1. First, I wanted to give you a quick heads-up that Rick Kaselj just released Muscle Imbalances Revealed 2.0 - and it's on sale through tonight (Friday, 11/12) at midnight. Many of you probably already know that I raved about this product in a review when it was initially launched, as it provided an awesome resource that compiled expertise from some really bright folks in our industry.
Well, based on customer feedback, Rick tinkered with the product, added some sweet new content, including over 50 new corrective exercises for the lower body, a second presentation on fascial anatomy and its impact on spine function/back pain, and a detailed write-up on barefoot running - all in addition to the great content that was available in the first place. I'd highly encourage you to check it out and take advantage of this great introductory offer by the end of the day today.
For more information, check out Muscle Imbalances Revealed 2.0.
*Also, as an added bonus, this product is available for CEU/CEC for the fitness professionals out there - and I didn't even realize it until just now. So, I guess you could just call these credits "gravy" on a product that would have been well worth it anyway!
2. While on the topic of muscle imbalances, here's a quick study to check out, as it highlights the overwhelming importance of scapular positioning (secondary to adequate strength of the scapular stabilizers) with respect to rotator cuff function. This study saw reduced pain and increased rotator cuff strength following a program to restore strength of the peri-scapular muscles. While the study in question was a chronic intervention (3- and 6-month follow-ups), the truth is that these benefits can be seen transiently as well - just by positioning the scapula correctly during rotator cuff exercises. You'll notice that in both the following videos, regardless of the amount of abduction present, the scapula remains retracted and depressed to allow for optimal performance of rotator cuff exercises:
For this reason, whenever anyone ever says that an external rotation drill causes shoulder pain (particularly the front), the first thing I do is reposition their scapula into posterior tilt and retraction. In almost all cases, this will eliminate their shoulder pain instantly and they'll start to feel rotator cuff exercises in the posterior shoulder musculature (where they should). This is also one reason why many people will instantly go from painful shoulder movement to pain-free movement just by having soft tissue treatments on the pec minor; by getting some length in this muscle, the scapula can posteriorly tilt, which not only gives the rotator cuff tendons room to "breath" (less shoulder impingement), but also puts them in a more mechanically advantageous position to stabilize the humeral head (via the length-tension relationship).
3. If you're like me, you could have used a good laugh to brighten your day yesterday - and that's why we have puppies. Here's Tank's weekly cameo (make sure you turn up the volume):
Speaking of Tank, thanks to several minor league baseball players at Cressey Performance who have too much time on their hands, you can now follow him on Twitter - and I must say that these tweets have been very entertaining thus far. Check him out at http://www.Twitter.com/TankNasty.
4. Speaking of Twitter, you might notice the new addition to my blogs where you can tweet if you like what you read (and the same thing goes for clicking the "like" button for Facebook). These little icons are located at the top of each blog. If you enjoy a particular post and think others would benefit from reading, I'd appreciate it if you could help spread the word with just a quick click. Thanks in advance!
5. Last, but certainly not least, a few people forwarded me this link of our old friend - who apparently actually has a name (Keenan Cahill):
It just goes to show how awesome he is that he can make 50 Cent look like a JV player just by showing up....no bling or flat-billed cap needed to be a real high roller.
Call it a law of weightlifting: no matter how careful you are, at some point you're gonna get hurt. Now you probably won't decapitate yourself with a barbell or tear a pec or even rupture your spleen—the weightlifter's injuries are rarely that cool or sudden.
Nope, you'll probably just end up with a bum shoulder, a pinched elbow, a bad back, or creaky knees, all the result of years of faulty movement patterns, poor training habits, or just general wear and tear. And while these injuries are always frustrating, they're often manageable.
Because it's hard to build a good-looking body when you're hurt, I talked with Eric Cressey and Mike Robertson about how these body parts probably got jacked up in the first place, and asked them for simple strategies to get you healthy.
Continued Reading...
I had a one-time consultation client at Cressey Performance yesterday, and when I noticed that he had some interesting stuff going on, it made me realize that I need to do more "case studies" here in the blog.
This guy had a history of on-and-off right-sided lower back and left shoulder pain. Basically, it would act up every once in a while, then calm down when he cut out exercising. Then, he'd return to training for a bit - only to have another set-back. It has been one step forward, and one step back for years.
Now, if you'd seen this guy move, you'd realize that the lower back and shoulder stuff were clearly closely related. If you're at all familiar with the Postural Restoration Institute, he was a classic Left AIC pattern: adducted/internally rotated right hip and abducted/externally rotated left hip - and the compensations working their way up to lead to a low right shoulder and prominent left rib flair. Everything was definitely related.
