I'm really excited to announce that my new resource - a collaborative effort with the Fascia Training Academy - is now available. This two-hour course, Thoracic Outlet Syndrome: Diagnoses and Interventions, has been close to two years in the making.
In it, we take an unprecedented deep dive into understanding, identifying, and treating Thoracic Outlet Syndrome. Featuring detailed anatomical animations, guided cadaver dissections, practical exercises, and powerful case studies, it takes you "under the skin" to give rehabilitation specialists and fitness professionals essential knowledge surrounding this potentially debilitating condition. You can learn more HERE.
*Yes, you read that right: the product includes excerpts of a cadaver dissection (and accompanying voiceover) for the absolute best look at upper extremity functional anatomy that you can imagine. It's a remarkable perspective if you want to truly appreciate how structure dictates function. Gross Anatomy was the single-most beneficial course of my academic career, and I'm excited to share a glimpse into that world with you.
The benefits of controlled articular rotations (CARs) are now well known in the strength and conditioning and rehabilitation realms, thanks to Functional Range Conditioning teachings. One way in which we've evolved this approach is by taking a closer look at the position at which we perform our elbow CARs. Historically, they've been performed with the arms at the sides, like this:
However, I think there's a lot more benefit to be gained by performing them with the upper arms supported at 90 degrees of flexion, particularly in an overhead athlete population.
Here's why:
1. With more shoulder flexion, we are able to lengthen the long head of the triceps over both joints it crosses (elbow and shoulder). In the seated position, the long head of the triceps is actually shortened as a shoulder extensor.
2. In throwing athletes, you'll commonly observe Bennett's lesions, areas of increased calcification along the posterior glenoid rim. For most athletes, they're incidental findings in asymptomatic shoulders, but in some cases, they can get too big and cause rotator cuff pathology (I relate it to a speed bump that the cuff has to go over). While the true cause of Bennett's lesions has been debated in the sports medicine world, many are of the belief that it results from traction stress from the long head of the triceps (LHOT) tendon. The tendon attaches on the supraglenoid tubercle (which is on the inferior aspect of the glenoid) and extends up to the labrum and joint capsule. LHOT also eccentrically prevents excessive elbow flexion during the cocking phase of throwing (think of it being heavily lengthened in a shorter catcher-like arm action).
So, whether you believe it's related to Bennett's lesions or not, there's a strong anatomical basis for us to say that the long head of the triceps is an extremely important - but heavily underappreciated - muscle for overhead athletes. I've seen a lot of throwers over the years who've benefited tremendously from manual therapy on the triceps - and this mobility drill is a useful proactive initiative that'll help the cause as well.
3. At positions of 90 degrees of shoulder flexion or more, we get greater serratus anterior recruitment to drive the rotational component of scapular upward rotation - but also a reduction in latissimus dorsi tone that can restrict it. This is particularly important in athletic populations that tend to carry a lot of extensor tone and live in scapular depression and/or downward rotation. It also gives these folks a break from competing against gravity, so it can actually reduce protective tension of the upper traps.
4. Building on this last point, serratus anterior also works to preserve the convex-concave relationship between the scapula and rib cage, which is particularly important to address in the aforementioned athletes who may have acquired flat (extended) thoracic spines over years of extension/rotation. These athletes crave reaching, rounding, and rotating.
You can add this to a warm-up, use it as a filler, or plug it into a cooldown. Take your time with each rep, and be sure to drive not only full elbow flexion/extension, but also pronation/supination of the forearm.
If you're looking to learn a bit more about long head of the triceps, I'd encourage you to check out my Sturdy Shoulder Solutions course, as I delve into it quite a bit as part of my upper extremity functional anatomy module.
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With 2021 winding down, I'm using this last week of the year to direct you to some of the most popular content of the past 12 months at EricCressey.com, as this "series" has been quite popular over the past few years. Today, we start with the most popular articles of the year; these are the pieces that received the most traffic, according to my hosting statistics.
1. An Overlooked Function of Serratus Anterior- If you've followed my work for just about any length of time, you've probably quickly learned that I pay a lot of attention to serratus anterior for its profound impact on upper extremity function. And, this article was no exception.
3. 5 Lessons from a First-Round Draft Pick- In the 2021 Major League Baseball Draft, Cressey Sports Performance had 15 athletes selected – including three of the top 30 picks. Here are some important lessons you can learn from one of them.
5. Thinking Beyond Diagnostic Imaging - In the past, I've written about the need for both "Medical" and "Movement" diagnoses. In reality, there might be a middle ground that helps to unify the two - and I discuss it in this article.
