Q: Inspired by your articles on T-Nation, I've started to measure IR/ER/Total shoulder rotation deficits using a goniometer. I did have another question, however: you mentioned in an article that Hip Internal Rotation Deficit (HIRD) is a serious problem among baseball pitchers and hitters due to the asymmetrical front leg blocking in both mechanics. I absolutely agree, and I use corrective exercises and stretches to help alleviate these problems. However, I lack a good way to test for this; do you have any suggestions?
A: We check hip internal rotation in the seated position. Basically, you just have the individual sit up tall at the end of a table, and position the hips and knees at 90 degrees. Then, without allowing the hip to hike, you internally rotate the femur. This is one of the many assessments on our new DVD set, Assess and Correct, and it's featured on page 50 of the tag-along e-manual. Check it out:
For more information on how to correct the problem - and assess for other issues like this, check out www.AssessandCorrect.com.
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1. Exciting week around here, as it's getting to be that time of the year when our high school ballplayers - both 2010 and 2011 - finalize some of their plans.
Last weekend, RHP Barrett O'Neill (2011) verbally committed to the University of Virginia on a baseball scholarship, and on Tuesday, RHP Travis Dean (2010) signed his letter of intent to pitch at Kennesaw St. University in Georgia. A few weeks earlier, RHP/3B Joe Napolitano (2011) had verbally committed to Boston College. These three comprise 3/8 of our current 90mph+ high school crew - and I suspect that the other five will be following soon!
Also this week, 2B Erik Watkins (2010) committed to Skidmore and CF Billy Bereszniewicz (2010) committed to Binghampton. Previously, catcher James Alfonso (2010) had accepted a scholarship to play at the University of Hartford. Plenty more to come soon, no doubt...
2. Speaking of Travis, here is something I love about him: he has INTENT on every single medicine ball throw he makes. It isn't just about "tossing" a ball to a wall and rotating your hips. It's about getting your entire body into the effort - to the point that you're trying to break the ball (or wall!) on every single drill.
Once we have taught our guys the technique for the drill, it's about getting after it. If you aren't training rotation aggressively, you might as well not do it at all.
3. I got a lot of great comments from readers on my A Few Days in Arizona on Monday; I'd encourage you to check it out.
4. One of the key points I made was that respiratory function was essential for ideal performance and posture, and I recognize that the concept might be completely foreign for a lot of my readers. To that end, I'd encourage you check out The Anatomy of Breathing.
It's a pretty quick read that gives you good insights into the anatomy of the respiratory system and common dysfunctions that occur. Once you start getting an appreciation for the muscles involved, you can start to see how poor diaphragmatic function can easily lead to overactivity of sternocleidomastoid, scalene, pec minor, intercostals - basically, a lot of muscles commonly implicated in upper extremity dysfunction. You can just stretch and massage those areas, but it's just like putting a bucket on the floor when the roof is leaking; it's better to just fix the roof (aberrant breathing patterns).
5. I also touched on breathing patterns a bit in my seminar this past weekend. Check out a few great reviews of the event:
6. Some interesting findings HERE that shows that there may be a strong link between childhood obesity and the development of multiple sclerosis later on in life. One hypothesis is that it may be linked to the low levels of Vitamin D that one sees in overweight kids, and another that it could be related to the fatty tissue itself. One more reason to take Vitamin D!
7. We're all headed to Providence tonight to watch CP client and pro boxer Danny O'Connor try to run his professional record to 10-0. I think we'll be setting a world record for the number of professional baseball players in attendance at a boxing match. Let's go, Danny!
As many of you know, Mike Reinold and I put on a seminar that was "everything shoulder" this past Sunday at Cressey Performance. The event sold out within 36 hours back when we first announced it in early October, and we had strength and conditioning and rehabilitation specialists come from the likes of Canada, Texas, and the Midwest on only a month's notice. Our goal was to keep the seminar more intimate to allow for more speaker-attendee interaction, Q&A, and easy viewing - as we also recorded the event on DVD.
While production won't be complete until December at the earliest, I thought I'd give my loyal readers a little taste of some of what was discussed on Sunday. Our primary goals were to introduce some current concepts in evaluation of both symptomatic and asymptomatic populations as well as ways to treat/train them during and after injury. Above all else, we wanted to show how rehabilitation specialists and strength and conditioning specialists could work hand-in-hand to improve outcomes - but that this successful interaction hinged on whether all parties involved were willing to commit to learning about how the shoulder functions.
