Home Posts tagged "Throwing Injuries"

Why Rhomboids Probably Aren’t Your Best Friend

Today, I've got an excerpt from my new course, Sturdy Shoulder Solutions. I discuss the functional anatomy of the rhomboids, a commonly misunderstood muscle group with big implications.

For a lot more functional anatomy insights like these - as well as a comprehensive look at shoulder assessment, programming, and coaching - be sure to check out Sturdy Shoulder Solutions.

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Random Thoughts on Sports Performance Training – Installment 29

I didn't get in a May installment of this series, but the good news is that it gave me two months to gather my thoughts for a big June! Here goes...

1. Athleticism is doesn't have to be max effort if you have a strength and power "reserve."

Cressey Sports Performance athlete Logan Morrison is currently second in Major League Baseball in homeruns. I came across this video of #22 on Twitter and it immediately got me thinking:

Hitting bombs in the big leagues - particularly on 95mph sinkers - is really challenging, but that looked absurdly easy. He put some force into the ground, got himself in a good position to succeed, and athleticism "happened."

The only reason this is possible is that he's developed a strength and power "reserve." LoMo is strong - and more importantly, he's a powerful dude. When he throws a medicine ball, in many cases, the entire gym stops and watches because it sounds like he's going to knock the wall down. When you've got a foundation of strength and know how to use it quickly, this kind of easy athleticism happens. It does not, however, happen if you're a) weak or b) strong and not powerful. I'd call LoMo a nice blend on the absolute strength-to-speed continuum.

2. If you're struggling to feel external rotation exercises in the right place, try this quick and easy fix.

One of the reason some throwers struggle to "keep the biceps" quiet during external rotation drills is that they start too close to the end-range for external rotation. A quick strategy to improve this is to simply build a little success in a more internally rotated position. This video goes into more depth:

3. Be cautiously optimistic with new surgical advances.

On a pretty regular basis, we hear about remarkable sports medicine breakthroughs that will revolutionize the way we prevent and treat both acute and chronic diseases and injuries/conditions. Unfortunately, they usually don't live up to the hype. Most of the time, we're talking about a "miracle" supplement or drug, but sometimes, we have to ponder the benefits of a new surgical procedure.

In the mid 1990s, the thermal capsulorrhaphy procedure was introduced to attempt to treat shoulder instability. It gained some momentum in the few years that followed, but the outcomes didn't match the hype in spite of the fact that the initial theory seemed decent (heat can shorten capsular tissues, which would theoretically increase shoulder stability). Failure rates were just too high.

Conversely, in 1974, Dr. Frank Jobe revolutionized the way elbow pain was treated in baseball pitchers - and saved a lot of careers - when he performed the first successful ulnar collateral ligament reconstruction (better known as Tommy John Surgery). More than 1/4 of MLB pitchers have had Tommy John, so you could say that this procedure revolutionized sports medicine even though it's taken decades to fine-tune it.

More recently, a new surgery - the UCL repair with internal brace -  has been gaining some steam as an alternative to Tommy John surgery. The initial results have been very promising, particularly in situations where the patient is a good match (depending on age, activity level, and location and extent of the UCL tear). I've actually seen two of these surgeries in the past week myself. One pitcher (Seth Maness) was able to successfully return to the Major Leagues after having it - but we still have a long way to go to determine if it might someday dramatically reduce the number of Tommy John surgeries that take place. Why? 

Right now, we only have statistics on a limited number of these cases, and they're usually in the high school and college realms. All that is reported on is return to previous level of competition (e.g., varsity baseball). We don't know whether a kid that has it at age 16 is still thriving with a healthy elbow at age 22 during his senior year of college.

Additionally, Seth Maness has really been an 88-90mph pitcher throughout his MLB career. We don't know if this same level of success will be seen with 95-100mph flamethrowers. 

Dr. Jeffrey Dugas has become known as "the guy" when it comes to these procedures, and I loved the fact that he reiterated "cautious optimism" in his webinar at the American Sports Medicine Institute Injuries in Baseball course earlier this year. If this gets rolled out too quickly and in the wrong populations, the failure rate could be significantly higher and give an otherwise effective surgery a bad name.  I think it's important for all of us to stay on top of sports medicine research to make sure we don't miss out on these advancements, but also so that we know to be informed consumers so that we don't jump behind new innovations without having all the information we need.

