Home Posts tagged "Eric Schoenberg" (Page 2)

Understanding Scapular Positioning in the Throwing Motion

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.

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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.  

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Get Up to Get Down: The Impact of Scapular Movement on Pitch Location

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.

ScapularDownwardRotation

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. 

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Changing Baseball Culture: A Call to Action

Today's guest post comes from physical therapist Eric Schoenberg, who is an integral part of the Elite Baseball Mentorships team. Enjoy! -EC

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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.

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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.

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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.

EBM-Cressey
 

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The Best of 2014: Strength and Conditioning Features

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:

Installment 1
Installment 2
Installment 3
Installment 4
Installment 5
Installment 6
Installment 7
Installment 8

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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:

Installment 53
Installment 54
Installment 57
Installment 58
Installment 59

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.

Part 1
Part 2
Part 3

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The Best of 2014 series is almost complete, but stayed tuned for a few more highlights!

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Get with the Program: Strategies for Individualizing Baseball Development

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.

temporalchart

Daily programming:
• Practice vs. Gameday
• Prehab/Rehab
• Pre-game warm-up
• Pre-throwing
• Throwing (Long toss, bullpen, in-game)
• In-game (between innings, reliever warm-up)
• Nutrition
• Post-game/Recovery

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

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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:

agechart

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.

seasonchart

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.

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Exercise of the Week: Half-Kneeling 90/90 External Rotation Hold

Today’s guest post comes from my friend and colleague, physical therapist Eric Schoenberg. Eric is an integral part of our Elite Baseball Mentorships.

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I have yet to meet a high level baseball player that hasn’t done some form of rotator cuff strengthening exercise. The interesting part is that a high percentage of these athletes don’t actually know where their rotator cuff is and where they should be feeling these exercises. The most common response is the athlete will point to the front of their shoulder. This is also the same spot (biceps tendon, labrum) where all of their pain is when they throw!

In other words, the athlete is doing a “rotator cuff” exercise to help decrease or reduce the risk of shoulder pain, but in turn, ends up actually causing more stress and overuse to their already irritated anterior shoulder.

The ability to properly recruit the rotator cuff works hand in hand with being able to relax/shut down the posterior deltoid, latissimus, and lumbar extensors from overcompensating as an athlete “lays back” into external rotation.
We commonly see athletes/coaches performing the right exercises, but executing them improperly due to faulty recruitment, poor timing, or compensation. In these cases, the athlete looks the part and even appears stable and strong, but are not actually receiving the intended benefit of the exercise. In fact, more times than not, they are potentially making themselves worse.

Enter the ½ kneeling 90/90 External Rotation (ER) Hold. It is a great exercise to teach the baseball player (pitcher or position player) what they should feel and maybe more importantly, what they shouldn’t feel when attempting to build stability and proper alignment in their shoulder.

This exercise is one of many concepts that we discuss in our Elite Baseball Mentorships. With the continued rise in baseball injuries, we have made it our mission to help create an environment for collaborative learning among the leading strength coaches, health care professionals, and pitching instructors/coaches in the world.

Our next Upper Extremity course will be June 15-17, and the early-bird registration deadline is May 15; to learn more, click here

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Is Thoracic Spine Extension Work Necessary? – Part 3

Today marks the third and final installment of Eric Schoenberg's series on thoracic mobility drills - and whether or not they're indicated.  In case you missed them, be sure to check out Part 1 and Part 2.

In the final piece of this series, I want to tie things together with a few foundational concepts that we use in the daily management of our athletes and emphasize in our Elite Baseball Mentorships.

Eric C. has written about the concept of relative stiffness on this blog on numerous occasions.  So, feel free to refer back to his articles for more background information.  Relative stiffness or relative flexibility was introduced to me by Shirley Sahrmann and the incredible faculty at Washington University in St. Louis. This is a pillar of their Movement System Impairment model

Today, I am going to discuss how relative flexibility impacts the thoracic spine and shed some more light on why T-spine extension work is not always necessary in the baseball athlete.          

