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.
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.
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:
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.
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.
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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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.
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.
Sign-up Today for our FREE Baseball Newsletter and Receive Instant Access to a 47-minute Presentation from Eric Cressey on Individualizing the Management of Overhead Athletes!
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).
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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Mighty Cholesterol - Brady Cooper did a great job of discussing what cholesterol levels really mean for your health. This is the kind of article you can send to people who just don't "get it."
Does a Normal Elbow Really Exist? - This is an old post of mine that somehow got lost in the archives, but it's well worth a read, particularly if you deal with throwing athletes.
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Anyone who has ever broken or burned a finger will tell you that you just don't appreciate how much you use your hands until you don't have access to one for a bit. Obviously, you partially lose your ability to do things - but what many folks might not appreciate is that you also lose some of your ability to sense things, as the hands contain a tremendously amount of sensory receptors relative to the rest of the body. In fact, the tiny folds in our skin on the fingertips that comprise the fingertip are there because they increase the surface area of the hands - which allows us to get more sensory receptors where we need them. Cool stuff, huh?
Why then, do we not give the hands any love when it comes to soft tissue work? We'll foam roll our hip flexors, lats, and other large muscle groups (which are certainly valuable), but we'll ignore one of the most sensory-rich parts of our body - and one that is constantly active (and overused, in some cases) throughout the day. We grip, type, and flip people the bird - but we never really pay attention to soft tissue quality in this region...until today, that is.
If you look at the structure of the hand, you'll see that it has a large fascial, the palmar aponeurosis (we'll call it the palmar fascia to keep things simple). This structure has an intimate relationship with the muscles/tendons and ligaments of the hand, and serves as a link between the forearm and fingers.
Based on the size alone, you can see that it has plantar-fascia-caliber importance even if it isn't weight bearing. You see, of the five muscles that attach via the common flexor tendon on the medial epicondyle at the elbow, four cross the wrist joint and palmar fascia on the way to the hand, where they work to flex and abduct or adduct the wrist, and flex the fingers.
Loads of people have tendinopathies going on up on the medial elbow (Golfer's Elbow), but they only work on this spot (called a zone of convergence). Meanwhile, the soft tissue quality might be just as bad further down at the wrist and hand, adding tension on an already over-burdended common flexor tendon. Think about it this way: if you had a pulled hamstring up by your glutes, would you only work to improve tissue quality at that spot, or would you work all the way down to the posterior knee to make sure that you'd improved some of the poor tissue quality further down as well?
Below, massage therapist and Cressey Performance coach Chris Howard talks you through two different ways to work out the kinks in the palmar fascia and surrounding regions, but keep in mind that it'll always be more effective to have a qualified manual therapist do the job - and that's certainly someone you should see if you have any symptoms whatsoever.
We've found that quite a few of our pitchers comment on how the ball seems to come out of their hand easier after this work. Usually, they're the guys who have the most stiffness along the forearm, particularly into wrist extension and supination.
Give it a shot at your desk at work and see how it feels.
Today, I'll wrap up my "Best of 2011" series by highlighting the pieces that I enjoyed creating. Check them out:
1.11 Years, 11 Lessons, 100 Pounds - This T-Nation article recapped my long journey in the strength and conditioning world to get to where I am. It was definitely one of my most popular articles of all time at T-Nation.
2. The Fitness Business Blueprint - This product was a blast to create because I think it filled a gaping hole in the market. Until we launched it, nobody had created a fitness business product that didn't just discuss how to grow a business, but also how to improve as a trainer/coach. I had a blast collaborating with Pat Rigsby and Mike Robertson on it.
3.What I Learned in 2010 - I enjoy writing these articles every year, because they serve as a great opportunity to revisit some of the most valuable lessons from the previous year. And, as the saying goes, the best way to master something is to teach it to others.