You can call this my "Random Thoughts" for the week:
1.The side-lying external rotation (SLER) has the highest EMG of any rotator cuff exercise, and the adducted position is the safest position for most "testy" shoulders. So, if you have to pick one cuff exercise to get you a safety and a great return on investment, roll with the SLER:
2. Simply providing a small amount of "propping" to put the humerus in a slightly more abducted position actually increases EMG of the posterior rotator cuff muscles by 23%.
3. Shoulder evaluations rarely work completely independently of one another. For example, poor thoracic spine mobility directly impacts function of the scapula and, in turn, range of motion at the glenohumeral joint. So, rather than hanging your hat on 1-2 assessments, you need a barrage of assessments that cover glenohumeral range-of-motion, scapular stability/positioning, thoracic spine mobility, breathing patterns, and forward head posture. Then, once you've got all your information, you can look at each test as one piece in an individualized puzzle.
4. There are a ton of superior labrum anterior-posterior (SLAP) tests out there. It's because none of them are particularly great - but the better ones out there simulate the injury mechanism (e.g. pronated load and resisted supnation external rotation tests for overhead throwing athletes).
5. The true function of the cuff is - very simply - to center the humeral head within the glenoid fossa. So, rather than train it purely concentrically and eccentrically, we need to also work its isometric/stabilization function with rhythmic stabilization exercises. Here's a really entry level one we use quite a bit with our pitchers:
6. MRIs and x-rays can only tell you so much about a shoulder. For instance, 79% of professional baseball pitchers have "abnormal labrum" features. Likewise, a huge chunk of asymptomatic people in the general population are walking around with partial and even FULL thickness tears of the rotator cuff. It actually makes you wonder if abnormal is actually normal! The take-home message is that having adequate mobility, stability, and tissue quality in the torso and upper extremities matters more than anything else. You have to ASSESS, not assume!
7. We talk a lot about glenohumeral internal rotation deficit (GIRD) - and it certainly is important - but you have to appreciate that it's just one part of the total motion equation. Some internal rotation deficit is completely normal, and working to fix it may actually hurt some athletes. Look to total motion first, and then work backward to see whether IR, ER, or both need to be changed. It is better to be too tight than too loose!
8. If you have an athlete with good shoulders, thoracic spine, scapular stability, and tissue quality who has rehabbed and long-tossed pain-free, but has shoulder/elbow pain when he gets back on the mound, CHECK THE HIPS! Staying closed and flying open will be your two most common culprits, and this cannot be seen in a doctor's office or on an MRI.
9. Anytime you see an individual with a pronounced shrugging pattern as they try to reach overhead, it's wise to have them checked for a rotator cuff tear. The reason is that with a cuff tear, the deltoid's vertical action overpowers the cuff's compressive action. In a healthy shoulder, the supraspinatus "cancels out" this deltoid pull. Never, ever, ever, ever train through a shrugging pattern with overhead reaching!
10. External impingement and internal impingement are completely different "syndromes" that must be managed completely differently. Simply saying "impingement" is no longer acceptable with how far sports medicine has come! Both are generally multi-factorial issues that mandate a more specific diagnosis and comprehensive treatment/training plan. If you understand why/how they occur, you can understand how to train around them (and the same can be said about just about any shoulder condition).
UPDATE: The Optimal Shoulder Performance DVD set is now available! Check it out at www.ShoulderPerformance.com.
Sorry, everyone, for being a bit MIA of late. I'll use today's post as a quick catch-up on what's been going on, and what is on tap for EricCressey.com in the months to come.
Last week, I flew out to Phoenix on Tuesday to attend a seminar with Dr. Pavel Kolar. With the exception of just a few of us, everyone in attendance was a strength and conditioniong coach, athletic trainer, or physical therapist with a major league organization. For those who aren't familiar with Kolar, he is somewhat of a "rehabilitation rockstar" in the Czech Republic, with "clients" that include Jaromir Jagr, Roger Federer, Petr Korda, countless world-class track and field athletes, multiple Czech Olympic teams, and the president of the Czech Republic himself. Needless to say, he's a really smart dude; otherwise, people all around the world wouldn't be paying to hear him give seminars in Czech (yes, the majority of the seminar was through a translator).
