I've often alluded to how important I think the back to wall shoulder flexion drill is as both an assessment and actual training exercise. Today, I've got three strategies for improving your performance of this exercise:
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We spend a good chunk of our lives standing on one-leg. Obviously, that means we need to train on one leg, but it's also important that fitness professionals and rehabilitation specialists assess folks when they're in single-leg stance, too. Enter the overhead lunge walk, which is likely my favorite assessment because of just how comprehensive it is.
Why is it so great? Let's examine it, working from the upper extremity to the lower extremity.
First, you can evaluate whether someone has full extension of the elbows. Just tell folks to "reach the fingers to the sky." In a baseball population, as an example, you can quickly pick up on an elbow flexion contracture, as it's quick and easy to make a comparison to the non-throwing side.
Additionally, you can screen for congenital laxity, as a lot of hypermobile (loose jointed) folks will actually hyperextend the elbows during the overhead reach.
At the shoulder girdle, you can evaluate whether an individual has full shoulder flexion range of motion:
You can also tell whether the aforementioned hypermobile folks actually move excessively at the ball-and-socket joint of the shoulder, as they'll actually go too far into flexion instead of moving through the shoulder blades.
You can determine whether an individual has an excessively kyphotic, neutral, or extended thoracic spine. If they're kyphotic, they'll struggle to get overhead without compensation (arching the lower back or going into forward head posture). If they've got an excessively extended thoracic spine, they'll actually go too far with the overhead reach (hands will actually wind up behind the head if it's combined with a very "loose" shoulder).
You can tell whether an individual is able to fully upwardly rotate the shoulder blades in the overhead position.
You can tell whether someone preferentially goes into forward head posture as a compensation for limited shoulder flexion, poor anterior core control, or a lack of thoracic spine extension or scapular posterior tilt.
You can evaluate whether an individual has enough anterior core control to resist extension of the lumbar spine (lower back) during overhead reaching. This is a great test of relative stiffness of the rectus abdominus and external obliques relative to the latissimus dorsi.
You can evaluate whether an individual is in excessive anterior or posterior pelvic tilt from the side view.
Also from the side view, you can determine whether the athlete hyperextends the knees in the standing position.
With the lunge, you can see if an athlete is quad dominant - which is clearly evidenced if the stride is short and the knee drifts out past the toes of the front leg. You can also venture a guess as to whether he or she has full hip extension range of motion.
Also with the lunge, you can determine how much control the athlete has over the frontal and tranverse planes; does the knee cave in significantly?
You can make a reasonably good evaluation of foot and ankle function. Does the ankle collapse excessively into pronation? Or, does he stay in supination and "thud" down?
Does the athlete handle the deceleration component effectively, indicating solid eccentric strength in the lower extremity?
As you can see, this assessment can tell you a ton about someone's movement capabilities and provide you with useful information for improving your program design. Taking it a step further, though, it goes to show you that if you select the right "general" assessments, you can make your assessment process much more efficient.
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If you've read much of my stuff (most notably this article), you likely appreciate that I think it's really important for fitness professionals to understand corrective exercise and post-rehab training. Folks are demonstrating poorer movement quality than ever before, and injuries are getting more and more prevalent and specific. For the fitness professional, corrective exercise can quickly become a tremendous opportunity - or a huge weakness. To that end, given that Dean Somerset put his great resource, Post-Rehab Essentials, on sale for $50 off through the end of the day, I wanted to devote some thoughts to the subject with these seven points of "Eric Cressey Randomness."
1. Refer out. - With more and more certifications and seminars devoted to corrective work, the industry has a lot more "corrective cowboys:" people who are excited to be able to "fix" everything. Unfortunately, while this passion is admirable, it can lead to folks taking on too much and refusing to refer out. To that end, I think it's important for us to constantly remind fitness professionals to not work outside their scope of practice.
Referring out is AWESOME. I do it every single day - and to a wide variety of professionals. It provides me with more information, and more importantly, helps me toward the ultimate goal of getting the client/athlete better. Trainers often worry that if they refer out, they'll lose money. This generally isn't true, but even if it was, it's a short-term thing. If you appreciate the lifetime value of the client, you'll realize that getting him/her healthy will make you more profitable over the long-term.
