reducing injury rates across all levels:

1. Major League Baseball needs to implement a high school scouting "dead period" from October 1 through January 1. It is entirely hypocritical for MLB to push PitchSmart, but turn a blind eye when literally hundreds of scouts are showing up for October-December showcases and tournaments that directly compete with the PitchSmart initiative. Most of the highest-profile players aren't even attending these events anymore (advisors know it's an unnecessary injury risk), and there is absolutely nothing a scout would see in November that they can't see in the spring during the regular season.

2. MLB should also mandate that no pitcher can throw in more than three consecutive games - including "getting hot" (throwing in the bullpen, but not entering the game). Some might criticize me for this, but after extensive interaction with relievers at this level, I firmly believe that bullpen mismanagement is one of the biggest problems in MLB pitching injuries. Fans and the media only see the actual number of appearances, but when you factor in the number of times a pitcher "gets hot" without entering the game, you have relievers who are literally throwing over 120 times in a season.

3. The NCAA needs to implement innings limits on freshman and sophomore pitchers. Keep freshman pitchers to 120 innings and sophomore pitchers to 140 (combining the college season and summer ball). Additionally, any pitcher who throws more than 120 innings during the spring/summer should have a mandatory 60-day period of no throwing prior to starting fall ball.

4. The NCAA should also implement a conservative pitch count limit for college starters. I think 130 is a good place to start, and while I still think it's unnecessarily high, it reins in those coaches who'll leave a guy in for 150+ pitches. Sadly, this happens far too often in college baseball these days, and there are zero repercussions (although I do commend ESPN's Keith Law for always calling these coaches out on Twitter).

5. State athletic associations in warm weather climates need to structure high school seasons to allow for athletes to compete in multiple sports. As an example, in Massachusetts, the high school baseball season begins on the third Monday in March, while the first basketball practice is November 30. If a high school basketball player wants to play baseball, he might only have a 1-2 week overlap during that month - and it only happens if his team goes deep into the playoffs.

Conversely, the high school baseball season here in Florida begins on January 18, while the last regular season basketball game doesn't occur until January 30. The state championship games take place February 23-27 - which is roughly halfway through the baseball season! There is absolutely no reason for a high school baseball season (in which teams play about 30 games) needs to start prior to March 1.

CSP-florida-021

That extra six weeks would make a huge difference in getting more baseball players to also participate in winter sports and help to get a baseball out of young hands a bit longer. And, you'd see a lot more players well prepared on day 1 of baseball tryouts because they'd have more off-season preparation under their belts. It would simply force teams to play three games per week instead of two; this is exactly what's done in Northern states (and they'll sometimes play four, if weather interferes).

6. Similar to point #4, state athletic associations should also have regulations on permissible pitch counts for high school arms. I think 115 pitches is a good number.

Closing Thoughts

I should note that I actually think Little League Baseball does a solid job of disseminating information and including specific regulations within the game and between games. The changes - at least in my eyes - should rest with high school athletic associations, the NCAA, and Major League Baseball. Impact will come from the top down.

As you can see, with only two exceptions, I'm much more about managing the competitive year than I am about micromanaging pitch counts. And, the two pitch count recommendations I put out are remarkably conservative and just reaffirm common sense (which, unfortunately, isn't so common anymore). Pitch counts alone haven't proven to be tremendously effective, but do have a place when implemented alongside guidelines for managing the overall baseball calendar.

There is absolutely no reason for skeletally immature middle and high school baseball players to have longer competitive seasons than professional players.

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The Best of 2014: Strength and Conditioning Videos

With my last post, I kicked off the "Best of 2014" series with my top articles of the year. Today, we'll highlight the top five videos of the year. These videos only include instructional videos, not quick exercise demonstrations.

1. Thoracic Mobility and Back Squatting - Upper back positioning is a key factor in squat technique, but not everyone starts in the same position. Check out the video to learn more:

2. Serratus Wall Slide Variations - Serratus anterior is an incredibly important muscle for shoulder health and function. Here are two exercises we use in our serratus anterior activation progression.

3. Do You Really Have Poor Ankle Mobility? - It's been my experience that ankle flexibility restrictions are really "overdiagnosed," and in reality, people just don't know how to shut off their plantarflexors (calves) as part of a heavily extended posture. I elaborate in this video:

4. Are You Packing the Shoulder Correctly? - It's important to be able to pack the shoulder, but in many cases, folks don't know exactly what is or should be going on functionally. This webinar should clarify.

