Home Posts tagged "Physical Therapy"

CSP Elite Baseball Development Podcast: Performance Principles and Progressions with Kelly Starrett

We're excited to welcome renowned physical therapist, coach, author, and presenter, Dr. Kelly Starrett, to the latest podcast as we kick off a series of podcasts with a sports medicine focus. Kelly shares some awesome insights related to universal performance principles, recovery strategies, "upstream" initiatives, and long-term athletic development.

A special thanks to this show's sponsor, Marc Pro. Head to www.MarcPro.com and enter the coupon code CRESSEY at checkout to receive an exclusive discount on your order.

Sponsor Reminder

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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!

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CSP Elite Baseball Development Podcast: Tackling Controversial Throwing Topics with Mike Reinold

We're excited to welcome physical therapist Mike Reinold to this week's podcast. Mike has extensive experience working with baseball players. In this episode, we take on two controversial topics in the world of managing throwers: the sleeper stretch and weighted baseballs. Mike and I collaborate to discuss whether they belong in your training and rehabilitation programs, and if so, how?

In lieu of a sponsor for this podcast, we're instead going to highlight our Functional Stability Training sale that's ongoing. Through this Sunday at midnight, you can get 25% off on this popular series with coupon code MLB2020EC at www.FunctionalStability.com.

Show Outline

  • Why baseball players lose internal rotation in their throwing shoulder
  • Why professionals should care more about total range of motion at the shoulder as opposed to just ER vs. IR
  • How Mike teaches professionals to assess shoulder range of motion and what common mistakes are being made when testing for this information
  • How clinical research has progressed our understanding of the loss of IR in throwing shoulders and how previous notions (such as a thickening of the posterior capsule) could not be further from the truth
  • Why giving baseball players more internal rotation may not be the answer for building healthy arms and why this strategy may cause more harm than good in throwing populations
  • What Mike’s thoughts on the sleeper stretch are and how his perspective on the drill have evolved since the beginning of his career
  • What is happening mechanically at the shoulder joint during the sleeper stretch
  • What the true occurrence of internal rotation deficit cases in Mike’s practice is and how he goes about resolving the issue
  • Why there is so much hype about weighted balls and how can we implement them safely in athletes’ throwing programs
  • What Mike’s research demonstrated with respect to weighted balls and what insights can we gain from Mike’s breakdown of the study and its execution
  • What specific physical adaptations throwing weighted balls creates and how the weight of the balls thrown impacts these outcomes
  • What immediate physical changes throwing weighted balls creates and how these changes may increase the risk for injury
  • Why athletes need to be well-trained and prepared to withstand the stress of throwing weighted balls before looking to push the limits of their physiology
  • How injuries in baseball have evolved from repetitive to traumatic and why the next generation of baseball is in danger
  • Why the answer for the abuse of arms across baseball calls for the education of coaches and how we can continue to find the right balance in throwing volume, frequency, and intensity for our athletes

You can follow Mike on Twitter at @MikeReinold and on Instagram at @MikeReinold, and learn more about Functional Stability Training at www.FunctionalStability.com. Again, the coupon code for 25% off is MLB2020EC.

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!

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Arm Care: Why Are We Still Talking About “Down and Back?”

Today's guest post comes from Eric Schoenberg, the physical therapist at Cressey Sports Performance - Florida and a great resource to the entire CSP team. Enjoy! -EC

To get right to the heart of what I'm covering today, I think it's best that we start with a video:

So, as you can infer, the reason we're still talking about "down and back" is because we need to! Athletes are coming into the gym every week after multiple surgeries or drops in performance with postures and movement patterns that are faulty and easily correctible.

Obviously, the down and back concept is not the only reason for this, but the idea of driving our scapulae into maximal adduction (retraction), downward rotation, and depression is certainly something that we can control and improve upon.

To set the record straight, the only time an athlete should receive this cue is when their arms are by their side (Deadlifts, farmer’s walks, heavy dumbbell holds for lower body lifts). Once the humerus starts to move away from the side more than 20-30 degrees, the scapula needs to start moving in the appropriate direction to keep ball on socket congruency and reduce mechanical stress to the neighboring soft tissue structures (labrum, rotator cuff, neurovascular structures).

