Today’s guest post comes from my friend and colleague, physical therapist Eric Schoenberg. Eric is an integral part of our Elite Baseball Mentorships.
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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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:
The athlete will actually become hypermobile (segmentally) and develop a local stability issue. (inverted U-curve)
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.
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.
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.
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.
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!
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)
2. Scheurmann's Disease (greater than 60 degrees, and structural)
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.
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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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.
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.)
In 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?
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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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.
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.
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
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!
Today’s guest post comes from my friend and colleague, physical therapist Eric Schoenberg. Eric is an integral part of our Elite Baseball Mentorships.
The ability to properly assess, interpret, and manage hip range of motion (specifically rotation) is a critical skill in preventing injury and improving athletic performance in a baseball player. Proper hip rotation sets up better alignment and direction in the pitching motion which sets up proper pelvic and trunk rotation and an improved ability to generate torque. Stodden, et al. reports a direct correlation between increased hip rotation ROM and increased throwing velocity.
As we covered in Phase 1 of the Elite Baseball Mentorship , a pitcher who does not internally rotate fully through the back hip will tend to land closed-off. While some pitchers may use this to improve deception or get more movement on their pitchers, this positioning can lead to the pitcher (especially a less experienced one) to either miss high and arm side or attempt to throw across his body and cut the ball. The pitcher will in turn try to “make up” velocity with his arm/shoulder due to the movement faults in the kinetic chain. This compensation is a very common cause of shoulder and elbow injury in pitchers.
Additionally, Kibler, et al. notes that kinetic chain deficits are discovered on examination in a majority of patients with SLAP (superior labrum anterior-posterior) injuries. Deficits in hip abductor or extensor strength, deficits in hip rotation flexibility, or core strength weakness have been identified in 50% of SLAP injuries.
In Phase 1 of the mentorship program, we discussed in great detail the importance of understanding total motion of the shoulder as a key risk factor in pitching injuries. A recent study from Garrison, et al. once again demonstrated that total ROM (ER + IR) is a better metric for predicting injury risk than GIRD (Glenohumeral Internal Rotation Deficit).
These same concepts also apply to the hip. However, there are fewer research studies and less consistent findings of hip ROM norms in rotational athletes. In addition, you will see some clear differences in ROM based on position (pitcher vs. hitter) which need to be appreciated when designing training and rehab. programs.
Tippettreports increased hip IR in the trail leg (vs. lead leg) of college baseball players. In contrast, Hills (2005) reported no significant difference in hip IR between the back hip and lead hip in hitters, however hip ER and total ROM was significantly greater in the back hip. Whereas, Laudner, et al. notes that in pitchers, there is less internal rotation of the trail leg than position players resulting in a less effective and potentially more dangerous throwing motion.
Anecdotally, as we look at the lead leg in a hitter, internal rotation force often exceeds available hip internal rotation ROM resulting in microtrauma to passive structures and resultant instability of the hip (i.e. abnormal gliding and shear forces of the femoroacetabular joint). As a result, and similar to the shoulder, the athlete will lose dynamic stability (motor control) causing unequal distribution of force on the weight bearing surfaces and finally osseous (bony) or labral pathology ensues.
Finally, from a strength prospective, there is a clear difference between recruitment patterns used to hit a baseball vs. throw a baseball. EMG studies by Shaffer and Jobe et al. show hitters rely much more on the lower half and core for power development and transfer, while using the upper extremity/hands more for position and direction. On the other hand, pitchers seem to rely more on energy created in the core and upper extremity, potentially placing pitchers at an increased risk for upper extremity injury.
Key Takeaways
1. Failure to properly identify and correct hip ROM deficits (especially lack of hip internal rotation in pitcher’s drive leg) will result in increased injury risk throughout the kinetic chain.
2. Asymmetrical rotational patterns in baseball players result in need for training and rehabilitation programs to work rotation in both directions.
3. Continued proof of the need to respect structural changes (i.e. retroversion) as well as position specificity (i.e. pitcher vs. position player) in developing effective training and rehabilitation programs.
4. From a treatment perspective, don’t just rush to stretching what seems “tight”. Consider the principles of relative stiffness, pelvic alignment, breathing patterns, and lumbopelvic stability before we start cranking away at the hip joint.