Speaking of the ASMI Injuries in Baseball Course, it's on sale for $100 off through this Sunday, June 24, at midnight. I've enjoyed going through this collection of webinars, and I'm sure you will, too. You can check it out HERE.

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Cressey Sports Performance Lower Extremity Elite Baseball Mentorship – August 21-23, 2016

We're excited to announce our next Elite Baseball Mentorship offering: a lower-extremity course that will take place on August 21-23, 2016 at our Hudson, MA facility.

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The Cressey Sports Performance Elite Baseball Mentorships provide an educational opportunity to become a trusted resource to this dramatically underserved athletic population. Through a combination of classroom presentations, practical demonstrations, case studies, video analysis, and observation of training, you’ll learn about our integrated system for performance enhancement and injury prevention and rehabilitation in baseball athletes. Cressey Sports Performance has become a trusted resource for over 100 professional players from all over the country each off-season, and this is your opportunity to experience “why” first-hand at our state-of-the-art facility.

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Course Description:

The Lower Extremity Cressey Sports Performance Elite Baseball Mentorship complements our upper extremity course by introducing attendees to the most common injuries and movement impairments encountered by baseball players in a sport that combines violent extension, rotation, change-of-direction, acceleration, and top speed sprinting. Core control and lower extremity function considerations will be applied to the throwing and hitting motions.

Course Agenda:

Sunday

Morning Session: Lecture

8:30-9:00AM – Registration and Introduction (Eric Cressey)
9:00-10:00AM – Movement Impairments of the Lower Extremity and Core (Eric Schoenberg)
10:00-11:00AM – Common Injuries and their Mechanisms (Eric Cressey)
11:00-11:15AM – Break
11:15AM-12:15PM – Common Mistakes in Training and Rehabilitating the Core and Lower-Extremity (Eric Schoenberg)
12:15-1:00PM – Lunch (provided)

Afternoon Session: Lecture and Video Analysis

1:00-2:00PM – Understanding and Managing Asymmetry in Rotational Sport Athletes (Eric Cressey)
2:00-3:15PM – Video Evaluation of Throwers: Lower-Extremity Considerations for Push-off and Foot-Plant (Matt Blake)
3:15-3:30PM – Break
3:30-4:45PM – (Matt Blake) – Video Evaluation of Hitters: Lower-Extremity Demands and Sequencing
4:45-5:30PM – Case Studies and Q&A

5:30PM Reception (Dinner Provided)

Monday

Morning Session: Practical

8:00AM-10:00AM – Lower-Extremity Physical Assessment: Static and Dynamic (Eric Cressey and Eric Schoenberg)
10:00-11:30AM – Lower-Extremity Prehabilitation/Rehabilitation Exercises (Eric Cressey and Eric Schoenberg)
11:30AM-12:00PM – Lunch (on your own)

Afternoon Session: Observation at Cressey Sports Performance – 12PM-6PM*

Tuesday

Morning Session: Practical

8:00AM-9:30AM – Training Power Outside the Sagittal Plane (Eric Cressey and Eric Schoenberg)
9:30-11:00AM – Individualizing Driveline to the Pitcher (Matt Blake)
11:30AM-12:00PM – Lunch (on your own)

Afternoon Session: Observation at Cressey Sports Performance – 12PM-6PM*

* The afternoon observation sessions on Monday and Tuesday will allow attendees to see in real-time the day-to-day operation of the comprehensive baseball training programs unique to Cressey Sports Performance. This observation of live training on the CSP floor with our professional, college, and high school baseball players will allow you to experience firsthand our approaches to:

• Programming
• Proper coaching cues for optimal results
• Soft tissue techniques
• Activation and mobility drills
• Strength/power development
• Medicine ball work
• Multi-directional stability
• Metabolic conditioning
• Sprint/agility programs
• Base stealing technique

In addition, you will experience:

• Live throwing sessions
• Biomechanical video analysis using the Right View Pro system
• Movement evaluation
• Live evaluations of attendees with Eric Schoenberg

Location:

Cressey Sports Performance
577 Main St.
Suite 310
Hudson, MA 01749

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Cost:

$999

No sign-ups will be accepted on the day of the event.

