If you've read much of my stuff (most notably this article), you likely appreciate that I think it's really important for fitness professionals to understand corrective exercise and post-rehab training. Folks are demonstrating poorer movement quality than ever before, and injuries are getting more and more prevalent and specific. For the fitness professional, corrective exercise can quickly become a tremendous opportunity - or a huge weakness. To that end, given that Dean Somerset put his great resource, Post-Rehab Essentials, on sale for $50 off through the end of the day, I wanted to devote some thoughts to the subject with these seven points of "Eric Cressey Randomness."

1. Refer out. - With more and more certifications and seminars devoted to corrective work, the industry has a lot more "corrective cowboys:" people who are excited to be able to "fix" everything. Unfortunately, while this passion is admirable, it can lead to folks taking on too much and refusing to refer out. To that end, I think it's important for us to constantly remind fitness professionals to not work outside their scope of practice.

Referring out is AWESOME. I do it every single day - and to a wide variety of professionals. It provides me with more information, and more importantly, helps me toward the ultimate goal of getting the client/athlete better. Trainers often worry that if they refer out, they'll lose money. This generally isn't true, but even if it was, it's a short-term thing. If you appreciate the lifetime value of the client, you'll realize that getting him/her healthy will make you more profitable over the long-term.

Additionally, I've developed an awesome network of orthopedic specialists in the greater Boston area. As a result, I can generally get a client in to see a specialized doctor for any joint in about 24-48 hours. It's an awesome opportunity to "overdeliver" to a client - but it never would have come about if I hadn't been willing to refer out. As an added bonus, we'll often get referrals from these doctors as well.

2. Ancillary treatments are key. - For my entire career, I've been motivated by the fact that I absolutely hate not knowing something. It's pushed me to always continue my education and not get comfortable with what I know, and it's helped me to be open-minded to new ideas. However, I'm humble enough to recognize my limitations. I know a lot about elbows, but I'm not going to do your Tommy John surgery. I've worked with more pitchers than I can count, but I'm not a pitching coach. And, even if I was able to do all these things, there's no way I'd have time to do them all and leverage my true strengths. In other words, I rely heavily on competent professionals around me for everything from sport-specific training, to manual therapy, to diagnostic imaging, to surgery, to physical therapy, to nutritional recommendations. Surround yourself with great people with great skillsets, and corrective exercise quickly becomes a lot easier.

3. Soft tissue work is effective.

Here's what I know: people feel better after they foam roll, and their range of motion improves. Additionally, soft tissue treatments have been around for thousands of years for one reason: they work!

For some reason, though, every 4-6 months, somebody with a blog claims that foam rolling is the devil and doesn't work, and then dozens of people blow up my email address with questions about whether the world is going to end.

The truth is that we know very little about why various soft tissue approaches work. I recall a seminar with bodywork expert and fascial researcher Thomas Myers from a few year back, and he commented that we "know about 25% of what we need to know about the fascial system." If Myers doesn't have all the answers, then Johnny Raincloud, CPT probably hasn't found the secrets during his long-term stay in his parents' basement.

With that in mind, I do think it's safe to say that not all people respond the same to soft tissue work, and certainly not all soft tissue approaches are created equal. Foam rolling doesn't deliver the same results as an instrument-assisted approach, and dry needling likely works through dramatically different physiological avenues than cupping. As a result, we're left asking the client: "does it make you feel and move better?" If the answer continues to be "yes," then I'll keep recommending various soft tissue treatments - including foam rolling - until someone gives me a convincing contrarian argument with anecdotal evidence.

4. Strength can be corrective.

Ever had a friend with anterior knee pain (patellar tendinopathy) who went to physical therapy, did a bunch of leg extensions, and somehow managed to leave asymptomatic? It was brutally "non-functional" and short-sighted rehab, but it worked. Why?

Very simply, the affected (degenerative or inflamed) tissues had an opportunity to rest, and they came back stronger than previously. A stronger tissue is less likely to become degenerative or inflamed as it takes on life's demands.

