Home Posts tagged "GIRD"

Random Thoughts on Sports Performance Training – Installment 35

It's a new month, so here's a new installment of Random Thoughts on Sports Performance Training. This month, it won't be quite so random, as I want to hone in on shoulder stuff because today is the last day to get $40 off on my popular resource, Sturdy Shoulder Solutions. Just head to www.SturdyShoulders.com and enter coupon code OFFSEASON19 to get the discount.

Now, let's get to the new content:

1. The neck is the easiest place to start with cleaning up shoulder movement.

I've written a lot in the past about how our arm care programs work proximal to distal, meaning that we focus on the center of the body before the extremities. Usually, the right proximal changes yield immediate distal improvements both via reducing protective tension and reducing stiffness in the muscles we're trying to "overpower" to create good movement. Usually, though, when it comes to proximal changes, folks look at the thoracic spine and rib cage only. In reality, the cervical spine ought to take precedence over both of them - particularly because all the nerve of the upper extremity originate from the brachial plexus, which ranges from C5 to T1.

Fortunately, while it might be anatomically correct, coaching optimal positioning in the neck is actually very simple in the context of weight training and arm care drills: get it to neutral and keep it there. In 99% of cases, that means getting people out of upper cervical extension, which fires up the levator scapulae (which competes against all the scapular upward rotation we want). Here's a video that walks you through what you need to know:

The thoracic spine and rib cage are sexy right now, but the cervical spine is an older, reliable option for cleaning up movement quickly in just about everyone.

2. Whenever possible, get core control integrated in your arm care drills.

I often come across arm care protocols that literally have athletes laying on a table for 30 minutes worth of "exercise." This not only leads to a disengaged athlete, but also overlooks the fact that the entire kinetic chain needs to be synced up to keep a shoulder healthy. We'll often use predominantly table-based exercises in month 1 to make sure athletes are picking up the technique in a controlled environment, but in almost all scenarios, these table drills are actually "fillers" between sets of strength training exercises that have the athletes up and around in the gym.

More importantly, after that first month, I try to make sure that at least half of our arm care exercises are done separate from the table. Maybe we do our horizontal abductions in a side bridge position, or integrate more bottoms-up carries or bear crawls for serratus activation. Perhaps the prone trap raises take place on a stability ball, or we shift to a TRX Y instead. Or, we could move the athlete to half-kneeling, split-stance, or in a rear-foot elevated position for their 90/90 external rotation holds.

Regardless of what we choose, the buy-in from athletes is definitely better - and just as importantly, the resulting training effect has a more specific carryover to sporting success.

3. Yet another study reminds us that GIRD is a measurement and not an actual pathology.

Glenohumeral internal rotation deficit (GIRD) was all the rage in the baseball sports medicine community for decades. Unfortunately, what many practitioners fail to appreciate is that GIRD can be a completely normal finding as long as an individual's total motion is symmetrical between throwing and non-throwing shoulders. We expect to see less internal rotation and more external rotation in a throwing shoulder because of retroverion in the throwing shoulder; the arc is just shifted. Here's a glimpse at what it looks like:

 

Today is Day 12 of #30DaysOfArmCare. Thanks to #Tigers pitcher @adamrav12 for the assist! Key takeaways: 1. Retroversion is a common finding and throwing shoulders. It gives rise to greater lay-back at max external rotation. 2. The more passive range of motion you have, the more consistently you must work to maintain active stability of that ROM. ROM without stability is injury risk. 3. Perform your cuff work in the positions that matter - and keep in mind that individual differences in passive ROM may be present. 4. Don't stretch throwers into external rotation, especially if they already have this much lay-back! Follow #30DaysOfArmCare and @cresseysportsperformance for more tips to keep throwing arms healthy. #cspfamily #armcare #baseball #mlb

A video posted by Eric Cressey (@ericcressey) on

Anyway, we are now at a point in time where more and more research on GIRD is out there, and it's pretty resounding: it doesn't predict injury as well as we once thought. And, more importantly, the opposite seems to be true: a loss of external rotation (usually from a combination of less retroversion and soft tissue limitations) equates to a greater injury risk. We need to get more of the "GIRD? So What?" literature into the hands of doctors who aren't familiar with the latest research, as many are still making "GIRD" diagnoses when they really are just range-of-motion measurements. I delve into this in great detail in the Sturdy Shoulder Solutions product, but figured another study reiterating the point can't hurt. This one - Relationship Between Glenohumeral Internal Rotation Deficit and Medial Elbow Torque in High School Baseball Pitchers - just found that GIRD wasn't associated with medial elbow torque in high school pitchers.

