Home Posts tagged "Hip Internal Rotation"

Elite Baseball Mentorships: The Importance of Hip Rotation

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.

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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.

Weaver closed stride

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.

Tippett reports 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.

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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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Ankle, Hip, and Thoracic Mobility Training for Catchers

Today, my good friend Joey Wolfe has a great guest post on the topic of training baseball catchers.  Joey's a really bright guy with a lot of experience on this front; I think you'll enjoy this. - EC

One of the biggest challenges for young players is being able to make adjustments to their swing, throwing mechanics, running mechanics, etc. Sometimes mental barriers get in the way of making the adjustment, yet often times it is a physical limitation; more specifically a mobility, stability or sequencing issue. As a coach it can be very frustrating trying to get a player to make an adjustment to their mechanics that their body is simply unable to make. A good coach will try to figure out another way to communicate the adjustment to the player. A great coach will figure out where the problem lies. This is where the strength & conditioning coaches come in. Although most of us may not know what it means to beat the ball to the spot, all of us should have a good understanding of how to improve the mobility of our athletes. It is this skill set that will directly affect the performance of our athletes.

The main responsibility of any catcher is to catch the ball. If a catcher cannot consistently catch the ball he will quickly find himself playing in the outfield. A catcher has many responsibilities; handling the pitching staff, calling pitches, receiving, blocking, throwing; the list goes on. In order for a catcher to be successful they must first and foremost be comfortable. Without the proper mobility the catching duties can quickly go from hard to impossible. Here are the three areas that stand out as the limiting factors in regards to mobility for catchers.

1. Limited ankle mobility: It is imperative that a catcher has mobile ankles. Having mobile ankles allows the catcher to comfortably get in a squatting position. With nobody on base (primary stance) a catcher is generally going to sit into a deep, comfortable squat with the ankles slightly everted. Stiff ankles have a tendency to put more stress on the hips. Also, without ankle mobility a catcher’s ankle sway will be limited. Ankle swaying is extremely important for catchers, especially at the lower levels because pitchers tend to lack command of their pitches. Ankle swaying allows the catcher to get their nose and body in front of the ball without moving the receiving arm too much. When there is a lot of movement with the receiving arm the pitch doesn’t look as good from the umpire’s vantage point. Finally, if an ankle is locked up it will limit the catcher’s ability to get in the proper throwing position to deliver the ball to second base. Although the movement may start at the hip, the ankle needs to have the appropriate amount of mobility to allow the ankle to externally rotate so the back foot can get in the correct position. Here are some of our favorite ankle mobility exercises.

Multiplanar Wall Ankle Mobilizations (previously described by EC here)

Ankle Inversion with Band

Sit with the band attached to your inside foot with a pad under calf so heel is off the ground. Use only your ankle, pull toes to stretch the band shin and return to the starting position for prescribed number of repetitions. Do not allow any movement throughout your leg or hip during the exercise. There should be less motion moving your foot out than in. This exercise will work the muscles in your lower leg and challenge the coordination in your ankle.

Ankle Eversion with Band

Sit perpendicular to a band that is attached to the outside of your foot. Place a pad under your calf so the heel is off the ground. Move your ankle away, stretching the band for the prescribed number of repetitions. Do not allow any movement throughout your leg or hip during exercise. There will be less motion moving your foot out than in. Working the muscles in your low leg and challenging the coordination in your ankle.

2. Poor thoracic mobility: It has been pretty well documented that limited shoulder mobility and/or thoracic extension will impede one's ability to get into the correct squatting position. Well imagine trying to catch an Aroldis Chapman fastball or a Tim Collins curveball if you can’t get down in a comfortable squatting position; not fun! Remember, the key to being a successful catcher is being comfortable. The absence of thoracic mobility is highlighted when a catcher has to get down into their secondary stance (two strikes on the batter and/or a runner on base). What you’ll find is a rounded upper back and shoulders that roll forward. This creates three problems.

First, it makes for a smaller target for the pitcher. Pitchers want a big target to throw to, not a small one. Therefore, generally speaking, it is the catcher’s job to make himself look as big as possible.