Good rehab would have obviously focused on redistributing stress throughout the body so that this one tissue wouldn't get overloaded moving forward. In the patellar tendon example, developing better ankle and hip mobility would be key, and strength and motor control at the hip and lumbar spine would be huge as well. Certainly, cleaning up tissue quality would be a great addition, too. However, that doesn't diminish the fact that a stronger tissue is a healthier tissue.

This also extends to the concept of relative stiffness. As an example, a stronger lower trapezius can help to overcome the stiffness in the latissimus dorsi during various upper extremity tasks.

And, a stronger anterior core can ensure corrective spine and rib positioning during overhead reaching - again, to overcome stiff lats.

Don't ever forget that it's your job to make people stronger. If you get too "corrective" in your mindset, pretty soon, you've got clients who just come in and foam roll and stretch for 60 minutes, then leave without actually sweating. You still have to deliver a training effect!

5. Minimalist sneakers might be your worst nightmare if you have high arches.

I love minimalist sneakers for my sprint and change-of-direction work. I don't, however, love to wear them on hard floors for 8-10 hours a day. I'm part of the small percentage of the population that has super high arches and doesn't decelerate very well, so cushioning is my best friend. Throwing in a $2 "cut-to-fit" padding in my sneakers has done wonders for my knees over the years, and I'll actually wear through them every 4-6 weeks.

The New Balance Minimus 00 is a sneaker I've been wearing recently to overcome this. It's a zero drop shoe (no slope down from the heel to the toe), and while lightweight, it offers a bit more cushioning (and lateral support, for change of direction) than typical minimal options.

All that said, just don't force a round peg in a square hole with respect to footwear. Some people just aren't ready for minimalist footwear - and even if they are ready to try them out, make sure you integrate usage gradually.

6. The pendulum needs to swing back to center with respect to thoracic spine mobilizations. - Thoracic spine mobility deficits are a big problem in the general population, given the number of people who spend too much time sitting at a computer. Athletes are a bit of a different situation, though, as some actually have flat (excessively extended) thoracic spines and don't need more mobility. As an example, check out the top of this yoga push-up before we corrected it.

This athlete has a flat thoracic spine, limited shoulder flexion, and insufficient scapular upward rotation. So, he'll logically go to the path of least resistance: excessive thoracic motion (as evidenced by the "arch" in his upper back). The shoulder blades don't rotate up sufficiently, and he's also "riding" on the superior aspect of his glenohumeral (shoulder ball-and-socket) joint. Here is it, "mostly" corrected a few seconds later:

By getting him to "fill up" the space between his shoulder blades with his rib cage (encouraging more thoracic flexion) and cueing better upward rotation of his scapula, we can quickly recognize how limited his shoulder flexion is. In the first photo, he's forcing shoulder ROM that isn't there, whereas in the second one, he's working within the context of his current mobility limitations.

If we just feed into his thoracic spine hypermobility with more mobilizations, we'll just be teaching him to move even worse.

7. You'll never address movement impairments optimally unless nutrition and supplementation are spot on. - It never ceases to amaze me how many athletes will bust their butts in the gym and in rehab, following those programs to a "T" - but supplement that work with a steady diet of energy drinks and crappy food. I'm not talking about debating whether grains and dairy are bad, and whether "paleo" is too extreme for an athlete; those are calculus questions when we should be talking about basic math. A lot of athletes literally don't eat vegetables or drink enough water. That's as basic as it comes. Movement quality will never improve optimally unless you're healthy on the inside, too.

This article was actually a lot of fun to write, so I'll probably turn it into a series for a bit down the road. In the meantime, though, I'd encourage you to check out Dean Somerset's Post-Rehab Essentials resource to learn more in this regard. I don't hesitate to endorse this comprehensive corrective exercise resource, as the content is fantastic, Dean is an excellent teacher, and the product provides some continuing education credits. The $50 off just sweetens the deal. Check it out HERE.

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Today marks the third and final installment of Eric Schoenberg's series on thoracic mobility drills - and whether or not they're indicated.  In case you missed them, be sure to check out Part 1 and Part 2.