Additionally, I've developed an awesome network of orthopedic specialists in the greater Boston area. As a result, I can generally get a client in to see a specialized doctor for any joint in about 24-48 hours. It's an awesome opportunity to "overdeliver" to a client - but it never would have come about if I hadn't been willing to refer out. As an added bonus, we'll often get referrals from these doctors as well.
2. Ancillary treatments are key. - For my entire career, I've been motivated by the fact that I absolutely hate not knowing something. It's pushed me to always continue my education and not get comfortable with what I know, and it's helped me to be open-minded to new ideas. However, I'm humble enough to recognize my limitations. I know a lot about elbows, but I'm not going to do your Tommy John surgery. I've worked with more pitchers than I can count, but I'm not a pitching coach. And, even if I was able to do all these things, there's no way I'd have time to do them all and leverage my true strengths. In other words, I rely heavily on competent professionals around me for everything from sport-specific training, to manual therapy, to diagnostic imaging, to surgery, to physical therapy, to nutritional recommendations. Surround yourself with great people with great skillsets, and corrective exercise quickly becomes a lot easier.
3. Soft tissue work is effective.
Here's what I know: people feel better after they foam roll, and their range of motion improves. Additionally, soft tissue treatments have been around for thousands of years for one reason: they work!
For some reason, though, every 4-6 months, somebody with a blog claims that foam rolling is the devil and doesn't work, and then dozens of people blow up my email address with questions about whether the world is going to end.
The truth is that we know very little about why various soft tissue approaches work. I recall a seminar with bodywork expert and fascial researcher Thomas Myers from a few year back, and he commented that we "know about 25% of what we need to know about the fascial system." If Myers doesn't have all the answers, then Johnny Raincloud, CPT probably hasn't found the secrets during his long-term stay in his parents' basement.
With that in mind, I do think it's safe to say that not all people respond the same to soft tissue work, and certainly not all soft tissue approaches are created equal. Foam rolling doesn't deliver the same results as an instrument-assisted approach, and dry needling likely works through dramatically different physiological avenues than cupping. As a result, we're left asking the client: "does it make you feel and move better?" If the answer continues to be "yes," then I'll keep recommending various soft tissue treatments - including foam rolling - until someone gives me a convincing contrarian argument with anecdotal evidence.
4. Strength can be corrective.
Ever had a friend with anterior knee pain (patellar tendinopathy) who went to physical therapy, did a bunch of leg extensions, and somehow managed to leave asymptomatic? It was brutally "non-functional" and short-sighted rehab, but it worked. Why?
Very simply, the affected (degenerative or inflamed) tissues had an opportunity to rest, and they came back stronger than previously. A stronger tissue is less likely to become degenerative or inflamed as it takes on life's demands.
Good rehab would have obviously focused on redistributing stress throughout the body so that this one tissue wouldn't get overloaded moving forward. In the patellar tendon example, developing better ankle and hip mobility would be key, and strength and motor control at the hip and lumbar spine would be huge as well. Certainly, cleaning up tissue quality would be a great addition, too. However, that doesn't diminish the fact that a stronger tissue is a healthier tissue.
This also extends to the concept of relative stiffness. As an example, a stronger lower trapezius can help to overcome the stiffness in the latissimus dorsi during various upper extremity tasks.
And, a stronger anterior core can ensure corrective spine and rib positioning during overhead reaching - again, to overcome stiff lats.
Don't ever forget that it's your job to make people stronger. If you get too "corrective" in your mindset, pretty soon, you've got clients who just come in and foam roll and stretch for 60 minutes, then leave without actually sweating. You still have to deliver a training effect!
5. Minimalist sneakers might be your worst nightmare if you have high arches.
I love minimalist sneakers for my sprint and change-of-direction work. I don't, however, love to wear them on hard floors for 8-10 hours a day. I'm part of the small percentage of the population that has super high arches and doesn't decelerate very well, so cushioning is my best friend. Throwing in a $2 "cut-to-fit" padding in my sneakers has done wonders for my knees over the years, and I'll actually wear through them every 4-6 weeks.
The New Balance Minimus 00 is a sneaker I've been wearing recently to overcome this. It's a zero drop shoe (no slope down from the heel to the toe), and while lightweight, it offers a bit more cushioning (and lateral support, for change of direction) than typical minimal options.
