Home Posts tagged "thoracic spine mobility"

Free Presentation: Hip Shoulder Separation in Rotational Athletes: Making Sense of the Thoracic Spine

We're really proud of what we've created with the CSP Elite Baseball Development Podcast. And, we're confident you will really like it, too - so we'd love it if you'd subscribe to the opt-in box below so that we can notify you each time a new episode goes live. To sweeten the deal, o start, everyone will receive free access to my 35-minute presentation, Hip Shoulder Separation in Rotational Athletes: Making Sense of the Thoracic Spine. I delivered this presentation to a packed house at the popular Pitchapalooza seminar, and it's yours free when you opt in.

Only email address is required; you'll be emailed the access link right away (be sure to check your junk mail folder): 

Join our mailing list to receive podcast updates and my free Hip-Shoulder Separation presentation!

Please complete the form below to subscribe.

 *
 *
 

 

Enjoy!

 
Read more

Strength and Conditioning Stuff You Should Read: 11/9/18

I hope you've had a good week. To kick off your weekend on the right foot, I've got some good reading from around the strength and conditioning world.

First, though, I just wanted to give you a heads-up that I'll be speaking at Pitchapalooza near Nashville in early December as part of an awesome lineup. You can learn more HERE.

Maximum Strength Training for Tennis: Why You Should Do It - Matt Kuzdub authored a great guest post for EricCressey.com a few months ago, and this was another recent post of his in the tennis world. Much it it could be applied to other sports as well.

Your Glutes Probably Aren't to Blame for Sore Knees, but They Could Still Be Stronger - Here's a solid dose of reality with some actionable strategies from Dean Somerset.

5 Great Analogies for Training Baseball Players - A big part of getting results is clearing communicating with athletes, and analogies are an invaluable way of doing so. This article outlines some of my favorites for working with a baseball population.

Top Tweet of the Week

Top Instagram Post of the Week

Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!

Name
Email
Read more

Exercise of the Week: Bent-over T-Spine Rotation with Hip Hinge

I wanted to introduce you to a new exercise we've been playing around with lately. I created the bent-over thoracic spine rotation with hip hinge because I was looking for a way for athletes to avoid compensatory movements as we worked on thoracic spine mobility in the standing position. Essentially, you'll often see folks with limited thoracic spine mobility move East-West with the hips or laterally flex through the spine as they try to find motion in spite of their limitations. By pushing the butt back to the wall, we effectively block off compensatory hip motion (and work on a better hip hinge pattern at the same time).

Key coaching points:

1. By having the eyes follow the hand, you get some cervical rotation to help things along.

2. Make sure the upper back is moving and you aren't just "hanging out" on the front of the shoulder. This is especially true in a throwing population who may have acquired anterior shoulder laxity.

3. We'll usually do eight reps per side. This can be included as a single set during a warm-up, or for multiple sets as fillers during a training session (we'll often plug it in between medicine ball sets).

4. This is a better option for those who have active range-of-motion limitations to thoracic spine rotation, as opposed to passive limitations. In the case of the passive limitations, athletes are better off with things like side-lying windmills, where they have assistance from gravity (instead of having to compete against it).

To learn more about how we assess, program, and coach around the thoracic spine (and entire shoulder girdle), be sure to check out Sturdy Shoulder Solutions.

Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!

Name
Email
Read more

Assessments You Might Be Overlooking: Installment 6

It's been quite some time since I published an update to this series, but some recent professional baseball initial offseason evaluations have had me thinking more and more about how important it is to take a look at lateral flexion.

In the picture above, I'd say that the athlete is limited in lateral flexion bilaterally, but moreso to the left than right. You'll also notice how much more the right hip shifts out (adducts) as he side bends to the left; he's substituting hip fallout for true lateral flexion from the spine. The most likely culprit in this situation is quadratus lumborum on the opposite side (right QL limits left lateral flexion).

As you can see from the picture below, the triangle shaped QL connects the base of the rib cage to the top of the pelvis and spine.

Stretching out the QL isn't particularly challenging; I like the lean away lateral line stretch (held for five full exhales). This is a stretch that can be biased to target the lat, QL, or hip abductors.

That said, the bigger issue is understanding why a QL gets tight in the first place. As Shirley Sahrmann has written, whenever you see an overactive muscle, look for an underactive synergist. In this case, the right glutes (all of them) are likely culprits. If the gluteus maximus isn't helping with extending the hip, the QL will kick on to help substitute lumbar extension. And, if the gluteus medius and minimus aren't doing their job as abductors of the hip, the QL will kick in to "help out" in the frontal plane. This double whammy has been termed a Left AIC pattern by the good folks at the Postural Restoration Institute, and they've outlined many drills to not only address the apical expansion (which creates length through the QL), but also bring the pelvis back to neutral.