In the final piece of this series, I want to tie things together with a few foundational concepts that we use in the daily management of our athletes and emphasize in our Elite Baseball Mentorships.

Eric C. has written about the concept of relative stiffness on this blog on numerous occasions.  So, feel free to refer back to his articles for more background information.  Relative stiffness or relative flexibility was introduced to me by Shirley Sahrmann and the incredible faculty at Washington University in St. Louis. This is a pillar of their Movement System Impairment model. 

Today, I am going to discuss how relative flexibility impacts the thoracic spine and shed some more light on why T-spine extension work is not always necessary in the baseball athlete.          

Relative flexibility describes the relationship of how the amount of stiffness (or tension) in one area of soft tissue (muscles, ligaments, tendons, etc.) results in compensatory movement at an adjoining joint that is controlled by less stiffness.  This relationship can change (positively or negatively) based on the exercises we choose and the manner in which we perform them.

There are countless examples of relative stiffness in the body.  One of the most common examples that we see involves the lumbar spine.  If the lats are stiffer than the anterior core, then the athlete will be more prone to an extended posture. The athlete will compensate with lumbar extension with overhead activity.  The video that I included in part 2 of this series is a good example:

In this video, Lats, lumbar extensors > (stiffer than) Anterior Core = Lumbar extension tendency.

Note: Clearly, there is a lot more involved (fascia, ligaments, structural issues, motor control, relative position of adjacent joints, etc.) than just this simple math problem, but for the scope of this article, we will leave it at this.  This example is fairly straightforward and I think we are all on the same page here.  We would not program activities that would further encourage lumbar extension and drive the improper recruitment and motor pattern.

In this case, we know that simply “stretching” or foam rolling the lats will not work in isolation. We need to go ahead and “stiffen” the anterior core, while at the same time, downregulating the overuse of the lats.  We often will do this by using exericses that encourage a neutral alignment with overhead activity (i.e. wall slides, back to wall shoulder flexion) as well as limiting the amount of carrying by our sides (e.g. deadlifts, dumbbell lunges, farmer’s walks, etc.) and instead, focusing on options like bottoms-up kettlebell carries, landmine presses, and goblet variations.

In the case of someone that is in too much thoracic extension (or relative thoracic flexion), though, things can get a little more confusing.  The athlete will have increased stiffness of the thoracic extensors vs. flexors: Thoracic Extensors > (stiffer than) Thoracic Flexors = Thoracic extension tendency.

However, we often see the emphasis remain on bench T-spine mobs, quadruped extension/rotations, and side-lying windmill variations? This results in two problems:

1. The athlete will actually become hypermobile (segmentally) and develop a local stability issue. (inverted U-curve)
2. The athlete has difficulty “getting out of extension” due to increased relative stiffness of the thoracic extensors, lats, and scapulothoracic musculature.

This inability to properly flex the spine at ball release can result in a decrease in the required scapular upward rotation and elevation to maintain proper scapulohumeral and glenohumeral joint congruency.  This is a fancy way of saying that if your upper back isn’t positioned correctly, the ball won’t sit flush with the socket. This process can contribute to some of the shoulder and elbow pathologies that we so commonly see in the throwing population.

There is one more point that needs to be addressed to complete this series – and that is the role of the rectus abdominus in thoracic spine mobility.  In this case, the athlete will present in too much thoracic flexion and may appear as though they would benefit from T-spine extension mobility drills.  However, this athlete will not benefit from these exercises unless we appreciate the following point.

When we cue an athlete to limit his extension or “rib flare” we often say “ribs down”.  This seems like a relatively benign cue to help promote a neutral spine and pelvic orientation.  However, we must be sure that the athlete is able to properly recruit external obliques (often with lower level exercises such as back to wall shoulder flexion or a dead bug variation) to help achieve this movement correction.

The reason for this is that increased stiffness of rectus abdominus (dominance) limits ability of T-spine to move out of flexion (or neutral).  Using our relative stiffness example from before, if: Rectus abdominus > (stiffer than) Thoracic Extensors = Thoracic Flexion Tendency.