It's time to move on from GIRD!

4. If you're about to have shoulder surgery (or any surgery), get your Vitamin D checked.

For years, we've known that having an adequate Vitamin D status was important for a myriad of biologic functions. Perhaps the most well known among observations on this front was a 2015 study of NFL players that demonstrated that players with inadequate preseason Vitamin D levels were more likely to have suffered a lower extremity or core muscle injury. In fact, the likelihood of a hamstrings injury was 3.61 higher in those with inadequate vitamin D levels! As such, it's become a big area of focus in the nutrition and supplementation world for athletes.

However, I've honesty never heard of an orthopedic surgeon looking at it for those who either have chronic pain or are about to undergo a surgical intervention to treat a structural defect. We need to change that, though. A recently published study, Preoperative Vitamin D Deficiency Is Associated With Higher Postoperative Complications in Arthroscopic Rotator Cuff Repair, should help in that goal, though. Patients with pre-operative Vitamin D deficiency were 1.54 times more likely to require a revision surgery and 1.16 times more likely to require manipulation under anesthesia to overcome post-op stiffness.

Clearly, Vitamin D has a huge link to soft tissue health, so don't overlook it!

Wrap-up

I'm a shoulder nerd and could ramble on all day on this stuff, but instead, I'll direct you to check out Sturdy Shoulder Solutions, particularly at the great $40 off discount we've got in place through tonight at midnight. You can learn more at www.SturdyShoulders.com.

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Strength and Conditioning Stuff You Should Read: 9/26/13

Here's this week's list of recommended strength and conditioning reading:

Hacking Sleep: Engineering a High Quality, Restful Night - Brian St. Pierre goes into great detail on how to improve sleep quality in order to optimize recovery and fitness progress.

What You Need to Know About GIRD - Mike Reinold put together a great review of the literature and outlined the common mistakes he sees with respect to glenohumeral internal rotation deficit (GIRD).  This is stuff that Mike and I discuss literally every week, so I'm glad he's finally put it into a comprehensive article.  If you're a coach who is universally prescribing sleeper stretch to all your players, this is must-read material; you'll reconsider it after you're done.

Injuries are an Opportunity - Andrew Ferreira is a CP pro guy in the Twins system, and he offered this great insight on how you can't just have a pity party when you get hurt; you have to use it as an avenue through which you can get better.

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Baseball Showcases: A Great Way to Waste Money and Get Injured

Q: I read your blog here the other day about your "ideal competitive year" for a baseball player.  What's your take on showcases and college camps?  They always occur during the "down periods" you mentioned: fall ball and the early winter.  How do these fit in to a baseball player's development?

A: To be blunt, while there are some exceptions to the rule, they rarely fit into development. In reality, they usually feed into destruction - at least in the context of pitchers.  I openly discourage all our young athletes and parents from attending them almost without exception.

I know of very few showcase directors and college baseball coaches who legitimately understand anatomy, physiology, the etiology of baseball injuries, the nature of adolescent development, or motor skill acquisition.

Showcase directors specialize in promoting and running showcases.  College coaches specialize in recruiting players, developing talent, planning game and practice strategy, and winning games.  To my knowledge, understanding scapulohumeral rhythm and the contributions of a glenohumeral internal rotation deficit (GIRD) to SLAP lesions via the peel-back mechanism isn't all in a day's work for these folks.

nomo

The fundamental issue with these events is their timing.  As you noted, they almost always occur in the fall and winter months.  Why?

1.  It's the easiest time to recruit participants, as they aren't in-season with their baseball teams.

2. It's not during the college baseball season - so fields and schedules are open and scouting and coaching man-power is free.