Taking this a step further, typically, those with very overactive QLs will also present with limited thoracic rotation (in light of the QL attachment on the inferior aspect of the ribs), so you'd be wise to follow up this stretch with some thoracic mobility work. The athlete in the example at the top of this article had the most limited thoracic rotation (both active and passive) that I've seen in any pitcher this offseason.

That said, here's a good rule of thumb:

If you have a flat thoracic spine athlete with limited thoracic rotation, look at pectoralis major, latissimus dorsi, and quadratus lumborum. If horizontal abduction (pec) and shoulder flexion (lat) both check out well, go right for QL tissue extensibility (as measured by lateral flexion). It will be absolute game changer - particularly in rotational sport athletes.

If you're looking to learn more about how we assess, program, and coach at the shoulder girdle, be sure to check out my new resource, Sturdy Shoulder Solutions.

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!

Name
Email
Read more

Stop Thinking About “Normal” Thoracic Spine Mobility

Two years ago, I published a post, Tinkering vs. Overhauling - and the Problems with Average, where I discussed the pitfalls of focusing on population averages, especially in the world of health and human performance. I'd encourage you to give it a read, but the gist is that you have to be careful about overhauling a program because you see someone as being outside a "norm" that might have been established for an entire population when they are unique in so many ways.

Thoracic spine mobility is an excellent example. What would be considered acceptable for an 80-year-old man would be markedly different than what we'd want from a 17-year-old teenage athlete in a rotational sport. This athlete, for instance, had some marked negative postural adaptations that contributed to two shoulder surgeries during his time as a baseball pitcher. If he was far older with different physical demands, though, he might have never run into problems.

Lumbar locked rotation is a great thoracic spine rotation screen I learned from Dr. Greg Rose at the Titleist Performance Institute. Briefly, you put the lumbar spine in flexion (which makes lumbar rotation hard to come by) and the hand behind the back (to minimize scapular movement). This allows you to better evaluate thoracic rotation without compensatory motion elsewhere. Check out the high variability among three athletes who are all roughly the same age:

On the left, we have a professional baseball pitcher. In the middle, we have an aspiring professional golfer. And, on the right, we have a powerlifter who's moved well over 600 pounds on both the squat and deadlift. Adaptation to imposed demand is an incredibly important part of this discussion of "normal." The hypertrophy (muscle bulk) that benefits the powerlifter could possibly make the baseball pitcher and golfer worse, but at the same time, I wouldn't necessarily say that the powerlifter is "lacking" in thoracic rotation because you don't need a whole lot of movement in this area for a successful, sustainable powerlifting career.

I should also note that these are all active measures. If we checked all three of these guys passively, we'd likely see there's even more thoracic rotation present than you can see here. And, that can open up another can of worms, as having a big difference between active and passive range of motion can be problematic, too.

The take-home message is that if you're going to call someone's movement quality "abnormal," you better have a clear designation of what "normal" is for their age and sport, as well as what's required for their athletic demands.

For more information on how we assess and train thoracic mobility, I'd encourage you to check out my new resource, Sturdy Shoulder Solutions.

Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!

Name
Email
Read more

What (Physically) Goes Into a Good Swing

Cressey Sports Performance athlete Chris Taylor had a big go-ahead 2-run HR last night for the Dodgers - and the second I saw this photo of his swing on Instagram, I immediately got to thinking about how great a representation it is of the demands of the swing.

 

CT3 for the lead! #LADetermined

A post shared by Los Angeles Dodgers (@dodgers) on

As a right-handed hitter, the pelvis rotates counterclockwise toward the pitcher during the swing. However, "counterclockwise" doesn't really do justice to the fact that it's actually hip movement in three planes: rotation (transverse), abduction (frontal), and extension (sagittal). Additionally, earlier in the swing, the torso actually rotates clockwise to create the separation that allow for greater storage of elastic energy and sets the stage for the barrel getting to the zone at the right time and angle - and for as long as possible. This reminds us that you can't have good swing mechanics if you don't have mobility in the hips and thoracic spine, and adequate stability in the core to prevent any energy leaks.