Therefore, if an athlete is actually is in too much flexion… i.e. sway back (most commonly - posterior tilt and lumbar extension - hanging on rectus as their anti-gravity muscle), he will have a very difficult time getting out of flexion.  This occurs regardless of how many T-spine drills we prescribe.  This is akin to stretching rectus femoris when someone is stuck in a faulty thoracic and lumbopelvic position.

The best approach in our case above is to “allow” t-spine mobility (extension) to occur by decreasing rectus dominance and getting someone out of T-spine flexion.  I am all for cuing the ribs down and establishing alignment, but HOW we get an athlete to do this is of the utmost importance.  The main point here is forcing T-spine extension in the presence of increased relative stiffness of rectus abdominus is not going to give us results.  In other words, weak external obliques will result in rectus overuse and thoracic “immobility” regardless of how many T-spine mobility drills we include in our programs. 

To summarize, this is a very important (and difficult) concept that – like everything else – requires a trained eye and an individualized approach.  If an athlete has too much thoracic and lumbar extension, this can result in scapular depression and downward rotation via, among others things, excessive lat dominance, which leads to a lot of our shoulder and elbow dysfunction.  On the other hand, too little thoracic extension results in scapular anterior tilt and decreased glenohumeral external rotation (“lay back”), also resulting in dysfunction and pathology. 

As a quick review, you want to be able to answer the following questions before prescribing T-Spine extension exercises:

• Is there a lack of T-spine extension (or rotation). If not, then why prescribe T-spine extension mobility drills?
• Where is the extension coming from (upper or lower T-spine, L-spine, C-spine)?
• Is the athlete already at end-range extension and if so, is our attempt to “gain” extension at end-range creating unwanted motion elsewhere? (hypermobility)
• Lastly, if an athlete presents with mal-alignment (too much thoracic extension or thoracic flexion): first, identify it, then determine why this is happening prior to simply prescribing a bunch of mobility exercises.

Conclusion

This point, along with many others, is a main reason why we chose to develop the Elite Baseball Mentorship program.  As we gather together in these groups, many conventionally accepted ideas and concepts are questioned and explored and the demand for proof (whether it be from research or experience) requires us all to think more critically.  Most importantly, with baseball-related injuries continuing to rise, this allows us to question the status quo of generally accepted baseball-specific protocols.  Ultimately, this collaboration allows us all to advance the bar and develop a better opportunity for our athletes to meet their goals through better health and performance.

Also, if you are interested in more information like this, we would love to see you at one of our Elite Baseball Mentorships. We'll be hosting these events in June, October, and December of 2014. Please click here for more information.

Author’s Note: I would like to thank Michele Ionno, MS, SPT (Wash U Program in Physical Therapy) for his contribution to the 3^rd phase of this blog series.

About the Author

Eric Schoenberg, MSPT, CSCS is co-owner of Momentum Physical Therapy, located in Milford, MA.  He can be reached at eric@momentumpt.com. 

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Today is Part 2 of a detailed series on the thoracic spine from Eric Schoenberg.  If you missed it, be sure to check out Part 1. -EC

At this point, we need to quickly touch on the concept of “neutral.”  This is certainly a hot topic in the physical therapy and strength and conditioning worlds, as it should be.  For our purposes, we like to be clear that when someone is too flexed (i.e. fully slumped posture), our cue is to “extend back to neutral.”  In addition, when someone is too extended, the cue would be to “flex back to neutral.”  This holds true in all segments of the body and in all three planes of motion (e.g. pelvic tilt, genu valgus, etc.)  The problem that we tend to see is we don’t grade our correction and “overcorrect.”  This results in fixing one problem only to create a new one in the opposite direction.  

In Malcolm Gladwell’s new book, David and Goliath, he refers to this as the “inverted U curve.”  Its application here is that IF an athlete truly lacks T-spine mobility, then once we properly gain it, continued efforts to improve (rather than just maintain) this mobility will ultimately create a brand new problem (hypermobility).  This needs to be considered when we write new programs and lends itself nicely to the importance of thorough evaluation and re-evaluations.