4. Strength and Conditioning Program Success: The Little Things Matter - This was a fun blog to write, as I did so right around the time when several of our athletes were recognized for some awesome achievements. It gave me a chance to reflect on why they were successful - and why many other folks aren't. There will be some valuable takeaways for you, regardless of your athletic or fitness goals.5. Oblique Strains in Baseball: 2011 Update - I'd written about oblique strains in the past, but they continue to be the big fat white elephant in the corner that is being ignored in the context of baseball development. Hopefully this article got some people to start paying attention to the fact that it's just the fallout of a lot of things that are wrong with the current approaches being employed with respect to baseball strength and conditioning.
6. The IYCA High School Strength and Conditioning Coach Certification - I was fortunate to be a contributor on this awesome resource that will hopefully change the tide of how high school athletes are trained. Based on the feedback we've received thus far, it's already helped tremendously in this regard.
7. Strength Training Program Success: How Dr. P did at 47 What He Couldn't Do at 20 or 30 - This blog (and accompanying video) were awesome because our entire gym got involved on this goal - and were there to see our good friend accomplish it.
8. The Everything Elbow In-Service - This was an in-service I filmed for our staff this summer to prepare them for all the elbow issues that may come through our doors. It lasted 32 minutes, and sold far better than I would have imagined - and led to a lot of requests for us to continue filming staff in-services and making them available for sale.
9. Strength and Conditioning Programs: Think the Opposite - This has a few tips about a counterintuitive way to achieve success in training and in business.
10. Hip Pain in Athletes: The Origin of Femoroacetabular Impingement - FAI is becoming more and more common (especially in young athletes), and in this blog, I talk about some of the reasons why.
That wraps up our "Best of 2011" series. Thank you very much for your support of EricCressey.com in 2011; I'm looking forward to making 2012 even more memorable!
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As I sat down to write this blog, I recalled a quote I heard some time ago, but only with a quick Google search did I discover that it came from Pete Seeger:
"Do you know the difference between education and experience? Education is when you read the fine print; experience is what you get when you don't."
Seeger might be in his 90s and done singing, this quote definitely still resounds - and will continue to do so - in the field of strength and conditioning, even if that wasn't his intention.
I think one of the reasons it gets us thinking so much is that there really isn't a lot of fine print to read; the strength and conditioning field is still in its infancy, especially since there was very little research in this area before the 1980s. And, just when we think we learn something and publish it in the textbook, we discover that it's completely false (the lactic acid debacle was a great example). Moreover, we're dealing with constantly changing demographics; as examples, obesity is rising dramatically, and early youth sports specialization is destroying kids' bodies and fundamentally changing the way that they develop (examples here and here).
So, it's hard to learn how to do things the right way (or at least head in that direction) when the information wasn't available - and the population to which it applies is constantly changing. It's like trying to change the tire on a moving car - and doing so without having instructions on how to use the jack in the first place.
Moreover, even when the information is out there, we appreciate that no two people respond to the same stimulus in the same way - and my experiences with baseball players with elbow pain serves as a great example. I've seen dozens of post Tommy John surgery athletes in my career. Some start throwing before the three-month mark, and others aren't throwing until six months post-op. Everyone heals differently - and even once they get back to throwing, every guy is unique. Some have more shoulder stiffness than elbow stiffness after the long layoff, where it might be vice versa for other guys. Additionally, many post ulnar nerve transposition pitchers have a lot of elbow stiffness when they return to throwing at 6-12 weeks post-op, while others have absolutely zero complications with their return-to-throwing progression.
If the game is changing, and we never really knew what the game was in the first place - and each person is unique, what do we do?
The only thing we can do is draw on personal experience and the lessons that it's provided to us.
To that end, if you're an up-and-comer in the field, you have to look at continuing education as a multi-pronged approach. You've got to read the textbooks and stay on top of the most up-to-date research, but you also have to be "in the trenches" to test-drive concepts and see how they work.
If you're not in the industry - but want to make sure that you're getting the best possible strength and conditioning programs - you need to seek out expert advice from someone who has "been there, done that." Honestly would you want to be on the table for a surgeon's first surgery? I know I wouldn't.