Relative flexibility describes the relationship of how the amount of stiffness (or tension) in one area of soft tissue (muscles, ligaments, tendons, etc.) results in compensatory movement at an adjoining joint that is controlled by less stiffness.  This relationship can change (positively or negatively) based on the exercises we choose and the manner in which we perform them.

There are countless examples of relative stiffness in the body.  One of the most common examples that we see involves the lumbar spine.  If the lats are stiffer than the anterior core, then the athlete will be more prone to an extended posture. The athlete will compensate with lumbar extension with overhead activity.  The video that I included in part 2 of this series is a good example:

In this video, Lats, lumbar extensors > (stiffer than) Anterior Core = Lumbar extension tendency.

Note: Clearly, there is a lot more involved (fascia, ligaments, structural issues, motor control, relative position of adjacent joints, etc.) than just this simple math problem, but for the scope of this article, we will leave it at this.  This example is fairly straightforward and I think we are all on the same page here.  We would not program activities that would further encourage lumbar extension and drive the improper recruitment and motor pattern.

In this case, we know that simply “stretching” or foam rolling the lats will not work in isolation. We need to go ahead and “stiffen” the anterior core, while at the same time, downregulating the overuse of the lats.  We often will do this by using exericses that encourage a neutral alignment with overhead activity (i.e. wall slides, back to wall shoulder flexion) as well as limiting the amount of carrying by our sides (e.g. deadlifts, dumbbell lunges, farmer’s walks, etc.) and instead, focusing on options like bottoms-up kettlebell carries, landmine presses, and goblet variations.

In the case of someone that is in too much thoracic extension (or relative thoracic flexion), though, things can get a little more confusing.  The athlete will have increased stiffness of the thoracic extensors vs. flexors: Thoracic Extensors > (stiffer than) Thoracic Flexors = Thoracic extension tendency.

However, we often see the emphasis remain on bench T-spine mobs, quadruped extension/rotations, and side-lying windmill variations? This results in two problems:

  1. The athlete will actually become hypermobile (segmentally) and develop a local stability issue. (inverted U-curve)
  2. The athlete has difficulty “getting out of extension” due to increased relative stiffness of the thoracic extensors, lats, and scapulothoracic musculature.

This inability to properly flex the spine at ball release can result in a decrease in the required scapular upward rotation and elevation to maintain proper scapulohumeral and glenohumeral joint congruency.  This is a fancy way of saying that if your upper back isn’t positioned correctly, the ball won’t sit flush with the socket. This process can contribute to some of the shoulder and elbow pathologies that we so commonly see in the throwing population.

Baseball_pitching_motion_2004

There is one more point that needs to be addressed to complete this series – and that is the role of the rectus abdominus in thoracic spine mobility.  In this case, the athlete will present in too much thoracic flexion and may appear as though they would benefit from T-spine extension mobility drills.  However, this athlete will not benefit from these exercises unless we appreciate the following point.

When we cue an athlete to limit his extension or “rib flare” we often say “ribs down”.  This seems like a relatively benign cue to help promote a neutral spine and pelvic orientation.  However, we must be sure that the athlete is able to properly recruit external obliques (often with lower level exercises such as back to wall shoulder flexion or a dead bug variation) to help achieve this movement correction.

The reason for this is that increased stiffness of rectus abdominus (dominance) limits ability of T-spine to move out of flexion (or neutral).  Using our relative stiffness example from before, if: Rectus abdominus > (stiffer than) Thoracic Extensors = Thoracic Flexion Tendency.

Therefore, if an athlete is actually is in too much flexion… i.e. sway back (most commonly - posterior tilt and lumbar extension - hanging on rectus as their anti-gravity muscle), he will have a very difficult time getting out of flexion.  This occurs regardless of how many T-spine drills we prescribe.  This is akin to stretching rectus femoris when someone is stuck in a faulty thoracic and lumbopelvic position.

rfstretch

The best approach in our case above is to “allow” t-spine mobility (extension) to occur by decreasing rectus dominance and getting someone out of T-spine flexion.  I am all for cuing the ribs down and establishing alignment, but HOW we get an athlete to do this is of the utmost importance.  The main point here is forcing T-spine extension in the presence of increased relative stiffness of rectus abdominus is not going to give us results.  In other words, weak external obliques will result in rectus overuse and thoracic “immobility” regardless of how many T-spine mobility drills we include in our programs. 

