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Dr. William Brady: Integrated Diagnosis

This past weekend, I attended a great seminar here in Boston with Dr. William Brady.  In fact, it was among the best I've seen.  I was the only non-chiropractor/manual therapist in attendance, but walked away from the seminar with some tremendously valuable insights that'll help me with each and every one of my clients moving forward.

The first lesson of the day is that those of you who have an opportunity to see Dr. Brady speak should absolutely, positively check him out: Integrated Diagnosis.  Diagnostically, he's among the best I've ever seen - and that includes his ability to teach others.

The second lesson of the day revolves around an important concept Dr. Brady extended - and my take on how you can modify this message to accommodate your role as a coach, trainer, or fitness enthusiast/athlete.  There is a reason that almost any doctor or physical therapist gets results - and it resolves around understanding where symptom threshold occurs.  To illustrate this, let's examine a shoulder problem purely from a soft tissue perspective.

Dr. Brady talked about how you have building blocks to threshold.  Let's say that after an accurate physical examination, this particular shoulder problem (supraspinatus tendinosis, for example) presents with soft tissue restrictions at the infraspinatus, teres minor, subscapularis, inferior capsule, and pec minor.  So, symptom threshold (the dotted line) might look like this relative to baseline (straight line):

Pec Minor - - - - - - - - - - - Inferior Capsule Subscapularis Teres Minor Infraspinatus BASELINE - NO SYMPTOMS

So, imagine a therapist who just addresses pec minor.  He gets that patient below threshold, but doesn't necessarily "fix" him; he might be back in with the same problem weeks later.  This is confounded by the fact that "overuse" is actually one of the building blocks, too.  So, even if you leave all the soft tissue restrictions alone, simply resting will get someone below threshold - even if the therapist has done ZERO to address the underlying problems.

This is one reason why a MRI might not tell you much at all about someone's problem.  With this problem, the MRI would probably just say "supraspinatus tendinopathy" and recommend physical therapy and rest from painful activities.  So, in the "full picture" - where soft tissue work is one of several components (assume they are equal contributors, for the sake of our argument) - the building blocks to threshold might look something like this:

Overuse Rotator Cuff Weakness Scapular Stability Poor Glenohumeral (Ball-and-Socket) Range of Motion - - - - - - - - - - - - - - - - Soft Tissue Restrictions Poor Thoracic Spine Mobility Type 3 Acromion (non-modifiable, without surgery) Poor Exercise Technique Poor Cervical Spine Function Opposite Hip/Ankle Restrictions (baseball pitchers are great examples) Inappropriate Structural Balance in Programming (e.g., pressing more than pulling) Faulty Breathing Patterns BASELINE - NO SYMPTOMS

So, we've got 12 factors, and it's been my experience that conventional physical therapy only treats the first four - which would, in fact, bring a patient below symptom threshold.  Put that patient back in the real-world with the other eight factors still present (seven of which are modifiable), and as soon as he gets back to bench pressing with terrible technique Monday, Wednesday, and Friday, he's going to be back in for more physical therapy sooner than later.

So, what do we do in an ideal scenario (not always possible with today's insurance plans)?

1. More time with patient education (exercise technique, programming strategies - or just outsource it to a qualified professional or good book/article or DVD). 2. Address Thoracic Mobility (Assess and Correct is a great resource for this)

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3. When present, address Hip and Ankle Mobility 4. Retrain some breathing patterns with initial instructions home exercises 5. Provide some take-home neck drills and get people out of chronic forward head posture

All told, I think this could be as simple as 4-5 extra drills in each shoulder rehab program plus a brief sit-down conversation with each patient on exercise program modifications; it really is that simple.  Unfortunately, it rarely happens - and that's when things become chronic.

So, fitness professionals and coaches need to step up as advocates for their clients and athletes, respectively, and fitness enthusiasts need to be relatively informed "consumers" to look out for themselves.

New Blog Content

The Mainstream Media Lag Why Wait to Repair an ACL? (Abbreviated) Random Friday Thoughts

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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Cressey Athlete Finishes 10th at Ford Ironman World Championship

Cressey Performance Athlete, Dede Griesbauer Finishes 10th at Ford Ironman World Championship! This was Dede's second consecutive podium finish.  Awesome job, Dede!

EricCressey.com Subscriber-only Q&A

Q: Could you please explain the rationale for the wall triceps stretch you used in a previous blog post? A: Here’s a photo of that stretch, for those who missed it:

We find that this stretch can relieve shoulder issue in a lot of the guys who come to us with typical pitcher problems – particularly posterior/superior shoulder pain (and sometimes medial elbow pain – but no glenohumeral internal rotation deficit (GIRD). Posterior cuff/capsule stiffness will cause the humeral head to translate superiorly and posteriorly during the late cocking phase of throwing. And, this stiffness also has huge implications on humeral head position during the deceleration and follow-through phases of throwing.

Most throwers with shoulder problems will have the most pain at:

a. maximal external rotation/late cocking phase (usually the worst type of problems, SLAP 2 lesions, that warrant a great consideration of surgery)

or

b. follow-through/deceleration (usually something that’s more easily fixed with good posterior cuff/capsule stretching and good scapular stability work, so conservative treatment is the name of the game)

Of course, all this depends on symptoms, degree of mechanical pain, and what the MRI says. Sometimes, though, if the stiffness isn't present posteriorly, but you're still seeing these kind of symptoms, you have to look to the inferior capsule. The shoulder capsule is large and relatively “loose” to allow for the wide range of shoulder movements present. When tightness kicks in somewhere, you can see some noteworthy problems. So, the roundabout answer to your question is that the truth is that this is as much an inferior capsular mobilization/stretch as it is a triceps stretch. As a general rule of thumb, you always migrate opposite capsular tightness. Inferior tightness leads to superior migration. Inferior tightness is the big problem in regular ol' weekend warriors, and definitely moreso in those who have had surgery and been immobilized with the arm at the side As an aside to this, rarely will someone need JUST inferior capsule mobilizations; they usually need other attention to areas such as

thoracic spine mobility work.