Second, it limits the catcher’s ability to receive the ball comfortably from the pitcher. Often times the catcher will feel “locked up” when they are unable to move freely through their t-spine. A low and away curveball from a right-handed pitcher will give them fits and you can forget about a good right-handed two-seam fastball or filthy left-handed slider. Basically any pitches that require the catcher to go get the ball will create challenges for a catcher that is tight in their t-spine.

Third, when a mobility issue is present the lengthened muscles will serve to dissipate the force transfer from the ground and lead to slower feet. This will make it near impossible to do anything quickly. Whether it is going down to block a ball, throw a runner out or back up first base, being tight up top will effect what is going on down below. Here are a few great exercises to help improve mobility in the t-spine.

Thoracic Spine Mobility - Double Tennis Ball

Tape two tennis balls together to for a "peanut" shape. Lie on your back with the balls under your spine just above your lower back and your hands behind your head. Perform 5 crunches. Then raise your arms over your chest and alternately reach over your head for 5 repetitions with each arm. Move the balls up your spine 1 to 2 inches and repeat the crunches and arm reaches. Continue moving the balls up your spine until they are just above your shoulder blades and below the base of your neck. During the crunches, try and "hinge" on the ball rather than rolling over it. Think about keeping your ribs pushed down to the ground during the arm reaches, as if you were getting a deep massage in your mid to upper back.

Side-Lying Extension-Rotation

Quadruped Extension-Rotation

3. Bad hip mobility: Last, but certainly not least, on the list of mobility restrictions is bad hip mobility. Of the three limitations I have mentioned, this one may be the biggest culprit in young catchers today. Given the number of hours kids spend sitting in class, watching T.V. and playing video games, it comes as no surprise that their hip mobility is negatively affected. We often find that the catchers we work with lack internal rotation (internal rotation deficit), and are short/tight in their hip flexors and adductors.

Two of our favorite stretches to address an internal rotation deficit are the knee-to-knee stretch and the supine dynamic hip internal rotation stretch. Allowing for more rotation in the hips is going to free the catcher to better perform the ankle sway, which really starts at the head of the femur. That internal hip rotation gives the ankles and the rest of the body a better chance to get in front of the ball when receiving a pitch and also allows the feet to get in the proper position when throwing the ball.

Lying Knee-to-Knee Mobilization

As Eric mentioned a few weeks ago in his epic post 15 Static Stretching Mistakes, the lying knee-to-knee stretch can impose some valgus stress at the knees if it isn't coached/cued properly. So, instead of thinking of letting the knees fall in, tell the athlete to actively internally rotate the femurs. The stretch should occur at the hips, not the knees.

Supine Dynamic Hip Internal Rotation

When addressing the adductors (groin), we are advocates of doing as much soft tissue work as one can stand. It’s not easy to get in to all of these areas with a foam roll, so we'll often we’ll have our clients use a tennis ball or lacrosse ball (if they can handle it). After hammering these areas with some soft tissue work, we’ll have our catchers do a few lengthening exercises. A couple of our favorites are the Split-Stance Kneeling Adductor Mobs and the Half-Kneeling Hip Stretch. When done right, both of these exercises emphasize the importance of hip mobility while maintaining core stability. Here’s a look at some of these exercises.

Split-Stance Kneeling Adductor Mobs

Half-Kneeling Hip Stretch

Simple and easy way to stretch some of the tightest muscles in the body. Squeeze the glutes of the knee that is on the ground, then push the hips forward. To progress, raise your arms overhead.

Typically, catchers are big guys who – for their size – move free and easy, especially in the aforementioned areas. Being a good catcher is more than just being big and strong. It is about being big and strong while maintaining your mobility and flexibility. Anyone can add size and strength, but if your movement is compromised in the process, then it is almost certain that you will see a decrease in performance. Spend some time doing these mobility exercises before, during (preferable) or after your workouts for the next few weeks and see how much better your body feels. Good luck!

About the Author

Joey Wolfe is the owner and founder of Paradigm Sport, a Santa Cruz based training business that specializes in performance training for athletes. Before his career as a strength & conditioning coach, Joey played baseball professionally in the Toronto Blue Jays organization. He now works with dozens of youth, high school, college and professional baseball baseball players. Joey's aptitude in the specific skill sets as well as the strength and conditioning aspects of the game provide him with a unique perspective from which to work with his clients on multiple levels. He can be reached at joey@paradigmsport.com.