To summarize, this is a very important (and difficult) concept that – like everything else – requires a trained eye and an individualized approach.  If an athlete has too much thoracic and lumbar extension, this can result in scapular depression and downward rotation via, among others things, excessive lat dominance, which leads to a lot of our shoulder and elbow dysfunction.  On the other hand, too little thoracic extension results in scapular anterior tilt and decreased glenohumeral external rotation (“lay back”), also resulting in dysfunction and pathology. 

As a quick review, you want to be able to answer the following questions before prescribing T-Spine extension exercises:

  • Is there a lack of T-spine extension (or rotation). If not, then why prescribe T-spine extension mobility drills?
  • Where is the extension coming from (upper or lower T-spine, L-spine, C-spine)?
  • Is the athlete already at end-range extension and if so, is our attempt to “gain” extension at end-range creating unwanted motion elsewhere? (hypermobility)
  • Lastly, if an athlete presents with mal-alignment (too much thoracic extension or thoracic flexion): first, identify it, then determine why this is happening prior to simply prescribing a bunch of mobility exercises.

Conclusion

This point, along with many others, is a main reason why we chose to develop the Elite Baseball Mentorship program.  As we gather together in these groups, many conventionally accepted ideas and concepts are questioned and explored and the demand for proof (whether it be from research or experience) requires us all to think more critically.  Most importantly, with baseball-related injuries continuing to rise, this allows us to question the status quo of generally accepted baseball-specific protocols.  Ultimately, this collaboration allows us all to advance the bar and develop a better opportunity for our athletes to meet their goals through better health and performance.

Also, if you are interested in more information like this, we would love to see you at one of our Elite Baseball Mentorships. We'll be hosting these events in June, October, and December of 2014. Please click here for more information.

Author’s Note: I would like to thank Michele Ionno, MS, SPT (Wash U Program in Physical Therapy) for his contribution to the 3rd phase of this blog series.

About the Author

Eric Schoenberg, MSPT, CSCS is co-owner of Momentum Physical Therapy, located in Milford, MA.  He can be reached at eric@momentumpt.com

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Is Thoracic Spine Extension Work Necessary? – Part 2

Today is Part 2 of a detailed series on the thoracic spine from Eric Schoenberg.  If you missed it, be sure to check out Part 1. -EC

At this point, we need to quickly touch on the concept of “neutral.”  This is certainly a hot topic in the physical therapy and strength and conditioning worlds, as it should be.  For our purposes, we like to be clear that when someone is too flexed (i.e. fully slumped posture), our cue is to “extend back to neutral.”  In addition, when someone is too extended, the cue would be to “flex back to neutral.”  This holds true in all segments of the body and in all three planes of motion (e.g. pelvic tilt, genu valgus, etc.)  The problem that we tend to see is we don’t grade our correction and “overcorrect.”  This results in fixing one problem only to create a new one in the opposite direction.  

In Malcolm Gladwell’s new book, David and Goliath, he refers to this as the “inverted U curve.”  Its application here is that IF an athlete truly lacks T-spine mobility, then once we properly gain it, continued efforts to improve (rather than just maintain) this mobility will ultimately create a brand new problem (hypermobility).  This needs to be considered when we write new programs and lends itself nicely to the importance of thorough evaluation and re-evaluations.

invertu

To quickly recap part 1, for the purpose of this series, a cue to “extend the T-spine” is really a case of moving out of excessive flexion and learning to control flexion throughout the throwing motion.