Not surprisingly, he'd been told he had scoliosis previously - but the "interesting" thing about it is that this was an acquired posture. He hadn't had these when he was a kid; he developed them when he was a rower who was always on the right side of the boat. If you can acquire them, you can "unacquire" them - but it takes time.
We're getting him started on some drills to iron out his hip imbalances, but for the sake of this blog, I wanted to highlight what we saw with his shoulder, as I think it includes some great take-home messages on how to manage shoulder function - both in the presence and absence of pain.
If you look at the research, if you look at shoulder total motion (internal rotation + external rotation with the scapula stabilized at 90 degrees of abduction), you should see symmetry between right and left in a healthy shoulder. The internal and external components may be different between sides (e.g., more external rotation and less internal rotation in a throwing shoulder), but the total motion should be the same. When it's not, "normalizing" total motion should be a primary goal, whether you're trying to address or prevent shoulder issues.
In our case study's situation, here is what we measured with the goniometer:
Left: 39° (IR) + 98° (ER) = 137° (TM)
Right: 58° (IR) + 109° (ER) = 167° (TM)
In other words, it was a 30° total motion deficit, with most of that deficit coming from internal rotation.
The logical next step would be to manually stretch the shoulder girdle, right? Well, certainly, it may be justified. However, before I go having an athlete crank on a somewhat "delicate" joint, I like to see what we can do to get that area to relax without even touching it.
The first thing we did was simply close down that left rib cage flair a bit while flexing his left hip and flexing his left arm overhead. And, we just left him there to breath for 30 seconds or so. Then, we remeasured:
Left: 44° (IR) + 104° (ER) = 148° (TM)
In other words, we got 11° of total motion without ever touching his shoulder. His body did that work just by getting air in with a new posture (no left rib flair).
Next, I simply had him get on all fours and go through a pretty low-key thoracic spine mobilization with his arm gently positioned behind his back so that it was on absolutely no stretch. He did eight reps on each side, using cervical motion to drive a bit of thoracic extension and rotation and scapular movement. Then, we remeasured:
Left: 46° (IR) + 107° (ER) = 153° (TM)
There's another 5° of total motion, and it got us a lot closer to where he needs to be - without ever touching his shoulder. And, the coolest part was that when he stood up, the low right shoulder was markedly less prominent - and it was a positioning that "stuck around" for the rest of his session.
Sure, manual stretching of the shoulder is probably warranted for him to get those last 14 degrees, and I don't expect him to maintain all this range indefinitely after this session. He'll need to be consistent with the movements to regain range bit-by-bit and use his strength training to ingrain it in his movement patterns, but the point is that the less aggressive, seemingly indirect, and self-applied interventions are often the best way to get lasting results. And, when they work, it makes you realize just how "synced up" our entire body is from head-to-toe.
For more information on the best assessments and corrective exercises for the shoulder, check out our Optimal Shoulder Performance DVD Set.
1. I haven't done a "Random Friday Thoughts" blog in a while, so in the spirit of randomness, I thought I'd throw you a curveball and kick off the week with some Tuesday random thoughts.
2. Last week, I booked two plane tickets to Halifax, Nova Scotia for my fiancee and I. She's a bridesmaid in a wedding up there in a few weeks, so I'll be making the trip as well. As part of being what amounts to a "third wheel" for the weekend (the only people I know other than Anna in the entire wedding are the bride and groom), I'll have quite a bit of downtime while in the area. Any readers out there have any suggestions for what to do in Halifax? It's not hockey season, and I don't drink Molson, so I'm at a bit of a loss...
Also, just out of curiosity, when did one have to sell off all his/her internal organs in order to afford a flight to Halifax? Roundtrip airfare was over $1,500, and Air Canada followed up with an email that said, "We also mandate that you name your first child after us."
3. I wrote a guest blog for Men's Health last week; check it out: A Quick Fix for Stiff Shoulders.
4. Also on the writing note, I've written a few guest chapters lately. The first was a strength and conditioning chapter for an upcoming pitching book for young baseball players and their parents. The second (which is still a work in progress) is a chapter for a new IYCA project. So far, it's coming along really well - and I'm really honored to be on-board for this with a group of really talented guys who are trying to do something very special.
5. Tonight (Tuesday), Boston Red Sox Head Athletic Trainer (and Optimal Shoulder Performance co-creator) Mike Reinold is hosting a free webinar: "What's New for 2010." Click here for more information.
