We’re excited to welcome renowned orthopedic surgeon Dr. David Altchek of the Hospital for Special Surgery to this week’s podcast. Dr. Altchek shares some outstanding clinical insights on the diagnosis and treatment of anterior shoulder pain in overhead throwing athletes.
A special thanks to this show's sponsor, Marc Pro. Head towww.MarcPro.comand enter the coupon code CRESSEY at checkout to receive 10% off on your order.
Sponsor Reminder
This episode is brought to you by Marc Pro, a cutting-edge EMS device that uses patented technology to create non-fatiguing muscle activation. Muscle activation with Marc Pro facilitates each stage of the body’s natural recovery process- similar to active recovery, but without the extra effort and muscle fatigue. Athletes can use it for as long as they need to ensure a more full and quick recovery in between training or games. With its portability and ease of use, players can use Marc Pro while traveling between games or while relaxing at home. Players and trainers from every MLB team - including over 200 pro pitchers - use Marc Pro. Put Marc Pro to the test for yourself and use promo code CRESSEY at checkout at www.MarcPro.com for 10% off on your order.
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And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.
Thank you for your continued support!
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We're excited to welcome renowned orthopedic surgeon, Dr. Anthony Romeo, to the latest podcast. He shares some great insights regarding the diagnosis and treatment of latissimus dorsi and teres major injuries. The incidence of these injuries has increased significantly in recent years, and Dr. Romeo has been at the forefront of addressing this new sports medicine challenge.
A special thanks to this show's sponsor, Marc Pro. Head towww.MarcPro.comand enter the coupon code CRESSEY at checkout to receive an exclusive discount on your order.
Sponsor Reminder
This episode is brought to you by Marc Pro, a cutting-edge EMS device that uses patented technology to create non-fatiguing muscle activation. Muscle activation with Marc Pro facilitates each stage of the body’s natural recovery process- similar to active recovery, but without the extra effort and muscle fatigue. Athletes can use it for as long as they need to ensure a more full and quick recovery in between training or games. With its portability and ease of use, players can use Marc Pro while traveling between games or while relaxing at home. Players and trainers from every MLB team - including over 200 pro pitchers - use Marc Pro. Put Marc Pro to the test for yourself, and use promo code CRESSEY at checkout at www.MarcPro.com for an exclusive discount on your order.
Podcast Feedback
If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.
And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.
Thank you for your continued support!
Sign-up Today for our FREE Baseball Newsletter and Receive Instant Access to a 47-minute Presentation from Eric Cressey on Individualizing the Management of Overhead Athletes!
Why pitch counts are important, and how that importance relates to the SAID (specific adaptation to imposed demand) principle
● What coaches should consider when incorporating vertical pulling exercises with athletes who have a history of lat injury
● What the best exercises are for strengthening the deceleration muscles of the throwing motion
● What professionals should assess in an athlete when personalizing an arm care program
Sponsor Reminder
This episode is brought to you by Athletic Greens. It’s an all-in-one superfood supplement with 75 whole-food sourced ingredients designed to support your body’s nutrition needs across 5 critical areas of health: 1) energy, 2) immunity, 3) gut health, 4) hormonal support, and 5) healthy aging. Head to www.AthleticGreens.com/cressey and claim my special offer today - 20 FREE travel packs (valued at $79) - with your first purchase. I use this product daily myself and highly recommend it to our athletes as well. I'd encourage you to give it a shot, too - especially with this great offer.
Podcast Feedback
If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.
And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.
Thank you for your continued support!
Sign-up Today for our FREE Baseball Newsletter and Receive Instant Access to a 47-minute Presentation from Eric Cressey on Individualizing the Management of Overhead Athletes!
We're excited to welcome Baltimore Orioles relief pitcher Richard Bleier to the podcast for Episode #11. A special thanks goes out to this show's sponsor, Pedestal Footwear. Head to http://www.PedestalFootwear.com and enter the coupon code EC20 and you'll receive a 20% off on your order.