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Review of Rehab=Training, Training=Rehab: Top 10 Takeaways – Part 2

Today, we've got a follow-up of my blog from late last week, Rehab=Training, Training=Rehab: Top 10 Takeaways - Part 1.  This mini-series highlights some of the key takeaways from Charlie Weingroff's great new DVD set, which is on sale at an introductory price through midnight tonight only.  We pick up today with #6. 6. I’ve written a lot in the past about why a hip internal rotation deficit (HIRD) is a huge problem in both athletes and the general population.  Weingroff raises an interesting point in discussing the “Hip Internal Rotation Paradox” that I’d never really considered – probably because nowadays, I really don’t train as many female athletes where we see valgus-initiated knee and lower leg injuries.  In this population, we see lower extremity pathologies largely because a lot of females can’t control femoral/tibial internal rotation and pronation at the subtalar joint (left side in the photo below).

The casual observer to kinesiology might say that a good way to prevent these injuries would be to make sure that athletes have insufficient internal rotation and pronation; if you can’t hit a dangerous end-range, then you can’t tear anything nearly as easily.  Hooray for HIRD then, right?  Wrong. The problem with this thought process, though, is that it doesn’t appreciate that the hip DOES need full internal rotation for proprioception.  As Charlie puts it, the hip “needs to know it to prevent it.”  If we don’t have adequate proprioception, we can’t get the hip external rotators to turn on to prevent it from becoming excessive.  This is really true of all joints; we must have full mobility so that the mechanoreceptors can tell the brain that a joint can go from point A to point B.  Otherwise, we can’t stabilize naturally and reflexively. 7. Weingroff reaffirmed a great assertion that I remember Bill Hartman making a year or two ago: you only need stability in the presence of mobility.  In other words, “functional” mobility is not just about being capable of adequate stability in wild excursions of joint range of motion – unless that’s what your functional demands are.  In other words, a powerlifter, gymnast, and baseball pitcher would all have different “optimal mobility” schemes, and even within these populations, you’d see different needs for different folks based on body type and the specific activity in question. This also can influence our training programs.  While exactly simulating the sporting movement will only lead to overuse without enhancing functional mobility, working to improve stability in similar joint alignments and ranges of motion can still have a favorable carryover.  This came to mind the other day when Kansas City Royals prospect Tim Collins was doing some core work at the facility; you just have to consider the movement alongside his functional demands.

8. Charlie also cited some more up-to-date research that shows that problem with lateral knee pain is usually too much femoral internal rotation during closed chain movements (e.g., squatting, lunging), not too much lateral patellar tracking.  So, you think the hundreds of thousands of lateral release surgeries that have been performed in the last decade were a good idea?  A lot of people could have gotten their issues under control the right way by getting the hip under control – because the patella was already where it was supposed to be. 9. I liked the way that Weingroff broke corrective exercise down into three categories: isolated, integrated, and functional movement.

Isolated work might include manual therapy (massage or joint mobilizations) or stretching.  Essentially, this category consists of interventions where the client/patient has little to no active participation (foam rolling would technically be a mild exception, as the client has to actively reposition his/her body for this soft tissue work).  Effectively, these modalities get the ball rolling on undoing a dysfunction that won’t clear up with gross movement because the individual with the problem will simply go to the path of least resistance and feed into that dysfunction. Integrated work is aimed at tying this new mobility with the core – whether it’s with a more comprehensive mobility drill or stabilization exercise.  Many people can benefit from going directly to integrated work; examples include someone who has always trained on machines, or someone who sits at a desk all day; they simply need to move). Functional movement is the third piece of the puzzle and involves tying the upper and/or lower extremity to the core.  This is the fun stuff. 10. There is a difference between functional movement and functional exercise.  This might seem like wordplay, but in reality, it’s an important differentiation to make. Charlie cited the example of a baby going into lumbar flexion when squatting down.  It’s a range-of-motion that a child should have and utilize in normal development and day-to-day living.  That doesn’t, however, mean that it’s a good idea to put 405 on your back and squat through lumbar flexion. That wraps up my not-so-quick recap of Rehab=Training, Training=Rehab.  To be honest, I could have written another dozen blog posts just like this on all the other stuff – both “big picture” points and finer subtleties – that I picked up from Charlie’s presentation.  That, however, is best left to Charlie – which is why I’d strongly encourage you to pick up a copy of the DVD set yourself, especially since it is on sale at the introductory price ($50 off) through Monday 12/20 at midnight.  You won’t regret it: Rehab=Training, Training=Rehab