If you would like more information regarding the mentorships, please visit our website, www.EliteBaseballMentorships.com. The early bird registration deadline for the August 18-20 Phase 2 Mentorship is this Thursday, July 18, 2013.Click here to register.
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Today’s guest post comes from my friend and colleague, physical therapist Eric Schoenberg. Eric is an integral part of our Elite Baseball Mentorships.
One of the topics that came up most commonly in the course evaluations and feedback from our first Phase 1 Elite Baseball Mentorship in January was “how lucky” Eric, Matt, and I are to have such a great facility (CP) to work in and “how nice it must be” to have strength and conditioning, pitching instruction, and physical therapy all under one roof (or in very close proximity to each other).
The truth is, professional relationships do not just happen unless you make them happen. Coaches, business owners, medical professionals, and athletes themselves don’t let just anyone into their circle. People are skeptical by nature and need to know that you care and are not a threat to their goals, reputation, or career. However, once trust is established, then the foundation for success in any partnership (i.e. coach/player, strength coach/physical therapist) can be built.
At the center of every great performance team must always be the athlete. I suggest making this the first criteria you look for when building a great network of performance coaches, medical professionals, and athletic coaches.
The success of any coach or medical professional is measured by the success of the athletes or teams with whom they work.
It is important to surround yourself with people that understand and follow this very simple concept. High level athletes have had people trying to latch onto them from a very young age. They are very skilled at seeing right through people with egos who don’t have their best interest at hand. This is the quickest way to lose credibility in our field.
In response to the feedback from our last mentorship, I've outlined five principles (non-clinical) below that you can use to help build a strong network to ensure better results for your athletes.
1. Communication: Be clear and concise. Don’t leave anything to chance or assume that everyone is on the same page. I have seen countless examples of athletes failing in physical therapy, training, or following a throwing program because any combination of the doctor, PT, strength coach, skill coach, or parent were unclear with their communication. In addition, it is a simple courtesy to keep referral sources current with the progress of their athletes. Failure to communicate is a sure way to end a professional relationship.
2. Time:
Donate your time: Show that you care. Ask and expect nothing in return. Have the best interest of the athlete in mind (always). Understand that it is not about you. Show that you can add value and provide a service that is not currently being met. Along the same lines…
Respect other people’s time: Don’t just “show up” unannounced at someone’s office, gym, or field and expect them to give you time. Be professional and set up a meeting that works for the person you are trying to work with. Better yet, ask them a good time that you can come by and observe and then go out of your way to offer your services to one or their athletes on the spot. This goes a long way to establish selflessness and credibility.
3. Understand and respect each person’s role: Don’t try to be all things to all people. Be good at what you do and don’t try or claim to be an “expert” at everything. Surround yourself with people that challenge you and know more than you in certain areas (but make sure you know more than them about something or you will be phased out!) Understand the strengths and weaknesses of yourself and the people in your immediate network. Observe often and learn as much as you can about each person’s role. Eric Cressey and Matt Blake know more about physical therapy and human movement than the vast majority of licensed physical therapists on the planet. However, they don’t claim to be a PT, they understand ethical boundaries, and they respect scope of practice.
4. Know your role (really well!): Never stop learning. Stay open minded on things you have yet to learn. You owe it to your athletes and your network to be an authority and trusted resource in your field. However, it’s critical to have the confidence to know when to refer out. You don’t need to be the hero all the time. At the end of the day, if the athlete succeeds because you had the humility to refer them to someone that could help them more than you, then you did your job. Remember, you will gain respect if your athletes get better, regardless of who gets the credit at the end.
5. Swing for the fences: Once all your hard work and patience finally pays off and you “get your shot” to work together with a particular coach, PT, or athlete, knock it out of the park. In our fields, we have moments (successes or failures) that allow us to either gain or lose the confidence of the people that we are trying to impress. Be prepared for the situation and get results. Remember to always be confident and overdeliver.
A founding mission of the Elite Baseball Mentorships is to develop a national network of qualified professionals in the baseball community that share a similar philosophy in managing baseball players. This is pivotal in keeping athletes healthy and allowing them the best opportunity for success in their careers.
