Home Posts tagged "High Performance Training" (Page 10)

Random Friday Thoughts: 6/4/10

1. I'm headed to Providence first thing tomorrow to speak at the Perform Better Summit.  If you're in attendance, be sure to introduce yourself and say hello; it's always great to meet my readers. 2. It's the time of year where all the all-star and league MVP awards are handed out around here as playoffs are just getting underway. Here's a great article about one Cressey Performance athlete, Carl Anderson of Lincoln-Sudbury, who won the Dual County League MVP as he set school records for homeruns and RBIs: Diamond Natural, If a Bit Rough 3. Likewise, another CP athlete, Jeff Bercume in the Oakland A's organization, just got a little love: Bercume's Game Going North.

bercume

4. HERE is some recent research to support the use of accommodating resistance in the form of bands in resistance training.  Many of us in the powerlifting community have anecdotally been able to verify its efficacy, but it's nice to see some research out there that confirms what a lot of folks have insisted for quite some time. It's important to interpret this research with caution, though.  Using bands on top of free weight resistance is fantastic, but it can really beat up your joints if you use it for too long without taking a break.  I always found that the added eccentric stress really beat up my shoulders and elbows on the bench press if I used bench presses against bands in my training cycles for more than three weeks without a break from them.

bench-press-vs-bands-top

5. Researchers from the University of Nebraska report that energy expenditure in untrained college students is the same on ellipticals and treadmills when working at a self-selected intensity.  An unnamed researcher from the Cressey School of Hard Knocks reports that working at a "self-selected intensity" on these modalities requires about as much effort and coordination as watching NASCAR.

nascar-back-hair2

Call me crazy, but I think most college-age folks would be better off hitting things with sledgehammers as exercise; it's just way more badass.

6. Here's another solid testimonial we just received on Optimal Shoulder Performance: "Eric and Mike did a great job of taking complex information and making it easy to understand for the viewer.  I really liked the collaboration between the clinical side of things, and the training side.  I now have a much better understanding of how to effectively assess the shoulder.  More importantly, I am now better equipped to take that information and improve the training strategies and techniques for my clients." -Danny McLarty, CSCS Click here to pick up a copy of Optimal Shoulder Performance for yourself.

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Understanding Elbow Pain – Part 6: Elbow Pain in Lifters

Today, I'm going to wrap up this six-part series entirely devoted to the elbow.  In case you missed the first five, check them out: Part 1: Functional Anatomy Part 2: Pathology Part 3: Throwing Injuries Part 4: Protecting Pitchers Part 5: The Truth About Tennis Elbow In this final installment, I'm going to discuss elbow issues as they pertain to a strength training population.  Even though some of the treatments for these injuries/conditioning may be very similar or even identical to what we see in a throwing population, I separate lifters because their problems are almost always soft tissue in nature.  While we may see stress fractures, ulnar nerve issues, and ulnar collateral ligament tears in throwers, we are virtually always dealing with problems with muscles and tendons in folks who are avid lifters.  What gives? Well, it's very simple: they grip stuff a lot more than normal folks, and also perform a ton of repetitive movements at the elbows and wrists.  This difference also makes you appreciate why we often see elbow issues in those who work on factory lines, performing the same task for hours on-end. Why is it that all these issues present at the elbow?  You see, many of the muscles involved in gripping originate at the superomedial aspect of the forearm, particularly on the medial epicondyle:

medialepicondyle

When these structures get overused, they shorten - and as we discussed in Part 1, the zones of convergence (where tendons bunch up and create friction with one another) are where we develop some nasty soft tissue adhesions.

However, this doesn't just happen from gripping.  Think about what happens when you put the bar in this position to back squat:

hammer-back-squat2

That bar wants to roll off his back, and while the majority of the weight is compressive loading, a good chunk of it becomes valgus stress that must be resisted by the flexors and pronators that attach at the medial aspect of the forearm/elbow. It's not a whole lot different than the stress we see here; we just trade off the velocity and extreme range of motion in the throwing motion for prolonged loading in the lifting example:

wagner2

As a general rule of thumb, the narrower the squatting grip, the more stress on the elbow.  Unfortunately, the wider the grip, the more shoulder problems we tend to see, as this position can chew up the biceps tendon.  The solution is to maintain as much specificity as possible with respect to one's chosen endeavor, but find breaks from the repetition of these squatting positions by plugging in options like front squats, giant cambered bar squats, and safety squat bar squats.