Continuing Education Credits:

2.0 NSCA CEUs (20 contact hours)

Registration Information:

Click here to register using our 100% secure server.

Notes:

• No prerequisites required.
• Participants will receive a manual of notes from the event’s presentations.
• Space is extremely limited
• We are keeping the size of this seminar small so that we can make it a far more productive educational experience.
•This event will not be videotaped.

For details about travel, accommodations, and other logistics, please email cspmass@gmail.com.

We hope to see you there!
  

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Expanding the “Safe” Exercise Repertoire

In his outstanding new book, Back Mechanic, spine expert Dr. Stuart McGill speaks frequently to how he works with patients to “expand pain-free abilities” over the course of time. This begins with practicing good “spine hygiene” throughout daily activities while avoiding any positions or movements that provoke symptoms.

Back-Mechanic

As a patient gets some asymptomatic time under his/her belt, new movements and exercises are gradually introduced. Over time, the individual’s pain-free movement repertoire can be integrated into a comprehensive exercise program. Effectively, it’s a way to test the waters without simply jumping into the deep end. This is an especially important process for patients who have lived with chronic back pain and need to break the cycle to relearn what it actually is like to feel good. As Dr. McGill writes,

“The approach that has produced the best results for us over the years has been to teach the patient pain-free movement. This is based on the ‘gate theory’ of pain. Finding simple movements that do not cause pain floods the proprioceptive system with joint and muscle sensor signals, leaving little room for pain signals to get through the neural ‘gates.’ These pain-free movements are repeated to encode the pattern in the brain. Slowly, the patient’s ability repertoire of pain free movement increases until they are able to move well, and for longer periods. They successfully replaced the pain inducing patterns wired into their brains with pain-free patterns.”

As I read through Dr. McGill’s work, I couldn’t help but think about how it can be adapted to other realms of the rehabilitation and fitness communities. As an example, speaking to my main realm of interest – training baseball players – we have to consider how this applies to return-to-throwing programs in the baseball rehabilitation world. Truth be told, this approach traditionally has not been applied well in most rehabilitation scenarios in overhead throwing athletes because they have just about the most specific kind of mechanical pain there is. In other words, the elbow or shoulder only bothers them in this position, and usually at higher velocities:

layback

Most of the significant upper extremity throwing injuries you see don’t involve much pain at rest. Rather, the arm only hurts during the act of throwing. Unfortunately (or fortunately, depending on how you look at it), nothing in our daily lives really simulates the stress of throwing. As such, for a thrower, expanding pain-free abilities really have just traditionally meant:

throwingprogression

You’d actually be surprised to find that there often aren’t any progressions that “link” one phase of this progression to the next. In the “not throwing” phase, we often see a lot of generic arm care exercises, but little attention to speed of movement, integrating the lower half and core, and incorporating training positions specific to an athlete’s arm slot. Unfortunately, just laying on a table and doing some exercises with a 5-pound dumbbell won’t necessarily prepare you to throw the ball on a line at 120-feet.

For this reason, we always seek out physical therapists who treat the athlete “globally” and appreciate the incremental stress of various phases of throwing. The name of the game is to incorporate several “test the water” steps between each of these three categories. We do the exact same things as players ramp up their off-season throwing programs. As physical therapist Charlie Weingroff has astutely observed in the past, “Training = Rehab, Rehab = Training.”

How do we bridge the gap between not throwing and flat-ground throwing as much as possible? For starters, rotator cuff exercises need to take place near 90 degrees of abduction to reflect the amount of scapular upward rotation and shoulder elevation that takes place during throwing. Moreover, it’s important to work closer to true end-range of external rotation in testing strength that “matters” during the lay-back phase of throwing. And, we need to test how they do with the external-to-internal rotation transition.