6. Speaking of Mike, he had a great post last week about Epicondylitis and Cervical Radiculopathy. It's a great adjunct to my "Understanding Elbow Pain" series from back in May. If you missed it, here's a link to the sixth (final) installment (and you can link back to the previous five).
7. I realized the other day that there is one big thing I've always considered in our training programs for pitchers, but failed to mention on this blog: they need both open- and closed-chain hip mobility, as the right and left hips must rotate independently of one another during the stride to the plate. Here's a good example:
You can see that Beckett is just short of stride foot contact here - which means that he's at just about maximal hip external rotation on the lead leg...in open chain motion. The femur is rotating on the acetabulum.
Meanwhile, he's riding out his trailing leg...in closed chain motion. The acetabulum is rotating on the femur.
As such, adequate mobility training for pitchers should include a combination of both open- and closed-chain drills, although I'd say that the majority should be closed-chain.
8. Today's Mike Robertson's birthday; head over to RobertsonTrainingSystems.com and show him a little love.
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I don't know if there is something in the water that the reporters around the country (and particularly the Massachusetts sports scene) have been drinking, but Cressey Performance's Elite Baseball Development Program has gotten a lot of love in the news this weekend.
Last week, CP athlete Tim Collins was part of a blockbuster trade, as he went from the Toronto Blue Jays to the Atlanta Braves. Tim didn't disappoint in his debut, striking out five batters in two innings pitched without allowing a walk, hit, or run. In a recent posting about Collins in the Atlanta-Journal Constitution, beat writer David O'Brien wrote the following:
"I asked [Braves Manager] Bobby Cox if he knew anything about him, and Cox started talking about seeing video of him. Said he's extremely athletic, a muscular little guy who's real aggressive. Apparently the video showed him pitching and also working out, because he made quite an impression on Cox and others with the workout portion."
Apparently, Bobby Cox is quite a fan of the EricCressey.com and Cressey Performance YouTube pages. Hello, Bobby!
Saturday night, CP athlete Kevin Youkilis had the game-tying and game winning RBIs for the Red Sox in a come-from-behind win at home against the Rangers.
These features were followed shortly by another one - this time on a talented pitching prospect from Worcester, MA, Louisville pitcher Keith Landers. The Worcester Telegram just did this feature on Keith and the training he started up about eight weeks ago at Cressey Performance as he works his way back from a shoulder surgery.
Finally, here's a blog post from ESPN.com's Brendan Hall that features a boatload of CP studs who have had great summer showings: Tyler Beede, Adam Ravenelle, Carl Anderson, Barrett O'Neill, John Gorman, Jordan Cote, Ben Smith, Matt Luppi, AJ Zarozny, and David St. Lawrence.
I've seen a few acromioclavicular (AC) joint impingement cases at our facility in the last couple of weeks and thought it'd be good to do a quick blog to talk about how different they are from "regular" (external) shoulder impingement cases. And, it is a very important differentiation to make.
I've already written at length about AC joint issues in Getting Geeky with AC Joint Injuries: Part 1 and Part 2. And, I kicked out a two-part series called The Truth About Shoulder Impingement; here are Part 1 and Part 2.
While I talk a lot about the symptoms for both, several provocative tests for these issues, and training modifications to avoid exacerbating pain under these conditions, there was one important "differential assessment that I missed." Mike Reinold actually taught me it as we were planning the Optimal Shoulder Performance DVD set.
Just paying close attention to (and asking about) where folks have their pain during overhead motion can tell you quite a bit. In an external impingement - where we're talking about the rotator cuff tendons and bursa rubbing up against the undersurface of the acromion - you'll usually get pain as folks approach 90 degrees of abduction (arm directly out to the side). That pain will persist as they go further overhead, and in my experience, start to die off as they get to the top.
Conversely, for those with AC joint impingement - what is essentially bone rubbing up against bone - you see a "painful arc" only at the last portion of abduction:
You can usually confirm your suspicions on this front with direct palpation of the AC joint and checking to see if folks have pain when reaching across the chest.
Much of the training modifications will be the same for these two conditions, but there are also going to be several key things that should be managed completely differently. For instance, front squatting someone with an AC joint issue would not be a good idea due to the direct pressure of the bar on the AC joint; it would, however, be just fine for most cases of external shoulder impingement. In another example, some serious AC joint issues are exacerbated even by just doing the end-range of a rowing motion (to much shoulder extension/horizontal abduction) - whereas even folks with full-blown rotator cuff tears can generally do rows pain-free.