5. Limited Shoulder Flexion in Pitchers - We often hear that shoulder dysfunction relates to elbow pain in throwers, but very rarely do we hear the "why" behind this link. In this video, I elaborate:

I'll be back soon with the top guest posts of 2014!

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Quick and Easy Ways to Feel and Move Better: Installment 58

It's time for the latest installment of Quick and Easy Ways to Feel and Move Better. Here are five tips for you to put into action right away:

1. Try homemade arm sleeves for cranky elbows.

I actually have a subluxating ulnar nerve, which basically means that it sometimes snaps back and forth over the medial epicondyle (funny bone) as my arm goes through flexion and extension. At time, when I'm lifting and playing catch a lot, it'll get a bit cranky. One of the strategies I've employed in the past is simply cutting the end off of a tube sock, then sliding it on from mid-forearm to mid-biceps.

photo-61

Just like a knee sleeve can help with keeping the knees warm and compressed, a simple sock can make a pretty big difference at the elbow. We're learning more and more about how useful compression can be with facilitating recovery, too, so I actually have a lot of pitchers who'll do this between pitching outings to help them bounce back faster. You certainly can't beat the price, either! If your elbows are cranky with heavy lifting, you should first and foremost seek out treatment for it - but this might help expedite the healing process and help you to maintain a training effect while you're on the mend.

2. Make core stability exercises harder by exhaling at the fully lengthened position.

Athletes will often complain that they can't make core stability exercises harder without adding external loading. That's not true at all!  One way we can increase the challenge - and improve the training effect - is to add an exhale at the fully "lengthened" position on anterior core exercises. 

kneelingfallout

So, when you're stretched all the way out on a rollout, fallout, inchworm, or other drill, blow your air out; the ribs will come down a bit as you activate your external obliques and rectus abdominus. Then, give it a 2-3 second pause before inhaling again as you return to the starting position. As I discuss in my Understanding and Coaching the Anterior Core presentation, manipulating breathing alone will increase your time under tension dramatically.

3. When struggling to teach a new technique, coach the toughest position first.

In a past installment of this series, Greg Robins talked about the value of teaching the finish position first on certain exercises, with the TRX inverted row being an example:

Sometimes, though, I find that the quickest way to get a client to learn a tough movement is to put them in the most challenging position to acquire first.  This works extremely well with good athletes who are kinesthetic learners; they do best when they feel the positions they need to get. I've started employing this strategy with the Turkish get-up, as a lot of athletes struggle to find the hip hinge pattern it takes to go from the hip bridge position to this part:

Get-up hip hinge

Seriously, with those who struggle to pick up this transition during the movement, try just putting an athletes into this position so that they can feel it prior to teaching the entire movement. It works like a charm - and it makes sense to them, as you're putting them in a good position to support the load overhead.

4. Rock some grilled zucchini this summer.

Everyone knows that summer is grilling season.  One thing I actually hate about this time of year is that I have to be in two places when I'm cooking dinner. The grill is outside, and the oven/stove is indoors, so I invariably find myself bouncing back and forth between the two spots while I'm cooking. A quick and easy solution to this problem is to just grill your vegetables right alongside the meat - and there is no easier option on this front than zucchini, which just so happens to be "in season."  Simply cut the zucchini length-wise into 3-4 strips, then grill it like you would a hot dog.  You can throw some basil, rosemary, or other spices on it, too.

Grilled_zucchini

5. Value professional collaborations just like you value training partners.

Everyone knows that having a good training partner can make a huge difference with strength and conditioning success. However, not many strength and conditioning professionals realize that the same strategy can be applied to your continuing education work.  You'll get better if you have others constantly pushing you to do so as they share ideas and ask questions.  I benefit tremendously from our weekly staff inservices, where our coaches discuss various topics. I also find that seminars are more beneficial when I'm attending with a colleague with whom I can discuss different topics that are covered by the speaker.  I actually know of several training facilities where the staff watches Elite Training Mentorship presentations together so that they can best digest the information and put it into practice.

etmLogo

Just like "going it alone" makes it tougher to progress in the gym, flying solo in your quest to improve as a coach minimizes your professional "upside." So, as lame as it sounds, find a study buddy!

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Strength and Conditioning Stuff You Should Read: 7/18/13

This week's list of recommended strength and conditioning reading (and listening) will have a heavy baseball focus.  Check out these websites:

Elite Baseball Mentorships - We've run two of these, and the feedback has been fantastic.  With that in mind, today is the early-bird registration deadline for the August 18-20 Phase 2 (no prerequisites required). We'd love to see you there!