To this point, in my career, I’ve seen a lot of throwers who have passed physical exams of cuff strength in the adducted (arm at the side) position, but failed miserably in the “arm slot” positions that matter. Picking the right progressions really matters.

Additionally, more aggressive rotational medicine ball drills can help to teach force production, transfer, and acceptance in a manner specific to the throwing motion.

Unfortunately, at the end of the day, the only thing that can truly reflect the stress of throwing is actually throwing. And this is also why there have to be incremental steps from flat-ground work to mound work (where external rotation range-of-motion is considerably higher).

Fortunately for most rehab specialists and the fitness professionals who pick up where they leave off, most return-to-action scenarios aren’t as complex as getting a MLB pitcher back on the mound. A general fitness client with a classic external impingement shoulder presentation might just need to test the waters in a progression along these lines:

(Feet-Elevated) Push-up Isometric Holds > (Feet-Elevated) Body Weight Push-up > Stability Ball Push-up > Weighted Push-up > Neutral Grip DB Floor Press > Neutral Grip Decline DB Press > Pronated Grip Decline DB Press > Barbell Board Press (gradual lowering) > Barbell Floor Press > Neutral Grip DB Bench Press > Low Incline DB Press > Close-Grip Bench Press > Bench Press > Bottoms-up KB Military Press > Barbell Incline Press > Barbell Overhead Pressing

Different people might start at different places on this continuum, and some folks might not need to progress all the way along. The point is that there needs to be a rhyme and reason to whatever continuum you create for expanding individuals’ pain-free abilities.

A lot of folks have a pretty good understanding of “progression.” This, to me, refers to how we sequentially teach movements and make training more challenging. Unfortunately, not nearly as many professionals understand “pain-free progression” under the unique circumstances surrounding injury.

This is one of many reasons why I think understanding post-rehab training is so important for the modern fitness professional. It’s a tremendous competitive advantage for differentiating oneself in the “training marketplace.” Moreover, on a purely ethical level, having a solid understanding of various injuries and their implications helps a coach deliver a safe training experience.

With all this in mind, I'd really encourage my readers to check out Dean Somerset's resource, Post-Rehab Essentials. It's a fantastic product that also happens to be on sale for $50 off through Sunday at midnight. You can learn more HERE.

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The Most Important Three Words in Strength and Conditioning

From 2007 to 2009, I was a big sleeper stretch guy. All our throwing athletes did this stretch at the end of their training sessions, and we meticulously coached the technique to make sure it accomplished what we *hoped* it would accomplish. I featured it in the program in my first book, Maximum Strength, and this picture of me even shows up in the first row of photos on Google Images if you search for "sleeper stretch."

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Then, in March 2010, I attended my first Postural Restoration Institute (PRI) event and "saw the light." I left the course with some great new positional breathing drills that often delivered quick results in terms of improving shoulder internal rotation - without having to actually stretch the shoulder, a joint that doesn't really like to be stretched. Looking back, we were probably trying to "stretch" out an alignment issue - and that never ends well.

We've since progressed our approach, complementing PRI exercises with thoracic spine mobility drills and manual therapy at the shoulder in those who present with true internal rotation deficits. Only after they've still come up short following these initiatives do we actually encourage stretching of the glenohumeral (ball and socket) joint. And, even when that happens, it's gentle side-lying cross-body stretching with the scapula stabilized; this has proven safer and more beneficial for improving internal rotation.

The three preceding paragraphs about my experiences with the sleeper stretch could really be summed up in three words:

                           I was wrong.

It's not the only time I've been wrong, either.

I wish I'd done more barefoot work and ankle mobility training with the basketball players with whom I worked early in my career.

I wish I'd not just assumed that all athletes needed more thoracic mobility when, in fact, there are quite a few who have hypermobile t-spines.

I wish I'd focused more on the benefits of correct breathing - especially full exhalation - with athletes sooner in my career.

TRXDeepSquatBreathingWithLatStretch

In my own powerlifting career, I wish I'd spent more time free squatting and less time box squatting. And, I wish I'd competed "raw" instead of with powerlifting equipment.

