It's widely known that approximately 80% of the population will suffer from lower back pain at some point during their lives.  What isn't widely known, however, is that even those who are asymptomatic are usually walking around with a host of nasty stuff going on with their spines.  Don't believe me?

A 1994 study in the New England Journal of Medicine found that in a study of MRIs of 98 asymptomatic individuals, 82% of those MRIs came back as positive for a disc bulge, protrusion, or extrusion at one level.  And, 38% actually had these issues at more than one level.  You can read the free full text HERE.

As the others discovered, it doesn't stop with disc issues, either - and that's where a great study from Soler and Calderon comes in.  They looked at the incidence of spondylolysis (vertebral fractures) in elite Spanish athletes, and found that 8% of those they examined had them.  Only about half of those diagnosed via imaging actually had back pain, though.  The incidence was highest in track and field throwers, rowers, gymnasts, and weightlifters - and I'd expect that this figure is actually higher in the U.S., where we have more sports (hockey, baseball, lacrosse) involving violent extension and rotation, more contact sports, and more participation in weight training.

What does this mean for us?  Well, as Chou et al. reported in The Lancet, "Lumbar imaging for low-back pain without indications of serious underlying conditions does not improve clinical outcomes. Therefore, clinicians should refrain from routine, immediate lumbar imaging in patients with acute or subacute low-back pain and without features suggesting a serious underlying condition."  That's not the point of my article today, though; I'll leave that stuff to the physicians to decide and rehabilitation specialists to interpret and treat.

As fitness professionals, strength coaches, and even just fitness enthusiasts and athletes, we need to assume that there is are probably a lot of structural abnormalities going on in the spines we encounter - including our own.  The programs we write and follow need to be sound and take these issues into account, considering differences in age, gender, sport participation, and injury history.  The technique we use needs to position us so that we can avoid causing them to reach threshold.  And, we need to appreciate that there is a risk-reward balance to be "struck" with everything we do in training because nobody will ever be "perfectly prepared" for the demands to be placed on their bodies.

Rather than lay all my thoughts out here, I'm going to direct you to some previous writing of mine:

To Squat or Not to Squat?
Lower Back Savers: Part 1
Lower Back Savers: Part 2
Lower Back Savers: Part 3

I'd also highly recommend Ultimate Back Fitness and Performance by Dr. Stuart McGill.

Please enter your email below to sign up for our FREE newsletter.

Here, you've got supination of the forearm, external rotation of the shoulder, scapular retraction/posterior tilt, and thoracic spine extension/rotation occurring simultaneously on the "lay back" component.  And, the opposite occurs as the athlete returns to the starting position.  Again, to reiterate, this is NOT a drill that is appropriate for a large chunk of throwing shoulders who already have crazy external rotation; it's just one we use with specific cases of guys we discover need to gain it. With the broomstick dislocation, you're going to be throwing a lot of valgus stress on the elbow - and as I noted in my recent six-part series on elbow pain, pitchers already get enough of that.  To read a bit more, check out Part 3: Throwing Injuries.

In just the past few days, I've had two separate conversations with some really knowledgeable CP "dads" who also happen to have a ton of experience with coaching youth baseball players, particularly hitters.  In both conversations, a (paraphrased) line that stood out was "improving as a hitter in the teenage years is largely about learning to use the hips."

In contrast, have the same hitting conversation with just about any professional baseball player, and he'll tell you "I hit with my hands."

So who is right?  Do professional players not use their hips?  Or, do kids not use their hands?

Actually, both parties are right.  You don't get to professional baseball in the first place if you don't use your hips well when hitting.  And, you don't succeed (and stick around) in professional baseball unless you use your hands efficiently and have remarkable hand-eye coordination.  It's just multiple levels of natural selection that set the best apart - and they may sometimes forgot about the early stages of progress.

Need proof?  Watch a little league batting practice session, and then go to a big-league game to watch their batting practice.  The young players all pull the ball on every pitch, whereas the big-leaguers usually spray the ball all over the field, moving from the opposite field to the pull side.  They do this with their hands and wrists, all the while taking the hips for granted.