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Stuff You Should Read: 3/9/10

I just got back from speaking at the NSCA Personal Trainers Conference in Las Vegas, so I'm a bit short on content as I play catch-up now that I'm back in Boston.  Luckily, Bill Hartman put together an excellent two-part series on femoral anteversion as it relates to hip mobility.  Check them out: Hip Mobility: Femoral Anteversion - Part I Hip Mobility: Femoral Anteversion - Part II Along similar lines, this old video blog of mine might interest you: Measuring Hip Internal Rotation
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The Best of 2009: Videos

This week, we've already covered the most popular articles and product reviews from EricCressey.com in 2009.  Next up are the popular videos. One of my goals for 2009 with this site was to include a lot more video content - whether it was "built in" to the text, or serving as a stand-alone content source in itself.  Here were some of the most popular ones for the year: Correct Push-up Technique - This one got over 9,000 views in spite of the fact that I never even included it in a blog post (that I can remember).  I guess my theory that most people really need to learn how to do good push-ups was right on the money.

My 660 Deadlift - I guess lifting heavy stuff is only about 89% as cool as body weight push-ups.

Tim Collins Can Jump - Great guy, stud athlete, bright future.  Gotta' love him.

16x16 Sled Madness - This sled masochism was popular among our staff early in the year.  There is more info on it HERE.

Rollouts: Friend or Foe - This video went hand-in-hand with this newsletter.

Anterior Core Progressions - This video was a follow-up to the previous one, and was found in this newsletter.

Measuring Hip Internal Rotation - This video was featured as part of this newsletter.

Lastly, there were a few newsletters that included a ton of video content.  Here's my personal favorite, a follow-up from Mike Reinold and my shoulder seminar (available soon on DVD): Recap: Testing, Treating, and Training the Shoulder.

Tomorrow, we'll cover the top guest submissions for the year at EricCressey.com.

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The Best of 2009: Articles

In place of "Stuff You Should Read" this week, I thought it might be cool to direct you to our most popular pages and videos for 2009, according to our website statistics.  Presumably, these are the ones that people forwarded to friends the most, and/or the ones that caught the most people's eyes.  This excludes pages like the homepage, baseball content, products, etc.  Here we go: Medicine Ball Madness - This piece outlined some of the medicine ball work I do with both my baseball guys and the rest of our clients.  It was so popular that it actually led to me deciding to cover this topic at my Perform Better talks for 2010. Hip Internal Rotation Deficit: Causes and Fixes - This Q&A on what the lying knee-to-knee stretch does actually led to a discussion of the who, what, when, where, why, and how. Front vs. Back Squats - This is a different kind of discussion on a debate that's been going on for years. Crossfit for Baseball - Controversial?  Yup.  I got a little hate mail for this one, but on the whole, I think I was pretty fair with how I approached it. "Quad Pulls" and Sprinting Warm-ups - This article discusses how the term "quad pull" might not be the most accurate one out there - and, more importantly, how to avoid them. A Common Cause of Hip Pain in Athletes - This piece discusses femoral anterior glide syndrome, a term coined by Shirley Sahrmann. Next, we'll feature the most popular product reviews of 2009.
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Measuring Hip Internal Rotation

Q: Inspired by your articles on T-Nation, I've started to measure IR/ER/Total shoulder rotation deficits using a goniometer.  I did have another question, however: you mentioned in an article that Hip Internal Rotation Deficit (HIRD) is a serious problem among baseball pitchers and hitters due to the asymmetrical front leg blocking in both mechanics. I absolutely agree, and I use corrective exercises and stretches to help alleviate these problems. However, I lack a good way to test for this; do you have any suggestions? A: We check hip internal rotation in the seated position.  Basically, you just have the individual sit up tall at the end of a table, and position the hips and knees at 90 degrees.  Then, without allowing the hip to hike, you internally rotate the femur. This is one of the many assessments on our new DVD set, Assess and Correct, and it's featured on page 50 of the tag-along e-manual.  Check it out:

For more information on how to correct the problem - and assess for other issues like this, check out www.AssessandCorrect.com.

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