All that said, just don't force a round peg in a square hole with respect to footwear. Some people just aren't ready for minimalist footwear - and even if they are ready to try them out, make sure you integrate usage gradually.
6. The pendulum needs to swing back to center with respect to thoracic spine mobilizations. - Thoracic spine mobility deficits are a big problem in the general population, given the number of people who spend too much time sitting at a computer. Athletes are a bit of a different situation, though, as some actually have flat (excessively extended) thoracic spines and don't need more mobility. As an example, check out the top of this yoga push-up before we corrected it.
This athlete has a flat thoracic spine, limited shoulder flexion, and insufficient scapular upward rotation. So, he'll logically go to the path of least resistance: excessive thoracic motion (as evidenced by the "arch" in his upper back). The shoulder blades don't rotate up sufficiently, and he's also "riding" on the superior aspect of his glenohumeral (shoulder ball-and-socket) joint. Here is it, "mostly" corrected a few seconds later:
By getting him to "fill up" the space between his shoulder blades with his rib cage (encouraging more thoracic flexion) and cueing better upward rotation of his scapula, we can quickly recognize how limited his shoulder flexion is. In the first photo, he's forcing shoulder ROM that isn't there, whereas in the second one, he's working within the context of his current mobility limitations.
If we just feed into his thoracic spine hypermobility with more mobilizations, we'll just be teaching him to move even worse.
7. You'll never address movement impairments optimally unless nutrition and supplementation are spot on. - It never ceases to amaze me how many athletes will bust their butts in the gym and in rehab, following those programs to a "T" - but supplement that work with a steady diet of energy drinks and crappy food. I'm not talking about debating whether grains and dairy are bad, and whether "paleo" is too extreme for an athlete; those are calculus questions when we should be talking about basic math. A lot of athletes literally don't eat vegetables or drink enough water. That's as basic as it comes. Movement quality will never improve optimally unless you're healthy on the inside, too.
This article was actually a lot of fun to write, so I'll probably turn it into a series for a bit down the road. In the meantime, though, I'd encourage you to check out Dean Somerset's Post-Rehab Essentials resource to learn more in this regard. I don't hesitate to endorse this comprehensive corrective exercise resource, as the content is fantastic, Dean is an excellent teacher, and the product provides some continuing education credits. The $50 off just sweetens the deal. Check it out HERE.
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2. Warm-ups for Sparing the Shoulders - This came as part of a post for Schwarzenegger.com.
3. Supine Alternating Shoulder Flexion on Doubled Tennis Ball - This upper back mobility/soft tissue drill was a big hit!
4. Fine-Tuning the Band Pullapart - This is a very popular exercise for shoulder health, but it's commonly performed incorrectly. Try these modifications!
5. Standing External Rotation Hold to Wall - This is an awesome warm-up that requires no equipment. We use it a lot with our throwers when they're on the field and don't have access to a table to do prone exercises.
As you can see, 2013 was the "Year of the Shoulder" at EricCressey.com! I'll be back soon with the top guest posts of 2013.
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A few years ago, I read What the Dog Saw, a collection of short stories from popular author Malcolm Gladwell.
In one particular short story, Gladwell introduces the concept of "risk homeostasis." Essentially, risk homeostasis refers to the fact that modifications that are designed to make things safer often eventually have a break-even effect on safety because of adaptations to those modifications. In other words, something that should protect us doesn't because new compensatory factors make things more dangerous.
As an example, Gladwell observers that taxi drivers who are given anti-lock brakes actually wind up with higher incidences of traffic violations and accidents. Presumably, this occurs because the drivers feel they can drive faster and more aggressively because of this added "protection."
In another case, a study showed that adding childproof lids to medicine bottles actually increased the likelihood that children would die from accidental overdose of consuming drugs not meant for them. The added “safety” leads to adults being less cautious with where they hide bottles of pills.
While watching an absolutely atrocious YouTube video with some of the worst box squat technique in history the other day, my thoughts flashed back to this concept of risk homeostasis from when I read Gladwell's work. There are actually some remarkable parallels in the world of strength and conditioning.
1. Wearing a belt.
When a lifter throws on a belt, he assumes that it will make an exercise safer for him. While the research isn't really in agreement with this assertion, we'll roll with this assumption.