I'll be back soon with another "Best of 2021" feature. Up next, the top videos of the year!
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About ten years ago, I was in the operating room to observe my first Tommy John surgery. Much like my time in gross anatomy class during my undergraduate studies, it was an invaluable experience that helped me to appreciate human structure (and, in turn, movement) in a way that anatomy textbooks couldn't offer.
Textbooks typically present a very "neat" anatomy where muscles, tendons, ligaments, bones, and nerves are predictably positioned. You can imagine my surprise, then, when the surgeon made the initial incision along the medial elbow and it yielded a bunch of "stuff" in the way. The fascia, the intermuscular septum, the ulnar nerve, and a host of other unrecognizable structures make you realize that a) every anatomy course or textbook you've ever undertaken hasn't done justice to what's really going on at the elbow (or anywhere else in the body, for that matter), b) it takes a lot of practice to become a great surgeon, and c) you shouldn't let just anyone cut you open for surgery.
Now, let's fast-forward to the post-operative timeline. After the repair is complete and the patient is stitched up, the elbow is splinted at 90 degrees of flexion for a week. Following that week, the arm is put in a hinged brace that gradually allows more motion over the course of weeks 2-6. After six weeks, the brace goes away. In short, it's quite a bit of time with the elbow in a limited range-of-motion situation as a means of protecting the repair.
Not surprisingly, some patients have a lot of trouble getting back their motion - both from the graft gradually stretching out and the musculotendinous structures regaining their length. We'd be crazy to think that the aforementioned fascia structures aren't implicated in the challenges of regaining ROM, though. And, if they've got a role in limiting ROM, they've certainly got a role in the associated stiffness (and, sometimes, pain) that post-operative patients feel. Here's where a variety of manual therapy interventions - ranging from dry needling to instrument-assisted work - have yielded outstanding results. While some folks like to scream and shout in opposition to this fact, it's hard to refute that manual therapy has endured the test of time to the tune of thousands of years.
Massage has been around for 4,300+ years, yet there are still people out there who deny the value of manual therapy? pic.twitter.com/uMUSPpPpJK
Only recently have there been technology advancements that allow us to better understand the role of the fascia system with respect to pain and performance (Bill Parisi spoke to this on our podcast a while back; listen here). In a seminar not too long ago, my friend Sue Falsone highlighted some great evidence on the "decompression" that takes place in this regard with a cupping intervention.
Now, let's take a step back and think about the big picture of diagnostic imaging. When we have chronic pain that alters movement patterns, we have adaptive changes of the fascial system. While the diagnostic imaging - MRI, CT scans, x-rays - might pick up on the structural defect, it might overlook the compensatory changes to the fascial system (much of which overlays the actual injury) that can't be appreciated by these types of scans.
When we look at chronic shoulder pain, is the problem only the rotator cuff tear? Or is that problem magnified by the fascia limitations that arise from years of avoiding various ranges of motion (including at adjacent joints) that would normally be accessible?
I've written extensively about having both a Medical and Movement Diagnosis. The truth is that the discussion of the fascia system is probably a happy medium between the two. We may think too much about the injury the diagnostic imaging identifies and too little about the overlying and surrounding tissues. At the other end of the spectrum, we may be too quick to define a movement limitation as joint, musculotendinous, ligamentous, or motor control without first considering the role the fascial system is playing.
What's the most important lesson here? Professionals from all walks of sports medicine need to work together to thoroughly evaluate injuries and movement competencies in order to design the best performance and rehabilitation programs. And, we need to remain openminded to new technology that may make it easier for us to take an even more accurate and individualized approach to each case.
In this vein, I'd highly recommend checking out my new Thoracic Outlet Syndrome course, as this challenging diagnosis is a great example of how a condition often can slip past common diagnostic imaging.
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We're excited to welcome Colorado Rockies relief pitcher Tyler Kinley to the latest podcast. A self-described "Red Shirt All-American," Tyler overcame a number of injuries in his early career to eventually become a 100mph arm with one of the best sliders in baseball. In this conversation, he shares a collection of lessons he's learned along the way.
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!
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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 towww.MarcPro.comand enter the coupon code CRESSEY at checkout to receive an exclusive discount on your order.
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!
For the latest podcast, we're excited to welcome Dr. Christopher Camp, team doctor for the Minnesota Twins and orthopedic surgeon at the Mayo Clinic. Dr. Camp goes into great detail on the classification, management, trends, and prevention of baseball injuries. Additionally, he speaks to the complexities of various surgeries we see in overhead throwing athletes, and discusses where further innovation is needed to better manage these players.