A final option, at the very least, is to educate yourself fully on how to write your own workout routines. That's one reason why I created two free webinars for you: The #1 Reason You Are Not Making Progress and How to Create a Real Strength and Conditioning Program.
You can check them both out HERE at absolutely no charge. I'd just ask that you help spread the word with a Facebook "like" or comment or "Tweet" if you enjoyed what you saw.
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On Tuesday, we had our first ever "Night with the Pros" at Cressey Performance. At the event, 15 of the professional baseball players who train at Cressey Performance in the off-season sat in on a roundtable, answering questions about their careers, long-term developmental approach, college recruiting processes, weekly routines during the season, and a host of other topics. Marlins closer Steve Cishek discussed how he dealt with pressure as a rookie; Indians pitcher Corey Kluber explained why he wound up selecting a smaller D1 program over the baseball "powerhouses;" Royals reliever Tim Collins threw a live bullpen for the crowd and talked about his rise to the big leagues against all odds, and New Balance Baseball was there to provide some sweet prizes and showcase some of their great products.
Even with 15 players on the panel, no two stories were alike; everyone has had a different path to success. Accordingly, when it came time to do my live demonstration, I wanted to emphasize the unique nature of every arm - and how a quick elbow assessment can provide quite a bit of information about what you need to do for a whole-body strength and conditioning program. More than anything, for a bit of "shock value," I used the elbow of one of our pro guys who came to use following a Tommy John surgery where he didn't get all his extension back during his rehabilitation. In speaking with a few of the young attendees the following day, seeing a 25-degree elbow flexion contracture with a "zipper" scar along the medial side was a big eye opener that they needed to be serious about arm care.
We can use the Beighton scale to assess for both generalized congenital laxity and specific laxity at a joint. The screen consists of five tests, four of which are unilateral:
1. Elbow hyperextension > 10° (left and right sides)
2. Knee hyperextension > 10° (left and right sides)
3. Flex the thumb to contact with the forearm (left and right sides)
4. Extend the pinky to >90° angle with the rest of the hand (left and right sides)
5. Place both palms flat on the floor without flexing the knees
So, at the end of the day, you can score up to nine points on the screen if you are ultra-lax. This would be something you'd certainly find more often in women than in men, and the incidence of laxity is going to be higher in sports like swimming, baseball, gymnastics, and tennis (that can benefit from increased range of motion) than it is in football, hockey, etc; it's just natural selection at work, to some degree.
That said, I mentioned earlier that the elbow assessment alone - which, in my eyes, is the quickest and easiest of the bunch - can tell you a ton about what your priorities are going to be when writing a strength and conditioning program. There are really four scenarios that I come across on a weekly basis. For the record, describing joint end-feel in the rehabilitation community is much more elaborate (and specific to each joint) than I make it out in these examples; I just want them to be user-friendly for the lay population. I'll describe the first scenario, Elbow Hyperextension, in today's piece, and come back tomorrow to cover the rest.
Usually, elbow hyperextension has a very soft or "empty" end-feel - as if the forearm could just pop off if it was pulled into further hyperextension. When I see this, I know that there is a very good chance that this individual will have a high Beighton score and I won't have to do much (if any) stretching for him whatsoever - especially in the upper body (you can expect to see upwards ot 200° of total motion at the shoulders, too). Of course, I'll follow up with additional specific and general screens to determine whether this hypermobility characterizes the elbow, upper extremity, or entire body.
Generally, these individuals need more stabilization exercises - so a hearty dose of strength training is in order. Unfortunately, many people like to stick to what they are good at doing, so it's not uncommon at all to see folks with raging congenital laxity going to yoga class after yoga class, wondering why their backs still hurt. It's simply because they're taking an unstable body into end-ranges of motion over and over again. I think specific yoga exercises have outstanding benefits for specific people, but those with congenital laxity need to approach them with caution. And, certainly, trying to turn young gymnasts into human pretzels probably isn't a great idea for long-term health; for every Olympian, there are 10,000 kids with stress fractures in their spines.