In real life, most lifters throw on a belt because it helps them handle additional weights - and at these weights, their form usually deteriorates rapidly, and does so under additional compressive loading.
2. Popping anti-inflammatories and getting cortisone shots.
When a doctor gives you a cortisone shot or recommends oral anti-inflammatories, it's because he believes you have some level of inflammation, whether it's a bursitis, tenosynovitis, or other issue. This short course of anti-inflammatories will reduce that inflammation.
You rarely see these issues in isolation, though; they're usually accompanied by degenerative changes (e.g., tendinosis) or structural changes (e.g., bone spurs) that could also be causing your symptoms. Unfortunately, your anti-inflammatories don't know that; they just know they're supposed to kill off all your pain. They make you asymptomatic, but not necessarily "healthy."
Many individuals get a cortisone shot or take a few days of NSAIDs and assume they can just go right back to training hard with no restrictions because their pain is gone. A few weeks or months later (when the cortisone shot wears off), they're back in pain (and usually it's worse than before) because they've done nothing to address the underlying causes of the problem in the first place. They shut off the inflammation and pain, but kept the degeneration, structural changes, and stupid.
The anti-inflammatory intervention is supposed to be part of a treatment plan to make folks healthier, but actually gives them a false sense of security, which in turn makes an injury or condition worse.
3. Lifting alongside an "experienced" coach who has done stupid s**t for decades, but has never been hurt.
It's not uncommon to feel a sense of security when you train with a coach with tons of time "under the bar" himself. His training background - and reportedly clean injury history - gives you peace of mind and you buy into his system. And, you continue lifting heavier and heavier in poor form because he's proof that it works, right?
Unfortunately, he's a sample size of one.
His experience should make training safer, but instead, it just leads you to take more poorly calculated risks with your training.
As an example, I did this while goofing around a few years back, but I'd never let one of my athletes try it. There are enough ugly box jump videos out there on YouTube to appreciate that a lot of coaches don't have the same kind of self-restraint.
4. Wearing elbow sleeves and knee wraps.
Elbow sleeves and knee wraps are incredibly common in the world of strength sports, and with good reason: they can really help with getting or keeping a joint warmed-up.
The only problem is that most lifters use them just so that they can power through the exact exercises that caused the joint aches in the first place.
As an example, a lot of lifters lack the upper back and shoulder mobility to use a narrow grip position on the barbell when back squatting, and the medial (inside of the) elbow takes a beating as a result. Rather than doing some shoulder mobility drills, they just throw on a band-aid in the form of an elbow sleeve.
5. Picking "joint-friendly" strength exercises.
There are lots of ways to deload a bit in the context of strength exercise selection. Maybe you do some single-leg work instead of squatting. Or, maybe you do some barbell supine bridges in place of deadlifting. These substitutions usually make a strength training program safer.
That is, of course, unless you do them with horrendous technique. Sadly, this isn't uncommon. You see people who meticulously prepare for squatting and deadlifting and heavily scrutinize their technique with video analysis, yet they'll blow through other exercises with terrible form. They expect exercise selection alone to make their strength training program safer, but compensate for this added safety by butchering technique.
Of course, these are only five examples of how risk homeostasis applies to strength and conditioning programs, and there are certainly thousands more. Where do you see good intentions go astray in your training? I'd love to hear your thoughts in the comment section below.
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In part 1 of this series, I touched on some of the mechanical factors one must consider in relation to increasing stride length in pitchers. Then, in part 2, I got discussed physical factors – hip mobility and lower-body strength/power – that govern how far you can stride. In wrapping up today with part 3, we’ll work our way up the kinetic chain to discuss three more physical factors that control stride length.
3. Rotary Stability – As I discussed in my recent article at T-Nation, What I Learned in 2011, hip mobility “sticks” better when you have adequate rotary stability, so we’ve been doing more of our core stability exercises in more “extreme” positions of hip mobility.
If you’re going to push the limits of hip abduction, internal, and external rotation range of motion, you need to be sure that you have adequate rotary stability to be stable in these positions in weight-bearing and not destroy the spine. Anybody can just get into these positions in slow speed, but not everyone can control the body precisely with a combination of isometric and eccentric muscle action at the high velocities we see with pitching.