For these reasons, I also look at soft tissue work on the forearms - and particularly the medial aspect - as a form of preventative maintenance.  Regardless of the soft tissue modality you select, get some work done every few months and stay on top of your stretching in the area to maintain adequate length of these tissues.

We'll also see a fair amount of "underside" elbow pain in lifters, in most cases where the three heads of the triceps join up as a common tendon (another zone of convergence; does anyone see a pattern here?) to attach to the olecranon process.  The smaller anconeus - a weak elbow extensor - also comes in here.

Almost universally, the lifters who present with overuse injuries posteriorly are the ones who use loads of elbow-only extension movements like skullcrushers/nosebreakers/French presses/triceps extensions.  As a random aside to this, how can these movements have four different names, and not one of them begins with some Eastern European nationality?  "French" just doesn't get it done when we have Russian good mornings, Bulgarian split squats, Romanian Deadlifts.

lying_triceps_extension_5314_7

Anyway, we vilify leg extensions and leg curls as being non-functional and overly stressful at the knee.  The knee is the joint most similar to the elbow, yet it's much bigger than the elbow, yet nobody contraindicates 4-5 elbow extension-only exercises per week in many routines as being inappropriate - or even excessive.  If you want to build big legs, you squat, deadlift, and lunge.  If you want to build big triceps, you bench, do weighted push-ups, overhead press, and do dips.  The absolute load is higher, but the stress is shared over multiple joints.

In just about every instance, when you drop the direct elbow extension work from someone's program, their elbow issues resolve very quickly and they don't miss a beat with training.

So, as you probably inferred, it's very rarely a lack of strength that causes elbow pain in lifters.  Rather, it's generally poor tissue quality, a lack of flexibility, and overuse of a collection of muscles that have "congested" insertion points.  Simply changing the program around, getting some soft tissue work done, and following it up with some stretching can go a long way to both prevent and address these issues.  That said, there will be cases where elbow pain may originate further up at the cervical spine or shoulder or - as I learned from a reader in the comments section of Part 5 - from an abducted ulna.  So, there is definitely no one-size-fits-all approach.

That wraps up this series.  Hopefully, you've gained insights into some of what's rattling around inside my brain with respect to elbows.  Thanks for putting up with me for all six installments!

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Haven’t Purchased Optimal Shoulder Performance Yet?

To pick up a copy for yourself, check out www.ShoulderPerformance.com.

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Training Schedules for Summer Baseball

Q: I've been going through some research, and your articles about training between starts, and I was wondering what kind of approach you take with college pitchers who are playing summer ball. Do you treat them as in-season and try to keep them fresh for their starts, or are you more aggressive with them since it's not their primary season? A: My answer is - as always - it depends. If you have a younger player who is weak, scrawny, and altogether physically unprepared, he is going to train hard.  The long-term benefits of that training far outweigh any short term decrements in performance (which, as I'll note in a second, can easily be attenuated markedly). If we are talking about a more advanced player for whom summer ball performance may be extremely important (e.g., an unsigned draft pick in the Cape Cod League during the summer after his junior year who is trying to get his signing bonus up), you have to treat things quite a bit differently.  And, within this category, we manage starters and relievers differently. For starters, it's pretty easy, as they generally have predictable seven-day rotations.  I outlined my thoughts with the 7-day rotation component of A New Model for Training Between Starts: Part 2.  Here it is: Day 0: pitch Day 1: challenging lower body lift, light cuff work Day 2: movement training only, focused on 10-15yd starts, agility work, and some top speed work (50-60 yds); upper body lift Day 3: low-Intensity resistance training (<30% of 1RM) circuits, extended dynamic flexibility circuits Day 4: full-body lift Day 5: movement training only, focused on 10-15yd starts, agility work, and some top speed work (50-60 yds) Day 6: low-intensity dynamic flexibility circuits only (or off altogether) Day 7: pitch again

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I treat relief pitchers as if they are position players - but if we know that there is a good chance that they'll throw in the next 24-36 hours, we'll markedly drop the volume and intensity and just focus on them leaving the gym feeling "refreshed."  If they have a longer outing (more than an inning), we'll get some really good weight-room work in the next day, as we know they won't have to pitch that night.  If it's a shorter outing and they may be expected to throw two days in a row, we'll go easier (potentially even pushing things back a day). Sign-up Today for our FREE Baseball Newsletter and Receive a Copy of the Exact Stretches used by Cressey Performance Pitchers after they Throw!
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Memorial Day Sale!