Think about this: how many more TFCC (wrist) injuries and hamate (hand) fractures do we see in professionals when compared to teenagers?  There are a lot more - because this area gets used a ton more.  Kids, on the other hand, get stress fractures if they misuse their hips.  It's no surprise, given the crazy rotational velocities and ranges of motion we see in hitters (outlined in my old articles, Oblique Strains and Rotational Power and Oblique Strains in Baseball: A 2011 Update).

What is a surprise, though, is that nobody has caught on to the ramifications of what this means for the youth baseball player who is learning to hit.

If a kid wanted to be a NASCAR driver, would we start him with a few 200mph laps at the Speedway amongst dozens of other drivers?  Of course not.

Why, then, do we have kids playing 180-200 games per year between school teams, AAU, fall ball, and even winter ball?  Where is the opportunity to learn how to hit in a controlled environment (closed loop), as opposed to trying to learn how to hit in live situations off of kids with no control (open loop).  Don't get me wrong; many programs do a tremendous job with instruction and really do build outstanding technical hitters - but as much as I hate to say it, the occupation of "hitting coach" seems to be a dying profession.  Why?

1. Schools are starting to put batting cages on campus for year-round hitting, and some kids don't appreciate that they need to learn to hit.

2. Some people see more money in AAU programs than individual instruction.  If a hitting lesson is personal training, running a team practice is semi-private training: more money in less time (and it's usually cheaper for the players).  This strategy can work if it's executed properly with sufficient coaching on-hand and the right demographic in mind; I have seen some AAU programs that are run with outstanding organization and excellent individual instruction at crucial parts of the year.

What is the right demographic?  I can't say for sure - but I can tell you that we need to be really careful in dealing with kids in the 11-17 year-old range.  They're learning to use their hips in an incredibly technically precise motion while their bodies are changing rapidly thanks to growth spurts and the fact that they spend 20 hours a day on their cans, thanks to sleeping, sitting at school desks, and playing around on Facebook and Instant Messenger.  We're giving more physically demanding challenges to less physically prepared (and, many times, less motivated) kids.

Kids need good hitting instruction early.  They also need targeted mobility work, foam rolling, and appropriate resistance training.

Sign-up Today for our FREE Baseball Newsletter and Receive a Copy of the Exact Stretches used by Cressey Performance Pitchers after they Throw!

For more information on the specific return-to-pressing progressions that we use with the athletes and clients we see with shoulder impingement, AC joint issues, and a host of other shoulder conditions, check out the Optimal Shoulder Performance DVD Set.

I moved to Boston in 2006, so this is the fourth season I've gone through with the L-S guys - and while I knew power numbers had increased, I didn't realize that they had virtually quadrupled.  I did, however, get my first hint of what was happening when we saw seven pitchers hit 80mph on the radar gun on the first day of tryouts this year.  This is a pretty big deal for any high school, and certainly one in Massachusetts that has to compete with nasty winter weather and the draw of lacrosse, track, tennis, golf, and volleyball during the spring season.  It's also significant because the competition in the area has improved quite a bit; L-S actually faces many of the players from other schools that we train - and they've gone 85-10 since the start of the 2007 season (when they won the state championship). Needless to say, it was pretty cool to be able to put some numbers with the trend we'd been observing.  And, it serves as a great reminder that - contrary to what a lot of "old school" coaches will try to tell you - a strength and conditioning program is absolutely essential for high school baseball players to not only perform at a higher level, but stay healthy in the process.  In this four-year period, LS baseball has had only one arm surgery, and it was in early 2008 on a player who had been misdiagnosed on ulnar nerve issues since middle school.  He's now playing Division 1 baseball.  The guys understand that arm care is about more than just some foo-foo rotator cuff exercises. This is what happens when the players in a program dedicate themselves to something and are consistent with it over the course of several years. Please enter your email below to sign up for our FREE newsletter.

A while back, I had the privilege to experience Thomas Myers in seminar for the first time.  For those who aren't familiar with Myers, he is the author of Anatomy Trains and a pioneer in the world of bodywork and fascial research.

There were a wide variety of attendees present, and Myers made dozens of interesting points - so the take-away message could easily have been different for everyone in attendance as they attempted to fit his perspective into their existing schemeta.