Additionally, many of the big-time long stride guys rely heavily on controlling lumbar spine hyperextension as they ride the back hip down the mound. This is something you’ll see if you watch the deliveries of smaller, athletic guys like Tim Lincecum, Tim Collins, and Trevor Bauer. If they don’t maintain adequate anterior core function, they’ll wind up with extension-based back pain in no time.
4. Thoracic Mobility – Throwing and hitting (and really any rotational challenge like a hockey slapshot or tennis stroke) present a unique challenge to an athlete: the hips and shoulders are temporarily moving in opposite directions. This creates separation, which allows an athlete to store elastic energy and create velocity via the stretch-shortening cycle.
The first issue to consider is that not all separation is created equal. You can create separation with the hips and lower back – and jack up a lumbar spine over time. The goal is to having adequate thoracic spine mobility to ensure that this separation occurs higher up (and engages the upper extremity well).
The second issue is that the more you push the limits of hip mobility, the more you must push the limits of thoracic mobility. We’ve always heard “equal and opposite” when it comes to the throwing arm and glove arm, but the truth is that it probably apply to the lower half and thoracic spine as well. You simply don’t see guys with terrible thoracic mobility getting way down the mound, as that lack of thoracic mobility would cause them to leak forward with the upper body. I covered this in part 1, but the Cliff’s Notes version is that the head doesn’t stay behind the hips long enough, so throwers lose separation.
The third issue is that poor thoracic mobility will really interfere with getting an adequate scap load, so the arm speed will be slower. Throwing with a poorly positioned scapula is like trying to jump out of sand; you just don’t have a firm platform from which to create force.
A very basic thoracic spine mobility drill that would be a “safe” bet for most throwers would be the quadruped extension-rotation.
This drill doesn’t crank the shoulder into excessive external rotation, which may be a problem for the really “loose” arms in the crowd. Progressions for the really stiff pitchers would be the side-lying windmill and side-lying extension-rotation. I also like the yoga plex, a drill I learned from Nick Tumminello, as a means of syncing everything up with a longer stride.
Note: be sure to read this shoulder mobility blog on why not all thoracic spine mobility drills are created equal for throwers!
5. Quick Arm – When I say that you have to have a quick arm to have a long stride, I really just mean that you need some upper body power to make things work. The longer the stride, the quicker your arm must be to catch up in time to create a downward plane and throw strikes.
You simply don’t see guys with long strides competing at high levels unless they have a quick arm that can catch up to the lower body.
When a guy’s arm isn’t quick enough to catch up to his lower half, you see him miss up and arm side.
This type of thrower would be better off shortening up his stride (at least temporarily) and spending more time on good throwing programs to increase arm speed.
This is one reason Justin Verlander is great. If you watch him, he’s not an insanely long stride. Rather, he’s shorter with it, and much stiffer on his landing leg to create an awesome downward plane. Plus, he actually does have a ridiculously quick arm and outstanding secondary stuff. A lot of pitching coaches would try to lengthen his stride – and while this might work, I don’t know about you, but I think overhauling a Cy Young winner’s mechanics is silly.
The “long stride, slow arm” issue is (in my experience) most common in young, lax players who have the joint range-of-motion and just enough stability to get a long stride, but don’t have adequate arm speed to catch up. This is really common in the 14-17 age ranges, and I think it’s one reason why so many of these kids respond incredibly favorably to long toss; it teaches their arms to go faster and keep up with their strides.
Conversely, as you start to deal with 18-year-olds and older (or kids who have grown quickly), you start to see that preparing everything below the arm is arguably more important than arm speed. You don’t pitch in college or professional baseball unless you have a reasonably quick arm, and getting more aggressive with the lower half to stride longer is often exactly what guys need to make the big velocity jump. Likewise, when guys don’t take care of the lower half, but continue on aggressive throwing programs, they often wind up with velocity drops, injuries, or control issues because they’ve lost the separation that made them successful.
Closing Thoughts
While a long stride can certainly be advantageous in the throwing motion, as I've shown in this series, forcing it when you don't have the right physical preparation or mechanical coaching in place can actually hurt an pitcher's performance and health. Remember that the best changes are subtle ones; in other words, you might increase a stride by six inches over the course of a year, not in a single session.
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The prone external rotation is a strength exercise for the posterior rotator cuff that we've added to our strength and conditioning programs over the past few months with good success. And, while the primary goal is to increase shoulder stability via improved rotator cuff function, the truth is that this drill also served as a motor control exercise to reeducate folks on what should be moving and when.