All of us in attendance are probably still trying to wrap our heads around his ideas, but Kolar presented a very interesting perspective on dynamic neuromuscular stabilization (DNS) based on developmental kinesiology. The "Cliff's Notes" version is that the central nervous system and muscular system it governs are immature at birth, and must go through a very specific adaptation process to achieve anatomical maturation. In rehabilitation down the road, examining this sequence of events during the first few years of life - from rolling over, to crawling, to standing up, to walking - can help us to understand how we must re-educate the nervous system to optimize function in those with aberrant patterns.
According to Kolar, one can have altered stabilization patterns for any of three reasons: 1) abnormal early development, 2) abnormal training methodology, and 3) trauma. Sounds simple, right?
Unfortunately, it's not that easy. Sequencing of patterns - from the feet all the way up to the head (and including things like diaphramatic breathing and optimal tongue positioning) - is what's important...NOT recruitment of specific muscles.
So, while EMG of the vastus medialis, posterior rotator cuff, lower trapezius, transversus abdominus, and loads of other muscles that's important, it's how all those muscles work together that's important.
All in all, it was an awesome seminar that really tested those in attendance. A pessimist would have walked away from it saying that it was too complex and that it couldn't be applied right away. The optimist (and I'd include myself in this camp) left realizing that there were a lot of things I'm anxious to research and integrate in one's programming to get our clients back to their "roots" of rolling and moving from ground-based to upright movements (think sprint-start from the ground and Turkish Get-ups).
We're also looking a ton more at breathing patterns in all our athletes - especially after spending a few days in AZ with my buddy Neil Rampe, a great manual therapist with the Arizona Diamondbacks. Most people don't realize that the diaphram is both a respiratory and postural muscle, so if you're not using it properly, it'll interfere with both oxygenation and muscular activity.
Fun stuff. Just trying to get better...
Sorry for the delay in getting this one posted, everyone; I just got back from a seminar with Pavel Kolar in Phoenix and my brain is fried (in a good way!). Luckily, Matt Blake has provided some more excellent content - and it is incredibly appropriate, as I spent the entire weekend with physical therapists, athletic trainers, chiropractors, and strength and conditioning coaches in an awesome learning environment. Check it out:
Philosophizing from Goliath's Shoulders
By: Matt Blake
In continuing the theme of discussing some of the basic tenants of the Elite Baseball Development Program here at Cressey Performance, I wanted to follow up on one of the thoughts I had in a previous post. This idea is that the leaders in most fields are polymaths. This is something that I think should be expounded upon and I'm going to take that opportunity in this post.
For those of you who are not sure what a polymath is and do not feel like looking it up, I'll provide the definition for you here from Wikipedia:
"A polymath (Greek polymath?s, ?????????, "having learned much")[1] is a person, with superior intelligence, whose expertise spans a significant number of subject areas."
I think this term can be used on many levels. In the post to which I'm alluding, I used it to describe people who reach outside their own field and acquire knowledge from other disciplines. I also think this is a term that should apply to people who stay within their niche and look to other thought leaders and how they go about their business.
For Eric, this would be like pulling from physical therapists, strength coaches in other sports, manual therapists, athletic trainers, powerlifters, golfers, tennis coaches, Olympic lifters, sprinters, and vision experts. By doing this, he is acknowledging that he doesn't know everything and is working to fill in some of his own gaps. He is making his personal philosophy and his own school of thought that much more solid. Look at his latest product, Assess and Correct,as an example: it's a collaboration of two strength and conditioning coaches and a physical therapist with great soft tissue treatment skills. It brings together three people who specialize in the shoulder, knee, and lower back.
Eric doesn't have to like everything that each of these people teach or preach, but if he blends one new thought into his own training, then he just made himself a better trainer. Applying one piece of someone else's puzzle doesn't have to signal a 100% endorsement of an individual. There should always be some level of individuation and originality if you expect to contribute at the highest level. I'm not even talking about being inventive in nature, but simply blending up the same ingredients, in your own proportions, to create a different concoction that is unique to you.
I think this applies in the very same way in the baseball industry, and particularly with respect to teaching pitching. Both of these fields share similarities in that they have been around a while, and if you're attempting to reinvent the wheel in these fields, you are failing to acknowledge that people have been able to do some pretty amazing things with what's already there.
For me, it is looking at what the great pitchers and great pitching coaches before me have done. Obviously, Nolan Ryan, Roger Clemens, and Greg Maddux are modern day legends who can show us a thing or two about pitching, and, more importantly, pitching healthy.
