Home Posts tagged "Thoracic Outlet Syndrome"

Does Posture Actually Matter?

You often find people who claim that static posture doesn't matter. In many cases, their argument is based on research that doesn't demonstrate a definitive relationship between posture and pain. While I've got an extensive rebuttal to this opposing viewpoint, the easiest way to answer is to say that posture alone doesn't perfectly relate to pain or performance. Rather, it's the interaction of posture with both positions and load that matters.

Take this downsloped clavicle, as an example. Someone with this posture might live a completely normal life as a track and field runner, or someone who sits in the desk all day. However, throw this posture (scapular/clavicular depression) into the overhead athlete community, and the positions and loads encountered change dramatically.

If you're familiar with the Postural Restoration Institute school of thought, it shouldn't surprise you that this presentation was part of a larger left AIC/right BC pattern in a right handed pitcher, but let's just focus on this specific location for the sake of making a point with this article.

You can't tell me that the neurovascular bundle isn't compromised between the clavicle and first rib in this scenario. Or, it could happen more distally, under the attachments on the coracoid process of the scapula.

 

There's a reason we see thoracic outlet syndrome far more in baseball players than other athletic populations.
[bctt tweet="Posture loads the gun, but positions and loads specific to an athlete's sport pull the trigger."] 

This is one reason why I went to great lengths to dig in on posture in my "How Posture Impacts Pain and Performance" webinar as part of my Sturdy Shoulder Solutions resource. If you want to understand movement and its role in dysfunction and pain, you'd be crazy to overlook where people start.

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CSP Elite Baseball Development Podcast: Trevor Rosenthal

We welcome free agent MLB pitcher Trevor Rosenthal to the latest podcast. We talk about transitioning from shortstop to pitching, and then from starting to relieving. He discusses why some pitchers thrive with being challenged at young ages while others struggle, and highlights some key components of his pre-game preparation. We also touch on lessons learned from Tommy John and Thoracic Outlet Syndrome surgeries, as well as key competencies of the best coaches he's had.

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.

 

You can follow Trevor on Twitter at @TrevRosenthal.

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.

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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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CSP Elite Baseball Development Podcast – January 2023 Q&A: Assessment Principles, Thoracic Outlet Syndrome, Warm-ups, and 91mph 13-year-olds

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

  1. "Big Rock" Assessment Principles
  2. Why Thoracic Outlet Syndrome is a Diagnosis of Exclusion
  3. The Key Components of a Good Warm-up
  4. Injury Concerns in Young Pitchers with Elite Velocity

A special thanks to this show's sponsor, Proteus Motion. They're changing the way we assess and train athletes with their 3D Resistance. Head to www.ProteusMotion.com/elite to learn more about this cutting-edge technology. 

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Proteus Motion has a patented technology that allows us to measure power for the overwhelming majority of human movements. Proteus software guides users through 4-minute physical assessments to arm trainers with unprecedented performance data and insights, creating an entirely new standard for personalized fitness and physical rehabilitation. All of this is enabled by a total reinvention of resistance training called 3D Resistance. Training power and acceleration with Proteus’ patented 3D Resistance can be safer, more efficient, and more effective than traditional resistance training tools in many cases. I’ve been a big fan of Proteus for the past few years. We have a unit in both Cressey Sports Performance facilities, and actually helped to develop the Cressey Power test for rotational athletes. The information we’ve gathered from this testing has been an absolute game-changer in helping us to more optimally program for our athletes. Additionally, as a training initiative, work on the Proteus has allowed us to train different points on the force-velocity curve in rotational patterns in ways that medicine ball work never could.

You can learn more about them by listening to Episode 106 of the Elite Baseball Development Podcast, or by heading to www.ProteusMotion.com/elite.