We use this drill a lot with guys who are in a dramatic anterior pelvic tilt, and start everything with the "gluteus tight, core braced" cues. Effectively, this means that you force the athlete to actually externally rotate the shoulder instead of simply arching through the lower back to get to the desired "finish" point. You'll be amazed to see how many athletes have significantly less "observable external rotation" when they are locked into neutral spine.
You also want to cue the athlete to keep the scapula (shoulder blade) on the rib cage, but he/she doesn't need to be aggressively pulled into scapular retraction in order to get there.
Once the scapula is set, I tell athletes to think about getting the ball to rotate in the socket without allowing the head of the humerus to slide down toward the table. This is a very important cue, as many athletes will allow excessive anterior migration of the humeral head during external rotation exercises; we want them to learn to keep the ball centered in the socket. If an athlete is really struggling with this, we may place a rolled up towel or half-roller underneath the anterior shoulder as feedback on where things should be.
Very rarely will we load this up, and in the rare instances we do, it wouldn't be for more than 2.5 -5 pounds. The shoulder is a joint with a broad range of movements that mandate a lot of dynamic stability, so we want to make sure things are working perfectly.
I'll generally include this movement in the warm-ups for sets of eight reps - or we may use it as a filler on a lower-body day between sets of more compound strength exercises. It can also serve as a great follow-up to shoulder mobility drill geared toward improving external rotation, as this is an avenue through which you can add stability to the range-of-motion you're creating.
Give it a shot in your strength and conditioning programs and then let me know how it goes in the comments section below!
Last summer, a college pitcher came up to Cressey Performance from the South to train for a month before his summer league got underway. He was seven months post-op on a shoulder surgery (Type 2 SLAP) and had been working his way back. Unfortunately, his arm was still bothering him a bit when he got up to see us.
After the first few days at CP, though, he told me that his arm felt as good as it’s felt in as long as he could remember. He’d been doing a comprehensive strength and conditioning program, but the “impact” stuff for him had been soft tissue work, some Postural Restoration Institute drills, an emphasis on thoracic mobility, and manual stretching into internal rotation, horizontal adduction, and shoulder flexion. From all the rehab, his cuff was strong and scapular stabilizers were functioning reasonably well – which led me to believe that his issues were largely due to tissue shortness and/or stiffness.
This realization made me immediately wonder what he’d been doing in the previous months for mobility work for his arm – so I asked. He then demonstrated the manual stretching series that every pitcher on his team went through every day on the table with their athletic trainer. Each stretch was done for 2x20s – and two of those stretches took him into extreme external rotation and horizontal abduction. I was pretty shocked.
Me: “You’re probably not the only guy on your team rehabbing right now, huh?”
Him: “No; there are actually too many to count.”
Me: “Elbows, too, I’m sure.”
Him: “Yep.”
Want to irritate a labrum, biceps tendon, or the undersurface of the rotator cuff? Stretch a thrower into extreme external rotation and simulate the peel-back mechanism. This also increases anterior capsular laxity and likely exacerbates the internal impingement mechanism over the long-term. To reiterate, this is a bad stretch!
Want to make an acromioclavicular joint unhappy? Stretch a thrower into horizontal abduction like this (again, this is a BAD stretch that is pictured):
Want to irritate an ulnar nerve or contribute to the rupture of an ulnar collateral ligament? Make sure to apply direct pressure to the forearm during these dangerous stretches to create some valgus stress. This is a sure-fire way to make a bad stretch even worse:
These stretches are very rarely indicated in a healthy population – especially pitchers who already have a tendency toward increased external rotation. The shoulder is a delicate joint that can’t just be manhandled – and when you’re dealing with shoulders that are usually also pretty loose (both from congenital and acquired factors), you’re waiting for a problem when you include such stretches. In fact, I devoted an entire article to this: The Right Way to Stretch the Pecs.
Everyone thinks that shoulder external rotation and horizontal abduction alone account for the lay-back in the extreme cocking position.
