Home Posts tagged "thoracic spine mobility" (Page 3)

Improving Thoracic Mobility in Throwers

It goes without saying that all rotational sport athletes need adequate thoracic spine (upper body) mobility in order to create appropriate separation as they work to transfer force from the lower extremity to the upper extremity during swings, throws, shots, and changes of direction.  In a throwing population, however, you need to take some special precautions as you work to build it.

One thing we know about pitchers is that their shoulder external rotation improves over the course of a season, and this likely takes place because the ligamentous structures in the front of the shoulder become looser. In this image of a left shoulder, it would be the area labeled "capsular ligaments:"

ghligaments

Effectively, the looser one's anterior capsule is, the more external rotation one will have.  The problem, however, is that if this area becomes too loose, the biceps tendon must pick up the slack as an important anterior stabilizer during external rotation.  Additionally, there are many nerve structures at the anterior shoulder that can be irritated because the humeral head isn't controlled.  This is yet another reason why it's not a good idea to stretch a throwing shoulder into external rotation.  In this video, I go into greater detail:

This knowledge gives rise to two thoughts:

1. If we lack thoracic rotation, our arm will drag during the pitching delivery, as it's a means of creating better separation (albeit in the wrong places).  Guys who have quick arms can often make up for it, but still inevitably irritate the anterior shoulder over time.  So, if your thoracic rotation stinks, you'll need to try to find more external rotation in the wrong places.  Additionally, if we lack thoracic extension, we often substitute lumbar extension (lower back arching) to maintain an upright torso.  These guys wind up with low back pain, oblique strains, and hip issues.

2. We can't just throw any thoracic mobility drill at throwers, particularly in the early off-season, when the anterior shoulder is all stretched out and it may be the path of least resistance.  As an example, the kettlebell arm bar might be a great drill for many folks in the population, but I would never use it with a thrower:

Instead, particularly in the early off-season, we need to pick drills that heavily emphasis thoracic movement independent of humeral (arm) movement. Here's a progression we might use over the course of the off-season:

Off-Season Months 1-2 (and during the in-season phase): Supine Alternating Shoulder Flexion on Doubled Tennis Ball, Thoracic Extension on Roller, Rock-Back Quadruped Extension-Rotation

tspineexte

Off-Season Months 3-4: Side-Lying Windmill, Bent-Over T-Spine Rotation

You'll notice that these options integrate a lot more humeral movement.  In many cases, you can use them earlier in the off-season, but only if they're coached really meticulously to ensure athletes are moving in the right places.

We use these exercises right after our foam rolling and positional breathing drills during the warm-up, and before anything we'd do to directly work on scapular stabilization and rotator cuff strength/timing.  Hopefully, this article gives you a little feel for not just some of the exercises we may use, but also the way we'd program them throughout the competitive season.

If you'd like to learn more about how we manage throwers, be sure to register for one of our Elite Baseball Mentorships.  The next one will take place June 14-16 in Hudson, MA.

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Coaching Cues to Make Your Strength and Conditioning Programs More Effective – Installment 7

It's been a while since we covered some strength training coaching cues that you'll want to have in your back pocket, so here's installment 7.

1. Follow your hand with your eyes.

It goes without saying the improving thoracic (upper back) mobility needs to be a big priority for many athletes.  However, individuals can lose out on the benefit of thoracic mobility drills can be performed incorrectly if one only moves through the shoulder and not the upper back.  Greg Robins covers that problem in this video, in fact:

To help ensure optimal technique, I encourage athletes, "Follow you hands with your eyes." It always seems to "right the ship" with respect to movement of the humerus.

2. Ease the bar out.

One of the biggest mistakes I see both lifters and spotters make is just picking UP the bar and handing it out from the pins on the bench press. This causes a lifter to lose his upper back tightness and start the lift from an unstable platform. Plus, the bar is more likely to drift excessively toward the hips, as opposed to staying right in the path the lifter prefers.

With that in mind, another Greg Robins video complements this tip well; check it out:

3. Get the chest to the floor before the chin.

Push-up variations are an incredibly valuable inclusion in just about any strength training program, but unfortunately, the technique goes downhill quite frequently, particularly under conditions of fatigue.  Everyone knows that we need to monitor core positioning so as to avoid excessive lumbar hyperextension (lower back arching).  However, what a lot of people may not realize is that this "sag" is only one potential extension-bias fault. 

You see, people who are in extension will find all the ways they can to shift away from a neutral posture and toward a more extended posture.  Take, for example, this shoulder flexion video. The individual doesn't just go into lumbar extension and a heavy rib flare to get his arms up overhead; rather, he also goes into a forward head posture.