Show Outline
How Richard’s complacency in high school limited his growth as a ballplayer and how his experience at Florida Gulf Coast provided the discipline he needed to arrive at purposeful development
How Richard remained patient and persevered through an extensive minor league career
What transformed Richard from a career minor leaguer to one of best statistical pitchers to ever toe a big league rubber
Why Richard moved away from relying so heavily on his fastball and how mixing his pitches to include more changeups allowed him to become a more consistent and effective pitcher
How commanding the inner half of the plate revolutionized the way Richard attacks hitters and how this led to the development of his cutter
How Richard extracts value from analytical information on hitters while still playing to his strengths to create a plan that inspires confidence against the best hitters in baseball
Why Richard considers himself the most unlikely big leaguer of all time
What characteristics in coaches have helped and hindered Richard’s development throughout his career
How Richard’s parents have proven to be his most supportive (and embarrassing) fans as he reflects on the best moments of his minor league career
How Richard strained his lat in 2018 and how he worked diligently and intelligently to rehab from this injury successfully
This episode is brought to you by Pedestal Footwear. As featured in Men's Health, Women's Health, Hufffington Post, and MSNBC - and trusted by the top strength coaches in the world - Pedestal Footwear is on a mission to get athletes out of traditional sneakers and into Pedestals to help mitigate injury and improve performance. They're durable enough to handle all of your training needs; I LOVE them for deadlifting because they keep me in contact with the ground and have a patented grip design for added traction. They're made in the USA and can fit in your pocket. Pedestal also offers cool customization and wholesale options. If you head to www.PedestalFootwear.com and enter the coupon code EC20 at checkout, you'll get 20% off on your order.
Podcast Feedback
If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.
And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.
Thank you for your continued support!
Sign-up Today for our FREE Baseball Newsletter and Receive Instant Access to a 47-minute Presentation from Eric Cressey on Individualizing the Management of Overhead Athletes!
I hope you had a great week. In case you're looking for some recommended reading while you're sipping coffee this weekend, here's a good collection:
Overcoming the "Best Coach on Staff" Problem - This might be my favorite blog post that my business partner, Pete Dupuis, has ever written. This is a problem that just about every gym faces as they experience growth.
Young athletes need to be given opportunities to fail in training without significant consequences. Beyond the obvious motor learning benefits, it keeps them humble and hungry.
There have been some noteworthy lat strains in MLB over the past few years, and this trend isn't showing any signs of letting up. Here are a few reasons why they're occurring at such an alarming rate.
1. Better Diagnosis
Any time a diagnosis becomes more "accepted," doctors know to look for it more immediately. In 2011, Jake Peavy was the first player to actually tear the lat off the humerus and have surgery on it, but now we're actually seeing 1-2 of these each year in guys who come to Cressey Sports Performance for consultations (on top of guys who have lower grade lat strains). In the past, a lot of doctors would mistake lat strains for rotator cuff injuries or biceps tendon issues (because the lat attaches on the front of the humerus). Sometimes, lat injuries would be missed on MRIs because the attachment is far enough down the humerus that a regular shoulder MRI wouldn't cut wide enough. In short, better identification and subsequent diagnosis are always a big reason why a class of injuries "surges."
2. Harder Throwers
Lat recruitment during acceleration is substantially higher in high level throws than it is in amateur pitchers. In particular, as lot of elastic energy is put into lat during the lay-back phase of throwing while it works as an anterior stabilizer of the shoulder as it prepares to unleash that energy into powerful internal rotation and horizontal adduction.
Sprinters who run fast pull hamstrings more often. Basketball players who jump high increase their risk of Achilles ruptures. It shouldn't be a surprise that harder throwers have a higher incidence of lat strains.
3. Inappropriate Strength Training
With each passing day, weight training gets more and more "accepted" in baseball populations, and I absolutely love it. Unfortunately, that means a lot of inferior programs get implemented, and nothing is more inferior in a baseball strength and conditioning setting than programs that are way too lat dominant. If you're doing pull-ups, bench presses, heavy deadlifts, farmer's walks, walking dumbbell lunges - and then coaching all your rows and arm care exercises to be very lat dominant, you're really just exacerbating all the negative adaptations we see in throwers. If you look around your weight room and see a ton of guys with limited shoulder flexion, that should be a red flag.
4. Poorly Executed Arm Care Programs
Lats are sneaky, as they'll find a way to creep into a lot of arm care exercises. You'll see people "tug down" (extension/adduct) the humerus (upper arm) during external rotation exercises using the lat when it should be relaxing to allow the arm to externally rotate.
