Home Posts tagged "Shoulder Surgery"

CSP Elite Baseball Development Podcast: Tommy Doyle on Tall Athletes, Shoulder Surgery, and Bullpen Success

We welcome Colorado Rockies pitcher Tommy Doyle to the latest podcast. We cover a number of different topics related to his development, including his college recruiting process; strategies for training as a taller pitcher; bullpen success, and rehabilitation from shoulder surgery.

A special thanks to this show's sponsor, AG1. Head to https://www.DrinkAG1.com/cressey and you'll receive a free 10-pack of Athletic Greens travel packets with your first order.

Sponsor Reminder

This episode is brought to you by AG1. AG1 is your daily foundational nutrition; it has 75 whole-food sourced ingredients designed to support your body’s foundational nutrition needs across five critical areas of health: 1) energy, 2) immunity, 3) gut health, 4) hormonal support, and 5) healthy aging. It is the new and future way of getting a multivitamin, and a whole lot more. Head to www.DrinkAG1.com/cressey and claim my special offer today – 10 FREE travel packs – with your first purchase. I use AG1 daily myself and highly recommend it to our athletes as well. I’d encourage you to give it a shot, too – especially with this great offer.

Podcast Feedback

If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.

And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.

Thank you for your continued support!

Sign-up Today for our FREE Baseball Newsletter and Receive Instant Access to a 47-minute Presentation from Eric Cressey on Individualizing the Management of Overhead Athletes!

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CSP Elite Baseball Development Podcast – March 2023 Q&A: Tommy John Training, “Clean” MRIs, and Shoulder Surgery Struggles

It's time for another listener Q&A, so I cover three questions from our audience in this week's podcast on the following topics:

  1. Do you have any tentative guidelines for working with post-op Tommy John patients who are trying to maintain a training effect during their rehab?
  2. What do you think when you hear that a MRI is “clean?”
  3. Why do shoulder surgeries in throwers have such a lower success rate than elbow surgeries?

A special thanks to this show’s sponsor, AG1 (formerly Athletic Greens). Head to http://www.athleticgreens.com/cressey and you’ll receive a free 10-pack of travel packets with your first order.

 

Sponsor Reminder

This episode is brought to you by Athletic Greens. It’s an all-in-one superfood supplement with 75 whole-food sourced ingredients designed to support your body’s nutrition needs across 5 critical areas of health: 1) energy, 2) immunity, 3) gut health, 4) hormonal support, and 5) healthy aging. Head to www.AthleticGreens.com/cressey and claim my special offer today - 20 FREE travel packs (valued at $79) - with your first purchase. I use this product daily myself and highly recommend it to our athletes as well. I'd encourage you to give it a shot, too - especially with this great offer.

Podcast Feedback

If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.

And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.

Thank you for your continued support!

Sign-up Today for our FREE Baseball Newsletter and Receive Instant Access to a 47-minute Presentation from Eric Cressey on Individualizing the Management of Overhead Athletes!

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CSP Elite Baseball Development Podcast: AJ Ramos

We're excited to welcome Colorado Rockies relief pitcher AJ Ramos to the latest podcast. As an athlete who has come back from both a Tommy John and a shoulder surgery, AJ has many insights to share on the rehab process to contribute to our sports medicine series.

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

You can follow AJ on Twitter at @TheAJRamos and Instagram at @TheAJRamos.

Sponsor Reminder

This episode is brought to you by Marc Pro, a cutting-edge EMS device that uses patented technology to create non-fatiguing muscle activation. Muscle activation with Marc Pro facilitates each stage of the body’s natural recovery process- similar to active recovery, but without the extra effort and muscle fatigue. Athletes can use it for as long as they need to ensure a more full and quick recovery in between training or games. With its portability and ease of use, players can use Marc Pro while traveling between games or while relaxing at home. Players and trainers from every MLB team - including over 200 pro pitchers - use Marc Pro. Put Marc Pro to the test for yourself and use promo code CRESSEY at checkout at www.MarcPro.com for an exclusive discount on your order.

Podcast Feedback

If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.

And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.

Thank you for your continued support!

Sign-up Today for our FREE Baseball Newsletter and Receive Instant Access to a 47-minute Presentation from Eric Cressey on Individualizing the Management of Overhead Athletes!