Feedback on The Truth About Unstable Surface Training

Here’s a quote from Leigh Peele of avidityfitness.com on my new e-book,

The Truth About Unstable Surface Training:

“This e-book, regardless of if they have to break out a dictionary, is for every trainer/coach/physical therapist out there. Period. If you are a trainer or if you plan on being a trainer or physical therapist, then you need to own this manual. This isn’t just about doing things “right,” either; this puts you ahead of the pack. Your teams, clients, and patients will thank you for the increase of knowledge.

“I also feel that this e-book is for those who are really serious about training and applying the best methods to their program. If you don’t have a good coach and you need one, sometimes yourself is all you have. If that is the case, go to the education. Coach yourself. “In short, if you design programming, be it for yourself or for others, you should get this e-book for a learning resource.”

Click here to purchase The Truth About Unstable Surface Training.

Blog Updates

Detailed Feedback on Maximum Strength Random Friday Thoughts A Little Monday Update Random Friday Thoughts All the Best, EC 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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5 Keys to Bulletproofing Your Knees

Mike Robertson flew up from Indianapolis to check out a seminar up here in Boston this past weekend. We really enjoyed watching Kevin Wilk, Bob Mangine, and Mark Comerford, three fantastic rehabilitation specialists. Additionally, I enjoyed catching up with Mike just as much, as he’s a wealth of information, particularly with respect to the knees. From just talking with Mike this weekend, I picked up some really good stuff – in addition to the entire day the presenters spent on the knee this weekend.

With that in mind, on Sunday, I wrote down five things that caught my attention this weekend. Then, I handed them to Mike and asked him to elaborate on them on his laptop on the plane ride home for a “guest spot” in my newsletter. Here’s what you’ve got:

5 Keys to Bulletproofing Your Knees

1. VMO specific work is currently poo-poo in the strength and conditioning industry. While I agree that we need to focus on strengthening the hip abductors/external rotators (especially glute max and posterior glute med), current literature leads us to believe that there’s more to the VMO than we might have expected.

Several studies in the past two years have indicated that there is a definite change in fiber pennation between the vastus medialis longus (VML) and the vastus medialis obliquus (VMO). Beyond that, while your other quad muscles like rectus femoris and vastus lateralis only have one motor point, the entire vastus medialis actually has THREE motor points! We may not totally understand the VMO yet, but I’m not willing to write off its importance with regards to knee health.

2. When looking at the body as a functional unit, we can’t overlook the core with regards to knee health. More specifically, we know the rectus abdominus and external obliques work to keep us in pelvic neutral and out of anterior pelvic tilt. Lack of strength in these core muscles increases anterior pelvic tilt, which drives internal rotation of the hip and valgus of the knee. Getting and keeping these muscles strong could go a long way to preventing knee injuries, especially in female athletes.

3. Are accelerated ACL rehab programs what we need? I’m not so sure, and I think making young athletes follow the accelerated programs the pros use may do more harm than good. Unlike the pros that are getting paid to play, we need to focus on the long-term outcomes of our young athletes, not simply getting them back on the field ASAP. Many have done an excellent job of rehabbing patients and getting them back on the field quickly, and quantifying strength and power production/absorption is critical.  Many of the leading PT’s and orthos, however, are moving back to a slightly more conservative approach to allow the graft itself more time to heal. The properties of a tendon graft slowly take on the properties of a ligament over time; this is called ligamentization. However, ligamentous changes can still be seen as late as 12-18 months post-surgery.

[Note from EC: so, if you have a patellar tendon graft for a new ACL, you might not really have what you want until 1-1.5 years post-surgery. Tendons and ligaments have different qualities.] 4. To piggy-back on the previous point, another factor that isn’t examined as often as it should is long-term outcomes of ACL rehabbed clients. Sure it’s great to get them back on the field in 6, 9 or 12 months, but what are the long-term ramifications? We know that females who have suffered ACL tears are much more likely to develop early osteoarthritis. If we can improve long-term outcomes by keeping them out a little longer, isn’t that worth it? As a PT or strength coach, it’s our job to help clients/athletes make the best decision for their long-term health, especially if they are too young to understand the long-term repercussions of their decision.

5. When an athlete tears their ACL, proprioceptive deficits are seen as quickly as 24 hours post-injury. What’s really intriguing, however, is that we often see this same deficit carried over to the healthy knee as well! Even after reconstruction this deficit can be seen for up to six years. To counteract this, don’t forget to include basic proprioceptive training (barefoot warm-ups, single-leg stance work, etc.), and train that “off” leg in the interim. For more tips, tricks, and programming recommendations on knees, check out Mike Robertson’s Bulletproof Knees manual. It’s by far the best resource I’ve seen on preventing and addressing knee pain.