You'll notice that neither #1 or #2 said "It's the time of year when a pitcher is the most prepared to perform at a high level safely."  It is just profitable and convenient for other people - and that occurs at the expense of many young pitchers' arms.

In 2006, Olsen et al. published a fantastic review that examined all the different factors associated with elbow and shoulder surgeries in pitchers by comparing injured pitchers (those who warranted surgery) with their non-injured counterparts.  Some of the findings of the study:

-Pitchers who eventually required surgery threw almost EXACTLY twice as many pitches as the control group (healthy pitchers) over the course of the year...from a combination of pitches per outing, total outings, and months pitched per year.  For those of you who think your kid needs to play on multiple teams simultaneously, be very careul; add a team and you instantly double things - at least acutely.

-The injured pitchers attended an average of FOUR times more showcases than non-injured kids.

-Interesting aside:  injured pitchers were asked what their coaches' most important concern was: game, season, or athlete's career.  In the healthy group, they said the coach cared about the game most in only 11.4% of cases. In the injured group, it was 24.2%!  These crazy little league coaches are often also the ones running the showcases...

The big problem is that these issues usually don't present until years later.  Kids may not become symptomatic for quite some time, or pop NSAIDs to cover up the issues.  They might even go to physical therapy for a year before realizing they need surgery.  It's why you see loads of surgeries in the 16-18 year-old population, but not very often in 15 and under age groups.

elbowsurgery

So why are appearances like these in the fall and winter months so problematic?  Well, perhaps the best way I can illustrate my point is to refer back to a conversation I had with Curt Schilling last year.

Curt told me that throughout his career, he had always viewed building up his arm each year as a process with several levels.

Step 1: Playing easy catch
Step 2: Playing easy catch on a line
Step 3: Building up one's long toss (Curt never got onto a mound until he'd "comfortably" long-tossed 200 ft.)
Step 4: Throwing submaximally off a mound
Step 5: Throwing with maximum effort off a mound
Step 6: Throwing with maximum effort off a mound with a batter
Step 7: Throwing with maximum effort off a mound with a batter in a live game situation
Step 8: Opening day at Fenway Park in front of 40,000+ people

curt-schilling1

Being at a showcase in front of college coaches and scouts with radar guns is Step 8 for every 14-16 year old kid in America.  And, it comes at the time of year when they may not have even been throwing because of fall/winter sports and the weather.  Just to be clear, I'll answer this stupid question before anyone asks it: playing year-round and trying to be ready all the time is NOT the solution.

I can honestly say that in all my years of training baseball players, I've only seen one kid who was "discovered" at a showcase.  And, frankly, it occurred in December of his junior year, so those scouts surely would have found him during high school and summer ball; it wasn't a desperate attempt to catch someone's eye.

I'll be honest: I have a lot of very close friends who work as collegiate baseball coaches.  They're highly-qualified guys who do a fantastic job with their athletes - but also make money off of fall baseball camps.  I can be their friend without agreeing with everything they do; there is a difference between "disagree" and "dislike."

Fortunately, the best coaches are the ones who go out of their way to make these events as safe as possible, emphasizing skill, technique, and strategy improvements over "impressing" whoever is watching.  So, it's possible to have a safe, beneficial experience at one of these camps.  I'd encourage you to find out more about what goes on at the events in advance, and avoid throwing bullpens if unprepared for them.

As far as showcases are concerned, I'd encourage you to save your money and go on a family vacation instead.

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So What Does a Pitching Coach Do, Anyway?