To celebrate Memorial Day and the long weekend that many call the "unofficial start to summer," Mike Robertson and I decided to put two of our most popular products to-date on sale through this Monday night - and update their websites. So, from now until midnight on Monday 5/31, you can get both Building the Efficient Athlete and Magnificent Mobility for 20% off.  The discount will be applied automatically at checkout; you just need to pick them up at the following websites:

www.BuildingTheEfficientAthlete.com

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www.MagnificentMobility.com

mm1 If you'd like to order them along with other products, just check out the RobertsonTrainingSystems.com Products page. Don't miss out on this great opportunity to pick up two of our "best sellers" at an excellent discount!

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CP Internship Blog by Sam Leahey – It’s the Person that Matters, not the Program

Today's guest blog comes from current Cressey Performance intern, Sam Leahey. Many of the valuable lessons an up and coming Strength & Conditioning Coach learns do not fall under the guides of content knowledge (coaching, program design, etc.). On the contrary, many educational moments manifest in a social sense (interpersonal skills). During my Cressey Performance internship, this semester I've come to appreciate even more so how a coach's success in the private sector of the profession (training facilities) is largely contingent upon the one's ability to interact with people in a respectful yet confident and authoritative manner. More specifically, "no one cares how much you know until they know how much you care."  To this I would add, "no one cares how much you know and what results your program can give them, until they know how much you care about satisfying their personal needs." In other words, through trial and error I've learned that a client or athlete really has more interest in-whether they know or admit it-how you make them feel as a person as opposed to how well-written and effective your program is. While this may be true in the collegiate setting, I find this truism has a larger bearing on a coach's success in the private sector. This principle is discussed in the book Peak, by Chip Conley. He describes "The Customer Pyramid," which is a derivative of Maslow's Hierarchy of Needs. He articulates how, in business, if you do not satisfy the base level needs of your clientele, they will never have the "peak experience" that you wish for them to have.

customer-pyramid

When we apply this concept to our field, S&C and personal training, there are a few implications worth noting, starting with the first level and moving upward. First, clients coming through our doors expect to feel valued as people. They expect to be important to you and your business. When you treat people appropriately, it fosters satisfaction from the clients towards your business. This should only be the beginning of a customer's experience at your training facility because if it ended here then your business would never reach its highest potential.  This area is where we need to spend the most time investing in the customers' experience. Most importantly, we need to realize this step forms the foundation of our customers' experience, or, the base level of the pyramid. If you noticed in the depiction above the "Meets Expectations" category is the largest of the three. The bigger the base of our customer pyramid then the bigger the subsequent categories will be. We need to then aim to meet our customers' desires as well. It's pretty intuitive that a personal training client or athlete who is paying for your services actually desires results. But what's not so obvious I think is that because of the lack of true results in our profession, mainly from the stain of commercial gyms, our potential clients have put actual program "results" in the desires category instead of keeping it in the expectations category. Believe it or not, an athlete may have signed up to train with you who previously trained elsewhere and left the experience with absolutely no, or barely any, improvements in strength, power, speed, body composition, etc., (aka results). Therefore, clients of today - be it a soccer mom just looking for fat loss or an athlete trying to make the varsity team at school - may have lowered their standards for what they consider "results." If you can (and you should be able to)  give results to your clients, then they will be committed to you and your business because they know their money is well spent  and they're actually getting the results they desired when they signed up for training.

peak

Now comes the final level: the "peak experience" we all would like our clients and athletes to have. If you're a business owner, you'd like to be able to guarantee each and every person who walks through your doors reaches this level. Unfortunately, the fact of the matter is that we really can't guarantee it. All we can do is keep buffering the base and middle level of the customer pyramid and the "needs" will take care of themselves. So, what exactly is the "peak experience" and what unrecognized needs does it meet? Honestly, we can't define it. All we can do is describe it. It's almost a surreal experience, one they didn't realize they would have before they came to your facility.  It's one that leaves each client evangelizing others and bringing in more customers better than any marketing plan ever could. It's to the point that a person can't even begin to think about training elsewhere because they "just HAVE to train at (your place)." It's that unique feeling someone gets when they walk through the door of your facility because they know what's about to transpire, and it's the feeling they leave with afterward. Some young athletes can have such a euphoric experience that they can't even fathom using equipment brands other than what you house at your facility. While that's an extreme case, it's a reality in some places and all goes under the "peak experience" category the folks at CP have worked to cultivate. The peak experience is best described as the culmination of environment and atmosphere CP provides its customers. It includes the interaction of staff members, interns, other customers, facility equipments, sights, sounds, etc. All these variables added together can help us describe that peak experience.