New Blog Content

Just One Missing Piece

Training Around Elbow Issues in Overhead Athletes

Random Thursday Thoughts

Sturdy Shoulders: Big Bench

All the Best,

EC

PS - For those who missed it last week, be sure to check out my new e-book, The Truth About Unstable Surface Training, at www.UnstableSurfaceTraining.com.
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Calling Out Exercise Myths

Warp Speed Reminder
Just a quick heads-up: the EricCressey.com subscriber-only discount on Warp Speed Fat Loss expires TONIGHT at midnight. For those who missed it, check out last week’s newsletter for more details.
The Pendulum Comes Back to Center: Calling Out Exercise Myths
This past weekend, I was down in Stamford, CT to participate on a roundtable at Ryan Lee’s Bootcamp (and to check out the event myself). There was a ton of business information available specific to fitness professionals, and I had a good time catching up with a lot of old friends.
However, as my mind was packed with ideas on the business front, I got a wake-up call on Sunday morning that quickly reminded me that we still need to get better at the training and nutrition side of things as well to elevate our industry as a whole.
You see, my girlfriend and I had the TV on as we were getting ready to head down to breakfast at our hotel. They had a representative from some mainstream magazine on the show to offer four quick tips for folks to improve their exercise programs. Simply put, she gave out exercise advice that was not only ineffective; it was flat-out incorrect.
This “expert” claimed that we absolutely had to eat carbohydrates upon rising to fuel early morning workouts. And, she insisted that one can’t burn fat without consuming carbs. Huh? Has she ever heard of the catecholamines, growth hormone, or cortisol? We had specific hormones that allow us to do exactly this! And, it’s pretty well documented in the research that of the three macronutrients (carbs, proteins, and fats), carbs are the only one that is non-essential.
She took her nutrition advice to the next level by noting that protein was not a good pre-exercise choice because it is too hard to digest. Apparently, it should only be taken post-exercise. Riiiight. Apparently, all those years of peri-workout nutrition research at the U-Texas Medical Branch were for nothing. For those who don’t feel like reading the actual study: “These results indicate that the response of net muscle protein synthesis to consumption of an EAC solution immediately before resistance exercise is greater than that when the solution is consumed after exercise…” Would you rather listen to seven PhDs, or a lady in pink spandex? It actually gets better, though! This woman encouraged the audience (who, we can assume are for the most part completely untrained and predominantly female) to put a BOSU ball in the middle of their living room floor in front of the TV. Her justification was that you simply couldn’t walk by one without wanting to get on it (for the record, I could totally walk by it with no problems, but that’s a discussion for next week). She went on to recommend squats on the ball – and that’s even in light of the fact that most of the folks who would be following this information can’t even squat on stable surfaces in good form. And, we know that most women have issue with anterior weight bearing, so encouraging further pronation with unstable terrain is not a good idea. It took me all of three seconds with Google images to dig up this photo:
Looks like a great squat to me.  If you listen really carefully, you'll hear her ACL yelling "UNCLE!"  Again, I’ll get into a lot of detail on this soon; I promise…
The idiocy continued when she encouraged people to make exercise more complex, using the examples of doing biceps curls while doing lunges. You know what? Most untrained people can’t lunge to save their life! How about teaching them to lunge first – and then teaching them to lunge with something other than a plastic three-pound weight? If I can do walking lunges with well over 100 pound dumbbells, but can’t curl more than 55 pounds in each hand, which is the limiting factor?
So, she was 0-for-4 – but it gets even better.
I returned home to about 200 emails on Sunday night, one of which was a pitch from a guy with a “shoulder stretching apparatus” to promote. In his sales attempt, he actually confused internal with external rotation. And, when he stretched the external rotators and posterior capsule by going into internal rotation, he didn’t fix the scapula. This is a sure-fire way to jack up the anterior capsule, particularly in overhead throwing athletes.
I guess, in the end, my message is that you have to be a devil’s advocate at times in any field. There are bad doctors, lawyers, cab drivers, plumbers – you name it. And, the fitness industry is certainly no exception; in fact, it’s probably the majority that you have to watch out for as being sketchy due to the lack of strict licensure and certification requirements in this field.
Hopefully, people have come to recognize this newsletter as an exception to that rule. My goal is to make it a great information source that touches on a bit of everything, but still focuses on the topics I know best. I’ve recommended some products along the way, but rest assured that it wasn’t just because it was from a friend; it was because they were actually good. Believe me, I have a pile of crap products at home that have been sent to me by all sorts of folks (friends included); these products sit in a pile and you’ll never hear about them because I simply didn’t think they were any good.
To that end, if you are contemplating a purchase and want an honest perspective, drop us an email and ask for a review. If it’s something I’ve read/viewed and didn’t like, I’ll tell you. Or, I might even pick up a copy and check it out myself. I like to keep this newsletter positive, so I won’t rip on any products – but you’ll definitely hear about the best stuff I see.
Along those same lines, don’t hesitate to let us know if there are particular topics you’d like covered in newsletters, audio interviews, blogs, or articles.
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Exclusive Interview with Mike Roussell