I liken this to patching up a hole in a leaky roof - only to find a leak starting up somewhere else.  It's important that we patch them all!  With that said, with push-up variations, you can either cue "make a double chin" or tell folks that the chest should make it to the floor before the chin. As long as you've already controlled for excessive arching of the lower back, the cue will be spot-on.

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Mobility Exercise of the Week: Supine Alternating Shoulder Flexion on Doubled Tennis Ball

In this installment of "Exercise of the Week," I've got a great drill you can use to improve upper extremity mobility.  I originally learned this from Sue Falsone of the LA Dodgers a few years ago. 

We've found this to be super helpful not only with folks who have poor thoracic spine mobility, but also those who have limited shoulder flexion and scapular upward rotation.  There's a bit of research and anecdotal evidence out there to support the idea that improving thoracic mobility in turn improves scapular upward rotation and glenohumeral (ball and socket) range of motion.  Basically, by reducing bad stiffness in one area, it makes it easier to establish good stiffness elsewhere - and that provides for better overall mobility.  So, reduced thoracic stiffness = better scapular upward rotation = better ball-and-socket congruency = better arm range of motion.

Internal rotation, in particular, seems to improve the quickest - and that's one reason why we'll always work proximal - positioning breathing, thoracic mobility, scapular control, and soft tissue work - before we ever stretch a throwing shoulder.  The glenohumeral joint is somewhat of a delicate one, so you never want to crank on it - especially if you haven't exhausted more conservative options.  This fits that bill.

Additionally, some folks with a more adducted scapula positioning will benefit quite a bit from this drill, as it essentially works out to self myofascial release on overactive rhomboids.  Get them to relax, and the shoulder blade will move better on the rib cage.

scapularadduction

All you need is a doubled tennis ball and some masking or duct tape.  Tape two balls together, and then go follow the instructions below.

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Ankle, Hip, and Thoracic Mobility Training for Catchers

Today, my good friend Joey Wolfe has a great guest post on the topic of training baseball catchers.  Joey's a really bright guy with a lot of experience on this front; I think you'll enjoy this. - EC

One of the biggest challenges for young players is being able to make adjustments to their swing, throwing mechanics, running mechanics, etc. Sometimes mental barriers get in the way of making the adjustment, yet often times it is a physical limitation; more specifically a mobility, stability or sequencing issue. As a coach it can be very frustrating trying to get a player to make an adjustment to their mechanics that their body is simply unable to make. A good coach will try to figure out another way to communicate the adjustment to the player. A great coach will figure out where the problem lies. This is where the strength & conditioning coaches come in. Although most of us may not know what it means to beat the ball to the spot, all of us should have a good understanding of how to improve the mobility of our athletes. It is this skill set that will directly affect the performance of our athletes.

The main responsibility of any catcher is to catch the ball. If a catcher cannot consistently catch the ball he will quickly find himself playing in the outfield. A catcher has many responsibilities; handling the pitching staff, calling pitches, receiving, blocking, throwing; the list goes on. In order for a catcher to be successful they must first and foremost be comfortable. Without the proper mobility the catching duties can quickly go from hard to impossible. Here are the three areas that stand out as the limiting factors in regards to mobility for catchers.

1. Limited ankle mobility: It is imperative that a catcher has mobile ankles. Having mobile ankles allows the catcher to comfortably get in a squatting position. With nobody on base (primary stance) a catcher is generally going to sit into a deep, comfortable squat with the ankles slightly everted. Stiff ankles have a tendency to put more stress on the hips. Also, without ankle mobility a catcher’s ankle sway will be limited. Ankle swaying is extremely important for catchers, especially at the lower levels because pitchers tend to lack command of their pitches. Ankle swaying allows the catcher to get their nose and body in front of the ball without moving the receiving arm too much. When there is a lot of movement with the receiving arm the pitch doesn’t look as good from the umpire’s vantage point. Finally, if an ankle is locked up it will limit the catcher’s ability to get in the proper throwing position to deliver the ball to second base. Although the movement may start at the hip, the ankle needs to have the appropriate amount of mobility to allow the ankle to externally rotate so the back foot can get in the correct position. Here are some of our favorite ankle mobility exercises.

Multiplanar Wall Ankle Mobilizations (previously described by EC here)

Ankle Inversion with Band

Sit with the band attached to your inside foot with a pad under calf so heel is off the ground. Use only your ankle, pull toes to stretch the band shin and return to the starting position for prescribed number of repetitions. Do not allow any movement throughout your leg or hip during the exercise. There should be less motion moving your foot out than in. This exercise will work the muscles in your lower leg and challenge the coordination in your ankle.