In reality, though, this position is derived from a bunch of factors:
1. Shoulder External Rotation Range-of-Motion – and this is the kind of freaky external rotation you’ll commonly see thanks to retroversion and anterior laxity:
2. Scapular Retraction/Posterior Tilt
3. Thoracic Spine Extension/Rotation
4. Valgus Carrying Angle
So, how do you improve lay-back without risking damage to the shoulder and elbow?
1. Soft tissue work on Pec minor/major and subscapularis – Ideally, this would be performed by a qualified manual therapist – especially since you’re not going to be able to get to subscapularis yourself. However, you can use this technique to attack the pecs:
2. Exercises to improve scapular retraction/depression/posterior tilt – This could include any of a number of horizontal pulling exercises or specific lower trap/serratus anterior exercises like the forearm wall slide with band.
3. Incorporate specific thoracic spine mobility drills – In most pitchers, you want to be careful about including thoracic spine mobility drills that also encourage a lot of glenohumeral external rotation. However, when we assess a pitcher and find that he’s really lacking in this regard, there are two drills that we use with them. The first is the side-lying extension-rotation, which is a good entry level progression because the floor actually limits external rotation range-of-motion, and it’s easy to coach. I tell athletes that they should think of thoracic spine extension/rotation driving scapular retraction/depression, which in turn drives humeral external rotation (and flexion/horizontal abduction). Usually, simply putting your hands on the shoulder girdle and guiding them through the motion is the best teaching tool.
A progression on the side-lying extension-rotation is the side-lying windmill, which requires a bit more attention to detail to ensure that the range-of-motion comes from the right place. The goal is to think of moving exclusively from the thoracic spine with an appropriate scapular retraction/posterior tilt. In other words, the arm just comes along for the ride. The eyes (and head) should follow the hand wherever it goes.
Again, these are only exercises we use with certain players who we’ve deemed deficient in external rotation. If you’re a thrower, don’t simply add these to your routine without a valid assessment from someone who is qualified to make that estimation. You could actually make the argument that this would apply to some folks in the general population who have congenital laxity as well (especially females).
4. Throw!!!!! – Pitchers gain a considerable amount of glenohumeral external rotation over the course of a competitive season simply from throwing. Sometimes, the best solution is to simply be patient. I really like long toss above all else for these folks.
In closing, there are three important things I should note:
1. You don’t want to do anything to increase valgus laxity.
2. You’re much more likely to get hurt from being “too loose” than you are from being “too tight.” When it comes to stretching the throwing shoulder, “gentle” is the name of the game – and all mobility programs should be as individualized as possible.
3. Maintaining internal rotation is a lot more important than whatever is going on with external rotation. In fact, this piece could have just as easily been named "The Two Stretches Pitchers Shouldn't Do, Plus a Few That Only Some of Them Need."
As you can probably imagine, given that I deal with a ton of baseball players - and the fact that I've written about shoulder pain a ton over the past decade - a lot of people initially come to Cressey Performance because their shoulder hurts. It might be rotator cuff pain, AC joint irritation, or any of a host of other issues, but you'd be surprised at how many similarities there are among the ways that you address most of these issues.
The problem is that pain can throw a wrench in your plans and limit you in your ability to get to exactly where someone needs to improve movement-wise. For instance, you might have someone who has a significant glenohumeral (ball-and-socket) internal rotation deficit, but it's hard to manually stretch them into internal rotation without further irritating a cranky AC joint. Or, someone with a partial thickness rotator cuff tear may be dramatically limited in shoulder flexion, but even shoulder flexion with assisted scapular posterior tilt and upward rotation exacerbates their symptoms. Very simply, you can't just pound round pegs into square holes when it comes to dealing with a delicate joint like the shoulder - and that applies to both asymptomatic and symptomatic shoulders.
To that end, there are three initiatives that I think are the absolute most important places to start in just about every case.
First, I'm a huge advocate of soft tissue work with a skilled manual therapist. In our office, we have a massage therapist and chiropractor who performs both Active Release and Graston. And, we make sure that any physical therapist to whom we refer clients uses manual therapy as an integral part of their treatment approach. Whether you're a regular exerciser or not, tissues can get dense, nasty, and fibrotic, and integrating some hands-on work on the pec minor, posterior rotator cuff, lats, scalenes, sternocleidomastoid, and several other areas can dramatically reduce an individual's symptoms and improve range-of-motion instantly - and that allows us to do more with a corrective exercise program.