To look even further back, take guys like Sandy Koufax, Bob Gibson, and Whitey Ford (just to name a few). When building what we'll call post-modern pitchers, wouldn't it make sense to grab a little bit of each and apply it on a case-by-case basis? A little rhythm here, some little knee lift there, and maybe mix in a type of stride for a particular body type, and top it off with the signature arm action? We have the same components, but a new pitcher - unique to his build.
The same could be said for all of the pitching coaches and pitching gurus that have preceded me. Dave Duncan, Lee Mazzone, Tom House, John Bagonzi, Ron Wolforth, Paul Nyman, and dozens more: each one presents something a little different from the next. I don't have to love everything that Ron Wolforth or Tom House does to appreciate that they are tremendous teachers of pitching and get great results. Wouldn't I want to know how they're doing it and see if there is anything I can borrow from their brand of pitching? I would never sell these thoughts as completely my own, but the fact that I understand them and can apply them properly allows me to use them, assuming I make the necessary acknowledgements.
For example, I love Ron Wolforth and Brent Strom's ideas for developing velocity using specific drills to activate and optimize different pieces of the mechanics (pitchingcentral.com). I like the way Tom House advocates controlling the body with different mechanical cues (tomhouse.com). I like pieces of Alan Jaeger's arm care and long toss program (jaegersports.com). I even like how Dick Mills breaks down video (pitching.com). All of these guys have pieces I like, and pieces of which I'm not a huge fan. I'd like to think if I blended a little bit of all of them into my own philosophy, I'd have a pretty good starting point to teach people about pitching.
I also think the reason it has to be my own is because I don't have the same experiences or resources as these people do, so naturally I have to make the most of my own ingredients. What we lack in warm winter throwing sessions outdoors, we make up for by optimizing individual strength training and throwing programs indoors in an attempt to condition pitchers to throw the ball as hard and healthy as anyone in the country. That's the reality of the situation. We wouldn't complain about the hand we are dealt in the Northeast, we would just make the most of what we have available to us.
The real importance in all of this comes down to whether or not Eric and I are able to get the desired results for our players. Your philosophy is only as good as the results it can continuously demonstrate. Can my pitchers throw the ball harder because of what I have showed them? Can they command the ball better than before because of what I explained to them? Will our players stay healthier because of what Eric has provided them in programming? Do our players understand the importance of a diligent work ethic, because of our collective training platform? At the end of the day, whether or not we get them to perform at the level they decided to commit to is all that it comes down to. If they don't, then the philosophy needs to be continuously shaped based on the evidence available to us.
I would like to believe the X factor in all of this is: can we effectively communicate our ideas to the point that the people around us understand how to apply these thoughts into their own world? The ability to command the attention of an individual to a degree that they are willing to open up their mind and acknowledge that there is a different way of doing things to get better is a tremendous skill that needs to be constantly refined. There are a lot of facets to this idea of effective communication that I will touch on in a future post, but one of the foundations is simply having something worth communicating, whether it be one idea from many fields, or many ideas from one field. Either way, viewing your methodology as limitless in its capacity for development, and embracing all knowledge as a potentially worthy addition is a good starting point.
Matt Blake can be contacted at mablak07@gmail.com.
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As you're reading this, I'm either watching a seminar in Arizona, or flying back from the trip. Luckily, I prepared this list of recommended reading for the week in advance:
Is the Seated 90/90 Stretch Safe? - This great Q&A with Bill Hartman emerged following a question from a reader after we released Assess and Correct. It's definitely worth a read.
The Best Exercise You're Not Doing - This was an excellent piece from Matthew Hertilus last week at T-Muscle. We use the Turkish Get-up quite a bit with our athletes, and this article does a fantastic job of teaching the lift - complete with video tutorials.
Returning to Deadlifting after a Back Injury - This newsletter from a while back was a popular one. If you've got poor deadlifting technique or you've had an injury performing the lift in the past, it's definitely worth a read.
Here's a quick continuation of last week's newsletter, which featured some introductory anterior core training exercises and the rationale for them. You'll need a TRX set-up to do these; it's an awesome investment, if you haven't picked one up already. They make it very easy to take your training anywhere you go.
For more information on my overall approach to core training and where these exercises fit in, I encourage you to check out Part 3 of my Lower Back Savers series.