An EricCressey.com Exclusive Interview with Mike Roussell – and a Special Offer! A while back, Alwyn Cosgrove and Mike Roussell introduced a new product together. Both these guys are really bright (and good friends of mine), but to be honest, this summer at Cressey Performance was crazy and I never got around to checking it out - until last week. Frankly, I'm pretty annoyed with myself for waiting this long, as Warp Speed Fat Loss blew me away. I emailed the guys right away about an interview for this newsletter, as I think this product would be right up a lot of our readers' alley. Mike agreed - and also decided to throw a special offer our readers' way. So, without further ado, Mike Roussell... EC: There are about 6 million fat loss products out on the market right now. What sets Warp Speed Fat Loss apart from the rest of them? MR: Warp Speed Fat Loss is different from a lot of the other fat loss stuff out there today (even stuff that Alwyn and I have previously made) for a few major reasons. The most important one that Alwyn and I focused on while building and tweaking this program is that we wanted the diet and exercise to work together in a synergistic fashion and not as two separate components. So, the Warp Speed Fat Loss diet is specifically set up to work with the Warp Speed training program; calorie manipulation and carbohydrate cycling, for instance, are both “in tune” with the program. EC: I noticed that right away. A lot of people overlook synergy in training and nutrition, just focusing on one or the other at a single time. You really took the guesswork out of this, didn’t you? MR: Yes, and that’s the second big difference with Warp Speed Fat Loss. We tell you EXACTLY what to do. There is no wiggle room. I think a lot of times people don’t give specific instructions because they don’t have 100% confidence that their system works. We have tested and tweaked this enough to know that it works. So, in the program we tell you exactly what to eat every single day and exactly what to do for training. It is black and white. Follow this exactly and lose a bunch of weight FAST. It is pretty cool. EC: You make some bold claims about how quickly people can drop body fat with a program like this – but the results thus far seem very promising. Can you please fill our readers in on them a bit? MR: You are correct. We do make bold claims, but we didn’t make them up. People went on our program and started losing 15-20lbs in 28 days. So we decided to start saying “Hey – do this and lose 15-28lbs in 28 days.” Your readers will be familiar with Bill Hartman and Mike Robertson; they both used the program (actually, I don’t believe they used Alwyn’s training, but they used the diet). Bill lost 17lbs in just over 3 weeks; he wanted to lose 10lbs. Mike lost 12lbs in 2 weeks (I emailed him back and called him a liar – but it turned out to be true). EC: Yeah, I figured Robertson would be reluctant to skip his step aerobics class on Alwyn’s recommendation. He loves those 1980s leg warmers. Those guys are in-tune with the industry and know what it takes to succeed from years of watching clients get lean. What about others who don’t do this for a living? MR: One of the best email’s I’ve gotten is from Paula Gawlas in Scottsdale, AZ. She said, “Your program rocks! I've exceeded my goals! I am so happy because whereas before every morning I would have to search for some pair of ‘elastic’ somethings to wear, now I know I can wear anything in my closet! (And there's a lot in my closet, so I can go weeks without doing laundry now!). I work out at an LA Fitness here in Scottsdale and a girl was watching me work out and she questioned me about my program. Thought it was some sort of national challenge! I told her about you guys--I kind of hate saying "fat loss" at this point because I don't have any more fat to lose, but I just love the total body workouts! So thank you, thank you! EC: Rave review, indeed. What blew me away the most was the amount of time you put in to the meal plans. When all is said and done, you’ve got about 350 pages of meal plans; that’s insane! Why so many, and what makes these meal plans different? MR: Yes you are right; it is INSANE. The reason why there are so many meals plans is because I wanted everyone to have a meal plan that fit their body. So, I created meal plans for bodyweights ranging from 115lbs to 240lbs in five-pound increments. This way the program will automatically be tailored to the person the second they download it. Initially we didn’t have meal plans lower than 125lbs but people asked for them so I put them together. On a side note, this is really a gem for trainers, as you have so many meal options to use with your clients. EC: Let’s talk training. What tricks does Alwyn have up his sleeve? How much synergy is there between the diet and training components? Would an athlete be able to use your dietary recommendations with his current training model and still get appreciable results? MR: For best results, you need to do the diet and training together. As I mentioned, though, Bill and Mike modified AC’s training program and it still went really well. The training program that Alwyn put together is really awesome. It is different from anything else that he has released. There are no barbell complexes in the program at all. Instead, he uses Metabolic circuits, some heavy weight, low-rep stuff, and a mixture of interval and steady state cardio. EC: What about athletes? Is this suitable for them? MR: We’ve gotten the question about athletes using the program before. In an ideal scenario, an athlete would not use the program until he/she has 28 days to fully dedicate to it. 28 days isn’t very long – especially when you consider most transformation contests are 84 days. EC: Awesome stuff. You’ve got a special deal on this e-book for our readers today, right? Please fill them in. MR: Yeah. So the price of Warp Speed Fat Loss has recently increased to $97 but since you are as big of a Patriots fan as I am, Alwyn and I will knock $20 off the price for your readers. Here’s the special link for that discount:http://www.warpspeedfatloss.com/ec_deal.php This link will be good until – Monday September 22nd EC: Thanks for taking the time, Mike. Here’s that link again, folks:http://www.warpspeedfatloss.com/ec_deal.php New Blog Content Random Friday Thoughts An Epic Battle Feedback on Maximum Strength Have a great week! EC
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This Week’s Top Articles by Eric Cressey

Just a quick one today, folks. First off, I published Part 2 of my article series from last week on training for pitchers between starts. Check it out: A New Model for Training Between Starts: Part 2 Additionally, I had a new article published at T-Nation last week: 5 More Common Technique Mistakes Lastly, here's some new blog content for you: Random Wednesday Thoughts Maximum Strength and HIIT Sessions Random Friday Thoughts Quick Monday Mentions The Continued Wussification of American Children Have a great week! EC
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Baseball Pitchers: Training Between Starts Part 3

CP in the News Here are two great articles about Cressey Performance athlete Sahil Bloom, who recently verbally committed to the Stanford Baseball Program.  Given that this week's newsletter focus has been baseball training, it seems only fitting to highlight a guy who has trained hard and smart to get to where he is.  Congratulations, Sahil! Weston High pitcher buffing up his body as well as his scores Weston's Bloom is Stanford-bound (this is a really old picture; he's 35 pounds heavier now!)