Talking Shoulders and Elbows with Eric Cressey - This is the audio of a podcast I did for the Blue Jays Plus Podcast.  We discuss baseball injuries, player development, and a host of other topics. I come on the show at the 34-minute mark, in case you want to fast-forward to it.

EverythingElbow

The Surgery that Changed Baseball Forever - With the upcoming induction of Dr. Frank Jobe (who thought up and did the first Tommy John surgery) to the Baseball Hall of Fame, Will Carroll wrote this outstanding four-part article for Bleacher Report.  Here are the links to check out each of the articles: Part 1, Part 2, Part 3, and Part 4.

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Pitching Injuries and Performance: Understanding Stride Foot Contact and Full External Rotation

At the end of the day yesterday, I took a quick glance at my Facebook feed and was quickly drawn to a "highlight" video from a baseball strength and conditioning program.  The athletes' energy was great, and there was a ton of camaraderie.  The only problem was that if you had watched the video without first seeing the word "baseball" in the title, you would have never known it was a baseball team training. The exercises - and the way that they were/weren't coached - clearly didn't reflect the unique demands of the sport.

With that in mind, I thought I'd use today's post to quickly highlight the most important positions you need to understand when you're training throwing athletes: stride foot contact/full external rotation.

Stride foot contact occurs just before maximum external rotation takes place.  As the foot touches down, the pelvis has started rotating toward home plate while the torso is still rotated in the opposite direction to create the separation that will enhance velocity.  Maximum external rotation - or "lay-back" - signifies the end of this separation, as the energy generated in the lower extremity is already working its way up the chain.  Nissen et al. (2007) presented this tremendous diagram to illustrate the separation that takes place.  This image represents a right handed picture, where the top image is the hips, and the bottom image is the torso (right and left shoulder joint centers of rotation).

Source: Nissen et al.

Based on this image alone, you should be able to see where most oblique strains and lower back pain originate; this is ridiculous rotational stress.  Additionally, you can appreciate why hip injuries are higher in throwers than they ever have been before; it takes huge hip rotation velocities to play "catch up" so that the pelvis and thorax are squared up at maximum external rotation (if they aren't, the arm drags).  This just refers to what's happening at the lower extremity and core, though.  Let's look at the shoulder.

At full lay-back (maximum external rotation), we encounter a number of potentially traumatic and chronic injuries to the shoulder.  In a pattern known as the peel-back mechanism, the biceps tendon twists and tugs on the superior labrum. The articular side (undersurface) of the rotator cuff may impinge (internal impingement) on the posterior-superior glenoid, leading to partial thickness cuff tears. Finally, as the ball externally rotates in the socket, the humeral head tends to glide forward, putting stress on the biceps tendon and anterior ligamentous structures. 

Likewise, at the elbow, valgus stress is off the charts.  That can lead to ulnar collateral ligament tears, flexor/pronator strains, medial epicondyle stress fractures, lateral compressive injuries, ulnar nerve irritation, and a host of other isssue.  I don't expect most of you to know what much of this means (although you can learn more from Everything Elbow), but suffice it to say that it's incredibly important to train throwers to be functionally strong and mobile in these positions. 

And, this brings to light the fundamental problem with most strength and conditioning programs for overhead throwing athletes; they commonly don't even come close to training people to be "safe" in these positions. "Clean, squat, deadlift, bench, chin-up, sit-up" just doesn't cut it.  You need to be strong in single-leg stance to accept force on the front side with landing.

You need to be able to apply force in the frontal and transverse planes.

You also need to transfer this force to powerful movements.

You need to have plenty of rotary stability to effectively transfer force from the lower to upper body.

You need to be strong eccentrically in the 90/90 position.

You need to have outstanding hip mobility in multiple planes of motion.

You need to attend to soft tissue quality in areas that other athletes rarely have to consider.

These demands are really just the tip of the iceberg, though, as you have to see how all the pieces fit together with respect to throwing and hitting demands at various times of year.  Training for baseball isn't as simple as doing the football strength and conditioning program and then showing up for baseball practice; there are far more unique challenges when dealing with any rotational sport, particularly those that also integrate overhead throwing.  Watch the sport, talk to the players, appreciate the demands, and evaluate each individual before you try to write the program; otherwise, you're simply fitting athletes to existing programs.

For more insights like these, I'd encourage you to check out one of our Elite Baseball Mentorships; we have two of these events scheduled for this fall.

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