On the performance side of things, the “down and back” posture (scapular adduction, downward rotation, and depression) limit the ability to get the hand out in front or overhead. This has obvious implications in overhead athletes.

 In the case of throwers, the difference in extension at ball release can vary by 3-4 inches depending on the position of the scapula. (as you can see in the comparison pics above and the video below).

When we don’t get full extension at ball release, any variety of downstream stresses can occur (aggressive elbow extension, lack of full pronation through the baseball) that result in increased injury risk and decreased performance.

As mentioned in the introduction video, we are bringing bad cues to good programming and it continues to result in faulty movement and injury. Even worse is when this “down and back” cue is brought into the rehabilitation setting and athletes that have already had surgery continue to experience symptoms similar to their pre-surgery presentation.

In conclusion, let’s continue to look at our cues and consider where the arm is in relation to the body when we decide to cue down and back. When the arms are by the side, then go ahead and cue the scaps down and back. However, when the arm is abducted to the side, overhead, layed back into ER, or out in front at ball release, we need to cue a degree of upward rotation and elevation to make sure the joint is aligned for success.

About the Author

Eric Schoenberg is a Physical Therapist and Strength Coach and the Owner of Diamond Physical Therapy located inside Cressey Sports Performance – Florida. Eric’s approach is to help athletes move more efficiently to reduce injury and improve performance. You can follow him on Twitter and Instagram at @csp_physicaltherapy, or email him at eric@diamondphystherapy.com.

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!

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Sports Rehab to Sports Performance 2010

Just wanted to give you all a heads-up that Joe Heiler is following up last year's successful Sports Rehab to Sports Performance Teleseminar with a 2010 installment.  I'm thrilled to be one part of an incredible lineup: Gray Cook Shirley Sahrmann Robert Panariello Stuart McGill (bonus interview with Chris Poirier from Perform Better) Craig Liebenson Clare Frank Mike Reinold Greg Rose Mike Boyle Gary Gray (and Eric Cressey) In all, it will be nine awesome interviews. The teleseminar series will begin on January 27th and Joe will play one interview per week (Wednesday nights at 8 pm).  If you can't catch them that night, don't worry; he'll be putting them up on his site for another 48 hours. For more information, check out the Sports Rehab to Sports Performance Sign-up Page.
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Stuff You Should Read (and Watch): 4/21/09

To kick off the week, I thought I'd give you a quick heads-up on some stuff you ought to read: What Your Doc Doesn't Know About Weightlifting - This great piece is from Nikhil Rao, an avid weight trainer who also happens to have recently become a doctor.  He shares some excellent insights about how prepared your doctor may (or may not) be to give recommendations to you on exercise and nutrition. The Proactive Patient - Along these same lines, it'd be worth checking out this article I wrote last year.  It talks a lot about things you ought to consider if you're injured and want to get the best care possible. I've actually got something good in the works along these lines right now, and should be submitting it at T-Nation by the end of the week. The Indianapolis Performance Enhancement DVD Set - I previously wrote a review about this product HERE, but it seemed like a good idea to give it another mention since it's on sale at 15% off through the end of the day Thursday.  Just use the coupon code "HITCHED" at checkout.
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The Truth About Unstable Surface Training: An Athletic Trainer’s Perspective

“As someone who has both rehabbed injured athletes and trained healthy people for over 18 years, I can honestly say that Eric Cressey’s The Truth about Unstable Surface Training is a breath of fresh air. "Being a certified athletic trainer and a strength and conditioning coach has afforded me a unique perspective in the training world. I have watched personal trainers, strength coaches, athletic trainers and physical therapists use and abuse unstable surface training. "Eric has combined his in-the-trenches experience with research to uncover the truth behind unstable surface training. This book is a must-read for anyone that trains, rehabs, or coaches, people in anyway. Yes, that means Physical Therapists, Athletic Trainers, Personal Trainers, and Strength Coaches. "I hope that this book will help to “Stop the madness” of a training fad that has gotten out of control and help to support the proper uses of unstable surface training. "I know I will be referring this work to my network of athletic trainers, strength coaches, physical therapists and personal trainers.” Keith Scott, MS, CSCS, ATC Certified Athletic Trainer, and Strength and Conditioning Coach www.BackToFormFitness.com Click here to get your copy of The Truth About Unstable Surface Training.
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The Truth About Unstable Surface Training: A Physical Therapist’s Perspective