Enthusiastic Feedback on Maximum Strength

Yesterday, I asked some readers for some feedback on Maximum Strength, and I received dozens of emails. This one definitely stood out in my mind, as it goes to show you how versatile the program really is:

Hi Eric,

I picked up Maximum Strength primarily for the "warm up & mobility" chapter. I'm a 48 year-old. masters sprinter. The bulk of my training is the deadlift at 85-95% 1RM, plyometrics and sprints from 25-70m at 95%+.   My biggest training limitation over the past couple years has been mobility at my hips.   Due to soreness and occasional spasms, I've had to reduce the intensity and volume of my deadlift and sprint workouts.  Earlier this year, I started looking at Stuart McGill's work and exercises, with some improvement. My progress accelerated after I picked up your book.   A few days after incorporating your warm-up drills, I noticed a significant improvement in the mobility of my hips and shoulders.   Around the time I began the drills, I was limited to a 1RM of about 365.   Because of the improved mobility, I was able to add another strength day to my training week.   After about six weeks, I've increased my 1RM to 405lbs (my weight is 165lbs) and I'm targeting 415-420 in 10 days.   My previous personal best was 395 when I was 178lbs. I'm not the only one, though.  I described some of the drills to a colleague (35 year-old former collegiate WR) who had had to discontinue deadlifting due to low back and shoulder problems.   His mobility was so restricted he couldn't raise his arms overhead, nor touch his toes.  After a few days of the drills he was touching his toes and his back hasn't felt this good in years.  He's sold – and he just told me he's getting the book. I've also got my daughter (college cheerleader) on your program. Thanks Again, Stephen Boland

Sacramento, CA

Check out Maximum Strength for yourself. A New Model for Training Between Starts: Part 3

Here, in part three of a series on why distance running is terrible for pitchers, I put the final nails in the coffin.

Reason #7: Nobody likes to babysit.

Simply put, running is babysitting. Catcher is actually the position that requires the most endurance in baseball, but we don’t run catchers extra, do we? Nope – and it’s because we have bullpens for them to catch, batting practice for them to take, and all the other responsibilities associated with handling a pitching staff and being a pseudo coach on the field.

My business partner actually was a division 1 pitcher almost ten years ago, and when I brought up this argument, he smiled and nodded, replying with, “When I was a pitcher, all we did was shag fly balls and run poles.” Meanwhile, 57% of pitchers suffer a shoulder injury during a competitive season (5) – and that doesn’t even include elbow, lower back, or lower-extremity injuries! At the major league level, pitchers are 49% of the players, but they account for 68% of the time on the disabled list league-wide (6). Running isn’t going to prevent these problems; it’s going to exacerbate them.

Strike 1.

Reason #8: Distance running ignores existing imbalances.

Baseball is an at-risk sport for a number of reasons. You’ve got an extremely long competitive season, overhead throwing, and – possibly most significantly – unilateral dominance. Switch hitters and guys who bat right and throw left (or vice versa) tend to be a bit more symmetrical, but the guys who bat and throw on the same side tend to have the most glaring issues. Many really smart dudes – most notably, Gray Cook – note that asymmetry is quite possibly the best predictor of injury. When we get pitchers after a long season, our first goals are to address range of motion deficits, particularly in:

1. lead leg hip extension (tight hip flexors)

2. lead leg hip internal rotation (tight external rotators)

3. lead leg knee flexion (tight quads)

4. Throwing arm shoulder internal rotation (tight posterior rotator cuff and capsule)

5. Scapular posterior tilt (tight pec minor and levator scapulae)

6. Throwing arm elbow extension (tight elbow flexors)

I knocked back some caffeine, splashed some water on my face, and really put my thinking cap on to see if I could come up with a rationale for how distance running addresses any of these issues. In the end, I had nothing. I came to the realization that jogging negatively affects the majority of them – and pitchers would be better off just shagging fly balls instead of splitting time between that and long runs. At least they move side-to-side when they’re chasing fly balls.

Strike 2.

Reason #9: It’s really boring!

I am a firm believer that the best coaches are the ones who engage their athletes. The best coaches I had in my athletic career were the ones who made me look forward to each training session. With that said, the only people who look forward to distance running are – you guessed it – distance runners!

Most of the ballplayers you’re coaching have always seen running as a form of punishment for doing something wrong; they hate it as much as I do (okay, maybe not that much). And, truth be told, they’d hate it even more if they realized it is limiting their development as athletes.

Strike 3. The batter’s out – and the side is retired.

Conclusion

I have always disliked it when people criticize the status quo, but fail to offer solutions of their own. With that in mind, the next installment of this series will outline my personal perspective on how to attack the time between pitching outings.

References

1. Gleeson, M. Immune systems adaptation in elite athletes. Curr Opin Clin Nutr Metab Care. 2006 Nov;9(6):659-65.

2. Komi, P.V. Stretch-shortening cycle. In: Strength and Power in Sport (2nd Ed.) P.V. Komi, ed. Oxford: Blackwell, 2003. pp. 184-202.

3. Hennessy L, Kilty J. Relationship of the stretch-shortening cycle to sprint performance in trained female athletes. J Strength Cond Res. 2001 Aug;15(3):326-31.

4. McCarthy JP, Agre JC, Graf BK, Pozniak MA, Vailas AC. Compatibility of adaptive responses with combining strength and endurance training. Med Sci Sports Exerc. 1995 Mar;27(3):429-36.

5. Ouelette, H, Labis J, Bredella M, Palmer WE, Sheah K, Torriani M. Spectrum of shoulder injuries in the baseball pitcher. Skeletal Radiol. 2007 Oct 3.

6. Fleisig, GS. The Biomechanics of Baseball Pitching. Spring 2008 Southeast ACSM Conference.

Until next week,

EC
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Baseball Pitchers: Training Between Starts

Maximum Strength Four-Month Mailer

Nearly four months ago, we first released Maximum Strength, and many of you purchased it. Now, we’d love to hear what you think.

