Today's guest post comes from my good friend and Elite Baseball Mentorships colleague, Eric Schoenberg. Enjoy! -EC
It is well documented that shoulder pain/injury is a primary reason for lost time in the gym and on the baseball field. Often times, the culprit is not poor exercise selection, but instead poor exercise execution. Most high level performers are going to do the work that we ask them to do, the issue is whether they are practicing getting better or practicing getting worse.
The following three tips will be useful for any strength coach or physical therapist to help ensure optimal function of the shoulder.
1. Understand and Appreciate Relative Stiffness.
There are several examples of relative stiffness around the shoulder that can result in faulty movement, pain and/or decreased performance.
A primary culprit occurs when the relative stiffness of the deltoid is greater than the rotator cuff. The result of this will be superior translation of the humeral head.
This can lead to undersurface rotator cuff tears, biceps tendon irritation, cyst formation, inferior glenohumeral ligament tears, or humeral head abnormalities – all of which are common to throwers.
Consider this when attempting to strengthen the cuff. Check to see if the humerus is in extension, as demonstrated in this photo. This faulty "elbow behind the body" pattern will lead to over-recruitment of the posterior deltoid:
You also want to cue the athlete away from excessive horizontal abduction, as demonstrated in the next photo. Prone external rotation with no support results in increased use of deltoid to support the arm against gravity:
Here it is corrected with support:
More times than not, we see athletes doing the correct exercise with the wrong execution and getting poor results. We want to avoid allowing an athlete to practice getting better at moving incorrectly.
2. Stop rowing so much, especially if your rowing technique is incorrect!
Rowing variations are generally the safest and easiest upper body exercises to program. However, even though a row is usually pain free, it can sometimes lead to patterns that result in injury down the road.
For example: If the rhomboids and lats are too stiff, you will see limited upward rotation of the scapula. Regardless of how much you strengthen the serratus anterior and lower trapezius, these smaller muscles will never match the force production of the lats and rhomboids.
With this in mind, the best “fix” is to increase stiffness and muscle performance of serratus and lower trapezius while simultaneously decreasing the stiffness and use of the lats/rhomboids.
This can be done by modifying the way we row. In this great video, EC discusses how to correct the row and ensure the scapula is moving properly on the ribcage with both phases of the rowing pattern.
In addition, we should program pressing or reaching exercises such as landmines, kettlebell presses, overhead carry variations.
3. Don’t let good lower body days double as “bad” upper body days.
We sometimes see athletes come in complaining about an increase in symptoms following lower body days. They will report something like “I don’t know what I did to my shoulder; I lifted lower body yesterday.”
By now we know that a common cause of shoulder pain is the scapula being too depressed and downwardly rotated.
If an athlete performed deadlifts, back squats, or any lower body exercise where the weight was held by their sides (DB reverse lunges, step ups, RDLs, Bulgarian split squats, etc.), chances are they were feeding the pattern of depression and downward rotation.
Taking this a step further, we commonly see these exercises resulting in postures and stabilization strategies that present with increased lumbar lordosis and anterior pelvic tilt. When this goes uncorrected, scapular alignment suffers. Here’s a look at a reverse lunge with excessive hip extension, lumbar extension, and anterior pelvic tilt:
Remember, there is no “corrective’ in the world that will counteract the stress of carrying 120-pound DBs by your side while training on a lower body day. This does not mean that you shouldn’t program it; instead, it means that we should just be aware of the consequences.
The solution to this is to consider alternate loading strategies (such as a Safety Squat Bar, KB Goblet set-up, or weight vests) that will allow the shoulder girdle to be freed up and positioned more optimally. If we pair this with consistent attention to proper alignment and movement strategies, we can use lower body days as another opportunity to enhance shoulder function.
About the Author
Eric Schoenberg (@PTMomentum) is a physical therapist and strength coach located in Milford, MA where he is co-owner of Momentum Physical Therapy. Eric is addicted to baseball and plays a part in the Elite Baseball Mentorship Seminars at Cressey Sports Performance. He can be reached at eric@momentumpt.com.
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!
Today's guest post comes from physical therapist, Eric Schoenberg. Eric is an integral part of the Elite Baseball Mentorships team.
A thought came to mind as I was considering how we can work towards reducing the incidence of injury in baseball: we need more specialists.