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CSP Elite Baseball Development Podcast: Tom Koehler

We're excited to welcome recently retired MLB pitcher Tom Koehler to this week's podcast. Tom shares some great stories from his playing career, reflecting on how he developed - and how up-and-coming players and their parents and coaches can learn from his path.

A special thanks to this show's sponsor, Athletic Greens. Head to http://www.athleticgreens.com/cressey and you'll receive a free 10-pack of Athletic Greens travel packets with your first order.

Show Outline

  • How growing up playing football and being raised in a blue collar family gave Tom an edge early in the game of baseball
  • How Tom became an 18th round draft pick out of Stony Brook
  • How Tom worked to make such a strong initial impression in pro ball and what adjustments he had to make to ascend through the ranks of minor league baseball
  • Why the biggest initial adjustment for Tom in professional baseball was throwing on a 5-day rotation and how finding a routine transformed the direction of his career
  • How entering affiliated baseball and throwing to wood bats impacted Tom’s outcomes
  • Why Tom reworked his off speed as he developed through pro ball and how he transformed two blending breaking balls into a hard slider and sharp curveball
  • How Tom eventually learned to throw a true slider
  • What grip and mental cues Tom used to continue to remain consistently nasty with these two different breaking pitches
  • How each of Tom’s pitches fit into his game plan on the mound and what specific counts and scenarios he looks to use each pitch
  • What level Tom found to be the toughest promotion in the minors and how the game changes as players progress to show ball
  • How Tom consistently made his starts every 5 days for nearly 8 years (2008-2017) and how finding a routine and having a bulldog mentality gave him 30+ starts in 3 of those 8 years (2014-2016)
  • Why Tom’s greatest attribute was his consistency and durability
  • Why the IL was more detrimental to Tom than other professional players and how Tom fought to never miss a start even on days he wasn’t 100%
  • How a shoulder capsule issue developed into a career ending injury and how Tom believes currently technology could have impact the derailing of his career
  • What TK’s Pitching Policy is and how your sweet spot on the mound is the balance between what your nastiest stuff is and what you can execute consistently
  • What value Tom finds in the new analytical side of baseball and how these numbers should be used to support your strengths as opposed to causing confusion in your ability
  • What Tom loves and hates about the direction the game of baseball is heading
  • How coaches can also learn to be more adaptable in their tactics and interventions and learn to recognize each player’s unique needs
  • You can follow Tom on Twitter at @TKRefresh22 and Instagram at @TKRefresh22.

Sponsor Reminder

This episode is brought to you by Athletic Greens. It’s an all-in-one superfood supplement with 75 whole-food sourced ingredients designed to support your body’s nutrition needs across 5 critical areas of health: 1) energy, 2) immunity, 3) gut health, 4) hormonal support, and 5) healthy aging. Head to www.AthleticGreens.com/cressey and claim my special offer today - 20 FREE travel packs (valued at $79) - with your first purchase. I use this product daily myself and highly recommend it to our athletes as well. I'd encourage you to give it a shot, too - especially with this great offer.

Podcast Feedback

If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.

And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.

Thank you for your continued support!

Sign-up Today for our FREE Baseball Newsletter and Receive Instant Access to a 47-minute Presentation from Eric Cressey on Individualizing the Management of Overhead Athletes!

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6 Saturday Shoulder Strategies

I thought I'd use today's post to throw out some thoughts on training the shoulders.

1. In the upper extremity, the assessments are often the solutions, too.

Imagine you're assessing an athlete, and their squat pattern is absolutely brutal. Usually, the last thing you're going to do is go right to a squat as part of their training. In other words, simply coaching it differently usually won't improve the pattern immediately. Rather, you typically need "rebuild" the pattern by working with everything from ankle and hip mobility to core control, ultimately progressing to movements that replicate the squatting pattern.

Interestingly, the upper extremity is usually the opposite in that the assessment might also be the drill you use to correct the movement. For instance, an aberrant shoulder flexion pattern like this...

...might be quickly corrected with some of these three cues on a back to wall shoulder flexion pattern.

This is also true of push-up assessments and shoulder abduction and external rotation tests we do; funky patterns are usually cleaned up quickly with some subtle cueing. This just isn't the case as much in the lower body, though. Why the difference?