Ankle Eversion with Band

Sit perpendicular to a band that is attached to the outside of your foot. Place a pad under your calf so the heel is off the ground. Move your ankle away, stretching the band for the prescribed number of repetitions. Do not allow any movement throughout your leg or hip during exercise. There will be less motion moving your foot out than in. Working the muscles in your low leg and challenging the coordination in your ankle.

2. Poor thoracic mobility: It has been pretty well documented that limited shoulder mobility and/or thoracic extension will impede one's ability to get into the correct squatting position. Well imagine trying to catch an Aroldis Chapman fastball or a Tim Collins curveball if you can’t get down in a comfortable squatting position; not fun! Remember, the key to being a successful catcher is being comfortable. The absence of thoracic mobility is highlighted when a catcher has to get down into their secondary stance (two strikes on the batter and/or a runner on base). What you’ll find is a rounded upper back and shoulders that roll forward. This creates three problems.

First, it makes for a smaller target for the pitcher. Pitchers want a big target to throw to, not a small one. Therefore, generally speaking, it is the catcher’s job to make himself look as big as possible.

Second, it limits the catcher’s ability to receive the ball comfortably from the pitcher. Often times the catcher will feel “locked up” when they are unable to move freely through their t-spine. A low and away curveball from a right-handed pitcher will give them fits and you can forget about a good right-handed two-seam fastball or filthy left-handed slider. Basically any pitches that require the catcher to go get the ball will create challenges for a catcher that is tight in their t-spine.

Third, when a mobility issue is present the lengthened muscles will serve to dissipate the force transfer from the ground and lead to slower feet. This will make it near impossible to do anything quickly. Whether it is going down to block a ball, throw a runner out or back up first base, being tight up top will effect what is going on down below. Here are a few great exercises to help improve mobility in the t-spine.

Thoracic Spine Mobility - Double Tennis Ball

Tape two tennis balls together to for a "peanut" shape. Lie on your back with the balls under your spine just above your lower back and your hands behind your head. Perform 5 crunches. Then raise your arms over your chest and alternately reach over your head for 5 repetitions with each arm. Move the balls up your spine 1 to 2 inches and repeat the crunches and arm reaches. Continue moving the balls up your spine until they are just above your shoulder blades and below the base of your neck. During the crunches, try and "hinge" on the ball rather than rolling over it. Think about keeping your ribs pushed down to the ground during the arm reaches, as if you were getting a deep massage in your mid to upper back.

Side-Lying Extension-Rotation

Quadruped Extension-Rotation

3. Bad hip mobility: Last, but certainly not least, on the list of mobility restrictions is bad hip mobility. Of the three limitations I have mentioned, this one may be the biggest culprit in young catchers today. Given the number of hours kids spend sitting in class, watching T.V. and playing video games, it comes as no surprise that their hip mobility is negatively affected. We often find that the catchers we work with lack internal rotation (internal rotation deficit), and are short/tight in their hip flexors and adductors.

Two of our favorite stretches to address an internal rotation deficit are the knee-to-knee stretch and the supine dynamic hip internal rotation stretch. Allowing for more rotation in the hips is going to free the catcher to better perform the ankle sway, which really starts at the head of the femur. That internal hip rotation gives the ankles and the rest of the body a better chance to get in front of the ball when receiving a pitch and also allows the feet to get in the proper position when throwing the ball.

Lying Knee-to-Knee Mobilization

As Eric mentioned a few weeks ago in his epic post 15 Static Stretching Mistakes, the lying knee-to-knee stretch can impose some valgus stress at the knees if it isn't coached/cued properly. So, instead of thinking of letting the knees fall in, tell the athlete to actively internally rotate the femurs. The stretch should occur at the hips, not the knees.

Supine Dynamic Hip Internal Rotation

When addressing the adductors (groin), we are advocates of doing as much soft tissue work as one can stand. It’s not easy to get in to all of these areas with a foam roll, so we'll often we’ll have our clients use a tennis ball or lacrosse ball (if they can handle it). After hammering these areas with some soft tissue work, we’ll have our catchers do a few lengthening exercises. A couple of our favorites are the Split-Stance Kneeling Adductor Mobs and the Half-Kneeling Hip Stretch. When done right, both of these exercises emphasize the importance of hip mobility while maintaining core stability. Here’s a look at some of these exercises.

Split-Stance Kneeling Adductor Mobs

Half-Kneeling Hip Stretch

Simple and easy way to stretch some of the tightest muscles in the body. Squeeze the glutes of the knee that is on the ground, then push the hips forward. To progress, raise your arms overhead.

Typically, catchers are big guys who – for their size – move free and easy, especially in the aforementioned areas. Being a good catcher is more than just being big and strong. It is about being big and strong while maintaining your mobility and flexibility. Anyone can add size and strength, but if your movement is compromised in the process, then it is almost certain that you will see a decrease in performance. Spend some time doing these mobility exercises before, during (preferable) or after your workouts for the next few weeks and see how much better your body feels. Good luck!