In part 2 of this series, we will focus on the postural alignment and movement examination and its implications in developing an individualized exercise prescription for the athlete.  As a quick side note, it is of particular importance to recognize that the body segments don’t work in isolation.  This is a simple statement; however, when attempting to capture the role of a particular body segment or group of exercises, we are missing the big picture if we try to develop a concept without appreciating the kinetic chain.

In our opinion, the hallmark of an effective examination is the ability to properly identify the athlete’s unique postural alignment and movement tendencies.  These exams must be done with the shirt off to appreciate the bony and soft tissue anatomy. With respect to the thoracic spine, we first identify whether that athlete is in flexion, neutral, or extension.

Here's an example of an athlete with a flattened T-spine, and shoulder blades that have no idea what to do!

FlattenedTSpine

Additionally, we need to appreciate the position of the scapula and its impact on the appearance of perceived thoracic flexion.  An athlete that presents with scapular anterior tilt, abduction, and/or internal rotation can easily fool you into thinking that the athlete’s upper back is “rounded” or kyphotic. An athlete with a flat thoracic spine (hypokyphosis) will have a more prominent scapula due to lack of normal contour of the T-spine and ribcage.  In extreme cases, we will see the following:

1. Hypokyphosis (lack of T-spine flexion)

Hypokyphosis

2. Scheurmann's Disease (greater than 60 degrees, and structural)

Scheurmanns

On x-ray, these cases will show a change in the normal vertebral “wedging.”  The intervention in this case is NOT to attempt to fix the mobility issue, but first determine if the issue is osseous/structural in nature.  Just like any other joint (the hip immediately comes to mind), you can’t stretch bone and any attempt to do so will result in an unhappy athlete!  These are extreme examples, but certainly something that warrants inclusion in this article.

However, more commonly in the physical therapy or strength and conditioning settings, we will see more “middle of the road” cases where there is too much or too little thoracic mobility. As you can see in the lateral view below, this athlete appears to be in excessive thoracic flexion, but it's really just anterior tilting of the scapulae.

SideView

However, in the posterior view, you'd be able to appreciate that the T-spine is relatively extended compared to accepted norms (40° flexion = normal curve). 

Moving forward, static alignment does not tell the whole story, so don’t test it alone and don’t let it fool you.  All too often, I hear people trying to prove a point about pitching mechanics or exercise technique and the only proof is a still photo.  This practice needs to stop because it is impossible to capture the complexity of human movement and make a conclusive statement from a screen shot. This concept is why the combination of the postural exam and movement analysis is so critical.

Athletes don’t get injured when they are standing still. They get injured moving (incorrectly!).  For that reason, watch your athlete’s move.  The concepts of FMS or whatever collection of multi-joint movements you like to combine to form a “movement examination” are great tools to collect data on your athlete’s preferred movement patterns.  However, it is also critical to watch the athlete perform the unique movements of their chosen sport. 

In our case, we like to talk to our athlete’s about pitching and we certainly like to watch them throw.  Asking questions like:  “What do you struggle with mechanically” or “where do you break down when you get tired” gives us valuable insight into movement tendencies and injury risk.  With respect to exercise, we observe closely to make sure we are achieving the desired result of the exercise.  In addition, we ask our athletes where they feel a particular exercise to help determine activation patterns and sequencing (motor control).

In addition to watching our athletes throw/pitch, swing, and/or run, we employ simple movement tests such as standing bilateral shoulder flexion (and abduction) to gather critical information about movement quality, timing, and relative stiffness. 

With respect to the video above, consider the excessive extension moment at the thoracic (and lumbar spine) due to increased relative flexibility resulting from poor anterior core stiffness.  This video brings up a lot of questions in my mind:

  • Does this athlete need more mobility work into thoracic extension? 
  • If he attempted these exercises, how can you be sure the motion will even come from the right place?
  • If an athlete is truly “lax” congenitally, then why would they lack mobility at the T-Spine and nowhere else?  
  • Are you sure his lack of shoulder flexion is due to decreased thoracic mobility? 
  • Or, is he too flexible in his spine and too readily pulls into extension due to the stiffness of his lats? 