If we use the field of medicine as a model, the Total Knee Replacement has pretty much been mastered. Of course, there is room for improvement, but over the past 25 years, this surgery has become a massive success. The biggest reason for this is a progression of specialization:
If you need a knee replacement, you don’t go to your primary care physician. Instead, you schedule an appointment with an Orthopedic Surgeon that specializes in TKR. So, if you are a baseball player, why does it make sense to work with a “general” strength coach or physical therapist?
[bctt tweet="Every profession matures into a state of “super-specialization” as it develops."]
Strength coaches and physical therapists have a great opportunity ahead of us to move our professions forward in this manner.
The current entry point for a strength coach is minimal. Most commonly, entry into the field falls somewhere between a fitness certification and a 4-year degree. In some cases, you will see dual degrees, Master’s degrees, and the occasional PhD.
However, there is no direct path available to niche into a “baseball specialist.” Instead, we have private sector, college, and even some professional strength coaches that may have seen baseball players by chance, but have no more experience with them than any other sport. It’s not a criticism of them, though; there simply isn’t an established “curriculum” they can pursue. As a result, in most cases, highly “specialized” baseball players are being managed by “general” strength coaches.
I have to believe that this is as much of a contributing factor as any to the high incidence of injury in the baseball world. By the time these athletes make it far enough in their careers to have access to “baseball specialists,” they are often too damaged for even the experts to manage.
Here are five tips to establish yourself as a trusted resource in the baseball community:
1. Watch baseball.
Don’t just watch it for entertainment value. Study the movements. Use slow motion and rewind on your TV. Watch video online and gain a better understanding of the actions and positions unique to the sport. Once you think you have it figured out, you are only just scratching the surface. Keep studying! Start to recognize why faulty mechanics can lead to improper distribution of stress and ultimately injury. By doing this, you can pair this knowledge with your individual assessment of the athlete to create a more optimal training program.
2. Spend time on a field.
Baseball players are unique in their habits and tendencies. Gain a “feel” for the game. Understand the culture of the game. Learn how to identify with and communicate with athletes that are much younger than you. Understand that most of their time on the field is spent standing around and waiting. Educate your players on how to optimize this time to prepare mentally, hydrate, properly warm up, etc. It is not enough to say you used to play baseball 20 years ago; nobody cares. My credibility and effectiveness in managing baseball players increased 10x once I started spending time at the field as part of a team. Create an angle to quickly establish trust and common ground with the athlete and watch your results dramatically improve.
3. Understand the unique physical characteristics and demands of baseball players.
Baseball players have physical characteristics that differ from other sports. Educate yourself for the benefit of your athletes. Learn about humeral retroversion, gross extension patterns, laxity, valgus stress, dynamic stability, rotator cuff timing, etc. Work towards understanding the importance of stability of the landing leg, proper hip hinge pattern, and the importance of tri-planar single leg balance. Don’t “stretch” a guy that is already too loose. Instead, give him some stability and watch his pain go away. The baseball player’s anatomy is a long way from “neutral.” Do your best to bring them closer to the middle and not further away. For example, your ability to recognize that a baseball player should not be cued to pull their shoulder blades “down and back” because their shoulder blades are ALREADY down and back may save dozens of careers.
4. Master functional anatomy and human movement.
Understand the critical role of the scapula. Train the rotator cuff in the throwing position through the entire range of motion (especially end-range external rotation). Learn how the kinetic chain applies specifically to baseball. Hitting and throwing are highly coordinated, precisely timed, multidirectional movements. Don’t train your athletes with single joint exercises that only occur in the sagittal plane. Learn about hip/trunk separation to maximize power and explosiveness. Be able to educate the athlete on what it means to have a labral tear or understand the specifics of an ulnar nerve transposition. If you can’t explain these pathologies, then how can you minimize risk when working with these athletes? Take pride in your job on this front.
5. Be willing to respectfully challenge the “institution of baseball.”
CSP coach Tony Bonvechio wrote a blog post a while back where he warned about the dangers of the phrase “this is how I’ve always done it.” I find myself observing on a daily basis that regardless of level – little league, high school, college, pro ball – at least 80% of the player’s warm up routine is exactly the same. How can that be? We have progressed as a profession; however, kids on baseball fields across the world are all doing the same useless warm-up routine.