To quickly recap part 1, for the purpose of this series, a cue to “extend the T-spine” is really a case of moving out of excessive flexion and learning to control flexion throughout the throwing motion.

In part 2 of this series, we will focus on the postural alignment and movement examination and its implications in developing an individualized exercise prescription for the athlete.  As a quick side note, it is of particular importance to recognize that the body segments don’t work in isolation.  This is a simple statement; however, when attempting to capture the role of a particular body segment or group of exercises, we are missing the big picture if we try to develop a concept without appreciating the kinetic chain.

In our opinion, the hallmark of an effective examination is the ability to properly identify the athlete’s unique postural alignment and movement tendencies.  These exams must be done with the shirt off to appreciate the bony and soft tissue anatomy. With respect to the thoracic spine, we first identify whether that athlete is in flexion, neutral, or extension.

Here's an example of an athlete with a flattened T-spine, and shoulder blades that have no idea what to do!

Additionally, we need to appreciate the position of the scapula and its impact on the appearance of perceived thoracic flexion.  An athlete that presents with scapular anterior tilt, abduction, and/or internal rotation can easily fool you into thinking that the athlete’s upper back is “rounded” or kyphotic. An athlete with a flat thoracic spine (hypokyphosis) will have a more prominent scapula due to lack of normal contour of the T-spine and ribcage.  In extreme cases, we will see the following:

1. Hypokyphosis (lack of T-spine flexion)

2. Scheurmann's Disease (greater than 60 degrees, and structural)

On x-ray, these cases will show a change in the normal vertebral “wedging.”  The intervention in this case is NOT to attempt to fix the mobility issue, but first determine if the issue is osseous/structural in nature.  Just like any other joint (the hip immediately comes to mind), you can’t stretch bone and any attempt to do so will result in an unhappy athlete!  These are extreme examples, but certainly something that warrants inclusion in this article.

However, more commonly in the physical therapy or strength and conditioning settings, we will see more “middle of the road” cases where there is too much or too little thoracic mobility. As you can see in the lateral view below, this athlete appears to be in excessive thoracic flexion, but it's really just anterior tilting of the scapulae.

However, in the posterior view, you'd be able to appreciate that the T-spine is relatively extended compared to accepted norms (40° flexion = normal curve). 

Moving forward, static alignment does not tell the whole story, so don’t test it alone and don’t let it fool you.  All too often, I hear people trying to prove a point about pitching mechanics or exercise technique and the only proof is a still photo.  This practice needs to stop because it is impossible to capture the complexity of human movement and make a conclusive statement from a screen shot. This concept is why the combination of the postural exam and movement analysis is so critical.

Athletes don’t get injured when they are standing still. They get injured moving (incorrectly!).  For that reason, watch your athlete’s move.  The concepts of FMS or whatever collection of multi-joint movements you like to combine to form a “movement examination” are great tools to collect data on your athlete’s preferred movement patterns.  However, it is also critical to watch the athlete perform the unique movements of their chosen sport. 

In our case, we like to talk to our athlete’s about pitching and we certainly like to watch them throw.  Asking questions like:  “What do you struggle with mechanically” or “where do you break down when you get tired” gives us valuable insight into movement tendencies and injury risk.  With respect to exercise, we observe closely to make sure we are achieving the desired result of the exercise.  In addition, we ask our athletes where they feel a particular exercise to help determine activation patterns and sequencing (motor control).

In addition to watching our athletes throw/pitch, swing, and/or run, we employ simple movement tests such as standing bilateral shoulder flexion (and abduction) to gather critical information about movement quality, timing, and relative stiffness. 

With respect to the video above, consider the excessive extension moment at the thoracic (and lumbar spine) due to increased relative flexibility resulting from poor anterior core stiffness.  This video brings up a lot of questions in my mind:

• Does this athlete need more mobility work into thoracic extension? 
• If he attempted these exercises, how can you be sure the motion will even come from the right place?
• If an athlete is truly “lax” congenitally, then why would they lack mobility at the T-Spine and nowhere else?  
• Are you sure his lack of shoulder flexion is due to decreased thoracic mobility? 
• Or, is he too flexible in his spine and too readily pulls into extension due to the stiffness of his lats? 