Conclusion Here I want to make myself vulnerable to the readers. Being young and eager to learn I've found it can be easy sometimes to get caught up in the scientific and technical side of things and effectively skip past the base level needs of some of the clients with whom I was working. Mistakenly, I wanted clients to have all their unrecognized needs met right away and right now! There were also times where I jumped right to coaching someone without taking the time to build a relationship with them first. While this might in some collegiate settings be acceptable, it does not yield a good outcome in the private sector. In fact, I would go as far as to say that as a college student this is the biggest mistake I've made in my learning process. There have been specific instances where an athlete simply did not like me because the very first day we met I was trying to coach him/her instead of trying to establish rapport first AND THEN coach him/her. Remember - "no one cares how much you know and what results your program can give them, until they know how much you care about satisfying their personal needs." Essentially I was skipping past this client's base level of needs to trying to cultivate higher lever needs first. I'm open and honest about my experiences for a couple reasons: 1.  I've always appreciated when those who have gone before me were candid about their mistakes so that young up-and-comers like me could learn from them. 2.  I think too many people subconsciously believe that just because someone is an internet author, they do everything right. You'd be surprised! Whether it's a big name in the profession or one of their interns everyone has made both big and small mistakes in their career. Some were easily recovered from while others might have even been so extreme that the outcomes were career ending. At any rate, we should all strive to learn from our own mistakes and that of others and be diligent to make a permanent change that will prevent us from screwing up again. Make sure we are investing most of our efforts satisfying base level needs of our clients before getting them up to higher levels. Sam Leahey CSCS, CPT can be reached at sam.leahey@gmail.com.

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Stuff You Should Read: 5/26/10

In this week's list of recommended reading, we've got some training and nutrition tips: Training Basketball Players - Here's an excellent, "outside-the-box" post from Charlie Weingroff about what he looks for in dealing with basketball players. If You Like Steak, Read On - This great blog from Brian St. Pierre highlights some recent research that helps to bury the myth that all red meat is bad for you. Oh, and you need to watch this.  If it doesn't get you a little fired up for the World Cup, nothing will.

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Understanding Elbow Pain – Part 5: The Truth About Tennis Elbow

Author's note: This is the fifth part of a series specifically devoted to the elbow.  Be sure to check out Part 1 (Functional Anatomy), Part 2 (Pathology), Part 3 (Throwing Injuries), and Part 4 (Protecting Pitchers) if you haven't done so already. Today, I'm going to cover a pretty common, yet remarkably stubborn issue we see at the elbow: tennis elbow. It's also called lateral epicondylitis, although the -itis ending may not do it justice (as we discussed previously in this series) because it is likely more of a degenerative - and not inflammatory - condition in the overwhelming majority of those who experience it.  To take this naming conundrum a bit further, while the term "tennis elbow" is used to describe pain on the lateral aspect of the upper arm near the elbow, tennis players often experience medial elbow issues as well (golfer's elbow) secondary to the valgus stress one sees with the forehand and serve.

womanserve2

In a tennis population, "tennis elbow" emerges almost solely from backhands (with the one-handed version logically being much more problematic), which require huge contributions from the extensors of the wrist to not only hold the racket, but stabilize the wrist against the vibrations from the racket as it redirects the ball.  The path of the ball against the racket creates a destabilizing torque that wants to force the wrist into flexion, and it's the job of these extensors to resist that movement.

The logical question for many is why does the pain occur at the elbow when the forces are applied so much further down the arm?  The answer rests with the zones of convergence topic from Part 1: there are lots of tendons coming together in congested area, creating friction and negatively affecting soft tissue quality.  At the lateral epicondyle, you have the common extensor tendon, which is shared by extensor carpi radialis brevis, extensor carpi ulnaris, supinator, extensor digitorum, and extensor digiti minimi (the extensor carpi radialis longus and brachioradialis attach just superiorly).

lateralepicondyle1

If this doesn't convince you of both the preventative and rehabilitative role of soft tissue work, then you might as well be living life with a bag over your head.  Yet, it amazes me how many treatment plans for tennis elbow don't have even the smallest element of hands-on work.  Here's a little demo from Dr. Nate Tiplady, with Graston and ART.