An example of progress is Joe Maddon and the Chicago Cubs. He softened the traditional stance of getting to the ballpark at 1pm for a 7pm game. Instead, they have created a culture that emphasizes more sleep, nutrition, and recovery and his players love him for it.
If we want different results, we have to continue to move towards a different approach. The efforts of strength coaches and physical therapists to move towards becoming baseball specialists will go a long way in helping to reach this goal.
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!
Here's some recommended strength and conditioning reading/viewing to get your Tuesday started off on the right foot:
How Neural Tension Influences Hamstrings Flexibility - This Mike Reinold video is an excerpt from our new resource, Functional Stability Training: Optimizing Movement. It's on sale for $30 off through the end of the week.
Why Physical Therapists are Movement System Experts? - I thought this was an excellent article from my good friend and colleague, Eric Schoenberg. I collaborate with Eric on a weekly basis with various rehab cases and he's an outstanding therapist and even better friend.
We're excited to announce our next Elite Baseball Mentorship offering: a lower-extremity course that will take place on August 21-23, 2016 at our Hudson, MA facility.
The Cressey Sports Performance Elite Baseball Mentorships provide an educational opportunity to become a trusted resource to this dramatically underserved athletic population. Through a combination of classroom presentations, practical demonstrations, case studies, video analysis, and observation of training, you’ll learn about our integrated system for performance enhancement and injury prevention and rehabilitation in baseball athletes. Cressey Sports Performance has become a trusted resource for over 100 professional players from all over the country each off-season, and this is your opportunity to experience “why” first-hand at our state-of-the-art facility.
Course Description:
The Lower Extremity Cressey Sports Performance Elite Baseball Mentorship complements our upper extremity course by introducing attendees to the most common injuries and movement impairments encountered by baseball players in a sport that combines violent extension, rotation, change-of-direction, acceleration, and top speed sprinting. Core control and lower extremity function considerations will be applied to the throwing and hitting motions.
Course Agenda:
Sunday
Morning Session: Lecture
8:30-9:00AM – Registration and Introduction (Eric Cressey)
9:00-10:00AM – Movement Impairments of the Lower Extremity and Core (Eric Schoenberg)
10:00-11:00AM – Common Injuries and their Mechanisms (Eric Cressey)
11:00-11:15AM – Break
11:15AM-12:15PM – Common Mistakes in Training and Rehabilitating the Core and Lower-Extremity (Eric Schoenberg)
12:15-1:00PM – Lunch (provided)
Afternoon Session: Lecture and Video Analysis
1:00-2:00PM – Understanding and Managing Asymmetry in Rotational Sport Athletes (Eric Cressey)
2:00-3:15PM – Video Evaluation of Throwers: Lower-Extremity Considerations for Push-off and Foot-Plant (Matt Blake)
3:15-3:30PM – Break
3:30-4:45PM – (Matt Blake) – Video Evaluation of Hitters: Lower-Extremity Demands and Sequencing
4:45-5:30PM – Case Studies and Q&A
5:30PM Reception (Dinner Provided)
Monday
Morning Session: Practical
8:00AM-10:00AM – Lower-Extremity Physical Assessment: Static and Dynamic (Eric Cressey and Eric Schoenberg)
10:00-11:30AM – Lower-Extremity Prehabilitation/Rehabilitation Exercises (Eric Cressey and Eric Schoenberg)
11:30AM-12:00PM – Lunch (on your own)
Afternoon Session: Observation at Cressey Sports Performance – 12PM-6PM*
Tuesday
Morning Session: Practical
8:00AM-9:30AM – Training Power Outside the Sagittal Plane (Eric Cressey and Eric Schoenberg)
9:30-11:00AM – Individualizing Driveline to the Pitcher (Matt Blake)
11:30AM-12:00PM – Lunch (on your own)
Afternoon Session: Observation at Cressey Sports Performance – 12PM-6PM*
* The afternoon observation sessions on Monday and Tuesday will allow attendees to see in real-time the day-to-day operation of the comprehensive baseball training programs unique to Cressey Sports Performance. This observation of live training on the CSP floor with our professional, college, and high school baseball players will allow you to experience firsthand our approaches to:
• Programming
• Proper coaching cues for optimal results
• Soft tissue techniques
• Activation and mobility drills
• Strength/power development
• Medicine ball work
• Multi-directional stability
• Metabolic conditioning
• Sprint/agility programs
• Base stealing technique
In addition, you will experience:
• Live throwing sessions
• Biomechanical video analysis using the Right View Pro system
• Movement evaluation
• Live evaluations of attendees with Eric Schoenberg
Location:
Cressey Sports Performance
577 Main St.
Suite 310
Hudson, MA 01749
Cost:
$999
No sign-ups will be accepted on the day of the event.