My point here is we need to consider the fact that improperly prescribed exercise will make the athlete worse than no exercise at all.  So, if you’re not sure, don’t guess.  Refer out or continue to re-assess until it becomes clear what the athlete needs.

Another simple movement test that we will have the athlete perform is standing thoracic flexion and extension.  Here we will assess the timing (quality), location, and amount of available range of motion that the athlete is working with.

It is also good practice to watch an athlete perform an exercise prior to putting it in his program. 

This athlete (also pictured above) demonstrates faulty movement by not getting out of extension at the top of his pushup prior to initiating the “pike” portion of the yoga push up.  When corrected, in the video below, he did a better job of getting his T-spine in position to allow his scapula to have a better platform to upwardly rotate and elevate as his hands moved overhead.  This was not a mobility issue; this was a patterning or motor control problem.

I should mention that in a full examination, we would consider movement testing of thoracic rotation and sidebending, ventilation, rib cage alignment, quadruped position/movement, etc.  But, for the purposes of this series, we again are choosing to focus primarily on the sagittal plane.  Pay attention to the way in which the athlete returns from flexion to get a good idea of his/her recruitment strategies.

In conclusion, the combination of static posture, movement testing, and unique athletic movement allows us to create a well-rounded profile of the athlete’s strengths and weaknesses.  Be sure that your examination a) identifies areas of limitation that need to be addressed and b) determines the reason why the athlete has these impairments.

In the third and final part of this series, we will discuss the concepts of relative flexibility and motor control as it relates to the topic of thoracic spine extension.

Also, if you’re interested in more information like this, we would love to see you at one of our Elite Baseball Mentorships, with the next one taking place in June. Click here to learn more.

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Today’s guest post comes from my friend and colleague, physical therapist Eric Schoenberg.  Eric is an integral part of our Elite Baseball Mentorships, and here, he kicks off a three-part series that I think you'll find very educational - even if it is a bit "geeky" along the way.  It'll test what you know and make you question some of the stuff you do with your training and work with clients. -EC

I’ll start by saying this is a classic case of giving an athlete what they need, not what we predict or assume they will need.  Let’s be clear up front: there are a lot of athletes that lack thoracic extension and rotation and certainly can benefit from T-spine mobility work.  This is especially true for your general population clients that live in flexion all day – although not every “average joe” is stuck in flexion; this is a wrong assumption!  However, for the purpose of this series, I am going to make a case for the following statement:

Not every individual - especially in baseball populations - needs thoracic extension and rotation mobility drills!  

In fact, to take it a step further, I would argue that in some cases, performing these types of exercises will actually make the athlete worse.

During our Elite Baseball Mentorship in August, I mentioned in passing during the postural examination portion of the breakout session that a lot of athletes present with flattened thoracic spines and some are actually relatively extended.  I followed this up by stating that some people don’t really need any T-Spine extension work.  This simple statement was met with a lot of surprise and follow up questions.

As a result, Eric and I thought it would be a good idea to explore this concept in greater detail.  As is often the case, a relatively benign statement takes on a life of its own and turns into a multi-part blog series.  As we develop these concepts, please feel free to share your thoughts and experiences in the comments section below.

The general assumption of the group was that everyone was kyphotic and T-spine extension was a default group of exercises that EVERY athlete needed.  This premise, however, does not take into account a host of key considerations, such as:

• Defining T-Spine Extension. (part 1)
• Anatomy and role of the Thoracic Spine, (part 1)
• Scapulothoracic joint kinematics, (part 1)
• Importance of a thorough static postural alignment and movement examination, (part 2)
• Scapular position/prominence, (part 2)
• Effect of the T-Spine on adjacent joints such as cervical spine, lumbar spine, pelvis, scapula, humerus, and ribcage, (part 2)
• Concept of relative stiffness, (part 3)
• Faulty motor control resulting in limited thoracic flexion (yes, lack of flexion!), (part 3)
• Timing and amount of relative T-spine extension and rotation in the pitching delivery. (covered in part recently by Matt Blake and Eric C. here and here.)