Soft tissue treatments, flexibility work, and progressive strengthening exercises for these degenerative tissues get the ball rolling - and you can find thousands of foo-foo forearm exercises and stretches online.  Additionally, as Mike Reinold has reported, there is some research to suggest that elbow straps are slightly effective in expediting the process.

tenniselbowstrap

And, eccentric exercise for the wrist extensors tends to show the most promise for tissue-specific return to function. This is all well and good - but I think it sometimes overlooks a big fat white elephant in the room.

I worked at a tennis club for eight summers when I was growing up, doing everything from court maintenance, to racket stringing, to lessons, to scheduling court time.  Toward the end of my eight-year tenure (around the time that I started getting involved with the fitness industry), I started to notice some interesting patterns.

When I looked out on the courts, about 1/3 of the participants were rocking tennis elbow straps (the research actually shows that about 40-50% of recreational tennis players get tennis elbow).  Yet, when I was in the office with some professional tennis match on TV in the background, I NEVER - and I really mean that I can't remember a single time - heard of a professional tennis player missing time because of tennis elbow.  How in the world would a pro - who might spend about 5-6 hours a day on the court - not break down faster than an elderly woman who plays a) 5-6 hours a week, b) at a slower pace, c) predominantly in doubles matches (1/2 as many ball contacts), and d) against competition that hits the ball much more softly than a professional opponent?  It really didn't make sense - until I got involved with exercise physiology.  Why?

1. The members were largely over the age of 40 - meaning that they were obviously as an increased risk of degenerative issues like tennis elbow, especially in light of their activity patterns.

2. The pros were also younger, and the two-handed backhand is markedly more common in the newer generation of players.  The one-handed backhand still predominates in the "old guard."  Research has demonstrated markedly more complexity in the swing kinetics for the one-handed backhand - so there are more ways for things to go wrong in this older population.

federerbackhand

3. This is the biggest one: the pros usually had a solid foundation of conditioning, meaning that they had the strength, power, coordination, footwork, and technical mastery to hit the ball in a biomechanically safe position.  Novice players with poor technique often hit the hit the ball with the wrists flexed and not neutral; in other words, they lead with the elbow instead of the racket, taking the wrist extensors outside of their ideal length-tension relationship.

In a non-tennis population, lateral elbow pain is almost always a function of overusing the grip and having some really nasty, fibrotic soft tissue accumulations at the lateral epicondyle.  In a tennis population, it isn't just an elbow problem; it's something that speaks to a lack of preparedness of the entire body, both physically and in the context of insufficient technical mastery.

In my eyes, tennis elbow rehabilitation should be treated much like a return to throwing program for a baseball pitcher.  The injured individual should take care of the soft tissue, flexibility, and strength issues at the elbow, but he/she should also get involved in a strength and conditioning program to improve ankle, hip, and thoracic spine mobility; core and scapular stability; and strength and power of the larger muscle groups at the hips and shoulders that should be creating the power instead of the smaller muscles acting at the wrist and elbow.

Layout 1

If you're slow to rotate your hips, you're going to hit the ball late (wrist flexed).  If you lack hip mobility to rotate to the ball, you're going to hit the ball late (or chew up your lower back).  If you lack core stability to transfer force from the hips, you're going to hit the ball late.  If you lack scapular stability or rotator cuff strength, you're going to hit the ball late.  Does anyone see a pattern?  This is about everything BUT the elbow!

Instead, what have we done?  We've done exactly what lazy people always does: created gadgets to avoid actually having to work hard!

In the 1990s, racket companies introduced oversized rackets, which have a larger surface area to minimize mishits (which increase vibrational stress) and increase power (at the expense of control).  Screw getting better at tennis or improving your physical fitness; we'll just make tennis easier!  As an interesting aside to this, strings break more frequently on oversized rackets as well - meaning that companies make more long-term on follow-up string purchases. This sucker is 125 square inches (as a frame of reference, Pete Sampras played with a 85-square-inch racket):

wilsontriad

Also in the 1990s, the titanium tennis racket was introduced.  These things are insanely lightweight - to the point that it requires very little physical exertion to swing if you are a 60-year-old woman in a doubles match.  So much for exercise!