• No prerequisites required.
• Participants will receive a manual of notes from the event’s presentations.
• Space is extremely limited
• We are keeping the size of this seminar small so that we can make it a far more productive educational experience.
•This event will not be videotaped.
For details about travel, accommodations, and other logistics, please email cspmass@gmail.com.
With baseball athletes being the largest segment of the Cressey Sports Performance athletic clientele, it seems only fitting to devote a "Best of 2015" feature to the top baseball posts from last year. Check them out:
1.Common Arm Care Mistakes - Installment 6 - In this article, I talk about how important it is to select arm care exercises that truly appreciate the functional demands placed on the shoulder and elbow during throwing.
2.Changing Baseball Culture: A Call to Action - Physical therapist Eric Schoenberg makes a call to action to step away from four baseball traditions so that we can more easily prevent baseball injuries.
3. What is a "Big League Body?" - Big leaguers come in all shapes and sizes. Your baseball strength and conditioning programs need to appreciate that.
5. Projecting the Development of High School Pitchers - Cressey Sports Performance Pitching Coordinator Matt Blake shows what a difference a year can make in projecting high school pitchers for college baseball success.
If you're interested in learning more about how we assess, program for, and train baseball players, I'd encourage you to check out one of our Elite Baseball Mentorships. The next course will take place January 17-19, 2016 at our Hudson, MA facility. You can learn more HERE.
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!
Today's guest post comes from Cressey Sports Performance - Massachusetts pitching coordinator, Matt Blake (@Blake_Matt). Matt is an integral part of the Elite Baseball Mentorships team. Enjoy! -EC
At a recent conference, Eric Cressey gave a presentation that tackled the importance of baseball professionals understanding scapular mechanics and the integral role they play in the throwing athlete’s kinetic chain. Eric Schoenberg also recently showed a great drill to incorporate scapular motion into the kinetic chain of activity. Given that I’m the third member of the Elite Baseball Mentorships team with these two, I figured I might as well chime in to highlight its importance from my perspective as well.
This is an important discussion to have because it can help demonstrate the need for all phases of development to work together to keep the high-level thrower operating on all cylinders. If we’re all speaking the same language, we can work to build the athlete’s awareness for their overall movement and integrate the education from the warm-up through the initial phases of the throwing progression.
If we’re all saying different things to the athlete using our own jargon, it’s easy for them to misinterpret the carryover of certain drills, exercises, and concepts across channels. If we all lay down similar verbiage in our conversations with the athlete regarding their prehab work, dynamic warm-up, strength training and throwing motion, it makes it a lot easier for them to appreciate the importance each piece holds in the puzzle.
In order to get started, let’s look at where the scapula is positioned and introduce its fundamental movements so we can begin to appreciate its role in the kinetic chain.
When looking at the scapula’s position and actions, you have to acknowledge the importance of its relationships with the rib cage and the humerus. These relationships are integral in tying the torso and the arm action together in a high-level throw. These interactions between the thoracic region, scapula and humeral head may be the most overlooked or misunderstood components of the delivery – especially for the average coach who has no anatomical background.
The degree of misunderstanding is mainly because the actions are so subtle and can’t be fully appreciated when the athlete throws with their shirt on. This is why its so vital to have a strength/rehab professional in the mix, who can provide a shirtless scapular screen to give us a baseline on where the scapula lies at rest and how it functions in relation to the movement of the arm.
Once you can identify how an athlete presents, you can begin to build a more individualized corrective movement progression. This will serve to help the athlete identify and turn on the appropriate movement patterns to keep the humeral head flush with the scapula through its full range of motion. This is essential in the throw, because of the importance of a “clean” arm action to help alleviate some of the stress involved in the high-level motion. For demonstration sake, here’s an example of a HS pitcher, who throws 88-91, with a relatively efficient arm action for his age.