I've made some errors in the ways I evaluated, trained, and programmed for athletes. I've made dumb decisions in both my business and personal life. However, at the end of the day, I can attribute a lot of my improvements as a person and a professional to the fact that I was completely comfortable admitting, "I was wrong." Heck, I'm so comfortable recognizing my mistakes that I've written entire posts on the subject!

This is trait just about every successful strength and conditioning coach generally shares. Humility is an essential trait for personal and professional advancement, especially in a dynamic field like strength and conditioning where new research and training techniques emerge on a daily basis.

This isn't just limited to strength and conditioning, though. If you asks a lot of the best surgeons in the country, they'd admit that they were wrong in doing a lot of lateral release (knee) surgeries and thermal capsule (shoulder) shrinkage procedures earlier in their careers. And, they'd probably admit that they misdiagnosed a lot of cases of thoracic outlet syndrome as ulnar neuropathy. If they aren't willing to admit their past mistakes, you probably ought to find a different doctor.

If you're an athlete, the same can be said of seeking out a strength and conditioning coach. If the person writing your programs hasn't learned from his/her mistakes, are you really getting a "modern" or forward-thinking program that has been tested in the trenches? We've all seen those programs - both in training and rehabilitation - that have been photocopied so many times over the years that they're barely legible.

Likewise, if you're an up-and-coming strength and conditioning coach, you want to seek out mentors that'll admit their past mistakes and reflect on how they learned from them. Only then can they help you avoid making them, too. You're better off learning under someone who has 15 years of strength and conditioning experience than someone who has 15 years of the same year of experience.

Finally, if you're an established professional, the only way to grow is to get outside your comfort zone. Five years from now, if you're not looking back on your current approaches and wondering what the heck you were thinking, then you're stuck in the bubble on the left.

comfortzone

You need to visit other facilities, talk with other coaches, and empower your employees/co-workers with a voice that challenges the norm. I learn a lot from my staff on a daily basis. And, looking back on that first PRI event I attended, I was the only "non-clinician" in the room. I was surrounded by PTs, PTAs, respiratory therapists, pelvic floor therapists, and ATCs. I got out of my element and it changed the course of my career dramatically.

Looking back on these experiences when I was clearly wrong, part of me wants to send individual apology notes to all the athletes I saw early in my career. By that same token, though, I feel like thank you notes might be more appropriate, as these mistakes played an essential role in my growth as a coach and person.

If you're looking for an up-to-date look on how we manage shoulders - including a look at identifying and addressing internal rotation deficits - be sure to check out my new resource, Sturdy Shoulder Solutions.

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How Can Pitchers Ever Be “Elite” If They Take Time Off from Throwing?

The other day, the following comment/question was posted as a reply to one of my articles:

"How does an elite pitcher take 2-3 months off from throwing and stay an elite pitcher? I can see shutting down for one month from any throwing, but any more than that and atrophy and loss of neuro patterns kick in."

The short answer is, "They just can - and have - for a long time." I absolutely appreciate the question, and think it's an excellent one. Unfortunately, high level throwers have shown time and time again that they can do it. I'll give you a few examples among Cressey Sports Performance guys from the 2014 season.

Corey Kluber (Indians) made his last appearance of 2013 on September 27, and he didn't start his off-season throwing program until December 9. According to FanGraphs, his average fastball velocity was up from 92.9mph in 2013 to 93.2mph in 2014 - in spite of the fact that he threw 235 innings in 2014, which was 47 more than he's ever thrown in his career. Corey's saw his average fastball velocity increase in each of his four seasons in the big leagues - and he took 2-3 months off from throwing in each of those off-seasons. Clearly, the time off didn't hurt him, as he won the American League Cy Young in 2014.

Sam Dyson (then Marlins, now Rangers) made his last appearance of 2013 on September 22, and also didn't start a throwing program until mid-December. Check out his FanGraphs velocity improvement from 2013 to 2014 "in spite of" his lengthy time off in the fall/winter.

dysonvelo

Corey and Sam are just a few examples, and I've got dozens more. Elite pitchers don't struggle to stay elite; in fact, time off from throwing allows them to recharge and get their strength and mobility back to prepare for becoming "more elite" in the subsequent season.