My point here is we need to consider the fact that improperly prescribed exercise will make the athlete worse than no exercise at all.  So, if you’re not sure, don’t guess.  Refer out or continue to re-assess until it becomes clear what the athlete needs.

Another simple movement test that we will have the athlete perform is standing thoracic flexion and extension.  Here we will assess the timing (quality), location, and amount of available range of motion that the athlete is working with.

It is also good practice to watch an athlete perform an exercise prior to putting it in his program. 

This athlete (also pictured above) demonstrates faulty movement by not getting out of extension at the top of his pushup prior to initiating the “pike” portion of the yoga push up.  When corrected, in the video below, he did a better job of getting his T-spine in position to allow his scapula to have a better platform to upwardly rotate and elevate as his hands moved overhead.  This was not a mobility issue; this was a patterning or motor control problem.

I should mention that in a full examination, we would consider movement testing of thoracic rotation and sidebending, ventilation, rib cage alignment, quadruped position/movement, etc.  But, for the purposes of this series, we again are choosing to focus primarily on the sagittal plane.  Pay attention to the way in which the athlete returns from flexion to get a good idea of his/her recruitment strategies.

In conclusion, the combination of static posture, movement testing, and unique athletic movement allows us to create a well-rounded profile of the athlete’s strengths and weaknesses.  Be sure that your examination a) identifies areas of limitation that need to be addressed and b) determines the reason why the athlete has these impairments.

In the third and final part of this series, we will discuss the concepts of relative flexibility and motor control as it relates to the topic of thoracic spine extension.

Also, if you’re interested in more information like this, we would love to see you at one of our Elite Baseball Mentorships, with the next one taking place in June. Click here to learn more.

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Is Thoracic Spine Extension Work Necessary? – Part 1

Today’s guest post comes from my friend and colleague, physical therapist Eric Schoenberg.  Eric is an integral part of our Elite Baseball Mentorships, and here, he kicks off a three-part series that I think you'll find very educational - even if it is a bit "geeky" along the way.  It'll test what you know and make you question some of the stuff you do with your training and work with clients. -EC

I’ll start by saying this is a classic case of giving an athlete what they need, not what we predict or assume they will need.  Let’s be clear up front: there are a lot of athletes that lack thoracic extension and rotation and certainly can benefit from T-spine mobility work.  This is especially true for your general population clients that live in flexion all day – although not every “average joe” is stuck in flexion; this is a wrong assumption!  However, for the purpose of this series, I am going to make a case for the following statement:

Not every individual - especially in baseball populations - needs thoracic extension and rotation mobility drills!  

In fact, to take it a step further, I would argue that in some cases, performing these types of exercises will actually make the athlete worse.

During our Elite Baseball Mentorship in August, I mentioned in passing during the postural examination portion of the breakout session that a lot of athletes present with flattened thoracic spines and some are actually relatively extended.  I followed this up by stating that some people don’t really need any T-Spine extension work.  This simple statement was met with a lot of surprise and follow up questions.

As a result, Eric and I thought it would be a good idea to explore this concept in greater detail.  As is often the case, a relatively benign statement takes on a life of its own and turns into a multi-part blog series.  As we develop these concepts, please feel free to share your thoughts and experiences in the comments section below.

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The general assumption of the group was that everyone was kyphotic and T-spine extension was a default group of exercises that EVERY athlete needed.  This premise, however, does not take into account a host of key considerations, such as:

  • Defining T-Spine Extension. (part 1)
  • Anatomy and role of the Thoracic Spine, (part 1)
  • Scapulothoracic joint kinematics, (part 1)
  • Importance of a thorough static postural alignment and movement examination, (part 2)
  • Scapular position/prominence, (part 2)
  • Effect of the T-Spine on adjacent joints such as cervical spine, lumbar spine, pelvis, scapula, humerus, and ribcage, (part 2)
  • Concept of relative stiffness, (part 3)
  • Faulty motor control resulting in limited thoracic flexion (yes, lack of flexion!), (part 3)
  • Timing and amount of relative T-spine extension and rotation in the pitching delivery. (covered in part recently by Matt Blake and Eric C. here and here.)