The ability to create elite levels of hand-speed in a durable manner can be won or lost based on how the humeral head functions in conjunction with the scapula. In my mind, this is the crux of the delivery, where you need to be able to tie the “whip-like” arm action into the sequential actions of the torso.
As the thrower engages his landing position, the kinetic forces of the delivery are beginning to flow up through the chain towards the scapula and arm. It’s crucial at this point for the arm to get set up in a sound position to optimize control of the (glenohumeral) joint in an effort to handle the energy that’s about to drive through that portion of the chain towards release. The “optimal” timing of this set-up will be dictated by how the athlete sequences hip and torso rotation, as well as how much laxity they present with, etc. - but for the sake of discussion, we’ll say landing is a crucial checkpoint.
From here, the key actions that we’re going to break out today are upward rotation and protraction. This isn’t to say that they are more important than the other actions, but throughout the season, throwers tend to lose upward rotation from the stress of the throwing motion. With that in mind, let’s identify what it is and how it works with protraction to aid the durability of the high-level delivery.
This concept is something that EC has written and produced videos about countless times over the years, but it continues to be a point that needs to be reiterated time and again. For those who haven’t seen it, this is a great video to consider in this discussion.
From this video, we’ll take it a step further, so you can visualize how this actually plays out in the throwing motion itself.
As you can see, there is a considerable amount of range of motion and control that needs to be in place if you expect to keep the humeral head “centered” from lay-back through the entirety of the deceleration phase. The challenge here is that we can’t always see how the arm action is working with the shoulder blade. One way to combat this is via communicating with your athletes about where they feel their soreness the day after throwing.
Generally speaking, I like to have guys tell me they’re sore near the medial border of the scapula, in the meat of back, where the scapular retractors are eccentrically controlling the scapula as it moves away from the mid-line. If guys are sore near the back, top, or front portion of the shoulder joint itself, then we’re probably getting too much “joint-play” and the humeral head is gliding and translating away from the center of the socket too much during the throw.
If these other patterns of soreness are presenting somewhere along the line, either the rotator cuff wasn’t doing its job, the scapula wasn’t working in sync with the humeral motion, or the thrower’s motion in general is putting them in positions that aren’t utilizing the correct patterns. In this case, let's assume that we did have a “good” post-throwing stress pattern.
Once we’ve identified that we are using scapular upward rotation and protraction to our benefit to control the socket, now we need to work extremely hard to counteract the eccentric damage associated with these actions. This is where the recovery protocol and the warm-up itself are crucial on a daily basis to make sure we’re getting back both the range of motion that we need, as well as activating it correctly before we begin to throw again.
To learn more about how physical assessment, strength and conditioning principles, video analysis, and drill work for the pitcher fit together, be sure to check out one of our Elite Baseball Mentorships. Our next event will be held January 17-19, 2016 at Cressey Sports Performance in Hudson, MA. The early-bird registration is December 17, 2015. For more information, check out www.EliteBaseballMentorships.com.
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!
Today's guest post comes from physical therapist Eric Schoenberg. Eric is an integral part of the Elite Baseball Mentorships team.
Every baseball player on the planet has heard their coach say “stay on top of the ball”, “get out in front”, and/or “throw downhill”. It is an easy thing to say, but a little more difficult to teach. A common response that I hear from players that I work with is: “I understand what the coach is saying, but I don’t know how to actually get my body to do it”.
There are many mechanical reasons why a pitcher will struggle to create this downhill plane. (e.g. front leg stability, trunk tilt angle). However, on the movement side of things, one of the main culprits that we see is a lack of scapular upward rotation. If you are a frequent visitor to this blog, you know that EC has hit on this topic for years. I wanted to add some thoughts to this critical concept.
If a pitcher lacks the ability to “get up” (insufficient scapular upward rotation and/or elevation), he will not be able to effectively get his hand out in front to maximize velocity. Pitchers will describe this feeling as “cutting the ball off” or “feeling stuck”. The result is a decrease in velocity and difficulty “getting down” in the zone. It is very common for this to occur later in the season once the off-season training effect has been lost and the predictable loss of range of motion (shoulder flexion, upward rotation, hip and thoracic mobility) kicks in.
The most effective pitchers share three things in common: consistent velocity, consistent location, and health. None of these are possible with faulty scapular movement patterns.