A while back, I wrote an article that went into quite a bit of detail on appropriately allocating CNS-intensive stress. Check it out HERE. Likewise, a bit later, Mike Boyle introduced a fantastic DVD of a presentation on CNS-intensive training.
In hindsight, a lot of the concepts in both my original article and Mike's DVD are probably best appreciated by taking a look at some sample programs. Some stuff we are doing right now with one of my pro pitchers is a perfect example, so I thought I'd turn it into a feature for today's blog.
First off, we're talking about one of the most gifted natural athletes I've ever seen. He has some incredible reactive ability, and just as significant to this discussion, he doesn't hold back...ever. We are talking an incredible motivation to train and a complete willingness to do everything put in his program to a "T." He is every coach's dream, but it can certainly pose more of a challenge with respect to program design. Here's what his October training schedule looked like:
Monday: Medicine Ball Work (88 total throws), Low-Volume, Less Intense Plyos (24 total landings), Lower Body Lift
Tuesday: Upper Body Lift
Wednesday: Medicine Ball Work (80 total throws), Plyos and Movement Training
Thursday: Full-Body Lift
Friday: Easy Flexibility Circuits (recovery-oriented)
Saturday: Medicine Ball Work (88 total throws), Low Volume Sprint Work, Full-Body Lift
Sunday: Off
Looking at this schedule, Monday, Wednesday, Thursday, and Saturday are really the CNS-intensive days - and a schedule like this had worked well for him in two previous off-seasons when he wasn't quite as highly trained. Each year, he dropped body fat, gained a ton of strength, increased his power numbers, and directly transferred those gains to increased velocity on the mound and zero injury issues.
Last month, though, our guy was feeling a little banged up two Thursdays in a row. The challenging sprint work on Wednesday was taking too much out of him prior to Thursday's lift. So, we simply decided to consolidate things a bit more, and drop our sprinting volume a bit. Here's what this month's schedule looks like:
Monday: Movement Training, Lower Body Lift
Tuesday: Medicine Ball (68 total throws), Upper Body Lift
Wednesday: Easy Flexibility Circuits (recovery-oriented)
Thursday: Movement Training, Full-Body Lift
Friday: Rotational Medicine Ball Work (66 total throws), Easy Flexibility Circuits (recovery-oriented)
Saturday: Overhead Medicine Ball Work (12 total throws), Less Intense Plyos (24 total landings), Full-Body Lift
Sunday: Off
In this set-up, our CNS-intensive days are Monday, Thursday, and Saturday. In other words, he's got one less training session per week that's really challenging - and he's seeing great progress without any of the little issues that he noticed last month.
This off-season, we will have over 30 professional baseball players. Some are big leaguers, some are on the cusp of making the big show, and others have a few years of work ahead of them to reach that dream. No two of them are identical. Every evaluation is unique. There are different health histories, different positions on the field, different ages, and different training experience levels. Every program needs to reflect these differences.
This is a great opportunity to talk about the interaction of programming for athletes and training athletes. Early on in an athlete's career, it's all about training them: teaching techniques, educating them on when to push and when to hold back, and how to progress. As they get more advanced, they know a lot about this stuff - so the programming gets more challenging as they get more individualized.
This is the main tenet upon which we have built our Elite Baseball Development Program at Cressey Performance. While many facilities will just put a program on the board and train a group of individuals off of it, we firmly believe that the real work to make athletes successful goes on behind the scenes when we're reviewing their evaluations, watching videos of them throwing/hitting/sprinting, and compiling a program that's right for them.
It's also an observation that led Bill Hartman, Mike Robertson, and I to create Assess and Correct: Breaking Barriers to Unlock Performance. If you aren't assessing, you're just assuming - and that's a recipe for mediocrity at best.
A Semi-Related Note
While we're on the topic of baseball, I wanted to send out a quick congratulations to my buddy Dana Cavalea, the strength coach for the NY Yankees, on his first world championship. Admittedly, I'm not a Yankees fan, but Dana's a great dude who does an excellent job, so you have to give him some love for an outstanding season.
That said, Dana and some colleagues are putting on the 2nd Annual Major League Strength Coaches Clinic at St. John's University in New York on November 21, 2009. I won't be able to present with my schedule, unfortunately, but I did present last year and can assure you that it's a top-notch event. I'd strongly recommend you check it out HERE.