If you would like more information regarding the mentorships, please visit our website, www.EliteBaseballMentorships.com. The early bird registration deadline for the June 23-25th Phase 1 Mentorship is: May 23, 2013. Click here to register.
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Today's guest post comes from my friend and college, physical therapist Eric Schoenberg. Eric is an integral part of our Elite Baseball Mentorships, and will be contributing more and more regularly here to outline some of the topics we'll cover in these mentorships.
As this great article from Tom Verducci at Sports Illustrated pointed out a few years ago, injuries cost MLB clubs $500 million dollars (an average of $16+ million/team) in 2011. In addition, over 50% of starting pitchers in MLB will go on the disabled list each year. Although there are many factors that contribute to these staggering numbers, an overwhelming majority of these injuries are due to five simple words:
"You Get What You Train."
This saying was made popular by the great physical therapist Shirley Sahrmann in her work at Washington University in St. Louis. This premise (in baseball terms) covers almost every issue that we encounter in the areas of injury prevention and performance enhancement. Here are some examples to illustrate the point:
If a pitcher is allowed to throw with bad mechanics (misuse), the result is a kid who is really good at throwing wrong and an increased risk of injury.
If high pitch counts (overuse) are allowed at a young age, the result is a pitcher throwing with fatigue, mechanical breakdown, and ultimately decreased performance and injury.
If a pitcher “throws with pain” (poor communication) due to pressure from coaches, parents, and teammates (culture of baseball), the result is compensated movement, decreased performance, and ultimately injury.
If a “one-size fits all approach” is rolled out in a strength and conditioning program or a pitching academy, then the result will be a program that doesn’t adequately “fit” anyone.
If performing “arm care programs” and long toss programs incorrectly before a game or practice is the norm, then the result will be athletes that are improperly “tuned” neurologically and fatigued before they even step on the mound for their first pitch.
If a hypermobile athlete performs a stretching program to “get loose”, then the result will be an athlete that has more instability than he can handle ultimately will get injured.
If we teach an athlete to get his shoulder blades “down and back” when his throwing shoulder is already depressed and downwardly rotated, then what we get is more strength in a dysfunctional position.
If we don’t teach proper movement, then we will get exactly what we train. The correct exercise performed incorrectly is a bad exercise.
This point is illustrated in the videos below. In the first video, the only instruction given to the athlete was to hold the top of a pushup on the elevated surface. As you can see, there is clear dyskinesia in the scapulae which if repeated without correction would result in reinforcement of the faulty movement pattern. Without actually seeing the shoulder blades (shirt off) or at the least putting your hands on the athlete, this faulty pattern is missed and the athlete will get worse.
In the next video, the athlete is instructed to get into the same position, however the athlete is cued to “engage the shoulder blade muscles and don’t let the shoulder blades come off your ribcage”. This simple cue can be coupled with some manual correction to activate the proper muscles to achieve a proper movement pattern.
In summary, both of these videos can be called a “pushup hold” or “elevated plank,” but only one achieves the desired movement and activation pattern.
This concept of “you get what you train” becomes a bigger problem when you realize that baseball players rarely play for the same coach or in the same “system” for more than a year or two (different leagues/levels, coaching changes, etc.). In addition, it takes a while before faulty movements and overuse reach the threshold where an athlete becomes symptomatic. As a result, there is no direct cause and effect and no “blame” to assign. A coach that overuses a kid in his 13 year-old season is never identified to be the actual cause of that same kid’s UCL tear in his 16 year-old season. This lack of accountability is a huge factor in the injury epidemic across all levels of baseball.
The goal of the Elite Baseball Mentorships is to bring together leaders in the baseball and medical communities in an effort to be proactive and share ideas to help improve the overall health of the game of baseball and its players. We'd love it if you'd join us for one of these events; please visit www.EliteBaseballMentorships.com for more information.
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As many of you know, my colleagues Matt Blake, Eric Schoenberg, and I introduced our Elite Baseball Mentorships program back in the fall, and the first phase 1 event in early January was a big success. Attendees included strength and conditioning coaches, baseball coaches, physical therapists, athletic trainers, massage therapists, and chiropractors - and the feedback was fantastic.