174px-Gray_111_-_Vertebral_column-colouredIn an attempt to properly define thoracic spine extension with respect to the baseball player, we must first look at functional anatomy. The thoracic spine, with its rib attachments from T1-T10, is built for stability – most notably to protect the internal organs.  In addition, the T-spine has thinner intervertebral discs, a feature that adds to its relative inflexibility.  The sagittal alignment of the thoracic spine is kyphotic: 40 degrees in adults. (Neumann D.A. 2002).  With that said, we are not really talking about the T-spine being “extended”, but instead are talking about the relative amount of flexion that an athlete is in.  With that description, it’s important to appreciate that T-spine extension drills are working to put an athlete into an acceptable amount of flexion!  It is this flexion (or convexity) that provides a surface for the concave, ventral surface of the scapula to “float” on and create the scapulothoracic joint. (medial border of scapula and ribs 2-7).

For these reasons, we need to not just label an athlete as being “kyphotic” or having a “flat T-spine.”  Instead, we should attempt to define which segments of the T-spine have static or dynamic alignment issue and/or movement dysfunction and address them accordingly.

An important concept to look at is the T-spine is comprised of 12 vertebrae, so we will often find components of flexion, extension, and rotation within those 12 segments. Crosbie, et al. reports that the majority of T-spine extension occurs in the lower T-spine during overhead arm movement. This makes sense due to the thoracolumbar junction and the shape of the lower thoracic vertebrae.  The T10-T12 vertebrae are similar in size and function to the lumbar vertebrae.  T10 has a different rib articulation than T2-9 and T11/T12 have no facets on their transverse process for rib attachments (thus, increasing relative mobility).  So, more often than not, when we see anterior pelvic tilt, and lumbar extension compensation, we can assume that the lower T-spine is doing the same thing.  So what if, for the purposes of this article, we grouped the lumbar spine as T10-L5?

Gray91

As a quick aside, it is recognized that the thoracic spine moves in three planes of motion.  More specifically, with respect to the frontal and transverse plane, with single arm elevation, the upper T-spine (T1-T5) has ipsilateral coupling of the lateral bending and rotation, whereas in the mid-lower T-spine T6-T12, we see contralateral coupling of lateral bending and rotation.  So in the frontal and transverse planes, the T-spine essentially works as two distinctly different subgroups.  This is important to consider when prescribing exercises to address a perceived movement impairment.  In addition, it is important to remember that the thoracic spine and hips (along with a stable lumbar spine) provide the rotational separation needed to excel in the game of baseball. However, for the purposes of this article, we will focus on the sagittal plane motion of flexion/extension.

As we continue to look at the sagittal plane, but shift our focus to T1, we see a smaller vertebrae (see picture above) that more resembles C7 (and other cervical vertebrae) than the caudal segments (T2-T9).  A case can be made that T1 (cervicothoracic junction) functions more like a cervical vertebrae than a thoracic vertebrae.

This leaves us with T2-T9: eight segments with an extreme mobility problem!  This is where we are really trying to mobilize “out of too much flexion” to get to an acceptable (neutral) position to allow for enough scapular (namely upward rotation and elevation) and glenohumeral motion to give us enough “space” to throw a baseball without causing an impingement.

So how can we be sure that we are following all these rules in three planes of motion when we are performing our T-spine mobility drills?  Are we in fact gaining motion in the correct segments within the context of their coupled motions?  Or, are we simply “mobilizing” what moves easiest and taking the “path of least resistance”?

Check back later in the week for part 2 of this series to read more about evaluation of static alignment and movement testing.  In addition, we will discuss how scapula position can fool us and (in part 3) how too many “abs” can be a bad thing.

In addition, if you’re interested in more information like this, we would love to see you at one of our Elite Baseball Mentorship, with the next one taking place in June. Click here to learn more.