About the Author

Joey Wolfe is the owner and founder of Paradigm Sport, a Santa Cruz based training business that specializes in performance training for athletes. Before his career as a strength & conditioning coach, Joey played baseball professionally in the Toronto Blue Jays organization. He now works with dozens of youth, high school, college and professional baseball baseball players. Joey's aptitude in the specific skill sets as well as the strength and conditioning aspects of the game provide him with a unique perspective from which to work with his clients on multiple levels. He can be reached at joey@paradigmsport.com.

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Increasing Pitching Velocity: What Stride Length Means and How to Improve It – Part 3

In part 1 of this series, I touched on some of the mechanical factors one must consider in relation to increasing stride length in pitchers.  Then, in part 2, I got discussed physical factors – hip mobility and lower-body strength/power – that govern how far you can stride.  In wrapping up today with part 3, we’ll work our way up the kinetic chain to discuss three more physical factors that control stride length. 3. Rotary Stability – As I discussed in my recent article at T-Nation, What I Learned in 2011, hip mobility “sticks” better when you have adequate rotary stability, so we’ve been doing more of our core stability exercises in more “extreme” positions of hip mobility.

If you’re going to push the limits of hip abduction, internal, and external rotation range of motion, you need to be sure that you have adequate rotary stability to be stable in these positions in weight-bearing and not destroy the spine.  Anybody can just get into these positions in slow speed, but not everyone can control the body precisely with a combination of isometric and eccentric muscle action at the high velocities we see with pitching. Additionally, many of the big-time long stride guys rely heavily on controlling lumbar spine hyperextension as they ride the back hip down the mound.  This is something you’ll see if you watch the deliveries of smaller, athletic guys like Tim Lincecum, Tim Collins, and Trevor Bauer.  If they don’t maintain adequate anterior core function, they’ll wind up with extension-based back pain in no time.

4. Thoracic Mobility – Throwing and hitting (and really any rotational challenge like a hockey slapshot or tennis stroke) present a unique challenge to an athlete: the hips and shoulders are temporarily moving in opposite directions.  This creates separation, which allows an athlete to store elastic energy and create velocity via the stretch-shortening cycle.

The first issue to consider is that not all separation is created equal.  You can create separation with the hips and lower back – and jack up a lumbar spine over time.  The goal is to having adequate thoracic spine mobility to ensure that this separation occurs higher up (and engages the upper extremity well). The second issue is that the more you push the limits of hip mobility, the more you must push the limits of thoracic mobility.  We’ve always heard “equal and opposite” when it comes to the throwing arm and glove arm, but the truth is that it probably apply to the lower half and thoracic spine as well.  You simply don’t see guys with terrible thoracic mobility getting way down the mound, as that lack of thoracic mobility would cause them to leak forward with the upper body.  I covered this in part 1, but the Cliff’s Notes version is that the head doesn’t stay behind the hips long enough, so throwers lose separation. The third issue is that poor thoracic mobility will really interfere with getting an adequate scap load, so the arm speed will be slower.  Throwing with a poorly positioned scapula is like trying to jump out of sand; you just don’t have a firm platform from which to create force.

A very basic thoracic spine mobility drill that would be a “safe” bet for most throwers would be the quadruped extension-rotation.

This drill doesn’t crank the shoulder into excessive external rotation, which may be a problem for the really “loose” arms in the crowd. Progressions for the really stiff pitchers would be the side-lying windmill and side-lying extension-rotation.  I also like the yoga plex, a drill I learned from Nick Tumminello, as a means of syncing everything up with a longer stride.

Note: be sure to read this shoulder mobility blog on why not all thoracic spine mobility drills are created equal for throwers! 5. Quick Arm – When I say that you have to have a quick arm to have a long stride, I really just mean that you need some upper body power to make things work.  The longer the stride, the quicker your arm must be to catch up in time to create a downward plane and throw strikes. You simply don’t see guys with long strides competing at high levels unless they have a quick arm that can catch up to the lower body.

When a guy’s arm isn’t quick enough to catch up to his lower half, you see him miss up and arm side.

This type of thrower would be better off shortening up his stride (at least temporarily) and spending more time on good throwing programs to increase arm speed. This is one reason Justin Verlander is great.  If you watch him, he’s not an insanely long stride.  Rather, he’s shorter with it, and much stiffer on his landing leg to create an awesome downward plane.  Plus, he actually does have a ridiculously quick arm and outstanding secondary stuff.  A lot of pitching coaches would try to lengthen his stride – and while this might work, I don’t know about you, but I think overhauling a Cy Young winner’s mechanics is silly.