In particular, we know that if you performed your “Packing Day” shortly after you received the book, chances are that you’re gearing up for “Moving Day,” when you get to put all the past four months’ hard work and dedication to the test. This is the time when you get to see some specific quantifiable results.

To that end, as I noted above, we’d love your feedback – whether it’s in the form of your pre- or post-testing numbers, subjective assessments, likes/dislikes, or even before/after pictures. A lot of work went in to preparing this book and program, and assuming that similar projects will be taking place in the months and years to come, feedback from the target audience can only help to make those projects even more successful – and in an efficient manner.

You can send your feedback to ec@ericcressey.com with the subject line “Maximum Strength Feedback.” Thank you for your time, consideration, and continued support.

A New Model for Training Between Starts: Part 2

Yesterday, in Newsletter 121, I got the ball rolling on a series I’ve been meaning to write for quite some time. The focus is why distance running is counterproductive for pitchers – and today, here are three more reasons it’s bad news.

Reason #4: Negative Effects on the Stretch-Shortening Cycle

Here, I need to get a bit geeky for a second so that I can explain the stretch-shortening cycle (SSC). The easiest analogy I can use is that when you want to shoot a rubber band at someone, you pre-stretch it before you release your shot. Muscles work the same way; pre-stretching them (eccentric action) prior to shortening them (concentric action) stores elastic energy and helps that muscle generate more force. Anecdotally, I’ve heard estimates that as much as 25-30% of pitching velocity is attributed to elastic energy – or how effectively someone makes use of the stretch-shortening cycle.

Where we’re different from rubber bands is that we can actually train those elastic qualities to make our tendons more efficient at collecting, temporarily storing, and releasing that elastic energy to help us run faster, jump higher, and throw harder. It’s why doing plyos, sprinting, and throwing medicine balls can do wonders for a player’s performance.

With the stretch-shortening cycle, we need three things, according to Komi (2):

1. a well-timed muscle preactivation before the eccentric phase

2. a short, fast eccentric component

3. immediate transition (minimal delay) between stretch (eccentric) and shortening (concentric) phases. This period is known as the amortization phase, and the shorter it is, the less elastic energy we lose (as heat).

To be honest, #1 takes care of itself. For #2 and #3, though, we are definitely working against ourselves with distance running, as the importance of the SSC rapidly diminishes as exercise duration continues. In fact, the vertical jump only predicts sprinting performance up to 300m (3).

In other words, the longer exercise goes, the more we “muscle” it instead of being relaxed. What do we know about guys who try to muscle the ball to the plate? They don’t throw hard because it impairs pitching specific mobility and they don’t let the arm whip through.

I will take a guy with a good vertical jump over a guy with a high VO2max anyday. Distance running conditions guys to plod instead of bounce – and this definitely has implications in terms of chronic overuse conditions.

Strike 1.

Reason #5: Strength and Power Reductions

As just one example of how stressful the pitching motion is on the body, the humerus internally rotates at 7,500°/second during the acceleration phase of throwing. It takes a lot of strength and power to generate this kind of velocity, but just as importantly, it takes a lot of strength and power – and in a timely fashion – to decelerate it. We need to not only be able to generate enough force to resist and control this acceleration at end-range, but also be able to generate this force quickly (power). To that end, you would think that conditioning for pitchers would be similar to that of strength and power athletes, who avoid distance running altogether.

Instead, most pitchers run several times a week. When was the last time you saw a marathoner throw 95mph?

Additionally, in many cases, coaches encounter Latin American players who have never had access to weight-training equipment – and this is a huge window of untapped potential. Using distance running when these athletes could be devoting more time to getting stronger is a huge hindrance to these players’ development, as it conditions them to go longer instead of faster. At some point, you have to put more horsepower in the engine instead of just changing the oil.

We know that when we first get young athletes started with weight training, there is a huge transformation to make them more athletic in the 8-10 weeks that follow. You would be surprised at what good training can do for many advanced pitchers in the initial phases, too. The reason is that, unlike position players, many pitchers are (to be blunt) one-trick ponies. They know how to throw a nasty cutter, a crazy 12-to-6 curveball, or a slider with a funny arm-slot. So, it’s always been “okay” for them to be completely unathletic outside of their delivery. They might get guys out, but they’re long-term gambles teams because of their increased risk of injury; weak, immobile bodies break down the fastest – just like distance runners.

Strike 2.

Reason #6: Inappropriate Intensities

In what was – at least in my eyes – a landmark study, McCarthy et al. (1995) looked at “compatibility” of concurrent strength training and endurance training. Traditionally, the attenuation of strength and power gains has been a big issue when endurance exercise is added to a strength training program. As I noted in Cardio Confusion, these researchers found that strength and power loss was only an issue when the intensity of the endurance exercise was greater than 75% of heart-rate reserve (HRR) (4). I can guarantee you that the majority of pitchers who are running distances are doing so at well over 75% HRR.

As I’ll note in my recommendations at the conclusion of this article, I strongly feel that the secret is to stay well above (circa-maximal sprinting, in other words) or below (70% HRR, to play it safe) when implementing any kind of running. The secret is to avoid that middle area where you don't go slow and don't go fast; that's where athletes get SLOW!  And, ideally, the lower-intensity exercise would be some modality that provides more mobility benefits.

Strike 3. The batter’s out!

More to come tomorrow...

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Why Distance Running Is Not The Answer

Building the Efficient Athlete Labor Day Sale!