EC's Note: Today marks the first of what I hope will be many guest blog posts from Matt Blake, an absolutely fantastic pitching coach who works out of the cage at Cressey Performance.  Matt is way ahead of the curve with what he's doing, and the results he's gotten with a lot of our athletes - from high school all the way up to the professional ranks - are nothing short of fantastic.  I consider myself tremendously lucky to have him as a resource with whom I can interact every day. Today's post from him is a bit of an introduction and preview of what's in store from us in the months to come. Since Eric mentioned to me a couple of weeks ago that he would like me to start contributing some articles to his blog, I have been debating about how to introduce myself to the EricCressey.com crowd and what his audience might want to hear. All sorts of thoughts had run through my head on whether it should be oriented toward pitching mechanics, maybe talking about what Eric and I are doing together that separates us from other Elite Baseball Development programs, or maybe even a tidy little piece about who I am. Lucky for us, though, we have Eric's business partner Pete around, and he conveniently gave me my first blog topic on Saturday. As everyone on this blog probably knows, Mike Boyle recently released a new product called Functional Strength Coach 3.0 last week. So, on Friday, Eric loaned me his copy to take home to view. I did my part and watched 6 of the 8 DVDs that night (for those of you counting at home that was about 5-6 hours of material straight to the dome on Friday Night; I promise I'm not that big of a geek normally). Upon return on Saturday morning, and much to Eric's shock, I gave him back the six DVDs that I had already watched and told him I would only need the other two for the afternoon.

functional_strength_coach

Here is where the crew of pro baseball guys from Pete's office chimes in. "Why would you spend six hours of your Friday night watching DVDs that have nothing to do with your field?" At first, I was kind of tongue tied, like, "Yeah, I guess that was pretty foolish, I teach pitching, so why would I want to know how to train people for functional strength?" And, to be honest, I continued to think about this most of Saturday, trying to justify why I just did that.  As I came to my contemplative answer, I realized the very exact same reason I am working with Eric at all, is why I'm watching these DVDs on Friday night. When it comes down to it, I believe to be the best at anything, you need to understand the inherent depth of complexities for what you're dealing with and this more often than not may involve pursuing multiple fields of knowledge to truly grasp your own discipline. In some sense, I believe the leaders in any field are polymaths of sort and this is something Eric clearly demonstrates in his own regard. With that said, for me to provide the most knowledge and best service to an individual, a team, or camp of baseball players, I should understand why we are using foam rolling before we static stretch. Why would SMR of this nature would make sense before stretching and then proceeding into a dynamic warm-up?

I should understand what flexibility deficits are and why they are affecting a player's performance.  I need to know why mobilizing the hips and thoracic spine while stabilizing the lumbar spine is allowing us to create more torque and whip for a pitcher. All of these things have huge ramifications for both player and coach, and if I want to optimize my players' talent, then I need to be able to convey to them the importance of our drills and Eric's exercises. There is a reason for all of it, we're not just throwing darts at the wall and hoping it works out for the player.  I'm also not going to claim to have all the answers for this, and that is why I am constantly searching for the next piece to add to my arsenal. It could be a psychological book about focus, or even an Eastern Martial arts book about how Tai Chi helps you find your center. Not any one of these books would have all of the answers on how to be a great pitcher, and they may even have none...but, at the end of the day, if I can take one thing away from Mike Boyle and add it to my knowledge of pitching in any way, then I just made myself better as a "Pitching Coach," whatever that may be loosely defined as. So I guess to answer their question: I was really watching Functional Strength Coach 3.0 because I plan on helping Eric turn out a large number of pitchers in Hudson, MA who are capable of throwing a baseball freakishly hard and stay healthy while doing so.

collins_stride

Obviously, there is a lot more to pitching and what we are working on together than that, but I think that should get the ball rolling. Over the next few months, I will be contributing more substantive articles that will cover a lot of the biomechanical aspects of a pitcher's delivery that Eric and I see daily and how best to activate and optimize awareness for each piece of the puzzle. We'll talk about what a flexibility deficit looks like in a pitcher and what its ramifications are in a player's mechanics. We'll discuss how we attack something of this nature with soft tissue/mobility/strength work and then how we teach the player to incorporate this back into his personal mechanics through progressive drill work. The end goal is obviously to remove the limitation, and in turn, raising a pitcher's velocity ceiling and keep him healthy. This could include anything from hip mobility, to thoracic spine mobility, to glenohumeral internal rotation deficit (GIRD), to a host of other issues. All of these issues could be holding a player back from optimal performance and maybe even putting a pitcher at a serious risk for injury. Well, that is more than enough for one blog, and I want apologize for ransacking your daily allowance of blog reading time if you made it this far with me. I tried to get a word count limitation on my post from Eric, but he told me to just let it rip. I guess this was my definition of letting it rip... Matt Blake can be reached at mablak07@gmail.com. Please enter your email below to sign up for our FREE newsletter.
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Random Friday Thoughts: 10/23/09

1. I got a question earlier this week about how I felt about swimming for pitchers.  To be honest, I'm not a huge fan for pitchers.  Swimmers actually have a lot of the same issues as pitchers in terms of adaptive changes in the shoulder: an acquired anterior scapular tilt, glenohumeral internal rotation deficit (GIRD), and generalized laxity.  I guess when it really comes down to it, I'd rather have guys actually throwing if they are going to develop imbalances.