The “long stride, slow arm” issue is (in my experience) most common in young, lax players who have the joint range-of-motion and just enough stability to get a long stride, but don’t have adequate arm speed to catch up.  This is really common in the 14-17 age ranges, and I think it’s one reason why so many of these kids respond incredibly favorably to long toss; it teaches their arms to go faster and keep up with their strides. Conversely, as you start to deal with 18-year-olds and older (or kids who have grown quickly), you start to see that preparing everything below the arm is arguably more important than arm speed.  You don’t pitch in college or professional baseball unless you have a reasonably quick arm, and getting more aggressive with the lower half to stride longer is often exactly what guys need to make the big velocity jump.  Likewise, when guys don’t take care of the lower half, but continue on aggressive throwing programs, they often wind up with velocity drops, injuries, or control issues because they’ve lost the separation that made them successful. Closing Thoughts While a long stride can certainly be advantageous in the throwing motion, as I've shown in this series, forcing it when you don't have the right physical preparation or mechanical coaching in place can actually hurt an pitcher's performance and health.  Remember that the best changes are subtle ones; in other words, you might increase a stride by six inches over the course of a year, not in a single session. Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!
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Why Your Workout Routine Shouldn’t Be “Routine”

Last Saturday night, the power went out at our house thanks to a rare October snowstorm in New England. Expecting it to come back on pretty quickly, I went to bed Saturday night assuming I’d wake up to a normal Sunday morning.

Instead, I woke up and it was 49 degrees in my house. And, that wound up being par for the course through Tuesday at about 4pm. No hot showers, no refrigeration, no coffee in the morning: it makes you realize how much you take some things for granted.

It’s not all that different than what you’ll hear from injured and sick athletes. We always just believe that we’re going to be healthy – and it’s that assumption that leads us to put too much weight on the bar and lift with poor technique, have the extra beer, go to bed an hour later, or make any of a number of other small, but crucial decisions that interfere with our short- and long-term health, and the continuity in our workout "routines."

I wish I’d foam rolled even when I wasn’t in pain.

I wish I’d done that dynamic flexibility warm-up even when I just wanted to get in and lift.

I wish I’d eaten my vegetables even though I was just trying to shovel in as much calories as I could in my quest to get strong and gain muscle.

These are all things I've heard from injured people. Hindsight is always 20/20.

Some of these decisions are made out of negligence, but often, they’re made simply because folks don’t know about the right choices. I mean, do you think this guy would really continue doing this if he thought it was good for his body?

Nobody is immune to ignorance; we’ve all “been there, done that.”

Almost a decade ago, I had no idea how much soft tissue work, high volumes of horizontal pulling, and thoracic spine mobility drills could do to help my shoulder. It’s why I stumbled through fails attempts at physical therapy with that shoulder back in 2000-2003, only to accidentally discover how to fix it with my own training in time to cancel my shoulder surgery.

Back in that same time period, nobody ever told me how eating more vegetables would help take down the acidity of my diet, or that Vitamin D status impacted tissue quality and a host of other biological functions. I never knew most fish oil products you could buy are woefully underdosed and of poor quality. Now, I crush Vitamin D, fish oil, and Athletic Greens on top of a healthy diet that’s as much about nutrient quality as it is about caloric content and timing.

In short, I didn’t know everything then, and while I know a lot more now, I still don’t claim to have all the answers. Nobody has all of them. So what do you do to avoid taking important things for granted?

Get around people who have “been there, done that.” Ask questions. Follow workout routines they’ve followed, and consult resources they’ve consulted. I touched on this in my webinars last week.

I also discussed this topic in a blog about strength and conditioning program design a while back. The best way to avoid making mistakes and taking things for granted is to be open-minded and learn from other people.

With that in mind, let’s use this post as a starting point. What mistakes have you made when it comes to taking things for granted? And, what lessons have you learned? Post your comments below.

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Corrective Exercise: Muscle Imbalances Revealed Review – Upper (Part 2)

This marks Part 2 of my write-up on Muscle Imbalances Revealed - Upper Body, a product that really impressed me.  In my first post, I highlighted some of Dean Somerset's great contributions to the project, and today, I thought I'd bring to light seven more great corrective exercise lessons from another excellent presenter on this resource.

Dr. Jeff Cubos is an Alberta-based chiropractor with an outstanding skill set that not only encompasses his clinical work, but also an excellent ability to relate how what he does in the clinic applies to those in the strength and conditioning field.  This "dual proficiency" was readily apparent in his presentations, too.