More specific to this photo, though, is the fact that all that motion from the trailing leg has taken place, which means all the force has been transferred forward - and something has to "accept it." We often use the analogy of riding a bike into a curb; if the curb isn't hard, the kid doesn't get launched over the handlebars. In this case, the "firm curb" is the front leg creating a blocking effect as the hip extensors and external rotators (glutes!) eccentrically control that aggressive force transfer into the lead leg. As you'll see in this photo, sometimes the tri-planar forces are so significant that guys might even roll to the lateral aspect of their shoes. And, unless they're in a great pair of New Balance cleats, they might even "swing out of their shoes" (yes, you'll sometimes see guys fold over the side of cleats that don't have good lateral stability).

Anyway, let's take this example to an untrained 15-year-old who doesn't have the strength, motor control, and mobility foundation that Chris has here. There's a good chance he's going to go to the wrong places to find a lot of this motion to generate, transfer, or accept force - and the most common spot is the lower back. You'll commonly see stress fractures and annoying tightness in this region in these kids because the lumbar spine isn't conditioned to produce force or go through significant rotational motion. Watch one of these kids go through a simple bowler squat and they usually fold up line a lawn chair.

In my experience (both in pitching and hitting), the kids most at risk are the ones who grow quickly at a young age. They have long levers that help them to generate velocity, but insufficient physical strength and range of motion to dissipate these aggressive patterns as they get to this position and beyond. They're all gas and no brakes.

Chicks can't dig the long ball if you're in a back brace because you ignored your hip and thoracic mobility and core stability. Take as much pride in your physical preparation as you do in your swing. Chris sure does!

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!

Name
Email
Read more

Strength and Conditioning Stuff You Should Read: 12/4/17

Happy Monday! It's been two weeks since my last recommended reading compilation, as I took a little blog hiatus last week in light of some travel and the chaos that is the professional baseball offseason. The good news is that it gave me time to stockpile some good content for you. Here goes...

Tinkering vs. Overhauling - and the Problem with Average - One of our interns asked me about my thoughts on the "average" range of motion at a particular joint, and it got me to thinking about this article I wrote last year. There are big problems with using averages in the world of health and human performances, so I'd encourage you to give it a read to learn more.

Core Control, Hamstrings Patterning, and Pitching Success - This was a whopper of an Instagram post from CSP-MA pitching coordinator, Christian Wonders. Be sure to check out all four parts.

Brett Bartholomew on the Art of Conscious Coaching - This was an excellent podcast from Mike Robertson, as Brett is a skilled coach and charismatic personality. It's definitely worth a listen.

Top Tweet of the Week

Top Instagram Post of the Week 

Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!

Name
Email
Read more

Strength and Conditioning Stuff You Should Read: 10/2/17

Happy Monday! The MLB regular season ended yesterday, so you could say that this is yet another reminder that the Cressey family "inseason" has begun. Our craziness starts when all the players' lives slow down a bit. Here's a little recommended reading for you:

Dr. Andy Galpin on How to Unplug from Tech and Social Media - This was a fascinating podcast with Dr. Galpin from Mike Robertson, where they critically review the role of technology and data collection in the training process. The points on the need to unplug from technology and social media really hit home for me, too, and I'll be checking out his book soon!

My Body Let Me Down...Again - This was a great article from Gray Cook on all the potential causative factors for why we may hurt. Many people default to the explanation that their bodies simply fail them, when in reality there were likely a lot of things "missed" on the path to that declaration. Aside from trauma, injuries are rarely just "happenstance."

Breaking Down the Quadruped Thoracic Rotation - Dean Somerset outlines the most common mistakes seen with this common upper back mobility drill.

Top Tweet of the Week

Top Instagram Post of the Week

 

*Put the elbows in your pockets.* 👇 When doing chin-ups and pull-ups, you want to be careful about extending the humerus past neutral at the top position. If the elbow moves behind the body, the humeral (upper arm) head can glide forward, irritating the structures at the front of the shoulder. Additionally, the thoracic spine (upper back) becomes excessively kyphotic (rounded), and the scapula may anteriorly (forward) tilt, closing down the subacromial space and exacerbating impingement on the rotator cuff tendons. 👎 On the left, you'll see what this bad position looks like. On the right, you'll see the corrected version. 👍 I’ve found that encouraging athlete to put the elbows in the pockets also makes athletes get the chest to the bar instead of just reaching with the chin and creating a forward head posture. Conversely, if you encourage many young athletes to “just get your chin to the bar,” you get some garbage kipping concoction that looks like Quasimodo on the monkey bars with his pants on fire. So don't do that. #cspfamily #sportsperformance #chinup #pullup #hudsonma #SportsMedicine #shoulderpain

A post shared by Eric Cressey (@ericcressey) on

Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!