With that point made, there are three perspectives I think are important to consider on this front.

1. Health vs. Mechanics

As I've written previously in 7 Reasons Pitchers Shouldn't Do Year-Round Throwing Programs - Part 1 and Part 2, there are a lot of physical adaptations that simply can't happen (at least not optimally) when an athlete is still throwing. You can't regain passive stiffness of the anterior shoulder capsule or ulnar collateral ligament. You can't make significant improvements to elbow and shoulder range-of-motion. You can't get rotator cuff strength/timing up, or improve scapular control. Trying to fix these things when a guy is always in-season is like trying to teach a 16-year-old to drive in the middle of the Daytona 500; things might get a little better, but don't expect great results when stressful situations are still in play.

Conversely, we can't optimize mechanics if a pitcher isn't throwing; we know that. However, I'd argue that having a healthy, strong, powerful, and mobile athlete is an important prerequisite to learning correct mechanics. Most players are really tired at this time of year - even if they don't appreciate it (more on this later). Motor learning never happens optimally under conditions of fatigue. I'm all for aggressive throwing programs and meticulous video analysis, but if mechanics and throwing programs are the only tools you have in your toolbox, then you're like a carpenter who only has a hammer: everything looks like a nail. If you understand structure, function, and adaptation, though, you've got a many resources at your fingertips to make an athlete better - and do so safely.

ECCishek

2. The Psychological Component

An example likely best illustrates this point. I recently saw a minor league pitcher who had an outstanding season: an ERA under 3.00 and a career high of 170+ innings. You'd think a guy like that would be wildly enthusiastic about baseball after such an awesome season, and even want to continue playing in any way possible.

That wasn't the case, though. He told me that for the first five days after the season, he avoided everything baseball. In fact, he was so worn out on baseball that he didn't do anything except watch TV and relax for two days. Only after that did he even feel like going for walks with his girlfriend - and he just started up his off-season training three weeks later. This is not uncommon.

It might come as a surprise, but a lot of players are completely "over" baseball by this time of year, particularly if they played for a team that wasn't in a playoff race, or pitched a career high in innings. Forcing them to continue throwing is a quick way to make them really apathetic to baseball and your coaching. If you need proof, ask any minor leaguer how he feels about being sent to Instructional League. A lot of necessary work happens there, but that doesn't mean they enjoy it.

3. Athletes might not know the difference between feeling "good" and "bad."

I'd argue that there are a lot of pitchers who say they feel great at the end of the season, but actually present really poorly in their post-season evaluations. I think a big part of the problem is that we can't necessarily perceive the issues - mobility and stability deficits - that lead to baseball injuries on a daily basis, as most arm injuries involve mechanical pain. In other words, they usually don't hurt unless you're throwing. I've seen athletes who claim they feel awesome at the end of the season, but they actually have experienced big losses in range of motion, stability, and power.

To apply this to kids who play year-round baseball, I think it's safe to say that we have a generation of kids who legitimately have no idea what it's like to feel good/fresh. They've never thrown a baseball with excellent rotator cuff strength or full scapular upward rotation. They don't know how to effectively create separation because their hip and thoracic mobility is so subpar, and even if they actually had good mobility, their poor core control wouldn't allow them to make use of it. You could make the argument that it's a "subclinical epidemic;" we just have a lot of "unathletic athletes" who aren't willing to take a step back to set themselves up for many steps forward. Build a big foundation and stay healthy, and you'll always pick up the specific mechanics corrections much easier.

Wrap-up

This article was a long response that could have been summed up with the sentence, "Don't be afraid to take time off from throwing." The research is very much in support of it helping to keep pitchers healthy, but the anecdotal evidence also supports the notion that it supports the long-term baseball development process, too.

Are you an athlete looking to learn more about Cressey Sports Performance's services at our Hudson, MA or Jupiter, FL locations? Check out www.CresseySportsPerformance.com.