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: Drew VerHagen

We welcome St. Louis Cardinals pitcher Drew VerHagen to this week’s podcast. Drew speaks to overcoming injuries, developing as a pitcher in Japan, and how he attacks both offseason and inseason training and throwing. This episode is timely, as my new Thoracic Outlet Syndrome course debuted earlier this week, and Drew details his experienced with both the diagnosis, surgical intervention, and rehabilitation for his TOS.

A special thanks to this show's sponsor, Ancore Training. This cutting-edge training innovation serves as an amazing replacement for cable columns and functional trainers, allowing you to train important movement patterns at a lower price point, with invaluable portability, and while taking up less space. We have multiple units at both our facilities and love them. Head to www.AncoreTraining.com and enter coupon code CRESSEY at checkout to save 10% on your order.

 

You can follow Drew on Twitter at @DrewVerHagen and on Instagram at @DrewVerHagen.

Sponsor Reminder

This episode is brought to you by Ancore Training. Ancore is an attachment that rigs up easily to power rack, support beam, or wall mount. Once it’s set up, you can do chops, lifts, rotational patterns, presses, rows, and a variety of arm care exercises. Basically, if you can do it on a functional trainer or conventional cable set-up, you can do it on Ancore – but at a dramatically lower price and with much less space taken up. For these reasons, it’s a perfect addition to baseball facilities and home gym that might have limited space and budget. And, we have multiple units at both Cressey Sports Performance facilities.

Perhaps most importantly, Ancore travels extremely light; you can throw it in a backpack or suitcase and not even know it’s there. I know of coaches and players that are taking these units on the road to overcome underequipped weight rooms and hotel gyms.

When all is said and done, it saves space, money, and headaches while also offering the benefits of portability.

To learn more, head to www.AncoreTraining.com and enter coupon code CRESSEY at checkout to save 10% on your purchase.

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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New Product: Thoracic Outlet Syndrome: Diagnoses and Interventions

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.

 

 

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Thinking Beyond Diagnostic Imaging

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.

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 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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CSP Elite Baseball Development Podcast: Daniel Bard

We're excited to welcome Colorado Rockies relief pitcher Daniel Bard to the podcast. In this episode, Daniel reflects on some of the potential causes of his command challenges, and the lessons he learned as came out of retirement to become the 2020 National League Comeback Player of the Year. There are outstanding lessons for players, coaches, and parents alike in this episode, as Daniel shares a truly unique perspective on the mental side of the game.

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.

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 - 10 FREE travel packs - 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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Understanding and Managing Ulnar Nerve Hypermobility

After an Instagram post of mine last week generated quite a few inquiries on how to manage ulnar nerve hypermobility, I thought I'd record a follow-up video to dig in a bit deeper on the topic.

If you're looking to learn a bit more about the structure and function of the elbow (particularly throwing elbows), my presentation, Everything Elbow, would also be worth checking out.

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Random Thoughts on Sports Performance Training – Installment 24

With only a few days to spare, here is the November 2016 edition of randomness!

1. Don’t let bad movement become cemented joints.

As I presented in Functional Stability Training of the Upper Body, mobility can be restricted for a lot of reasons.

One thing I didn't note in this video is that if you have muscular, capsular, or alignment issues that persist for an extended period of time, you'll eventually develop changes to the joint (bony overgrowth). In a 2013 study, world-renowned hip specialist Marc Phillipon examined how the incidence of femoroacetabular impingment (FAI) - bony overgrowth at the hip - changed across various stages of youth hockey. At the PeeWee (10-12 years old) level, 37% had FAI and 48% had labral tears. These numbers went to 63% and 63% at the Bantam level (ages 13-15), and 93% and 93% at the Midget (ages 16-19) levels, respectively. The longer one played hockey, the messier the hip – and the greater the likelihood that the FAI would “chew up” the labrum.

fai
Source: Lavigne et al. 2004

It's imperative for strength and conditioning coaches to understand these issues. On evaluation, if an athlete already has changes to the joint, we need to create training programs to deliver a training effect while working around these issues. If you squat an entire team of football players even though you know 4-5 of them already have significant FAI and associated pathologies in their hips, you're probably going to be funding some hip surgeon's retirement. Work on deadlifting and single-leg work instead, though, and you'll probably kick the can down the road for those athletes.