Understandably, not everyone has access to a qualified manual therapist all the time, so you can always utilize self-myofascial release in the interim. Here, in a video from Show and Go: High Performance Training to Look, Feel, and Move Better, CP massage therapist Chris Howard goes over a quick and easy way to loosen up the pecs:
The second area where you really can't go wrong is incorporating thoracic spine mobilizations. The thoracic spine has direct interactions with the lumbar spine, rib cage, cervical spine, and scapulae; as a result, it has some very far-reaching effects. Unfortunately, most people are really stiff in this region - and that means they wind up with poor core and scapular stability, altered rib positioning (which impacts respiration), and cervical spine dysfunction. Fortunately, mobilizing this area can have some quick and profound benefits; I've seen shoulder internal rotation improve by as much as 20 degrees in a matter of 30 seconds simply by incorporating a basic thoracic spine mobility drill.
That said, not all thoracic spine mobility drills are created equal. Many of these drills require the glenohumeral joint to go into external rotation, abduction, and horizontal abduction in order to drive scapular posterior tilt/retraction and, in turn, thoracic spine extension and rotation. If you've got a cranky shoulder, this more extreme shoulder position usually isn't going to go over well. So, drills like the side-lying extension-rotation are likely out:
For most folks, a quadruped extension-rotation drill will be an appropriate regression:
And, if the hand position (behind the head) is still problematic for the shoulder, you can always simply put it on the opposite shoulder (in the above example, the right hand would be placed on the left shoulder) and keep the rest of the movement the same.
Last, but certainly not least, you can almost always work on forward head posture from the get-go with someone whose shoulder hurts. We start with standing chin tucks, and then progress to quadruped chin tucks.
Additionally, working on cervical rotation is extremely valuable, although teaching that is a bit beyond the scope of this post.
Keep in mind that these three broad initiatives are really just the tip of the iceberg when it comes to a comprehensive corrective exercise plan that would also include a focus on scapular stabilization and rotator cuff exercises, plus additional mobility drills. They are, however, safe entry-level strategies you can use with just about anyone to get the ball rolling without making a shoulder hurt worse in a strength and conditioning program.
For more information on what a comprehensive shoulder rehabilitation program and the concurrent strength and conditioning program should include, check out Optimal Shoulder Performance, a DVD set I co-created with Mike Reinold, the Head Athletic Trainer and Rehabilitation Coordinator of the Boston Red Sox.
The Optimal Shoulder Performance DVD is a phenomenal presentation of the variables surrounding shoulder health, function, and performance. It combines the most current research, real world application as well as the the instruction on how to implement its vast amount of material immediately. After just one viewing, I decided to employ some of the tactics and methods into our assessment and exercise protocols, and as a result, I feel that myself, my staff and my clients have benefited greatly.
Michael Ranfone BS, CSCS, LMT, ART
Owner, Ranfone Training Systems
The other day, I received an email from a Show and Go customer who noticed that the scapular wall slide and the doorway slide were two similar, but not identical shoulder mobility drills included in the program. He asked if I could talk a bit more about the differences between the two - and when to use both.
First, let's have a look at the two exercises. Here's the scapular wall slide:
And, here's the doorway slide:
As the voice-over on the video above notes, the scapular wall slide is an acceptable fit for just about any workout routine. The only exceptions would be those who have upper extremity pain with overhead motions (rotator cuff tears, etc.).
However, we can utilize the doorway slide in certain folks to get to where we want to be a bit faster. More specifically, these folks are the ones who are REALLY immobile in their upper extremity and wouldn't even be able to get their arms back even close to the wall on the wall slides. So, in addition to not making them feel bad about their "tight shoulders", the doorway slide actually allows us to use the doorway as a stretching implement to get a gentle stretch across the anterior shoulder girdle (predominantly pec major and minor). There are three very important coaching points:
1. Don't let the head poke forward, as a forward head posture is simply a substitution for not retracting/depressing the scapulae or horizontally adducting the humerus.
2. Don't crank too aggressively on the shoulders; it should be a subtle stretch. And, it shouldn't be used with those (particularly overhead throwing athletes) who already have increased external rotation and, in turn, more anterior laxity.
3. Make sure to focus on pulling the shoulder blades down and back as the elbows are lowered. You shouldn't have movement of the humerus without movement of the scapula.