My theory is that because we're weight-bearing all day, the lower extremity is potentially less responsive to the addition of good stiffness in the right places. Conversely, a little bit of stiffness in serratus anterior, lower trap, or posterior cuff seems to go a long way in quickly improving upper extremity movement. My experience with the Postural Restoration Institute also leads me to believe that creating a good zone of apposition can have lead to a more pronounced transient movement in the upper extremity than it does in the lower extremity. This is likely because the rib cage is directly involved with the shoulder girdle, whereas the relationship with the lower extremity (ribs --> spine --> pelvis) is less direct. 

Zone-of-Apposition-300x220

These differences also seem to at least partially explain why upper extremity posture is much easier to change than lower extremity positioning. It's far more common to see a scapular anterior tilt change markedly than it is to see an anterior pelvic tilt substantially reduced.

Just thinking out loud here, though. Fun stuff.

2. Anterior shoulder pain usually isn't "biceps tendinitis."

First off, true tendinitis is actually quite rare. In this landmark paper, Maffulli et al. went to great lengths to demonstrate that the overwhelming majority of the overuse tendon conditions we see are actually tendinOSIS (degenerative) and not tendinITIS (inflammatory). It may seem like wordplay, but it's actually a very important differentiation to make: if you're dealing with a biceps issue, it's probably tendinosis.

shoulder

Second, if you speak with any forward thinking orthopedic shoulder specialist or rehabilitation expert, they'll tell you that there are a lot of differential diagnoses for anterior (front) shoulder pain. It could be referred pain from further up (cervical disc issues, tissue density at scalenes/sternocleidomastoid/subclavius/pec minor, or thoracic outlet syndome), rotator cuff injury or tendinopathy, anterior capsule injury, a lat strain or tendinopathy, labral pathology, nerve irritation at the shoulder itself, arthritis, a Bankart lesion, osteolysis of the distal clavicle, AC joint injury, and a host of other factors.

3. Thoracic outlet surgery really isn't a shoulder surgery.

Over the past few years, each time a professional pitcher gets thoracic outlet surgery, you see many news outlets call it "shoulder surgery." Sorry, but that really isn't the case unless you have a very expansive definition of the word "shoulder."

With this intervention, the surgeon is removing the first (top) rib to provide "clearance" for the nerves and vascular structures to pass underneath the clavicle.

Gray112thoracicoutlet

Additionally, surgeons usually opt to perform a scalenectomy, where they surgically remove a portion of the anterior scalenes, which may have hypertrophied (grown) due to chronic overuse. Again, this is not a "shoulder" procedure.

Finally, more and more surgeons are also incorporating a pec minor release as part of the surgical intervention. This is because the nerve and vascular structures that may be impinged at the scalenes or first rib can also be impinged at the coracoid process of the scapular if an individual is too anterior-tilted. While the coracobrachialis and short head of the biceps both attach here, the pec minor is likely the biggest player in creating these potential problems.

pecminor

This, for me, is the only time this becomes somewhat of a "shoulder" surgery - and it's an indirect relationship that doesn't truly involve the joint. We're still nowhere near the glenohumeral (ball-and-socket) joint that most people consider the true shoulder.

All that said, many people consider the "shoulder girdle" a collection of joints that includes the sternoclavicular, acromioclavicular, glenohumeral, and scapulothoracic articulations. In this case, though, the media just doesn't have a clue what they're trying to describe. With that in mind, hopefully this turned into somewhat of an educational rant.

4. Medicine ball scoop tosses tend to be a better than shotputs for cranky shoulders.

Rotational medicine ball training is a big part of our baseball workouts, and it's something we try to include as an integral part of retraining throwing patterns even while guys may be rehabilitating shoulder issues. When you compare rotational shotputs with rotational scoop tosses...

...you can see that the scoop toss requires far less shoulder internal rotation and horizontal adduction, and distraction forces on the joint are far lower at ball release. The shotput is much more stressful to the joint, so it's better saved for much later on in the rehab process.

5. Adequate rotator cuff control is about sufficient strength and proper timing - in the right positions.

To have a healthy shoulder, your cuff needs to be strong and "aware" enough to do its job in the position that matters. If you think about the most shoulder problem, there is pain at some extreme: the overhead position of a press, the lay-back phase of throwing, or the bar-on-your back position in squatting. For some reason, though, the overwhelming majority of cuff strength tests take place with the arms at the sides or right at 90 degrees of elevation. Sure, these positions might give us a glimpse at strength without provoking symptoms, but they really don't speak much to functional capacity in the positions that matter. 