Q: What do you think of Bodyblades and how - if at all- should they be incorporated into a pitcher's routine?
A: As many of you know, I'm a fan of integrating rhythmic stabilization drills that train the true function of the rotator cuff: maintaining the humeral head in the glenoid fossa. I wrote about it in some depth HERE, and Mike Reinold and I spent quite a bit of time on it in our Optimal Shoulder Performance DVD set.
Of course, if you compare the perturbations to stability that the Bodyblade provides, it appears to simulate some of what you'd get with a rhythmic stabilization drill. So, it's probably a good alternative to a pitcher who doesn't have a training partner, therapist, or coach who can provide those destabilizing torques. Shirts, apparently, are optional.
That said, to me, using a Bodyblade is a more closed-loop (predictable) drill, whereas manual rhythmic stabilizations are more open-loop (unpredictable). So, it goes without saying that the benefits of "surprise" stabilization probably extend a lot further - and they don't cost a penny. Moreover, I've heard claims about the Bodyblade being an effective way to build muscle, which (outside an untrained population) just isn't going to happen. There are also much better ways to train the core.
In the same grain as Monday's post on lower back pain, today, I thought I'd highlight some of the common findings in diagnostic imaging of the shoulder, as these findings are just as alarming.
Do you train loads of overhead throwing athletes (especially pitchers) like I do? Miniaci et al. found that 79% of asymptomatic professional pitchers (28/40) had "abnormal labrum" features and noted that "magnetic resonance imaging of the shoulder in asymptomatic high performance throwing athletes reveals abnormalities that may encompass a spectrum of 'nonclinical' findings." Yes, you can have a torn labrum and not be in pain (it depends on the kind of labral tear you have; for more information, check out Mike Reinold's great series on SLAP lesions, starting with Part 1).
This isn't just limited to baseball players, either; you'll see it in handball, swimming, track and field throwers, and tennis as well. And, it isn't just limited to the labrum. Connor et al.found that eight of 20 (40%) dominant shoulders in asymptomatic tennis/baseball players had evidence of partial or full-thickness cuff tears on MRI. Five of the 20 also had evidence of Bennett's lesions.
The general population may be even worse, particularly as folks age. Sher et al. took MRIs of 96 asymptomatic subjects, finding rotator cuff tears in 34% of cases, and 54% of those older than 60 - so if you're dealing with older adult fitness, you have to assume they're present in more than half your clients!
Also, in another Miniaci et al. study, MRIs of 30 asymptomatic shoulders under age 50 demonstrated "no completely 'normal' rotator cuffs." People's MRIs are such train wrecks that we don't even know what "normal" is anymore!
As is the case with back pain, these issues generally only become symptomatic when you don't move well - meaning you have insufficient strength, limited flexibility, or poor tissue quality. For more information on how to screen for and prevent these issues from reaching threshold, check out Optimal Shoulder Performance from Mike Reinold and me.
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Q: I would like to know what the main differences are between floor presses and pin presses in the power rack, obviously with the same range of movement. Usually, in talking about injury at the shoulders, the advice is to drop full range of motion in the bench press in favor of floor press; does the pin press in the power rack - starting around middle point - accomplish the same thing? In a strength program for a healthy individuals, do these two similar movements have same utility?
A: My experience with the pin press is that it is not as effective as a floor press or board press because the lifter isn't in a good position to appropriately "set" the scapular stabilizers to lock the shoulder blades down and back. As a result, the lifter tends to shrug up - which allows the shoulder blades to anteriorly tilt - which can exacerbate the shoulder impingement that may already be occurring.
Moreover, I believe that it is important to have a lifter lower the bar, as opposed to starting from a dead-stop. This way, we not only teach eccentric control of the muscles acting at the shoulder girdle, but we also train the movement by learning the appropriate bar path. Considering the number of individuals who take the bar too high on the chest and let the elbows flare out when benching, I think it's important to use movements like board presses and floor presses in lieu of the pin press. Otherwise, we won't get rid of clowns like this.
That said, generally speaking, I prefer board presses first, followed by floor presses, and then (if at all) pin presses. These, of course, come much later than push-up variations and (usually) dumbbell exercises.
For more information on the specific return-to-pressing progressions that we use with the athletes and clients we see with shoulder impingement, AC joint issues, and a host of other shoulder conditions, check out the Optimal Shoulder Performance DVD Set.
A while back, I had the privilege to experience Thomas Myers in seminar for the first time. For those who aren't familiar with Myers, he is the author of Anatomy Trains and a pioneer in the world of bodywork and fascial research.