A special thanks to this show's sponsor, Marc Pro. Head towww.MarcPro.comand enter the coupon code CRESSEY at checkout to receive an exclusive discount on your order.
You can follow Dr. Camp on Twitter at @ChrisCampMD.
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!
We're excited to welcome renowned physical therapist, coach, author, and presenter, Dr. Kelly Starrett, to the latest podcast as we kick off a series of podcasts with a sports medicine focus. Kelly shares some awesome insights related to universal performance principles, recovery strategies, "upstream" initiatives, and long-term athletic development.
A special thanks to this show's sponsor, Marc Pro. Head towww.MarcPro.comand enter the coupon code CRESSEY at checkout to receive an exclusive discount on your order.
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!
We're excited to welcome Dr. Chris Ahmad, team doctor for the New York Yankees, to this week's podcast. Dr. Ahmad goes into great detail on the throwing elbow with respect to anatomy, diagnostic challenges, surgical complexities, non-operative strategies, and biological interventions. He also touches on important lessons for players, parents, and coaches who want to avoid youth baseball injuries.
What makes the anatomy and function of the elbow so complex, specifically in throwing athletes
What the biggest mistakes are both surgically and diagnostically with respect to the elbow
Why injuries of the elbow aren’t as binary as partial and full tears and how professionals can better evaluate and understand the health of elbows in throwing populations
How UCL calcification and injury at a young age impacts the health of baseball players as they grow and advance in their career
What makes a Tommy John surgery successful from a surgical perspective
How Tommy John surgery has evolved since it was first performed in 1974
What the clinical implications are for Dr. Ahmad to perform an ulnar nerve transposition during UCL reconstruction surgery
What variables surgeons must consider when deciding where to take a tendon graft from for UCL reconstruction
How Dr. Ahmad manipulates grafts to ensure an elbow is strong and sturdy for his patients post-surgery
What key things Ahmad discusses with his patients as they begin their road to recovery post-surgery
What key benchmarks Dr. Ahmad looks for patients to progress to through the Tommy John rehab process
Why there isn’t a true standard timeline for athletes to return to performing in games after UCL reconstruction
Why Dr. Ahmad is an advocate for biological interventions such as PRP injections and the use of stem cells to manage elbow injuries, and what benefits these methodologies offer beyond throwing injuries
Where the future of biological treatments is headed, and what the drawbacks and dangers of using these powerful methods can be
Where Dr. Ahmad sees the need for more research to be done in the prevention, reconstruction, rehabilitation, and recovery of arm injuries
Why Dr. Ahmad has worked to create a registry with Major League Baseball to collect data on injured professional ball players and how this resource will be used to find answers to questions in the field without setting up a formal study
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!
We're excited to welcome Gary Reinl, Director of National Accounts and Professional Athletic Teams for Marc Pro, to this week's podcast. Gary delves into one of the most controversial topics in sports medicine history: icing.
How Gary become involved in the realm of sports medicine in 1973
How Gary became passionate about the science and practice of recovery
Where the belief in icing for recovery began, and how did it became so accepted in the sports medicine community
Where the RICE protocol (Rest, Ice, Compress, Elevate) originated
What the research says about the use of ice for recovery and the traditional RICE method
How Gary formulated his simple and organized system for healing damaged tissue away from the common belief in ice and the RICE protocol
Why tissue preservation, tissue regeneration, and angiogenesis are the primary goals when promoting recovery of damaged tissue
Why evacuating waste and clearing congestion is important for creating healthy tissue
What physiological mechanisms electrical stimulation takes advantage of to push waste out of damaged areas via the lymphatic system
How low intensity muscular contractions decongest damaged tissues, avoid the unnecessary killing of healthy tissue, restore circulation, and promote tissue regeneration
What benefits e-stim has beyond the recovery of damaged tissue
Why sports medicine professionals and the general population often confuse inflammation with degeneration
How can individuals maximize the effectiveness of Marc Pro and other e-stim units through pad placement and overall set-up during treatment
Where would Gary like to see the Marc Pro used more in the sports medicine world
You can follow Gary on Twitter at @TheAntiIceMan and email him at gary@marcpro.com. Be sure to check out his book, Iced!, and take advantage of the great offer on Marc Pro for podcast listeners by heading to www.MarcPro.com and entering the coupon code CRESSEY at checkout to receive 10% off on your 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!