2. Last, but not least, Mike Boyle has a good video up in conjunction with the release of his new Functional Strength Coach 3 product.  Check out The Death of Squatting.

3. Even if he never scores another goal in his life, this kid is a stud - quite possibly on par with the West Virginia Ninja from last week.

4. Tony Gentilcore just switched his blog over to a new site.  If you guys want to be entertained and learn something in the process (infotainment), check out www. TonyGentilcore.com.

5. Speaking of Tony, the two of us tested 1RM deadlifts yesterday (yes, together; it's kind of like when women go to the bathroom together).  This came after a month-long deadlift specialization program that kicked the crap out of us (let's just say it was 4x/week deadlifting for three weeks, then one week of rest).  Tony pulled a personal-best 550 pounds; here's our boy in action:

6. As for me, well, there was no PR.  In fact, I got sent down to the JV team.  I got 700 about three inches off the floor, and that was it.  A subsequent attempt at 675 went only slightly better in my fatigued state.  And I put a crater in the middle of my hand when a callus ripped off.

callus

7. If you're a strength and conditioning coach or personal trainer looking for work and are anywhere near (or willing to move to) just east of Philadelphia, please shoot me an email at ec@ericcressey.com.  I have a friend who is looking for some good coaches to work with athletes at his facility in that area.  It's a positive, learning environment - and he's a great dude.

8. And, last, but certainly not least: Assess and Correct will be up for sale on Monday!  Newsletter subscribers will hear about the product first, so if you aren't subscribed already, head HERE to get signed up.

Have a great weekend!

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Strength and Conditioning Programs: Crossfit for Baseball?

I've received a lot of emails just recently (as well as some in-person questions) asking me what I think of Crossfit for strength and conditioning programs with baseball players and, more specifically, pitchers.

Let me preface this email with a few qualifying statements.  First, the only exercise "system" with which I agree wholeheartedly is my own.  Cressey Sports Performance programming may be similar in some respects to those of everyone from Mike Boyle, to Louis Simmons, to Ron Wolforth, to the Crossfit folks - but taken as a whole, it's entirely unique to me.  In other words, I will never agree completely with anyone (just ask my wife!).

CP_monogram_ol.eps

Second, in spite of the criticism Crossfit has received from some people I really respect, I do feel that there are some things they're doing correctly.  For starters, I think that the camaraderie and enthusiasm that typifies their training groups is fantastic; anything that gets people (who might otherwise be sedentary) motivated to exercise is a plus.  Moreover, they aren't proponents of steady-state cardio for fat loss, and they tend to gravitate toward compound movements.  So, good on them for those favorable traits. Additionally, I know some outstanding coaches who run Crossfit franchises, so their excellent skill sets may be overshadowed by what less prepared coaches are doing simply because they have the same affiliation.

However, there are several issues that concern me with applying a Crossfit mentality to the baseball world:

1) The randomness of the "workout of the day" is simply not appropriate for a sport that has quite possibly the most specific sport-imposed asymmetries in the world of athletics.  I've written about these asymmetries in the past, and they can only be corrected with specific corrective training modalities.

I'm reminded of this constantly at this time of year, as we get new baseball players at all levels now that seasons are wrapping up. When a player presents with a 45-degree glenohumeral internal rotation deficit, a prominent scapular dyskinesis, terrible right thoracic rotation, a big left rib flair, a right hip that's stuck in adduction, and a complete lack of rotary stability, the last thing he needs to do is a 15-minute tri-set of cleans, kipping pull-ups, and push-ups - following by some 400m sprints. It not only undermines specificity of exercise selection, but also the entire concept of periodization.