Name
Email
Read more

Random Thoughts on Sports Performance – Installment 25

As we wind down to the holidays, here's the last installment of Random Thoughts on Sports Performance for 2016.

1. One of the most overlooked benefits of medicine ball training might be the frequency at which it can be trained.

Before I get to this point, check out this old video of mine on the Absolute Strength-Speed Continuum (if you haven't seen it already):

One of the things I've been thinking about is that medicine ball training doesn't absolutely crush people the same way that absolute speed work (whether it is sprinting, jumping, throwing a baseball, or something comparable), strength-speed (Olympic lifts, jump squats), and heavy lifting does. You could likely train it every day, and while it wouldn't be optimal, people could handle it and still derive some benefit.

More than likely, it's just a sweet spot in the "Force = Mass x Acceleration" equation. The mass is pretty low (especially since there really aren't huge ground reaction forces like we see in sprinting), and the acceleration drops off quite a bit. This likely parallels what we see with baseball vs. football throwing; the football is just much less stressful. 

This doesn't help us a lot in the quest for developing peak power, but it does give us a really good option for training power - especially rotationally - more frequently.

2. Good thoracic positioning will help you make the most of your overhead medicine ball training.

Speaking of medicine balls, check out this side-by-side comparison of two athletes that I recently posted on my Instagram account. On the left is one with a "normal" thoracic curvature and set of movement capabilities. He can get into thoracic extension at the top, and effectively flex at the bottom to deliver the scapula to the correct position for ball release. On the right, though, notice how flat the upper back stays at the ball release position. We'd like to see him able to round a bit more to ensuring a good convex-concave relationship between the scapula and rib cage.

3. Narrow exercise selections make for impressive lifters, but less impressive athletes.

With our typical minor league baseball player, we may actually have time to get through six 4-week programs over the course of an offseason. In six months - especially if we happen to have an athlete who is genetically gifted for strength development - we *could* get guys freaky strong on a few big lifts. We choose not to, however. Why?

A narrow exercise can lead to some very impressive weight room performances on a few lifts: squat, bench press, deadlift, clean, etc. This specificity can be great if you want to be a one (or three) trick pony (powerlifter), but not quite as helpful if you're an athlete who actually needs to change directions. To this end, a few thoughts:

a. I'd much rather see an athlete with a more versatile "strength portfolio." Show me a 200-pound athlete who can front squat in the mid-300s, deadlift in the mid-500s, turkish get-up in the 80s, and do axial-loading single-leg work in the mid-200s, and I'll show you a guy that has a great foundation to really move well.

b. These strength numbers aside, eventually, your priority needs to shift from just building strength to actually using that quickly. Simply chasing a number on one lift can quickly leave you unprepared in a particular movement/plane or in the context of creating more usable strength. I out-deadlift all of our pro baseball players, but many of them can broad jump longer than I can; who is using their force more efficiently? 

c. If you do insist on this narrower "main" exercise selection can be offset by variety in warm-ups, sprint/agility work, and assistance strength training drills.

d. I think narrower exercise selections have the most benefit in beginning lifters and teenage athletes who need to build a solid foundation and awareness of putting force into the ground. I'd honestly have no problem with sticking with the same 3-4 "main" exercises for 3-4 months straight in this population, although you have to be sensitive to the fact that some athletes will get really bored quickly. For this reason, we'll try to simple incorporate subtle changes; as an example:

  • Month 1: Trap Bar Deadlift (6-8 reps per set)
  • Month 2: Trap Bar Deadlift (4-5 reps per set)
  • Month 3: Trap Bar Deadlift vs. Band or Chains
  • Month 4: Low Setting Trap Bar Deadlift

Obviously, we don't rigidly adhere to this, but it gives you a feel for how to add some variety without overhauling things and having to completely re-groove a new skill.

That's all for 2016; happy holidays!

Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!

Name
Email
Read more

6 Saturday Shoulder Strategies

In light of the recent announcement of my upcoming shoulder course in Colorado, 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 my June 24 seminar in Colorado, please click here.

Have a great weekend!

Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!

Name
Email
Read more
Page 1 2 3
LEARN HOW TO DEADLIFT
  • Avoid the most common deadlifting mistakes
  • 9 - minute instructional video
  • 3 part follow up series