We've handed out tennis elbow straps like candy so that people can get back out to play as quickly as possible rather than getting their bodies right and then practicing with a qualified professional who can instruct them on proper technique as part of a return-to-hitting plan.  The straps can be very valuable if used appropriately - but not if used as a crutch to "get by" with poor movement patterns and a lack of physical preparation.

Is anyone else shocked at how comparable the rushed and careless return to action in adult tennis players is to what we see with young athletes trying to come back too quickly from ACL tears, rotator cuff strains, or stress fractures?  They say retirement is the second childhood; I guess they're right!

So, here are some take-home points on tennis elbow:

1. Take care of tissue quality at the lateral epicondyle alongside any flexibility and resistance training exercises for the muscles of the forearm.

2. Condition the entire body as part of rehabilitation.

3. Ease back into tennis participation, and do so under the supervision of someone who can correct the faulty mechanics in your backhand. Along those same lines, consider switching to a two-handed backhand if you have a history of tennis elbow.

Stay tuned for Part 6 to wrap up this series.

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Shoulder Health: Forearm Wall Slides with Band

On the recommendation of Mike Reinold, my co-creator of the Optimal Shoulder Performance DVD set, we've been using forearm wall slides as part of our warm-ups and shoulder health programs for the past year or so.  A variation is also featured on our Assess & Correct DVD as both an assessment and corrective drill. With this exercise, the goal is to get to about 135 degrees of shoulder flexion without shrugging.  In other words, you're checking just how well you upwardly rotate the scapulae.  A good progression for this is the forearm wall slides with band, where you simply wrap a band around the wrists.  The pull of the band forces your shoulder into internal rotation, so the external rotators (posterior rotator cuff and posterior deltoid) have to work isometrically to resist that movement.  As I learned from physical therapist Tim Tyler at the MGH/Harvard Med Sports Medicine 2010 conference recently, it also improves recruitment of the lower trapezius while decreasing anterior deltoid and upper trapezius activity.  In other words, it's one of the best bang for your buck scapular stability and rotator cuff exercises out there:

For more information, check out our Optimal Shoulder Performance DVD set.

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Understanding Elbow Pain – Part 4: Protecting Pitchers

This is Part 4 of a series specifically devoted to elbow pain in athletes.  Be sure to check out Part 1, Part 2, and Part 3 if you haven't already. As I presented in Part 3 of this series, there is absolutely nothing healthy about throwing a baseball, as the body is being contorted to extreme positions as the arm accelerates in the fastest motion ever recorded in sports.  These outrageous demands warrant a multi-faceted approach to protecting pitchers from injury.  In my eyes, this approach consists of four categories, and that's what I'll cover today. 1. Avoiding Injurious Pitching Mechanics Let me preface this section by saying that I do not believe there is a single mechanical model that governs how one should pitch.  Everyone is different, and those unique traits have to be taken into consideration in determining what is or isn't considered potentially harmful.  For instance, only a tiny fraction of the population could ever even dream about pitching like Tim Lincecum because of ideal blend of congenital laxity and reactive ability he possesses.

lincecum

I've trained Blue Jays left-handed pitching prospect Tim Collins for the past three seasons.  At a Double-A game earlier this year, Tim introduced me to his good buddy Trystan Magnuson, a right-handed pitching prospect who is also in the Jays system.  While Tim was a whopping 5-5, 131 pounds when he was signed right out of high school (now 5-7, 170), Trystan stands 6-7.  Check out this picture I recently came across from spring training:

magnuson-collins

Anyone who thinks these two are going to throw a baseball with velocity and safety via the same mechanics is out of his mind. As an aside, if you're interested in watching both of them throw, there is some decent warm-up footage of both HERE.

While we can never expect all pitcher to fit the same mechanical model, we can look to the research (a great 2002 study from Werner et al. is an excellent place to start) to educate us about certain factors that predispose pitchers to increased elbow stress.  To start, leading with the elbow too much  increases valgus stress by about 2.5N per degree of horizontal adduction that the arm must travel.  The problem with this is that every successful pitcher you'll ever see leads with the elbow to some degree, so it becomes an issue of "how much" and "when." Getting to maximal external rotation too early also increases valgus stress on the elbow.  According to Fleisig et al. (1995), the typical thrower is going to have about 67 degrees of shoulder external rotation at stride foot contact.  The more external rotation there is, the more elbow stress you'll see.  Unfortunately, this is one contributing factor to one's velocity, so these results must be intepreted cautiously.  If you take away that external rotation, you may take away a few miles per hour.  Again, the same goes for horizontal abduction. Lower extremity sequencing problems can also wreak havoc on an elbow.  Pitchers who fly open early tend to let their arm lag behind their body, increasing valgus stress in the process and making it harder to get good contribution from the lower half. Likewise, guys who stay closed and throw across their body can wind up with medial elbow issues.  If a pitcher maxes out his shoulder internal rotation and scapular protraction in coming across his body, the only choice to continue getting that range of motion is the elbow.  If you create more range of motion, you have to slow down more range of motion. This last point kicks off a brief, but important discussion.  Many pitchers stay closed to improve deception.  Others use it to help them get movement on sinkers.