There were a wide variety of attendees present, and Myers made dozens of interesting points - so the take-away message could easily have been different for everyone in attendance as they attempted to fit his perspective into their existing schemeta.
While I enjoyed all 150 minutes of his presentations, the portion of Myers' talk that jumped out at me the most was his list of the eight means of improving "fascial fitness:"
1. Use whole body movements
2. Use long chain movements
3. Use movements including a dynamic pre-stretch with proximal initiation
4. Incorporate vector variation
5. Use movements that incorporate elastic rebound - this consists of cylic motions of a certain speed (for instance, cycling wouldn't count)
6. Create a rich proprioceptive environment
7. Incorporate pauses/rest to optimize hydration status
8. Be persistent, but gentle (prominent changes can take 18-24 months)
A big overriding them of Myers' lecture was that the role of the fascia - the entire extracellular matrix of the body - is remarkably overlooked when it comes to both posture and the development of pathology. He remarked that he doesn't feel like we have 600+ muscles in the body; he feels like we have one muscle in 600+ fascial pockets because they are so interdependent. And, in this fascia, we have nine times as many sensory receptors as we've got in muscles.
Think about what that means when someone has rotator cuff problems - and treatment only consists of ice, stim, NSAIDs, and some foo-foo rotator cuff exercises. Or, worse yet, they just have a surgical intervention. It overlooks a big piece of the puzzle - or, I should say, the entire puzzle.
For me, though, these eight factors got me to thinking again about just how atrocious distance running is for pitchers. I have already ripped on it in the past with my article A New Model for Training Between Starts, but this presentation really turned on a light bulb over my head to rekindle the fire. Let's examine these eight factors one-by-one:
1. Use whole body movements - Distance running may involve require contribution from the entire body, but there is not a single joint in the body that goes through an appreciable range of motion.
2. Use long chain movements - Pitching is a long chain movement. Jumping is a long chain movement. The only things that are "long" about distance running are the race distances and the length of the hip replacement rehabilitation process.
3. Use movements including a dynamic pre-stretch with proximal initiation - This simply means that the muscles of the trunk and hips predominate in initiating the movement. While the hips are certainly important in running, the fundamental issue is that there isn't a dynamic pre-stretch. This would be a dynamic pre-stretch with proximal initiation:
4. Incorporate vector variation - A vector is anything that has both force and direction. Manual therapists vary the force they apply to tissues and the directions in which they apply them. There are obviously vectors present in exercise as well. Here are 30,000 or so people, and pretty much just one vector for hours: forward (to really simplify things):
Incorporating vector variation into programs is easy; it just takes more time and effort than just telling someone to "run poles." Take 8-10 exercises from our Assess and Correct DVD set and you've got a perfect circuit ready to roll.
5. Use movements that incorporate elastic rebound - Sorry, folks, but even though the stretch-shortening cycle is involved with jogging, its contribution diminishes markedly as duration of exercise increases. And, frankly, I have a hard time justifying bored pitchers running laps as "elasticity."
6. Create a rich proprioceptive environment - There is nothing proprioceptively rich about doing the same thing over and over again. They call it pattern overload for a reason. Pitchers get enough of that!
7. Incorporate pauses/rest to optimize hydration status - Myers didn't seem to have specific recommendations to make regarding work: rest ratios that are optimal for improving fascial fitness, but I have to think that something more "sporadic" in nature - whether we are talking sprinting, agility work, weight training, or dynamic flexibility circuits - would be more appropriate than a continuous modality like jogging. This is true not just because of duration, but because of the increased vector variation potential I outlined earlier.
8. Be persistent, but gentle - This one really hit home for me. Significant fascial changes take 18-24 months to really set in. I am convinced that the overwhelming majority of injuries I see in mature pitchers are largely the result of mismanagement - whether it's overuse, poor physical conditioning, or improper mechanics - at the youth levels. Poor management takes time to reach the threshold needed to cause symptoms. In other words, coaches who mismanage their players over the course of the few months or years they coach them may never actually appreciate the physical changes - positively or negatively - that are being set into action.
Distance running might seem fine in the short-term. Overweight kids might drop some body fat, and it might make the practice plan easier to just have 'em run. Kids might not lose velocity, as they can compensate and throw harder with the upper extremity as their lower bodies get less and less powerful and flexible.
However, it's my firm belief that having pitchers run distances not only impedes long-term development, but also directly increases injury risk. Folks just don't see it because they aren't looking far enough ahead.
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