On this page, you'll be able to find information on the agendas and dates for upcoming courses, see testimonials from previous attendees, and register to take part in the fun. Our next two events will be June 23-25 (Phase 1) and August 18-20 (Phase 2).
As a participant, you'll attend lectures, review case studies, observe training, and interact with hundreds of high school, college, and professional baseball players. We feel strongly that these events provide the premier baseball education experience in the industry, and we'd love an opportunity to show you why.
Over the next few weeks, we'll be featuring some guest blogs from CP pitching coordinator Matt Blake and physical therapist Eric Schoenberg to complement my own writing so that you can get a feel for how this provides a unique, multi-disciplinary educational opportunity. In the meantime, be sure to check out www.EliteBaseballMentorships.com to learn more and sign up, as we expect these to sell out quickly.
All the Best,
Eric Cressey
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Here's this week's list of tips to fine-tune your nutrition and strength and conditioning programs, compliments of CP Coach Greg Robins.
1. Improve your squat by starting neutral.
2. Remember: “Everything should made as simple as possible, and not simpler.”
At Cressey Performance, we are fortunate to be in an environment where we are constantly learning.
As an example, this past week we had a spectacular in-service delivered by Eric Schoenberg of Momentum Physical Therapy and Performance. Eric is someone with whom we work closely. I respect Eric immensely as he has the rare ability to make things simple. When I hear him speak, I am reminded of the quote from Albert Einstein:
"Everything should made as simple as possible, and not simpler."
In his presentation, Eric made one point in particular that really hit home with me.
His talk mainly focused on helping us create a united front on how we coach many of the arm care and movement drills used by our athletes; as many of them swing between his clinic and our gym floor. When pressed with questions on the specifics of these exercises (where should the shoulder blades be, what muscle are making this happen, that happen, etc?) he stressed the importance of making the movement just look and feel good.
If it looks good and feels good, it’s probably good. If it looks like poop, and feels like poop, it’s probably poop.
Makes sense, right? Everyone is a little different, and everything may measure out to be a little different, but it holds true in the majority of cases.
However, there are times when it might look good to the eye and feel fine to the athlete, but not actually be good. These are the cases we don’t want to make simpler. As an example, what if an overhead squat looks phenomenal, but when you assess the individual on the table, you notice considerable tissue shortness at the hips? These individuals may have phenomenal core stability to overpower their stiff hips, but still need to work hard on tissue length to prevent injury.
Focus on making things look good, and know what “good” looks like, and you’ll be in a great position 90% of the time. However, don’t ever forget about that 10%.
3. Get out of extension before bridging exercises.
4. Make water less boring.
I strive to drink a gallon of water every day. And, 80% of the year, I accomplish that objective just fine. I don’t dislike the taste because, well, it doesn’t taste like anything.
However, I guess the lack of taste is why I sometimes find myself falling off the wagon. When I can’t stand the thought of drinking another ounce of water, I simply spice it up. For many of you, doing so may be just what you need to start making hydration more enjoyable. It seems like a stupidly obvious suggestion, but I guarantee that half of the people who read this don’t drink enough water. I also guarantee they would if it tasted like something worth putting in their mouth.
We all know the benefits of cooking ahead of time. If you are struggling to drink enough water, then prepare a few gallons of flavored water ahead of time, too. Squeeze in lemons, limes, grapefruit, oranges, or anything else you want to include. Spread throughout the entire gallon, the squeeze of half of an orange is going to add a trivial amount of calories to your intake; don’t get worked up about it.
5. Overhaul your dishware for portion control.
Here is an easy tip to control portion size without even thinking about it. Take a look at your dishes: I’m willing to bet they are pretty massive. If you’re in the market for new kitchenware, or just looking for a strategy to reduce calorie intake, consider downsizing your plates and bowls. If there’s less to fill, you will be forced to consume a smaller helping.
Additionally, this is a great strategy for damage control at holiday parties. Many times, people will offer dinner plates and smaller plates for appetizers and desserts. Choose the smaller plate and limit yourself to what you can fit on top. This is another simple tip, but an incredibly effective way to make your nutrition program more successful if you struggle with portion control.
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