"Unstable surface training is many times misunderstood and misinterpeted in both the physical therapy and athletic performance fields. The Truth About Unstable Surface Training e-book greatly clarifies where unstable surface training strategically fits into an overall program of injury prevention, warm-up/activation, and increasing whole body strength. If you are a physical therapist, athletic trainer, or strength training professional, The Truth About Unstable Surface Training gives you a massive amount of evidence-based ammunition for your treatment stockpile." Shon Grosse PT, ATC, CSCS Comprehensive Physical Therapy Colmar, PA Click here for more information on The Truth About Unstable Surface Training.
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Active vs Passive Restraints

I’m of the belief that all stress on our systems is shared by the active restraints and passive restraints. Active restraints include muscles and tendons – the dynamic models of our bodies. Passive restraints include labrums, menisci, ligaments, and bone; some of them can get a bit stronger (particularly bone), but on the whole, they aren’t as dynamic as muscles and tendons. Now, if the stress is shared between active and passive restraints, wouldn’t it make sense that strong active restraints with good tissue quality and length would protect ligaments, menisci, and labrums (and do so through a full ROM)? The conventional medical model – whether it’s because of watered-down physical therapy due to stingy insurance companies or just a desire to do more surgeries – fixes the passive restraints first. In some cases, this is good. For instance, if you have an acromioclavicular joint separation with serious ligament laxity, you’ll likely need surgery to tighten those ligaments up, as the AC joint is an articulation without much help from active restraints. In other cases, it does a disservice to the dynamic ability of the body to protect itself with adaptation. Consider the lateral release surgery at the knee, where surgeons cut the lateral retinaculum on the outside of the knee, allowing the patella to track more medially. I’ve seen a lot of people avoid the surgeries (and, in turn, the numerous possible complications) with even just 2-3 weeks of very good physical therapy focusing on the active restraints. I’m not saying all these surgeries are contraindicated – just that we need to exhaust other options first. So, the next time you’ve got an ache or pain, consider whether it’s an active or passive restraint giving you problems – and if it’s the latter, work backward to find out which active restraint you need to bring up to par.
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Cement Your Neural Patterns

Q: I have a question about your latest blog post. In the question, that was ask, you talk about Dr. Eric Cobb saying "Strength training 'cements' your neural patterns." How does strength training affect your neural patterns vs. repetitive motion with no weight (i.e., weighted squats vs. body weight squats).

A: Give this article a read:


In particular, pay attention to the Law of Repetitive Motion (#7), which we cover in detail in our Building the Efficient Athlete DVD set. Resistance is the "F" in the equation - and you can use that equation to iron out imbalances in the same way it causes imbalances in the opposite direction (hopefully that makes sense).

Reps are still important – and light weights are the way to go early on when you’re trying to groove appropriate movement patterns. As an example, we can do supine bridges and birddogs to get the glutes firing in our warm-ups, but the real meat and potatoes in terms of ironing out quad vs. posterior chain dominance and improper glute-ham-adductor-lumbar erector firing patterns comes when we add in loaded single-leg movements, deadlifts, box squats, glute-ham raises, and pull-throughs.


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Enhancing Elite Runners

Q: I recently had an 'elite' runner come through the clinic where I work. I won't get into his injuries but he is jacked up. He does absolutely no strength, flexibility, or mobility work. His warm up consists of jogging about 5 minutes. I'm sure this is a familiar scenario. My question is before you created such an outstanding reputation as a strength/rehab/corrective coach, how did you get athletes to buy in to what you are telling them? It appears that my sales pitch is lacking. Do you have any tips/attention getters that you find useful when dealing with know it all but know nothing athletes? I know you are extremely busy, any advice would be helpful. A: Sell him on the easy stuff, first. Hop on a foam roller and show him that you're pain free, and then stick him on one and let him appreciate how much it hurts on his TFL/ITB. Do the same with a lacrosse ball on his butt and calves. That shows the soft tissue differences between the two of you. Start simple instead of trying to overhaul everything. Give him some supine bridges, birddogs, and a few more mobility exercises to improve hip rotation and extension. Next, add in some lifting and swap a distance session for a sprint session. Sit down with him and talk footwear as well. Runners love to buy new sneakers. Win him over bit by bit. Eric Cressey
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