Conversely, if your assessment reveals that an athlete is out of alignment and has some tissue density and core control issues that are preventing quality hip flexion and internal rotation, you need to design a program to get to work on those problems before they can develop bony blocks at the hip. As my buddy Mike Reinold often says, "Assess, don't guess." 

2. We might be seeing the end of the versatile strength and conditioning coach.

One thing I've noticed in the strength and conditioning field over the past decade is an increased tendency toward specialization among coaches. Over the years, there have some been really bright coaches - Al Vermeil, Mike Boyle, and Bob Alejo come to mind - who've had success across multiple sports at the highest levels. They were few and far between, but it was still something that was feasible if someone was educated and motivated enough. I think that's changing and this versatility will be obsolete very soon.

We're seeing a much bigger focus on analytics in all professional sports; the focus on minute details has never been greater. In college sports, we are seeing more "baseball only" and "hockey only" guys to build on the years of the football strength and conditioning coach typically not working with other teams. At every level, specialization among strength coaches (and rehabilitation specialists, for that matter) is increasing. As a result, if a coach tries to venture out into another sport at a high level, it takes longer to get up to speed. 

If a guy leaves basketball to go to baseball, he's got to learn about thoracic outlet syndrome, ulnar collateral ligament injuries, and lat strains; these just don't happen very often in hoops. He won't have to worry much about humeral retroversion in his programming for shooting guards, either - but it has a huge influence on how he manages functional mobility in pitchers.

 

Today is Day 12 of #30DaysOfArmCare. Thanks to #Tigers pitcher @adamrav12 for the assist! Key takeaways: 1. Retroversion is a common finding and throwing shoulders. It gives rise to greater lay-back at max external rotation. 2. The more passive range of motion you have, the more consistently you must work to maintain active stability of that ROM. ROM without stability is injury risk. 3. Perform your cuff work in the positions that matter - and keep in mind that individual differences in passive ROM may be present. 4. Don't stretch throwers into external rotation, especially if they already have this much lay-back! Follow #30DaysOfArmCare and @cresseysportsperformance for more tips to keep throwing arms healthy. #cspfamily #armcare #baseball #mlb

A video posted by Eric Cressey (@ericcressey) on

Likewise, just because I have a solid handle on managing shoulders in overhead athletes doesn't mean that I'm equipped to handle the metabolic demands that swimmers encounter.

Versatility is still important; a well-rounded professional will never go hungry. However, at the higher levels, I just see fewer and fewer professional teams and colleges valuing it highly when the quickest option is to seek out specialists in specific realms.

3. Create context not only to improve coaching, but also to improve adherence.

Recently, I saw a professional pitcher who noted that his team had commented on how limited his extension on each pitch was. For those who aren't familiar, in recent years, teams have started tracking the actual release point of various pitchers. Basically, if two pitchers both throw 95mph, but one releases the ball closer to the plate, the one with more extension is actually releasing the ball closer to the plate, so it "gets on" the hitter faster. All things considered, a higher extension is generally better. You can view it as part of the Statcast panel on each MLB pitchers' page; here's CSP athlete Steve Cishek's, as a frame of reference. Steve's extension is well above MLB average, so the perceived velocity of his pitches are over one mph higher than their actual velocity.

cishekextension2

Returning to the pitcher I evaluated recently, he commented that although his fastball velocity is among the best in the minor leagues and he has quite a bit of movement, he doesn't strike a lot of guys out. While there are a lot of reasons for this, one consideration has to be physical limitations that don't allow him to get extension out in front. In his case, on evaluation, we saw a pseudo military posture; his shoulder blades were tugged back into adduction, and he lacked the upward rotation to effectively "get out front."

adductedscap

Additionally, in the lower extremity, he had significant bilateral muscular/alignment limitations to hip internal rotation. If you don't have sufficient hip internal rotation on your back leg, you aren't going to ride your hip down the mound very far. If you don't have internal rotation on the front hip, you won't be able to accept force on the front leg, so you'll effectively cut off your deceleration arc, also shortening your extension out front. These are usually the guys who "miss" up-and-armside, or cut balls off in an attempt to correct the issue.