Here were a few highlights:

1. From an alignment standpoint, you can envision the core like a house - where the diaphragm is the ceiling, and the pelvic floor is the floor.  Just like with the house, too, the ceiling and floor should be parallel.  Having an anterior pelvic tilt and rib flair dramatically alters this:

2. Good training to address this issue isn't just about stretching hip flexors and activating glutes, though; it's about retraining breathing, "owning" one's breathing in various positions, and progressing that respiratory function (and, in turn, rib positioning) into more comprehensive strength exercises.

3. Jeff does the best job I've seen of discussing breathing drill progression - and how to sync them up with progressive strength training programs.  Just as importantly, though, he does a great job discussing the role of the diaphragm, utilizing an excellent video to show exactly how it works (as you watch it, be sure to check out how the right diaphragm attachment point is more prominent on the spine).  I've mentioned many times in the past in the blog about how we utilize breathing drills, and folks always want to know what they are.  Unfortunately, you can't really just describe a breathing drill; you need to show it and add specific cues.  Jeff does exactly that.  Here's a good excerpt on the assessment side of things, too:

4.  Dr. Cubos also discusses bits and pieces of both the Dynamic Neuromuscular Stability (DNS) and Postural Restoration Institute (PRI) philosophies.  Having been to seminars for both disciplines, I can tell you that Jeff does a great job of presenting this valuable, but sometimes confusing information in as user-friendly a format as one possibly can.  It's a cursory overview, but enough to give you an introduction to these philosophies to find out if they're right for you.

5. Even if you aren't planning to delve deeply into these disciplines, Jeff covers a few specific cues that you can apply to breathing correctly on every exercise you do - especially if you (or your clients) are stuck in anterior pelvic tilt, lordosis, and an elevated ribs posture.  For instance, Jeff uses the cue of performing a few diaphragmatic breaths at the point of greatest tension in a movement; this will enable an athlete to "own" that position more quickly.  He uses the example of holding for a count of "one-one-thousand" at the top position of the quadruped extension-rotation:

6. I've got to great lengths in several previous blog posts to distinguish between tendinitis (inflammatory) and tendinosis (degenerative) - and Dr. Cubos did a good job of reaffirming things on that front (tendinosis is much more common than tendinitis).  However, he took it even further with some excellent information on the "continuum" of tendinopathies.  I've spoken about how we're all waiting to reach "threshold" (presentation of symptoms), but haven't paid a lot of attention to sub-clinical tendinopathies.  Here's how Jeff portrayed the continuum:

Reactive Tendinopathy - This is acute overload (too much, too soon).  Soft tissue treatments are beneficial, but not locally to the tissue in question.  An example that immediately comes to my mind is a supraspinatus tendinosis; manual therapy to the pec minor, posterior rotator cuff, etc. would be very helpful, but working directly on the supraspinatus could exacerbate the problem significantly.

Tendon Dysrepair - Dr. Cubos referred to this as "a failed attempt at healing, and a disorganization of the connective tissue matrix."  Immediately, I thought of someone with chronically crank hamstrings following a previous strain.  Direct soft tissue work has much more immediate and profound benefits.

Degenerative Tendinopathy - This is the obnoxious, long-term tendinosis we've come to know - whether it's an Achilles tendon or common extensor tendon (Tennis Elbow).  Here we have cell death, disorganization of the connective tissues, and less collagen.  Unfortunately, full resolution isn't that common - but most people can respond over time to the right kind of rehabilitation programs.

7. Last, but certainly not least, Jeff introduces his audience to several common soft tissue treatment approaches, including Active Release Technique, Fascial Manipulation, Functional Range Release, and the various modalities of Instrument Assisted Soft Tissue Mobilization.  In describing each, he outlines why some may be better for others in certain instances, as well as the differences between approaches.  I think this is a "must-watch" for trainers to understand the skills of the manual therapists to whom they refer, and also up-and-coming rehabilitation specialists to decide which approaches they'll utilize in their professional careers.

All in all, Dr. Cubos was another new name (for me, at least) that I was glad to come across - and I'll definitely be following him more moving forward.  And, in addition to Cubos and Somerset's contributions, there are a host of other great professionals who have contributed to the entire Muscle Imbalances Revealed - Upper series, which is currently on sale with a 60-day money back guarantee, too, so check it out here.

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Shoulder Mobility Drills: How to Improve External Rotation (if you even need it)

Last summer, a college pitcher came up to Cressey Performance from the South to train for a month before his summer league got underway. He was seven months post-op on a shoulder surgery (Type 2 SLAP) and had been working his way back. Unfortunately, his arm was still bothering him a bit when he got up to see us.