That said, if you have someone who presents with a high Beighton score, but still doesn't move well, there are four likely scenarios, in my opinion.
First, and most obviously, there can be an injury that doesn't become symptomatic until they weight bear. Refer out if that is the case.
Second, they can be "grossly" unstable and simply need familiarization and strengthening in the movements you're teaching them. Just because someone is lax enough to be put in the bottom position of a lunge doesn't mean that they'll have adequate joint stabilization to hold that position. As I've written previously, you need adequate stiffness at adjacent joints to allow each joint to move optimally.
Third, they can have breathing issues (those who live in anterior pelvic tilt and rib flair are examples) or soft tissue restrictions (not as likely, but it does happen). These issues might not present with a Beighton score alone, because people can "fake" joint ROM in a passive sense when they are relaxed enough. As an example, I've seen folks with outstanding abduction range-of-motion who are fibrotic soft tissue messes where the adductors insert on the pubis. I'll always go to breathing and soft tissue work well before I go to stretching with these folks.
Fourth, I've seen quite a few folks with hypermobility everywhere except their ankles. It could be because we have absolutely destroyed feet and ankles over the years with high-top sneakers, high-heel shoes, and ankle taping. It could also be protective spasming from a previous ankle sprain that wasn't rehabilitated properly. Or, it could be that folks have shifted their center of gravity so far forward (due to the aforementioned postural distortions) that they simply can't shut off their plantarflexors. So, it's up to you to determine if things are short (measure passive dorsiflexion or do a wall ankle mobility test) or stiff (provide a counterbalance - such as a goblet squat - to see if dorsiflexion increases).
As I mentioned earlier, this is just one of four scenarios that I commonly see when I first look at an elbow. Be sure to check out Part 2, where I introduce the other three and outline the implications of your findings on strength and conditioning program design.
In the meantime, for more information on assessing and managing the elbow, I'd encourage you to check out the Everything Elbow In-Service. In this 32-minute in-service, I cover everything from functional anatomy, to injuries, to injury mechanisms, to strength training program modifications. There are valuable lessons for both those in the baseball world as well as those who don’t have any interest in baseball. It's affordably priced at just $12.99 - and half of all proceeds go to charity.
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Every Wednesday morning at Cressey Sports Performance, we have a staff in-service. It's an awesome chance for our staff and interns to exchange ideas, introduce new topics, standardize coaching cues, and explain strength and conditioning program design strategies. Yesterday, I presented on the elbow - and we decided to video it, as not all our staff members could be there.
Not to toot my own horn, but it came out really well. The elbow is right in my "wheelhouse," so when I get going on it, things seem to just roll off my tongue. The end result was a 32-minute in-service where I didn't use any notes, but covered everything from functional anatomy, to injuries, to injury mechanisms, to strength training program modifications. There are valuable lessons for both those in the baseball world as well as those who don't have any interest in baseball. With that in mind, I decided to put it up for sale today, as I feel strongly that the elbow is a topic that doesn't receive a lot of attention in spite of its importance.
Here are some links I'd encourage you to check out this week:
Understanding Elbow Pain - Part 3: Pitching Injuries - With recent (medial) elbow injuries to Adam Wainwright and Andrew Bailey - and the fact that the high school baseball season starts next week here in Massachusetts - this article is a timely read because it talks about the causes of elbow injuries in throwing, and how those injuries may be different for a young pitcher than an adult pitcher. The follow-up article (Part 4), Protecting Pitchers, is an important subsequent read, too.
Case Study: Anterior Knee Pain in a High School Runner - My buddy Shon Grosse, a physical therapist in Colmar, PA, just got his blog off the ground and will be doing some case study presentations. What I love about Shon is that he's not just a skilled physical therapist, but also an informed consumer when it comes to everything from strength and conditioning, to track and field, to martial arts. You'll see this reflected in his treatment strategies. This will make for a great regular read for up-and-coming physical therapists.
An Interview with Bret Contreras - Dean Somerset interviewed Bret on his blog, and as it typically the case, Bret really overdelivered on content. That man can write!
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