You'll see hands creeping toward the midline (shoulder internal rotation) during wall slide variations - when the lat should be relaxing to allow "clean" overhead motion to take place.
You'll see individuals lock the scapula down into depression during prone trap raises instead of allowing it to posterior tilt.
And, in the most commonly butchered exercise by every lat strain pitcher I've ever seen, you'll see the humerus tugged down during the prone horizontal abduction (when it should be at 90 degrees).
These examples should help to demonstrate that we've had a lot of success bringing lat strain injuries back to full function not only because of our quality manual therapy, but also because we know how to prescribe and meticulously coach the exercises that are so important for these individuals to master.
5. Weighted Balls
Weighted ball programs increase external rotation quickly (particularly in hypermobile throwers) and the lat - as one of the anterior stabilizers of the shoulder - is one structure that takes on the brunt of the load. When external rotation increases quickly and high speeds are involved, the lat at lay-back is analogous to the Achilles tendon of a basketball player that lands on a heavy dorsiflexed ankle; it just can't "give" any more. If you're a visual learner (and don't have a weak stomach), check out the 1:40 mark in this video to see what crazy eccentric stress at the end-range of a joint can do.
Now, imagine he's an untrained 14-year-old working at these speeds and you put a 100-pound weight vest on him; do you think it'll turn out well?
Weighted balls are awesome - when they're integrated at the right times, at the right loads, in the right dosages, with the right athletes who have earned the right to use them.
Closing Thoughts
If you look at these five contributing factors - and exclude the one (better diagnosis) that's actually a good thing - you'll realize that we have three that are completely in our control. Coach exercises correctly, prescribe strength and conditioning exercises appropriately, and integrate weighted baseball work the right way. If we do these three things correctly - and make sure to take care of tissue quality and length in our throwers - I firmly believe we can completely prevent lat strains, and that's been verified by our experience at Cressey Sports Performance.
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I hope you all had a great holiday week. Here's some recommended reading and listening from around the 'net over the past week:
The Best Team Wins - This was an awesome recommendation from my buddy Josh Bonhothal. Adrian Gostick and Chester Elton provide some outstanding strategies for both sports team settings and businesses alike. The section on Baby Boomers vs. Generation Xers vs. Millenials was particularly fascinating.
Matej Hocevar on the Physical Preparation Podcast- Matej is an absolutely awesome guy with a wealth of information to share, and this podcast is an excellent example. He was also an amazing host to my wife and me when we visited Slovenia a few years ago.
7 Ways to Increase Your Training Density - I reincarnated this post from the archives earlier in the week and it was a hit, so I wanted to give it a mention here as well.
Top Tweet of the Week
If throwers try too hard to drive early arm speed, they may give up the core create a late arm action that sprays balls up & arm side (or accidental cutters). We coach athletes: “allow the hips to deliver the hand.” Here’s one of our favorite exercises to teach this patterning. pic.twitter.com/vKRTCsCcFr
For today's guest post, I've collaborated with physical therapist Eric Schoenberg, one of my co-presenters at the Elite Baseball Mentorship. Enjoy! -EC
The #1 reason why a player or team does not succeed in baseball is injury. Today, there is a surplus of information, but at the same time a lack of basic understanding of how to keep a baseball player healthy. When in doubt, you can never go wrong by understanding and relying upon anatomy and quality human movement.
One key principle to understand in this regard is that there is a tremendous system of checks and balances working at the shoulder girdle to make sure that we control both the big movements (osteokinematics) and subtle joint movements (arthrokinematics) in a small window for health and performance. If we look to anatomy, we can appreciate a very important concept by looking at the attachment points for the deltoid, latissimus dorsi, and pectoralist major: your three biggest prime movers in the upper extremity. You'll notice that all three attach on the shaft of the humerus, not the humeral head. Take a look at their attachment sites on this anatomical chart, and then compare them to where the rotator cuff (supraspinatus, subscapularis, teres major, and teres minor) attach further up on the humeral head.
You can appreciate that all these big muscles attach on the anterior (front) aspect of the humerus, which means that they have powerful pulls into internal rotation that have to be counteracted by fewer, smaller muscles that attach on the posterior (back) aspect of the shoulder.
Here are three specific implications of these anatomical observations that relate to how you manage your throwing athletes:
1. The Deltoid is strong/active enough!
The deltoid works in conjunction with the supraspinatus to form a “force couple.”