The best time to establish proper scapular upward rotation is in the off-season (NOW!). The challenge comes with educating the athlete on how to not lose this motion during the season.
By now, we are aware of the importance of wall slide variations, back to wall shoulder flexion, and trap raises. However, the message of consistency with these exercises EVERY DAY during the season cannot be overstated. This is akin to brushing your teeth. A habit needs to be established and it then needs to be repeated. Every baseball player that I see in my office for elbow or shoulder pain comes in with faulty scapular movement. This is certainly not the only thing that leads to pain in pitchers, but it is certainly a good place for us to be looking early on.
A great exercise that we have been using to emphasize “getting up and out in front” is the One-Arm Band Rotational Row from a Low Setting.
This drill is much more about the deceleration phase than the actual rowing pattern, however all phases of the movement are important. I prefer to use a band instead of a cable due to the increased velocity of the recoil. This is a great drill to use in a training or warm-up program. With that said, I find the best application is to be used in a pre-throwing program (preferably the last drill before a pitcher picks up the ball to begin throwing).
Set-Up: Wide base to emphasize hip mobility. Front foot should mimic where the land foot is in the delivery. Back foot and hips are rotated fully so the athlete is “squared up” in the sagittal plane. Coaching from the Posterior View will give you a good vantage point to see this.
Instruction: Initiate the rowing motion from the hips first, then the thoracic spine, then the scapula, and finally the humerus. Make sure the athlete’s elbow doesn’t end up behind the line of his body. Back foot should rotate to mimic the position on the rubber with the hip hinged and loaded. Cue the athlete to decelerate the band with his body (core, front hip) and not just with his arm. Coaching from a 90 degree angle to the side will show this the best.
A key component for a pitcher to develop/maintain velocity and location is to make sure that their body is in a stable position to deliver their arm (and the baseball). The One Arm Rotational Row accomplishes this by via the following avenues:
1. Single Leg Strength
a. Land Leg: Proper stability and balance to accept weight, stop forward momentum, and translate force from the ground up the chain.
b. Drive leg: Ability to hinge back into drive hip and not translate forward (toward 3rd base for a RHP) or collapse into valgus. Keeping weight through the whole foot and not just on the toe
2. Stable core throughout delivery – especially as trunk and hips start to separate
Leaking into anterior pelvic tilt or lumbar extension will drive scapular downward rotation and depression (resulting in the hand moving under or around the ball, as opposed to staying behind the ball).
3. Optimal Thoracic Positioning
This drill drives thoracic flexion moment to allow for a congruent platform for the scapula to ride up and create the desired extension at ball release.
Give this drill a try with your athletes (make sure to train both sides) and emphasize consistency with their scapular upward rotation exercises in order to develop a more durable arm with improved velocity and location.
If you are interested in learning more about our approach to managing baseball athletes, we'd love to see you at one of our Elite Baseball Mentorships. The next three-day course is June 23-25, with May 23 serving as the early-bird registration deadline.
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!
Today's guest post comes from physical therapist Eric Schoenberg, who is an integral part of the Elite Baseball Mentorships team. Enjoy! -EC
Baseball is a game of ritual and tradition: lucky socks, pre-game meals, stepping over lines, special handshakes, and on-deck habits are all part of the “rhythm” of the game. Unfortunately, other “old-school” traditions are still the norm when it comes to the management and prevention of injury on the diamond. It is clear that we are moving in the right direction with new technologies and smarter training; however, injuries continue to pile up. A difficult question to answer is: are any of these injuries avoidable or are players already “damaged goods” by the time they get to the professional ranks? Some things are out of our control, but clearly we can do better.
Here are four opportunities for us to make a difference:
1. Identify the signs before there are symptoms.
The best form of treatment is prevention. The best rehab for a pitcher is one that does not exist at all. To support this point, a sign is a warning that something bad is about to happen. Some examples of objective signs in an at-risk pitcher are a decrease in velocity, loss of location/command, and ROM changes. This might be a loss of total glenohumeral ROM, internal rotation, or shoulder flexion; scapular upward rotation; elbow extension; forearm supination; and hip rotation. Or, it may be a significant increase in shoulder external rotation (see here and here for details). Some examples of subjective signs are poor body language, lack of confidence, altered communication, and working slower on the mound – just to name a few. Once a pitcher does become symptomatic, we need to take it seriously. I am not implying that we need to baby our athletes (there is enough of that going on!), but on the flip side, the solution is not to ignore the pain and “pitch through it.” As always, the truth is often found somewhere in the middle. In 15 years, I have yet to come across a pitcher that ended up needing surgery that did not first have signs and symptoms that were either missed or ignored.
