The medicine balls in question can be found HERE.

6. I've written quite a bit in the past about how a glenohumeral internal rotation deficit can be one contributing factor (among others) to medial elbow injuries in overhead throwing athletes.  The other day, someone asked me if I had any scientific evidence to support this idea.  The answer would be a resounding YES.

Very simply, if you lack internal rotation, you'll go to the elbow to "regain" that lost range-of-motion.  It's the same reason that ankle mobility deficits can lead to knee pain, and hip mobility deficits can lead to knee and lower back pain.

7. I don't really "get" how this whole Delicious bookmarking thing works, but Jon Boyle (who helps out with the blog) recommended I start sending him recommendations of good stuff I've read.  You can find some of my recommended reading/viewing off to the right-hand side of the page.  If there are books you recommend I check out, by all means, please post suggestions in the comments to these blogs; I'm always looking for new reading material.

Have a great weekend!

As you work to regain that mobility, it's valuable to build stability within that newly acquired range-of-motion (ROM) with loads of horizontal pulling (rows) and deadlift variations. With respect to the shoulder itself, it's important to regain lost external rotation ROM and scapular posterior tilt.  As I recently wrote in "The Right Way to Stretch the Pecs," I prefer the 1-arm doorway pec stretch and supine pec minor stretches.  You can find videos of both HERE - and you can expedite the process with regular foam rolling on the pecs. In the interim, substitute front squats, overhead squats, single-leg exercises, and deadlift variations to maintain a training effect.

Hopefully, these recommendations get you headed in the right direction and back to squatting as soon as possible! What the experts are saying about The Truth About Unstable Surface Training... "Unstable surface training is many times misunderstood and misinterpeted in both the physical therapy and athletic performance fields. The Truth About Unstable Surface Training e-book greatly clarifies where unstable surface training strategically fits into an overall program of injury prevention, warm-up/activation, and increasing whole body strength. If you are a physical therapist, athletic trainer, or strength training professional, The Truth About Unstable Surface Training gives you a massive amount of evidence-based ammunition for your treatment stockpile." Shon Grosse PT, ATC, CSCS Comprehensive Physical Therapy Colmar, PA Click here for more information on The Truth About Unstable Surface Training.

When we get a guy who comes to use with chronically restricted elbow extension ROM, soft tissue work - be it general massage, Graston techniques, and/or ART - are important immediate inclusions.  As the picture below shows, they can leave some marks, at times, but in this guy's case, just five minutes of soft tissue work and the above stretch got him over 10 degrees of ROM back.  He probably won't get all his ROM back, but he'll certainly get a lot closer to it.

For more information on screening baseball athletes for issues like these, I strongly encourage you to check out the 2008 Ultimate Pitching Coaches Bootcamp DVD set.

Mike Robertson flew up from Indianapolis to check out a seminar up here in Boston this past weekend. We really enjoyed watching Kevin Wilk, Bob Mangine, and Mark Comerford, three fantastic rehabilitation specialists. Additionally, I enjoyed catching up with Mike just as much, as he’s a wealth of information, particularly with respect to the knees. From just talking with Mike this weekend, I picked up some really good stuff – in addition to the entire day the presenters spent on the knee this weekend.

With that in mind, on Sunday, I wrote down five things that caught my attention this weekend. Then, I handed them to Mike and asked him to elaborate on them on his laptop on the plane ride home for a “guest spot” in my newsletter. Here’s what you’ve got:

5 Keys to Bulletproofing Your Knees

1. VMO specific work is currently poo-poo in the strength and conditioning industry. While I agree that we need to focus on strengthening the hip abductors/external rotators (especially glute max and posterior glute med), current literature leads us to believe that there’s more to the VMO than we might have expected.

Several studies in the past two years have indicated that there is a definite change in fiber pennation between the vastus medialis longus (VML) and the vastus medialis obliquus (VMO). Beyond that, while your other quad muscles like rectus femoris and vastus lateralis only have one motor point, the entire vastus medialis actually has THREE motor points! We may not totally understand the VMO yet, but I’m not willing to write off its importance with regards to knee health.

2. When looking at the body as a functional unit, we can’t overlook the core with regards to knee health. More specifically, we know the rectus abdominus and external obliques work to keep us in pelvic neutral and out of anterior pelvic tilt. Lack of strength in these core muscles increases anterior pelvic tilt, which drives internal rotation of the hip and valgus of the knee. Getting and keeping these muscles strong could go a long way to preventing knee injuries, especially in female athletes.

3. Are accelerated ACL rehab programs what we need? I’m not so sure, and I think making young athletes follow the accelerated programs the pros use may do more harm than good. Unlike the pros that are getting paid to play, we need to focus on the long-term outcomes of our young athletes, not simply getting them back on the field ASAP. Many have done an excellent job of rehabbing patients and getting them back on the field quickly, and quantifying strength and power production/absorption is critical.  Many of the leading PT’s and orthos, however, are moving back to a slightly more conservative approach to allow the graft itself more time to heal. The properties of a tendon graft slowly take on the properties of a ligament over time; this is called ligamentization. However, ligamentous changes can still be seen as late as 12-18 months post-surgery.

5. When an athlete tears their ACL, proprioceptive deficits are seen as quickly as 24 hours post-injury. What’s really intriguing, however, is that we often see this same deficit carried over to the healthy knee as well! Even after reconstruction this deficit can be seen for up to six years. To counteract this, don’t forget to include basic proprioceptive training (barefoot warm-ups, single-leg stance work, etc.), and train that “off” leg in the interim. For more tips, tricks, and programming recommendations on knees, check out Mike Robertson’s Bulletproof Knees manual. It’s by far the best resource I’ve seen on preventing and addressing knee pain.

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Just One Missing Piece

Training Around Elbow Issues in Overhead Athletes

Random Thursday Thoughts

Sturdy Shoulders: Big Bench

All the Best,

EC