With that in mind, I love the idea of testing rotator cuff strength and timing in the positions that matter. Here's an example:

Eric-Cressey-Shoulder_OS___0-300x156

Obviously, you can make it even more functional by going into a half-kneeling, split-stance, or standing position. The point is that there are a lot of athletes who can test pretty well in positions that don't matter, but horribly in the postures that do.

6. Pre-operative physical therapy for the shoulder is likely really underutilized.

It's not uncommon to hear about someone with an ACL tear going through a month or so of physical therapy before the surgery actually takes place. Basically, they get a head start on range-of-motion and motor control work while swelling goes down (and, in some cases, some healing of an associated MCL injury may need to occur).

I'm surprised this approach isn't utilized as much with shoulder surgeries. It wouldn't be applicable to every situation, of course, but I think that in some cases, it can be useful to have a pre-operative baseline of range-of-motion. This is particularly true in cases of chronic throwing shoulder injuries where regaining the right amount of external rotation is crucial for return to high level function. Adding in some work on cuff strength/timing, scapular control, and thoracic mobility before hopping in a sling for 4-6 weeks probably wouldn't hurt the case, either. And, as an added bonus, if this was more common, I think we'd find quite a few people who just so happen to become asymptomatic, allowing them to cancel their surgeries. It's probably wishful thinking on my part, but that's what these random thoughts articles are all about.

For more information on approaches to evaluating, coaching, and programming for the shoulder, be sure to check out Sturdy Shoulder Solutions.

Have a great weekend!

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Lose Fat, Gain Muscle, Get Strong: Eric Cressey’s Best Articles of 2010

Show and Go: High Performance Training to Look, Feel, and Move Better - This was obviously my biggest project of 2010.  I actually began writing the strength and conditioning programs and filming the exercise demonstration videos in 2009, and put all the "guinea pigs" through the four-month program beginning in February.  When they completed it as the start of the summer rolled around, I made some modifications based on their feedback and then got cracking on writing up all the tag along resources.  Finally, in September, Show and Go was ready to roll.  So, in effect, it took 10-11 months to take this product from start to finish - a lot of hard work, to say the least.  My reward has been well worth it, though, as the feedback has been awesome.  Thanks so much to everyone who has picked up a copy.

Optimal Shoulder Performance - This was a seminar that Mike Reinold and I filmed in November of 2009, and our goal was to create a resource that brought together concepts from both the shoulder rehabilitation and shoulder performance training fields to effectively bridge the gap for those looking to prevent and/or treat shoulder pain.  In the process, I learned a lot from Mike, and I think that together, we brought rehabilitation specialists and fitness professionals closer to being on the same page.

Why President Obama Throws Like a Girl - A lot of people took this as a political commentary, but to be honest, it was really just me talking about the concept of retroversion as it applies to a throwing shoulder - with a little humor thrown in, of course!

Overbearing Dads and Kids Who Throw Cheddar - This one was remarkably easy to write because I've received a lot of emails from overbearing Dads asking about increasing throwing velocity in their kids.

What I Learned in 2009 - I wrote this article for T-Nation back at the beginning of the year, and always enjoy these yearly pieces.  In fact, I'm working on my 2010 one for them now!

What a Stressed Out Bride Can Teach You About Training Success - I wrote this less than a month out from my wedding, so you could say that I had a good frame of reference.

Baseball Showcases: A Great Way to Waste Money and Get Injured - In case the title didn't tip you off, I'm not much of a fan of baseball showcases.

Cueing: Just One Piece of Semi-Private Training Success - Part 1 and Part 2 - These articles were featured at fitbusinessinsider.com.  I enjoy writing about not only the training side of things, but some of the things we've done well to build up our business.

Three Years of Cressey Performance: The Right Reasons and the Right Way - This might have been the top post of the year, in my eyes. My job is very cool.

How to Attack Continuing Education in the Fitness Industry - Here's another fitness business post.

Want to Be a Personal Trainer or Strength Coach?  Start Here. - And another!

The Skinny on Strasburg's Injury - I hate to make blog content out of someone else's misfortune, but it was a good opportunity to make some points that I think are very valid to the discussion of not only Stephen Strasburg's elbow injury, but a lot of the pitching injuries we see in youth baseball.

Surely, there are many more to list, but I don't want this to run too long!  Have a safe and happy new year, and keep an eye out for the first content of 2011, which is coming very soon!