After the first few days at CP, though, he told me that his arm felt as good as it’s felt in as long as he could remember. He’d been doing a comprehensive strength and conditioning program, but the “impact” stuff for him had been soft tissue work, some Postural Restoration Institute drills, an emphasis on thoracic mobility, and manual stretching into internal rotation, horizontal adduction, and shoulder flexion. From all the rehab, his cuff was strong and scapular stabilizers were functioning reasonably well – which led me to believe that his issues were largely due to tissue shortness and/or stiffness.

This realization made me immediately wonder what he’d been doing in the previous months for mobility work for his arm – so I asked. He then demonstrated the manual stretching series that every pitcher on his team went through every day on the table with their athletic trainer. Each stretch was done for 2x20s – and two of those stretches took him into extreme external rotation and horizontal abduction. I was pretty shocked.

Me: “You’re probably not the only guy on your team rehabbing right now, huh?”

Him: “No; there are actually too many to count.”

Me: “Elbows, too, I’m sure.”

Him: “Yep.”

Want to irritate a labrum, biceps tendon, or the undersurface of the rotator cuff? Stretch a thrower into extreme external rotation and simulate the peel-back mechanism. This also increases anterior capsular laxity and likely exacerbates the internal impingement mechanism over the long-term. To reiterate, this is a bad stretch!

Want to make an acromioclavicular joint unhappy? Stretch a thrower into horizontal abduction like this (again, this is a BAD stretch that is pictured):

Want to irritate an ulnar nerve or contribute to the rupture of an ulnar collateral ligament? Make sure to apply direct pressure to the forearm during these dangerous stretches to create some valgus stress. This is a sure-fire way to make a bad stretch even worse:

These stretches are very rarely indicated in a healthy population – especially pitchers who already have a tendency toward increased external rotation. The shoulder is a delicate joint that can’t just be manhandled – and when you’re dealing with shoulders that are usually also pretty loose (both from congenital and acquired factors), you’re waiting for a problem when you include such stretches. In fact, I devoted an entire article to this: The Right Way to Stretch the Pecs.

Everyone thinks that shoulder external rotation and horizontal abduction alone account for the lay-back in the extreme cocking position.

In reality, though, this position is derived from a bunch of factors:

1. Shoulder External Rotation Range-of-Motion – and this is the kind of freaky external rotation you’ll commonly see thanks to retroversion and anterior laxity:

2. Scapular Retraction/Posterior Tilt

3. Thoracic Spine Extension/Rotation

4. Valgus Carrying Angle

So, how do you improve lay-back without risking damage to the shoulder and elbow?

1. Soft tissue work on Pec minor/major and subscapularis – Ideally, this would be performed by a qualified manual therapist – especially since you’re not going to be able to get to subscapularis yourself. However, you can use this technique to attack the pecs:

2. Exercises to improve scapular retraction/depression/posterior tilt – This could include any of a number of horizontal pulling exercises or specific lower trap/serratus anterior exercises like the forearm wall slide with band.

3. Incorporate specific thoracic spine mobility drills – In most pitchers, you want to be careful about including thoracic spine mobility drills that also encourage a lot of glenohumeral external rotation. However, when we assess a pitcher and find that he’s really lacking in this regard, there are two drills that we use with them. The first is the side-lying extension-rotation, which is a good entry level progression because the floor actually limits external rotation range-of-motion, and it’s easy to coach. I tell athletes that they should think of thoracic spine extension/rotation driving scapular retraction/depression, which in turn drives humeral external rotation (and flexion/horizontal abduction). Usually, simply putting your hands on the shoulder girdle and guiding them through the motion is the best teaching tool.

A progression on the side-lying extension-rotation is the side-lying windmill, which requires a bit more attention to detail to ensure that the range-of-motion comes from the right place. The goal is to think of moving exclusively from the thoracic spine with an appropriate scapular retraction/posterior tilt. In other words, the arm just comes along for the ride. The eyes (and head) should follow the hand wherever it goes.

Again, these are only exercises we use with certain players who we’ve deemed deficient in external rotation. If you’re a thrower, don’t simply add these to your routine without a valid assessment from someone who is qualified to make that estimation. You could actually make the argument that this would apply to some folks in the general population who have congenital laxity as well (especially females).

4. Throw!!!!! – Pitchers gain a considerable amount of glenohumeral external rotation over the course of a competitive season simply from throwing. Sometimes, the best solution is to simply be patient. I really like long toss above all else for these folks.

In closing, there are three important things I should note:

1. You don’t want to do anything to increase valgus laxity.

2. You’re much more likely to get hurt from being “too loose” than you are from being “too tight.” When it comes to stretching the throwing shoulder, “gentle” is the name of the game – and all mobility programs should be as individualized as possible.

3. Maintaining internal rotation is a lot more important than whatever is going on with external rotation. In fact, this piece could have just as easily been named "The Two Stretches Pitchers Shouldn't Do, Plus a Few That Only Some of Them Need."