brandon-webb

Changing these mechanics could take away everything that makes these pitches successful, so you have to look to the other three factors to prepare them physically and protect them from these stresses.  It's like making sure you give a guy a helmet if he is going to be banging his head against a wall!

All that said, finding the right mechanics is important for little leaguers and professionals alike - and it's the first step in protecting the elbow in a throwing situation.  As we realize that the very issues that increase elbow stress happen to be the same ones that a) increase velocity and b) are often demonstrated by elite pitchers, we appreciate once again just how unnatural an act throwing a baseball really is!

2. Avoiding Acute and Chronic Overuse One of our high school kids threw 188 pitches in a game last week.  I'd like to think that I'm pretty good at what I do, but nothing I can do to keep a kid healthy if his coach asks him to do that time and time again. Acutely, fatigued pitchers put more stress on their arms.  There is less trunk tilt at ball release as the lower body gets more tired.  And, the usually elbow drops. "The next thing you know, there's money missing off the dresser, and your daughter's knocked up. I've seen it a hundred times." Gold star to those of you who caught that movie reference, but kidding aside, just about every case of elbow pain we see who comes through our door has been mismanaged in terms of pitch count - either acutely, chronically, or both.  They think they can pitch year-round.  They blow money on showcases.  They play on three teams team at a time.  They throw bullpens with their teams and with their private pitching instructors.  The research is out there and the answer is very clear: there is only so much stress an arm - especially a skeletally immature arm - can take.

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3. Being Chronically Physically Prepared to Pitch This is the topic of which I've written the most on this site, and it encompasses everything I've written with respect to strength training for pitchers and targeted flexibility work, not to mention my absolute hatred for distance running for pitchers.  Long story short, throwing a baseball is an action that takes its toll on the body; if you aren't functionally fit to pitch, you're just asking for an injury. 4. Being Acutely Physically Prepared to Pitch This is a very overlooked component of not only staying healthy, but also performing at a high level.  I'm amazed at how many young pitchers just "show and go" when it comes to pitching.  That is, they get to the field and just go right to throwing.  In other words, they throw to warm up. We teach our athletes, "You warm up to throw; you don't throw to warm up."  I've spent the last 57 paragraphs (give or take a few) outlining how incredibly stressful the throwing motion is, yet some kids can't wait to jump right into it before getting their body temperature up, optimizing joint range-of-motion, activating key neuromuscular connections, or doing anything that even vaguely resembles an appropriate "rest to exercise" transition.  We encourage athletes to go through 8-10 dynamic flexibility drills followed by some easy sprinting progressions before they ever pick up a ball.

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It's not just about what you do before an outing, either.  It's also about what you do in the 24 hours after an appearance that determines how you'll bounce back in your subsequent outing.  While the schmucks out there are doing "flush runs," the #1 thing I am worried about after a start is regaining lost range of motion.  Reinold et al. found that pitchers lost both shoulder internal rotation and elbow extension range-of-motion during a competitive season when an adequate stretching routine was not implemented.  It's no surprise, when you consider the overwhelmingly high eccentric stress that's placed on the shoulder external rotators and elbow flexors as they try to decelerate the crazy velocities we see with pitching.  As such, following an outing, the first thing we want our guys to do is get back their shoulder and elbow ROM (and get the hips loosened up).  There are some athletes who don't need to be stretched into internal rotation, so be careful about using this as a blanket recommendation (more on that in our Optimal Shoulder Performance DVD set).

For a bit more information on what we recommend for our pitchers between outings, check out A New Model for Training Between Starts: Part 2.

In closing, an important note I should make is that pitchers rarely get hurt because of just one of these factors; it's usually a combination of all of them. So, when evaluating a pitcher's health and performance, be sure to broad perspective.

We've got four down and two to go in this elbow series.  Stay tuned for more!

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