If the strength, recruitment, or timing of the deltoid is greater than the supraspinatus, then the result will be superior migration of the humeral head in the glenoid. This results in superior humeral head stress (chondral defect), undersurface rotator cuff tear, labral pathology, among other structural injuries to the glenohumeral joint.
Tip: Be sure that athletes feel rotator cuff strengthening exercises in the cuff and not the deltoid or biceps.
2. The lat is strong/active enough!
The lat (as it acts on the scapula) is opposed by the serratus anterior, lower trapezius, and upper trapezius to control scapular rotation. Increased relative stiffness of the lat results in excessive scapular depression and downward rotation at rest.
Additionally, if you have decreased activation or muscle performance of the scapular upward rotators and elevators with overhead motion, the outcome will be inferior migration of the glenoid on the humeral head.
This results in superior humeral head stress (chondral defect), undersurface rotator cuff tear, labral pathology, among other structural injuries to the glenohumeral joint.
Tip: Be sure that the athlete’s programs have a good balance of overhead reaching tasks done with proper mechanics and timing of the glenohumeral and scapulothoracic joints.
3. The pecs are strong/active enough!
Pectoralis major's impact on the anterior glenohumeral joint is opposed by the rotator cuff to prevent anterior humeral glide. Effectively, the pec and lats want to pull the ball forward on the socket as the arm goes through gross movements, and the rotator cuff works hard to prevent this gliding at the joint level.
Dominance of pec major over the rotator cuff muscles (namely subscapularis) will play a role in an athlete presenting with anterior humeral glide. We often hear the athlete report “tightness” in the front of the shoulder and their first option is to "stretch it."
This can lead to anterior shoulder pain and potential structural pathology including anterior joint laxity, biceps tendon pathology, and labral pathology – all common injuries in throwing athletes.
Tip: Rather than trying to decrease the “tightness” in the front of the shoulder by aggressively stretching—instead, focus on improving static alignment, proprioceptive awareness, and recruitment of the cuff. If you couple this with some self-massage work, this approach will yield far more favorable results.
In closing, the shoulder joint is happiest when alignment is optimal. Injury will occur if preferred alignment is altered. Examples of altered alignment at rest or with movement are the humeral head is riding too high in the socket, the socket is riding too low on the humeral head, or the humerus is gliding too far forward. The resultant stress to the active or passive restraints of the shoulder leads to injury and loss of playing time. Do yourself (and the players that you work with) a favor and master the basics to help improve success on the field.
Looking to learn more about our unique approach to assessing and managing throwing athletes? Check out the upcoming Elite Baseball Mentorship Upper Extremity Course on January 14-16, 2018. For more information, click here. The early-bird registration discount ends tonight at midnight.
About the Co-Author
Eric Schoenberg (@PTMomentum) is a physical therapist and strength coach located in Milford, MA where he is co-owner of Momentum Physical Therapy. Eric is addicted to baseball and plays a part in the Elite Baseball Mentorship Seminars at Cressey Sports Performance. He can be reached at eric@momentumpt.com.
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I have a love/hate relationship with the lats. On one hand, you need strong lats for all sorts of athletic endeavors, from throwing to sprinting. On the other hand, if they're too overactive, a host of different injuries/conditions can result. With that in mind, preserving full latissimus dorsi length is important, and that's why we incorporate a lot of stretches on this front. It's important that those stretches are done correctly, though, and in today's video, I want to discuss one big mistake we commonly see in this regard.
Speaking of upper body work, if you're interested in learning more, be sure to check out my new resource, Sturdy Shoulder Solutions.
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I hope you all had a great weekend. I turned 36 on Saturday, and it was a pretty mellow, unremarkable birthday - which is exactly what I wanted! Here's a little recommended reading/listening/viewing for you to kick off the week:
Lat Injuries in Major League Baseball - Here's an article from Lindsay Berra on an injury on the rise in MLB. I chipped in some info on the function of the lats in throwing.
EC on The Fit Clique Podcast - I hopped on Chris Doherty's podcast last week, and you can check it out on YouTube:
Business Bench Pressing with Pete Dupuis - Speaking of podcast, my business partner, Pete, shared some great business tips for fitness professionals on The Fitcast a few weeks ago.