To learn more about testing, training, and treating throwing shoulders, check out Optimal Shoulder Performance: From Rehab to High Performance.

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Shoulder Hurts? Start Here.

As you can probably imagine, given that I deal with a ton of baseball players - and the fact that I've written about shoulder pain a ton over the past decade - a lot of people initially come to Cressey Performance because their shoulder hurts.  It might be rotator cuff pain, AC joint irritation, or any of a host of other issues, but you'd be surprised at how many similarities there are among the ways that you address most of these issues.

The problem is that pain can throw a wrench in your plans and limit you in your ability to get to exactly where someone needs to improve movement-wise.  For instance, you might have someone who has a significant glenohumeral (ball-and-socket) internal rotation deficit, but it's hard to manually stretch them into internal rotation without further irritating a cranky AC joint.  Or, someone with a partial thickness rotator cuff tear may be dramatically limited in shoulder flexion, but even shoulder flexion with assisted scapular posterior tilt and upward rotation exacerbates their symptoms.  Very simply, you can't just pound round pegs into square holes when it comes to dealing with a delicate joint like the shoulder - and that applies to both asymptomatic and symptomatic shoulders. To that end, there are three initiatives that I think are the absolute most important places to start in just about every case. First, I'm a huge advocate of soft tissue work with a skilled manual therapist.  In our office, we have a massage therapist and chiropractor who performs both Active Release and Graston.  And, we make sure that any physical therapist to whom we refer clients uses manual therapy as an integral part of their treatment approach.  Whether you're a regular exerciser or not, tissues can get dense, nasty, and fibrotic, and integrating some hands-on work on the pec minor, posterior rotator cuff, lats, scalenes, sternocleidomastoid, and several other areas can dramatically reduce an individual's symptoms and improve range-of-motion instantly - and that allows us to do more with a corrective exercise program. Understandably, not everyone has access to a qualified manual therapist all the time, so you can always utilize self-myofascial release in the interim.  Here, in a video from Show and Go: High Performance Training to Look, Feel, and Move Better, CP massage therapist Chris Howard goes over a quick and easy way to loosen up the pecs:

The second area where you really can't go wrong is incorporating thoracic spine mobilizations.  The thoracic spine has direct interactions with the lumbar spine, rib cage, cervical spine, and scapulae; as a result, it has some very far-reaching effects. Unfortunately, most people are really stiff in this region - and that means they wind up with poor core and scapular stability, altered rib positioning (which impacts respiration), and cervical spine dysfunction.  Fortunately, mobilizing this area can have some quick and profound benefits; I've seen shoulder internal rotation improve by as much as 20 degrees in a matter of 30 seconds simply by incorporating a basic thoracic spine mobility drill.

That said, not all thoracic spine mobility drills are created equal.  Many of these drills require the glenohumeral joint to go into external rotation, abduction, and horizontal abduction in order to drive scapular posterior tilt/retraction and, in turn, thoracic spine extension and rotation. If you've got a cranky shoulder, this more extreme shoulder position usually isn't going to go over well.  So, drills like the side-lying extension-rotation are likely out:

For most folks, a quadruped extension-rotation drill will be an appropriate regression:

And, if the hand position (behind the head) is still problematic for the shoulder, you can always simply put it on the opposite shoulder (in the above example, the right hand would be placed on the left shoulder) and keep the rest of the movement the same.

Last, but certainly not least, you can almost always work on forward head posture from the get-go with someone whose shoulder hurts.  We start with standing chin tucks, and then progress to quadruped chin tucks.

Additionally, working on cervical rotation is extremely valuable, although teaching that is a bit beyond the scope of this post.

Keep in mind that these three broad initiatives are really just the tip of the iceberg when it comes to a comprehensive corrective exercise plan that would also include a focus on scapular stabilization and rotator cuff exercises, plus additional mobility drills.  They are, however, safe entry-level strategies you can use with just about anyone to get the ball rolling without making a shoulder hurt worse in a strength and conditioning program.

For more information on what a comprehensive shoulder rehabilitation program and the concurrent strength and conditioning program should include, check out Optimal Shoulder Performance, a DVD set I co-created with Mike Reinold, the Head Athletic Trainer and Rehabilitation Coordinator of the Boston Red Sox.

The Optimal Shoulder Performance DVD is a phenomenal presentation of the variables surrounding shoulder health, function, and performance. It combines the most current research, real world application as well as the the instruction on how to implement its vast amount of material immediately. After just one viewing, I decided to employ some of the tactics and methods into our assessment and exercise protocols, and as a result, I feel that myself, my staff and my clients have benefited greatly. Michael Ranfone BS, CSCS, LMT, ART Owner, Ranfone Training Systems

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