While I enjoyed all 150 minutes of his presentations, the portion of Myers' talk that jumped out at me the most was his list of the eight means of improving "fascial fitness:"

1.       Use whole body movements

2.       Use long chain movements

3.       Use movements including a dynamic pre-stretch with proximal initiation

4.       Incorporate vector variation

5.       Use movements that incorporate elastic rebound - this consists of cylic motions of a certain speed (for instance, cycling wouldn't count)

6.       Create a rich proprioceptive environment

7.       Incorporate pauses/rest to optimize hydration status

8.       Be persistent, but gentle (prominent changes can take 18-24 months)

A big overriding them of Myers' lecture was that the role of the fascia - the entire extracellular matrix of the body - is remarkably overlooked when it comes to both posture and the development of pathology.  He remarked that he doesn't feel like we have 600+ muscles in the body; he feels like we have one muscle in 600+ fascial pockets because they are so interdependent.  And, in this fascia, we have nine times as many sensory receptors as we've got in muscles.

Think about what that means when someone has rotator cuff problems - and treatment only consists of ice, stim, NSAIDs, and some foo-foo rotator cuff exercises.  Or, worse yet, they just have a surgical intervention.  It overlooks a big piece of the puzzle - or, I should say, the entire puzzle.

For me, though, these eight factors got me to thinking again about just how atrocious distance running is for pitchers.  I have already ripped on it in the past with my article A New Model for Training Between Starts, but this presentation really turned on a light bulb over my head to rekindle the fire.  Let's examine these eight factors one-by-one:

1.       Use whole body movements - Distance running may involve require contribution from the entire body, but there is not a single joint in the body that goes through an appreciable range of motion.

2.       Use long chain movements - Pitching is a long chain movement.  Jumping is a long chain movement.  The only things that are "long" about distance running are the race distances and the length of the hip replacement rehabilitation process.

3.       Use movements including a dynamic pre-stretch with proximal initiation - This simply means that the muscles of the trunk and hips predominate in initiating the movement.  While the hips are certainly important in running, the fundamental issue is that there isn't a dynamic pre-stretch.  This would be a dynamic pre-stretch with proximal initiation:

4.       Incorporate vector variation - A vector is anything that has both force and direction.  Manual therapists vary the force they apply to tissues and the directions in which they apply them.  There are obviously vectors present in exercise as well.  Here are 30,000 or so people, and pretty much just one vector for hours: forward (to really simplify things):

Incorporating vector variation into programs is easy; it just takes more time and effort than just telling someone to "run poles."  Take 8-10 exercises from our Assess and Correct DVD set and you've got a perfect circuit ready to roll.

5.       Use movements that incorporate elastic rebound - Sorry, folks, but even though the stretch-shortening cycle is involved with jogging, its contribution diminishes markedly as duration of exercise increases.  And, frankly, I have a hard time justifying bored pitchers running laps as "elasticity."

6.       Create a rich proprioceptive environment - There is nothing proprioceptively rich about doing the same thing over and over again.  They call it pattern overload for a reason.  Pitchers get enough of that!

7.       Incorporate pauses/rest to optimize hydration status - Myers didn't seem to have specific recommendations to make regarding work: rest ratios that are optimal for improving fascial fitness, but I have to think that something more "sporadic" in nature - whether we are talking sprinting, agility work, weight training, or dynamic flexibility circuits - would be more appropriate than a continuous modality like jogging.  This is true not just because of duration, but because of the increased vector variation potential I outlined earlier.

8.       Be persistent, but gentle - This one really hit home for me.  Significant fascial changes take 18-24 months to really set in. I am convinced that the overwhelming majority of injuries I see in mature pitchers are largely the result of mismanagement - whether it's overuse, poor physical conditioning, or improper mechanics - at the youth levels.  Poor management takes time to reach the threshold needed to cause symptoms.  In other words, coaches who mismanage their players over the course of the few months or years they coach them may never actually appreciate the physical changes - positively or negatively - that are being set into action.

Distance running might seem fine in the short-term.  Overweight kids might drop some body fat, and it might make the practice plan easier to just have 'em run.  Kids might not lose velocity, as they can compensate and throw harder with the upper extremity as their lower bodies get less and less powerful and flexible.

However, it's my firm belief that having pitchers run distances not only impedes long-term development, but also directly increases injury risk.  Folks just don't see it because they aren't looking far enough ahead.

Please enter your email below to sign up for our FREE newsletter and you'll receive a deadlift technique video!