As a little Labor Day special, through Friday at midnight, Mike Robertson and I are offering 20% off our Building the Efficient Athlete DVD set. To take advantage of this special offer, head to www.BuildingTheEfficientAthlete.com and add the product to your cart, filling in all the payment information with our 100% secure server. Then, before you check out, place the discount code LABOR08 in the discount section and click on "Apply" - and then complete your order. Here’s a great chance to get this product at an excellent discount.

"Eric Cressey & Mike Robertson's Building the Efficient Athlete Seminar was as information-packed as any two-day seminar that I've ever attended – and I’ve seen a lot.  From the functional anatomy, to the static and dynamic assessment procedures, to the hands-on exercises technique segments, Eric and Mike provided a thoroughly enjoyable, yet highly educational environment.  For those of you who weren’t fortunate enough to attend, I highly recommend getting this DVD set, as the information is well worth the investment."

Joe Dowdell, CSCS, CPT

Co-owner, Peak Performance, NYC

A New Model for Training Between Starts: Part 1

The management of pitchers between starts is one of the most debated topics in the world of baseball training. Some pitching coaches want multiple throwing sessions between starts, while others insist that a single bullpen is sufficient. Athletic trainers debate on whether or not a pitcher should ice after a throwing session. And, specific to my realm of expertise, there are differing opinions on what kind of running programs are appropriate for pitchers between bouts of throwing.

Not to toot my own horn, but I’m a pretty well-read guy – and I can honestly say that I’ve never read anything along the lines of a truly logical argument for or against a specific running program for pitchers. So, I guess that’s where I come in with this piece.

With that in mind, I’ll be very blunt with you: I despise distance running for pitchers (and the overwhelming majority of other athletes, for that matter). While many pitching coaches are probably reading this and cursing my name already for going against the norm, I’d encourage you all to hear me out on this. Below, I’ll outlined NINE reasons why distance running is not the correct course of action – and then, in my next installment, outline a new model for training between starts that we’ve used with great success at the professional, collegiate, and high school levels.

Why Distance Running is Not the Answer

Reason #1: Immunity Concerns

As a strength and conditioning coach, my number one priority in working with athletes is to keep them healthy. This refers not only to musculoskeletal health, but also general health. In an outstanding 2006 review, Gleeson wrote that “postexercise immune function depression is most pronounced when exercise is continuous [and] prolonged.” Interestingly, this review also noted that many of these symptoms are “attributable to inflammation of the upper respiratory tract rather than to infectious episodes (1).” In other words, distance running between starts is more likely to cause and spread sickness in your clubhouse than that tramp in the right field bleachers who wants to hook up with every guy in your bullpen. Strike 1.

Reason #2: Endocrine Concerns

Here’s a little excerpt from an email I got from a minor league guy I work with in the off-season:

Yesterday might have been the roughest day of my career. It started by getting back from our game Sunday night at 11:30PM. I couldn't fall asleep until at least 12:30AM, and then we had a 3:30AM wake up call to catch a bus to the airport for our flight at 6:15AM. We had a layover for an hour and a half, then got to the next city at 11AM. We drove to our hotel and I got to my stinky room at the Sleep Inn and tried to catch some sleep – except we had to be at the field at 4PM.

Days like this are the norm for many professional (and particularly, minor league) pitchers: late nights, early wake-up calls, red-eye flights, long bus rides, and – as a result – completely warped sleeping patterns. And, as I’m sure you can imagine, the diet that accompanies these travels is less than stellar, particularly when clubhouse food isn’t exactly gourmet or healthy. And, let’s just say that a lot of ballplayers at the collegiate and pro levels far too much alcohol, and that has direct negative consequences in terms of sleep and tissue quality.

So, basically, we’ve got absurd sleeping hours, terrible dietary habits, too much alcohol – and one of the longest seasons in sports. Effectively, we’ve done everything we possibly can to reduce lower testosterone and growth hormone output, creating a mess of a hormonal environment. Frankly, you could get this same hormonal response by forcing pitchers to watch Golden Girls reruns while sitting on bicycle seats and downing estrogen tablets – and you wouldn’t have any incidences of plantar fasciitis.

Instead, you know what’s done instead? Distance running! Yes, the same distance running that is responsible for the markedly lower testosterone levels and higher cortisol levels in endurance athletes. It’s like putting a new engine in a car with square wheels: studying for the wrong test.

It almost makes you wonder if some guys used performance-enhancing drugs just to counteract the negative effects of their running programs!

Strike 2.

Reason #3: Mobility Concerns

As I wrote in a previous newsletter, one of the issues with distance running is that it doesn’t allow for sufficient hip flexion to truly activate all the hip flexors. Specifically, we get a lot of rectus femoris recruitment, but not much activation of psoas, which predominately is active above 90 degrees of hip flexion. Likewise, you really aren’t getting much hip extension at all.

So, on the whole, by using a repetitive motion like jogging for an extended period of time, pitchers are losing mobility in their hips – and that’s the very mobility they depend on so much to generate stride length and, in turn, velocity. Frankly, runners are the athletes I see with the most marked lower extremity dysfunctions due to the lack of range-of-motion in the jogging stride – and the fact that they pile so much mileage on this faulty movement pattern. I am a firm believer that we were made to sprint, not jog.

Strike 3. The batter’s out!

We’ll have Part 2 of this article in tomorrow’s newsletter.

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A Review of the 2008 Indianapolis Performance Enhancement Seminar DVD Set

Last week, I was fortunate enough to get a free copy of Mike Robertson and Bill Hartman’s 2008 Indianapolis Performance Enhancement Seminar DVD Set. To be honest, the word “fortunate” doesn’t even begin to do the product justice; it was the best industry product I’ve watched all year.