If I had just told him he needed to fix these for the sake of fixing them - or even just to prevent injury - it probably wouldn't hold much water. However, by relating these movement inefficiencies back to aspects of his delivery with which he struggles, the buy-in is a lot higher. Striking guys out is a lot "sexier" than avoiding injury or conforming to some range-of-motion norm. 

4. This is a great weekend to be an up-and-coming fitness professional or rehabilitation specialist on a limited budget.

Black Friday/Cyber Monday might be annoying if you're in stores and dealing with a bunch of crazy Moms who are fighting over the last Tickle-Me-Elmo, but in an online context, it's pretty darn awesome - especially if you're an aspiring coach looking to get your hands on some quality educational material.

I did my undergraduate education at a smaller Division 3 school in Southern Maine. We didn't have a varsity weight room where I could observe or volunteer, and there weren't tip top internship opportunities right down the road where I could've found opportunities like that. Looking back, I realize that one of the main reasons I got on the right path was that I was willing to search high and low for those learning opportunities. I spent hours reading T-Nation and hard copy books I'd bought, not to mention driving to whatever seminars I could find.

Nowadays, education is much, more more accessible. Instead of driving nine hours to Buffalo or dropping $1,000 on a plane right, hotel, rental car, and seminar registration, you can spend 10% of that amount and get an awesome education - and you can pick and choose what you want to learn. This weekend, you can do it super affordably, too.

Want a crash course in relative stiffness? Check out my presentations in Functional Stability Training: Optimizing Movement (on sale for 20% off with coupon code BF2016). 

Looking to patch up the holes in your college anatomy course by learning about functional anatomy instead? Pick up Building the Efficient Athlete from Mike Robertson and me (20% off this weekend; no coupon code needed).

Need some cutting-edge hip mobility strategies? Watch Dean Somerset's presentations in The Complete Shoulder and Hip Blueprint (on sale for $30 off through Monday).

Interested in taking a peek into the mind of a successful NFL strength and conditioning coach? Soak up Joe Kenn's knowledge in Elite Athletic Development (20% off this weekend; no coupon code needed).

It's an amazing age in strength and conditioning; short of actual hands-on coaching experience, all the information you need to be successful is at your fingertips in a digital medium - and this is the weekend to get it at the best price.

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Strength and Conditioning Stuff You Should Read: 10/25/16

Before we get to the recommended content for the week, can we talk about how awesome it is to have a Cubs/Indians World Series match-up?!?! With four Cressey Sports Performance (CSP) guys in this series, you can bet that I won't miss a single pitch. I'm flying out today for Game 1 in Cleveland, but before I do, here's some strength and conditioning reading to hold you over for a few days!

Long-Term Success: What You Can Learn from Corey Kluber - With CSP athlete Corey starting Game 1 of the World Series, it seemed like a good time to reincarnate this article I wrote for Gabe Kapler's website back in 2014. Yesterday's article (here) on MLB.com reaffirmed my thoughts even more.

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Why Nutrition Science is So Confusing - Dr. John Berardi has a knack for making the complex seem simple, and in this infographic, he discusses why things have gotten so complicated on the nutrition front in the first place.

How to Write Better Youth Warm-ups - At our Massachusetts facility, Nancy Newell heads up the CSP Foundations program, which is geared toward 7-12 year-old athletes. They have an absolute blast and it has a lot to do with Nancy's contagious energy and fun programming.

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