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Weight Training For Baseball: Best Videos of 2010

I made an effort to get more videos up on the site this year, as I know a lot of folks are visual learners and/or just enjoy being able to listen to a blog, as opposed to reading it.  Here are some highlights from the past year: The Absolute Speed to Absolute Strength Continuum - Regardless of your sport, there are valuable take-home messages.  I just used throwing velocity in baseball pitchers as an example, as it's my frame of reference.

Should Pitchers Overhead Press? - This was an excerpt from Mike Reinold and my Optimal Shoulder Performance seminar (which became a popular DVD set for the year).

Shoulder Impingement vs. Rotator Cuff Tears - Speaking of Mike, here's a bit from the man himself from that seminar DVD set.

Thoracic and Glenohumeral Joint Mobility Drills - The folks at Men's Health tracked me down in the lobby at Perform Better in Providence and asked if I could take them through a few shoulder mobility drills we commonly use - and this was the result.

Cressey West - This kicks off the funny videos from the past year. A few pro baseball players that I program for in a distance-based format created this spoof video as a way of saying thank you.

Tank Nap - My puppy taking a nap in a provocative position.  What's more cute?

Matt Blake Draft Tracker - CP's resident court jester and pitching instructor airs his frustrations on draft day.

1RM Cable Horizontal Abduction - More from the man, the myth, the legend.

You can find a lot more videos on my YouTube page HERE and the Cressey Performance YouTube page HERE.

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Weight Training for Baseball: Featured Articles

I really enjoy writing multi-part features here at EricCressey.com because it really affords me more time to dig deep into a topic of interest to both my readers and me.  In many ways, it's like writing a book.  Here were three noteworthy features I published in 2010: Understanding Elbow Pain - Whether you were a baseball pitcher trying to prevent a Tommy John surgery or recreational weightlifter with "tennis elbow," this series had something for you. Part 1: Functional Anatomy Part 2: Pathology Part 3: Throwing Injuries Part 4: Protecting Pitchers Part 5: The Truth About Tennis Elbow Part 6: Elbow Pain in Lifters

Strategies for Correcting Bad Posture - This series was published more recently, and was extremely well received.  It's a combination of both quick programming tips and long-term modifications you can use to eliminate poor posture. Strategies for Correcting Bad Posture: Part 1 Strategies for Correcting Bad Posture: Part 2 Strategies for Correcting Bad Posture: Part 3 Strategies for Correcting Bad Posture: Part 4

A New Paradigm for Performance Testing - This two-part feature was actually an interview with Bioletic founder, Dr. Rick Cohen.  In it, we discuss the importance of testing athletes for deficiencies and strategically correcting them.  We've begun to use Bioletics more and more with our athletes, and I highly recommend their thorough and forward thinking services. A New Paradigm for Performance Testing: Part 1 A New Paradigm for Performance Testing: Part 2 I already have a few series planned for 2011, so keep an eye out for them!  In the meantime, we have two more "Best of 2010" features in store before Friday at midnight. Sign-up Today for our FREE Newsletter:
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Cressey Performance Athletes Excel, Reporters Write About It, Villagers Rejoice

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!

The AJC followed it up with a feature on Tim where my business partner, Pete Dupuis, was interviewed: Pitcher in Escobar Trade is 5-7 Fireballer.

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.

Landers Rehabbing Repaired Shoulder

landers

(yes, Keith is really almost as tall as I am, even though he's kneeling)

And, last, but certainly not least, the Daily New Tribue published this feature on CP athlete Travis Dean, who was drafted in the 14th round by the New York Yankees this year: Newton's Travis Dean Weighs Options as Yankees' Pitching Draftee.

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.

Click here for more information on Cressey Performance's Elite Baseball Development Program.

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Great Feedback on Optimal Shoulder Performance

We just received this great feedback on Optimal Shoulder Performance: "I just recently finished the Optimal Shoulder Performance DVD's.  Without a doubt, that was the best $100 I've spent on a home based CEU opportunity. The material was very well presented, the talks cut to the chase, and provided tons of practical ideas that I have already put into practice with my baseball and softball players. "In addition to the downloadable PowerPoint slides PDF, I took tons of notes because both of you offered up such great information. "I would highly recommend this to anyone who wants a quality shoulder DVD to add to their professional library. "Thanks, guys, for a very high quality practical product!" -Kevin Collins, MS, ATC

Click here to pick up your own copy of Optimal Shoulder Performance!

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