The DVD set is broken up into six separate presentations:

1. Introduction and 21st Century Core Training

2. Creating a More Effective Assessment

3. Optimizing Upper Extremity Biomechanics

4. Building Bulletproof Knees

5. Selecting the Optimal Method for Effective Flexibility Training

6. Program Design and Conclusion

To be honest, I’ve already seen Mike Robertson deliver the presentations on DVDs 1 and 4 a few times during seminars at which we’ve both presented, so more of my focus in this review will be on Bill’s presentations because they were more “new” to me. That said, I can tell you that each time I’ve seen Mike deliver there presentations, he’s really impressed the audience and put them in a position to view training from a new (and better) paradigm, debunking old myths along the way. A lot of the principles in his core training presentation mirror what we do with our clients – and particularly with those involved in rotational sports.

Bill’s presentation on assessments is excellent. I think I liked it the most because it really demonstrated Bill’s versatility in that he knows how to assess both on the clinical (physical therapy) and asymptomatic (ordinary client/athlete) sides of the things. A few quick notes from Bill’s presentation that I really liked:

a. Roughly 40% of athletes have a leg length discrepancy – but that’s not to say that 40% of athletes are injured or even symptomatic. As such, we need to understand that some asymmetry is normal in many cases – and determining what is an acceptable amount of asymmetry is an important task. As an example, in my daily work, a throwing shoulder internal rotation deficit (relative to the non-throwing shoulder) of 15 degrees or less is acceptable – but if a guy goes over 15°, he really needs to buckle down on his flexibility work and cut back on throwing temporarily. If he is 17-18° or more, he shouldn’t be throwing – period.

b. It’s important to consider not only a client/patient/athlete looks like on a “regular” test, but also under conditions of fatigue. There’s a reason athletes get hurt more later in games: fatigue changes movement efficiency and safety! This is why many tests should include several reps – and we should always be looking to evaluate players “on the fly” under conditions of fatigue.

c. Bill made a great point on “functional training” during this presentation as well – and outlined the importance difference between kinetics (incorporates forces) and kinematics (movement independent of forces). Most functional training zealots only look at kinematics, and in the process, ignore the amount of forces in a dynamic activity. For example, being able to execute a body weight lateral lunge with good technique doesn’t guarantee that you’ll be “equipped” to handle change-of-direction challenges at game speed. In reality, this force consideration is one reason why there are times that bilateral exercise is actually more function than unilateral movements!

d. Bill also outlined a multi-faceted scoring system he uses to evaluate athletes in the context of their sports. It’s definitely a useful system for those who want a quantifiable scheme through which to score athletes on overall strength, speed, and flexibility qualities to determine areas that warrant prioritization.

DVD #3 is an excellent look at preventing and correcting shoulder problems – and in terms of quality, this presentation with Mike is right on par with their excellent Inside-Out DVD. Mike goes into depth on what causes most shoulder problems and how we can work backward from pathology to see what movement deficiency – particularly scapular downward rotation syndrome – caused the problem. There is a great focus on lower trapezius and serratus anterior strengthening exercises and appropriate flexibility drills for the pec minor, levator scapulae, and thoracic spine – as well as a focus on the effects of hip immobility and rectus abdominus length on upper body function.

To be honest, I think that DVD #4 alone is worth far more than the price of the entire set. It actually came at an ideal time for me, as I’m preparing our off-season training templates for our pro baseball guys – and flexibility training is a huge component of this. Whenever I see something and it really gets me thinking about what I’m doing, I know it’s great. Bill’s short vs. stiff discussion really did that for me.

Bill does far more justice to the discussion than I can, but the basic gist of the topic is that the word “tight” doesn’t tell us much at all. A short muscle actually has lost sarcomeres because it’s been in a shortened state for an extended period of time; this would be consistent with someone who had been immobilized post-surgery or a guy who has just spent way too long at a computer. These situations mandate some longer duration static stretching to really get after the plastic portion of connective tissue – and this can be uncomfortable, but highly effective.

Conversely, a stiff muscle is one that can be relatively easily lengthened acutely as long as you stabilize the less stiff segment. An example would be to stabilize the scapula when stretching someone into humeral internal or external rotation. If the scapular stabilizers are weak (i.e., not stiff), manually fixing the scapula allows us to effectively stretch the muscles acting at the humeral head. If we don’t stabilize the less-stiff joint, folks will just substitute range of motion there instead of where we actually want to create it. In situations like this, in addition to good soft tissue work, Bill recommends 30s static stretches for up to four rounds (this is not to be performed pre-exercise, though; that’s the ideal time for dynamic flexibility drills.

DVD #5 is where Mike is at his best: talking knees. This is a great presentation not only because of the quality of his information, but also because of his frame of reference; Mike has overcome some pretty significant knee issues, including a surgery to repair a torn meniscus. Mike details the role of ankle and hip restrictions in knee issues, covers the VMO isolation mindset, and outlines some of the research surrounding resistance training and rehabilitation of knee injuries in light of some of the myths that are abundant in the weight-training world.

DVD #6 brings all these ideas together with respect to program design.

I should also mention that each DVD also includes the audience Q&A, which is a nice bonus to the presentations themselves. The production quality is excellent, with “back-and-forths” between the slideshow and presenters themselves. Bill and Mike include several video demonstrations in their presentations to break up the talking and help out the visual learners in the crowd, too.

All in all, this is a fantastic DVD set that encompasses much more than I could ever review here. In fact, if it’s any indicator of how great I think it is, I’m actually going to have all our staff members watch it. If you train athletes or clients, definitely get it. Or, if you’re just someone who wants to know how to keep knees, shoulders, and lower backs healthy while optimizing flexibility, it’s worth every penny. You can find out more at the Indianapolis Performance Enhancement Seminar website.

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