Getting guys strong isn't hard.  Neither is getting them powerful or building better endurance.  Finding the right mix to accomplish all these initiatives while keeping them healthy is the challenge.

2) The energy systems development found in Crossfit is inconsistent with the demands of baseball.  I wrote extensively about my complete and utter distaste for distance running in the baseball world, and while Crossfit doesn't go this far, in my eyes, anything over 60yds is "excessive distance" for baseball guys.  Most of my guys sprint two times a week during the off-season, and occasionally we'll go to three with certain athletes.  Let's just say that elite sprinters aren't doing Crossfit, and the energy systems demands of baseball players aren't much different than those of elite sprinters.

3) I have huge concerns about poor exercise technique in conditions of fatigue in anyone, but these situations concern me even more in a population like baseball players that has a remarkably high injury rate as-is.  The fact that 57% of pitchers suffer some sort of shoulder injury during each season says something.  Just think of what that rate is when you factor in problems in other areas, too!  The primary goal should not be entertainment or variety (or "muscle confusion," for all the morons in pro baseball who call P90X their "hardcore" off-season program).  Rather, the goals should be a) keeping guys on the field and b) safe performance enhancement strategies (in that order).

cockingphase

As an example, all I need to do is look back on a program we used in one of our first pro pitchers back for the off-season last fall.  He had a total of 20 pull-up and 64 push-up variation reps per week (in addition to some dumbbell bench pressing and loads of horizontal pulling/scapular stability/cuff work).  This 84-rep figure might be on the low-end of a Crossfit program for a single day.  Just like with throwing, it's important to do things RIGHT before even considering doing them A LOT.

4) Several of the exercises in typical Crossfit programs (if there is such a thing) concern me in light of what we know about baseball players.  I'll cover this in a lot more detail in an article within the next few weeks, but suffice it to say that most have significant shoulder (if not full-body) laxity (acquired and congenital), abnormal labral features, partial thickness supraspinatus tears, poor scapular upward rotation, retroversion (gives rise to greater external rotation), and diminished rotator cuff strength in the throwing shoulder (particularly after a long season).  Most pro pitchers will have more than 190 degrees of total motion at the shoulder, whereas many of the general population folks I encounter rarely exceed 160 degrees.

totalmotion

In short, the shoulders you are training when working with baseball players (and pitchers, in particular) are not the same as the ones you see when you walk into a regular ol' gym.  Want proof? Back in 2007, on my first day working with a guy who is now a middle reliever in the big leagues, I started to teach him to front squat.  He told me that with only the bar across his shoulder girdle, he felt like his humerus was going to pop out of the socket.  Not surprisingly, he could contort his spine and wrists like a 14-year-old female gymnast.  This laxity helps make him a great pitcher, but it would destroy him in a program where even the most conservative exercises are done to the point that fatigue compromises ideal form.  And, let's be honest; if I was dumb enough to let someone with a multi-million dollar arm do this, I'd have agents and GMs and athletic trainers from a lot of major league systems coming after me with baseball bats!

5) Beyond just "acts of commission" with inappropriate exercise selection and volume, there are also "acts of omission."  For example, a rotational sport like baseball requires a lot of dedicated work to address thoracic spine and hip mobility and anti-extension and anti-rotatoin core stability.  If you exhaust your training time and recovery capacity with other things, there may not be enough time or energy to pay attention to these important components.

All that said, I would encourage anyone who deals with baseball players to learn to borrow bits and pieces from a variety of methods available today.   Along the way, take into account the unique characteristics of the overhead throwing athlete and manage accordingly.  Simply saying "I'm a Crossfit guy"  and adhering to an approach that was never intended for a baseball population does a huge disservice to the athletes that count on you to bring them the most up-to-date, cutting-edge training practices available.

If you're interested in learning more about some of the asymmetries and training techniques I noted above, I'd strongly encourage you to check out Optimal Shoulder Performance, where both Mike Reinold and I go into some detail on assessment and corrective exercise for pitchers in this seminar (and there's also a lot more fantastic information for anyone looking to develop pitchers). You can buy it HERE, or learn more about it HERE.

shoulder-performance-dvdcover

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