In an attempt to properly define thoracic spine extension with respect to the baseball player, we must first look at functional anatomy. The thoracic spine, with its rib attachments from T1-T10, is built for stability – most notably to protect the internal organs.  In addition, the T-spine has thinner intervertebral discs, a feature that adds to its relative inflexibility.  The sagittal alignment of the thoracic spine is kyphotic: 40 degrees in adults. (Neumann D.A. 2002).  With that said, we are not really talking about the T-spine being “extended”, but instead are talking about the relative amount of flexion that an athlete is in.  With that description, it’s important to appreciate that T-spine extension drills are working to put an athlete into an acceptable amount of flexion!  It is this flexion (or convexity) that provides a surface for the concave, ventral surface of the scapula to “float” on and create the scapulothoracic joint. (medial border of scapula and ribs 2-7).

For these reasons, we need to not just label an athlete as being “kyphotic” or having a “flat T-spine.”  Instead, we should attempt to define which segments of the T-spine have static or dynamic alignment issue and/or movement dysfunction and address them accordingly.

An important concept to look at is the T-spine is comprised of 12 vertebrae, so we will often find components of flexion, extension, and rotation within those 12 segments. Crosbie, et al. reports that the majority of T-spine extension occurs in the lower T-spine during overhead arm movement. This makes sense due to the thoracolumbar junction and the shape of the lower thoracic vertebrae.  The T10-T12 vertebrae are similar in size and function to the lumbar vertebrae.  T10 has a different rib articulation than T2-9 and T11/T12 have no facets on their transverse process for rib attachments (thus, increasing relative mobility).  So, more often than not, when we see anterior pelvic tilt, and lumbar extension compensation, we can assume that the lower T-spine is doing the same thing.  So what if, for the purposes of this article, we grouped the lumbar spine as T10-L5?

As a quick aside, it is recognized that the thoracic spine moves in three planes of motion.  More specifically, with respect to the frontal and transverse plane, with single arm elevation, the upper T-spine (T1-T5) has ipsilateral coupling of the lateral bending and rotation, whereas in the mid-lower T-spine T6-T12, we see contralateral coupling of lateral bending and rotation.  So in the frontal and transverse planes, the T-spine essentially works as two distinctly different subgroups.  This is important to consider when prescribing exercises to address a perceived movement impairment.  In addition, it is important to remember that the thoracic spine and hips (along with a stable lumbar spine) provide the rotational separation needed to excel in the game of baseball. However, for the purposes of this article, we will focus on the sagittal plane motion of flexion/extension.

As we continue to look at the sagittal plane, but shift our focus to T1, we see a smaller vertebrae (see picture above) that more resembles C7 (and other cervical vertebrae) than the caudal segments (T2-T9).  A case can be made that T1 (cervicothoracic junction) functions more like a cervical vertebrae than a thoracic vertebrae.

This leaves us with T2-T9: eight segments with an extreme mobility problem!  This is where we are really trying to mobilize “out of too much flexion” to get to an acceptable (neutral) position to allow for enough scapular (namely upward rotation and elevation) and glenohumeral motion to give us enough “space” to throw a baseball without causing an impingement.

So how can we be sure that we are following all these rules in three planes of motion when we are performing our T-spine mobility drills?  Are we in fact gaining motion in the correct segments within the context of their coupled motions?  Or, are we simply “mobilizing” what moves easiest and taking the “path of least resistance”?

Check back later in the week for part 2 of this series to read more about evaluation of static alignment and movement testing.  In addition, we will discuss how scapula position can fool us and (in part 3) how too many “abs” can be a bad thing.

In addition, if you’re interested in more information like this, we would love to see you at one of our Elite Baseball Mentorship, with the next one taking place in June. Click here to learn more.

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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:"

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

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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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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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.

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

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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