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How Limited Shoulder Flexion Relates to Elbow Injuries in Pitchers

Today, I want to introduce you to one of the screens we do with all our throwing athletes - and what the implications of "failing" this test are.  Check out this six-minute video:

If you're looking for more information along these lines, I'd encourage you to check out one of our upcoming Elite Baseball Mentorships, with events running in both October and November.

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Pitching Injuries and Performance: Understanding Stride Foot Contact and Full External Rotation

At the end of the day yesterday, I took a quick glance at my Facebook feed and was quickly drawn to a "highlight" video from a baseball strength and conditioning program.  The athletes' energy was great, and there was a ton of camaraderie.  The only problem was that if you had watched the video without first seeing the word "baseball" in the title, you would have never known it was a baseball team training. The exercises - and the way that they were/weren't coached - clearly didn't reflect the unique demands of the sport.

With that in mind, I thought I'd use today's post to quickly highlight the most important positions you need to understand when you're training throwing athletes: stride foot contact/full external rotation.

Stride foot contact occurs just before maximum external rotation takes place.  As the foot touches down, the pelvis has started rotating toward home plate while the torso is still rotated in the opposite direction to create the separation that will enhance velocity.  Maximum external rotation - or "lay-back" - signifies the end of this separation, as the energy generated in the lower extremity is already working its way up the chain.  Nissen et al. (2007) presented this tremendous diagram to illustrate the separation that takes place.  This image represents a right handed picture, where the top image is the hips, and the bottom image is the torso (right and left shoulder joint centers of rotation).

Source: Nissen et al.

Based on this image alone, you should be able to see where most oblique strains and lower back pain originate; this is ridiculous rotational stress.  Additionally, you can appreciate why hip injuries are higher in throwers than they ever have been before; it takes huge hip rotation velocities to play "catch up" so that the pelvis and thorax are squared up at maximum external rotation (if they aren't, the arm drags).  This just refers to what's happening at the lower extremity and core, though.  Let's look at the shoulder.

At full lay-back (maximum external rotation), we encounter a number of potentially traumatic and chronic injuries to the shoulder.  In a pattern known as the peel-back mechanism, the biceps tendon twists and tugs on the superior labrum. The articular side (undersurface) of the rotator cuff may impinge (internal impingement) on the posterior-superior glenoid, leading to partial thickness cuff tears. Finally, as the ball externally rotates in the socket, the humeral head tends to glide forward, putting stress on the biceps tendon and anterior ligamentous structures. 

Likewise, at the elbow, valgus stress is off the charts.  That can lead to ulnar collateral ligament tears, flexor/pronator strains, medial epicondyle stress fractures, lateral compressive injuries, ulnar nerve irritation, and a host of other isssue.  I don't expect most of you to know what much of this means (although you can learn more from Everything Elbow), but suffice it to say that it's incredibly important to train throwers to be functionally strong and mobile in these positions. 

And, this brings to light the fundamental problem with most strength and conditioning programs for overhead throwing athletes; they commonly don't even come close to training people to be "safe" in these positions. "Clean, squat, deadlift, bench, chin-up, sit-up" just doesn't cut it.  You need to be strong in single-leg stance to accept force on the front side with landing.

You need to be able to apply force in the frontal and transverse planes.

You also need to transfer this force to powerful movements.

You need to have plenty of rotary stability to effectively transfer force from the lower to upper body.

You need to be strong eccentrically in the 90/90 position.

You need to have outstanding hip mobility in multiple planes of motion.

You need to attend to soft tissue quality in areas that other athletes rarely have to consider.

These demands are really just the tip of the iceberg, though, as you have to see how all the pieces fit together with respect to throwing and hitting demands at various times of year.  Training for baseball isn't as simple as doing the football strength and conditioning program and then showing up for baseball practice; there are far more unique challenges when dealing with any rotational sport, particularly those that also integrate overhead throwing.  Watch the sport, talk to the players, appreciate the demands, and evaluate each individual before you try to write the program; otherwise, you're simply fitting athletes to existing programs.

For more insights like these, I'd encourage you to check out one of our Elite Baseball Mentorships; we have two of these events scheduled for this fall.

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