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Register Now for the 2nd Annual Cressey Performance Fall Seminar

I’m psyched to announce that on Sunday, September 22, we’ll be hosting our second annual fall seminar at Cressey Performance.  As was the case with our extremely popular fall event last year, this event will showcase both the great staff we're fortunate to have as part of our team.  Also like last year, we want to make this an affordable event for everyone and create a great forum for industry professionals and fitness enthusiasts alike to interact, exchange ideas, and learn.

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Here are the presentation topics:

Cracking the Crossfit Code - Presented by Eric Cressey

Let's face it: Crossfit is here to stay.  With that in mind, it's time for someone to take an unbiased look at how we can make coaches and fitness enthusiasts successful within the scope of this training system.  In this presentation, Eric will look past the emotions people have with respect to this approach, and discuss rationale ways to accentuate the positives while offering solutions for the shortcomings. In short, the goal is to bring people together, not drive two sides further apart.

Training Joe vs. Jane:  Do Women Need to Train Differently Than Men? – Presented by Tony Gentilcore

Should women avoid lifting appreciable weight?  What are the most effective strategies for training women through pregnancy? Is there such a thing as an ACL-Prevention Program?

In this presentation, I will discuss many of the common misconceptions and "myths" relating to training female athletes.  I intend to provide extensive responses and feedback to some of the most frequently asked questions I have encountered relating to the art of strength training for women.

Insulin: The Hormone, The Myth, The Legend – Presented by Brian St. Pierre

Carbs spike insulin and insulin causes fat gain. So, cut the carbs and you'll end up lean and healthy. End of story. Or is it?

While the Paleo and low carb camps loudly proclaim that carbs and insulin are the enemy, the latest science suggests otherwise. In fact, we're starting to learn that high insulin is an effect of being overweight, not a cause. In this session, Brian will explore the real relationship between carbs and insulin, discussing some of the common myths about insulin, and sharing some practical eating strategies you can put into action immediately.

Integrating Corrective Exercise for Performance Enhancement – Presented by Mike Reinold

Often times, muscle imbalances, alignment issues, and movement impairments can lead to injury and decreased performance.  However, corrective exercises are often unsuccessful for various reasons.  By focusing on several key principles, you can maximize your ability to apply corrective exercises to optimize movement and enhance performance.

Getting To Know Your Athlete: Understanding Learning Styles to Be a More Effective Coach – Presented by Chris Howard

In this presentation, I will discuss the different learning styles and how knowledge of this information is helpful in becoming a more effective coach.  I will also delve into the differences between introverted and extroverted clients and how it is necessary to coach and assess them differently.

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Excellence In Group Training – Presented by Greg Robins

Group training, small group training, and bootcamps are here to stay. Let me help you understand how I manage the variables associated with group training to optimize a less than ideal scenario. The information presented will be sure to help everyone from the strength and conditioning specialist to commercial fitness professional alike.

The Role of Physical Therapy in a Strength and Conditioning Facility – Presented by Eric Schoenberg

Physical Therapy earns little respect in strength and conditioning circles due to the inability of traditional PTs to properly progress a patient from injury to high-level activity.  This lack of versatility has contributed to an increased role of the strength and conditioning professional in the care of the injured athlete.  But, is there a role for Physical Therapy in the training world?  Physical therapist Eric Schoenberg will share his thoughts on why partnering with the right physical therapist can add great value to your business and improve results for your clients.

Location:

Cressey Performance,
577 Main St.
Suite 310
Hudson, MA 01749

Cost:

Regular – $149.99
Student (must present current student ID at door) – $129.99

Date/Time:

Sunday, September 22, 2013
Registration 8:30AM
Seminar 9AM-5:30PM

Continuing Education:

0.7 NSCA CEUs (seven contact hours)

Click Here to Sign-up (Regular)

or

Click Here to Sign-up (Students)

We’re really excited about this event, and would love to have you join us! However, space is limited and each seminar we’ve hosted in the past has sold out quickly, so don’t delay on signing up!

If you have additional questions, please direct them to cresseyperformance@gmail.com. Looking forward to seeing you there!

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