2. There is no such thing as “normal soreness.”
To piggyback on point #1, the expectation is not that a pitcher will be pain-free 100% of the time. That is unrealistic. There is unavoidable stress and tissue breakdown associated with pitching. If there isn’t, my guess is the pitcher is not throwing very hard! However, I would like to make this point loud and clear: There is no such thing as “normal soreness.” By definition, if things were normal, then there would not be soreness (and certainly not pain). To this point, one could argue that throwing a baseball 100x at 85-100MPH is not “normal,” either, so what can we do about it? Let’s follow this rule: if a pitcher presents with pain, tightness, or fatigue in the front of his shoulder or the inside/outside of their elbow or forearm following an outing, then he needs an evaluation and treatment. If a pitcher presents with soreness in their glutes, core, and posterior cuff, then he needs some rest and a pat on the back for a job well done. Remember, just because the pain or soreness is common doesn’t make it right.
3. One size never fits all.
I can’t think of a situation in baseball (or life) where one approach works for everyone. For example, not every baseball player needs to stretch or “loosen up.” Most players are already too loose or lax and need to gain stiffness and stability with their pre-game routine. They need to warm-up and activate. Yet, at every level, we see teams line up and stretch before games. This robs their bodies of the good stiffness that they have worked to develop in the gym and during the off-season. We need to warm the tissues up and take the body through the appropriate ranges of motion to prepare to play; however, we don’t need to stretch these tissues right before asking them to generate massive amounts of force. For these loose-jointed individuals, throwing, sprinting, and hitting will provide all of the “stretching” that’s needed.
Another example that needs to be looked at is too many reps of strengthening or band exercises done right before activity on the field. If we don’t want to overstretch an athlete prior to playing, then we certainly don’t want to fatigue them. A fatigued pitcher has a 36x higher chance of getting injured than a non-fatigued pitcher. Let’s save the fatigue for the innings on the field and not with hundreds of band reps or a 50-pitch bullpen session before the 1st pitch is even thrown.
4. Avoid this question.
The worst question you can ever ask a pitcher on a mound visit or in the dugout is “How are you feeling?” This same question is asked every day on fields across the world and yields no valuable information. Any pitcher, at any level, will answer, “I’m good, coach.” If they don’t, they are playing the wrong sport.
Instead of asking this question, we should be using our experience as professionals to make unemotional decisions to best help our players stay healthy for the entire season.
It is our job is to acquire as much information as we can through experience and observation to make the best decision possible with the data that we have at that moment. Players lie. It is a way of showing their competitive spirit to stay in games and try to help their teams win. It’s called adrenaline. It’s not their fault. It is our fault for asking bad questions that have no good answers. The pitcher’s job is to get outs, not to decide what soreness is “normal.” That is what what we get paid to do.
Let’s close by comparing injury management in baseball to one of the world’s most successful companies. Apple talks about avoiding the “sameness trap.” This is the thought that if you ask a consumer what they want, they will tell you to do what other popular companies are doing. Steve Jobs worked to avoid this by not asking his customers what they wanted, but instead, giving them what they didn’t know they needed. So, let’s stop asking the same questions and getting the same generic answers and worked towards continuing to change the culture in baseball and help our athletes get better results.
If you are interested in learning more about our approach to managing baseball athletes, we'd love to see you at one of our Elite Baseball Mentorships.
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!
I really enjoying creating features with multiple installments because it really allows me to dig deep into a topic that interests both me and my readers. It’s like writing a short book, with each post being a different chapter. That said, here were a few of my favorite features from 2014 at EricCressey.com:
1. Random Thoughts on Sports Performance Training - I'm at my best when I'm my most random, and I think these posts are a great example of that. What started as a one-time post wound up becoming a regular series based on reader feedback. Here are links to all eight installments from 2014:
2. Quick and Easy Ways to Feel and Move Better - This series is mostly CSP coach Greg Robins' work, but I jumped in quite a bit in 2014. Installments 53-60 ran this year; here were the most popular ones:
3. Is Thoracic Spine Extension Work Necessary? - My good friend and colleague, physical therapist Eric Schoenberg, put together this in-depth series to demonstrate that not everyone needs extra thoracic extension work, contrary to what many folks think.
Today's guest post comes from physical therapist Eric Schoenberg, who is an integral part of the Elite Baseball Mentorships team. Enjoy! -EC
Regardless of your profession with respect to the baseball world, chances are that you spend a good portion of your days writing programs. Whether it is a home exercise program for a physical therapist, a training program for the strength and conditioning specialist, a throwing program for the pitching instructor, or a practice plan for a head coach, the quality of your programs can differentiate you from your competition. As opposed to writing a daily “workout,” a detailed, individualized program gives the athlete structure and sets expectations similar to a curriculum in education.
Each time we host an Elite Baseball Mentorship, the topic of programming comes up in our wrap-up roundtable discussion. As professionals, our job is to add value to our services and give our athletes a competitive advantage over their peers. A big way in which we can do this is by writing great programs for our athletes. It should be noted that writing such detailed and specific programs takes a lot of time and effort, but the athletes that we work with deserve nothing less. A “one size fits all” program with empty promises may sell well online, but most are a disservice to the athlete. This article will outline examples of different programs that we write on a daily basis.
There are many ways to subdivide programs to suit the needs of your athletes. For the purposes of this article, I’ve divided programs into three different categories: Temporal (length of program), Age, and Time of year/Season.
Within each category, athletes are divided into into three sub-categories: Lax, “Middle of the road”, and Stiff. Determining an athlete’s degree of laxity or stiffness is critical to determine whether an athlete needs to focus on mobility (“loosen up”) or stability (“tighten up”).
In addition, it serves as a more logical way to group athletes together when an individualized program is not possible based on time, space, and resources – most notably in the high school or college team settings.
Let’s take a look at each category, starting with temporal, and hit on some different points worth considering when designing programs for your athletes.
Weekly:
• Strength and Conditioning – frequency of strength and mobility sessions
• Rehab/Physical Therapy treatments (includes soft tissue work)
• Home exercise programs
• Throwing (5-day, 7-day, Reliever)
• Recovery work
Monthly/Season:
• Early season vs. late season (adaptive changes will require change in programming)
Year:
• Pre-season, in-season, post-season, time off
Next, age must be appreciated when considering program design. There are major differences between these age groups in terms of laxity, injury history, injury predisposition, activity tolerance, recovery time, and a host of other factors that must be considered when programming for your athletes. As an athlete gets older, the number of games played in a season dramatically increases and must be accounted for in their programs. The table below illustrates a breakdown of the age category:
Lastly, we need to pay attention to season when designing programs. An interesting study by Posner et al, found that MLB injuries were 10x more likely to occur in April than September. It is critical to appreciate that exercise selection needs to change based on season out of respect for throwing volume. In addition, the importance of adaptive changes such as decreased (or increased) ROM, pain, fatigue, weight loss, among others must be appreciated. Also, competing demands such as multiple sports in season, travel, schoolwork, and family commitments need to be taken into consideration as we create programs for our athletes.
Other considerations for varying volume, duration, and intensity in your programs include:
• Position (pitcher, catcher, IF, OF)
• History of injury in past year
• Multi-Sport vs. Early Specialized (include multi-sports in same season – high school athlete)
• Geography: Athletes from the Northeast will have a shorter competitive season with less games vs. their southern counterparts.
In conclusion, once you determine an athlete’s degree of laxity and define time, age, and seasonal considerations, you can use these templates in combination to help organize your programming and become more efficient.
For example:
➢ A daily in-season program for a lax 17 year old left-handed pitcher (and 3-sport high school athlete) with a history of medial elbow pain.
It is important to appreciate that this program design will vary greatly from:
➢ A weekly off-season program for a stiff 30 year old RHP (big leaguer) with a medical history of 2 shoulder surgeries and currently experiencing left knee pain.
If you found this information helpful in organizing your thoughts when it comes to managing the baseball players with whom you work, we encourage you to sign up for one of our upcoming Elite Baseball Mentorships. We have events in both October and November, and you won't find a more intensive baseball educational course.
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!
