Home Posts tagged "Tommy John Surgery" (Page 5)

Can Little Leaguers Strength Train?

Q: Mr. Cressey, I was given your name and website from my massage therapist, who is a big fan of yours. I was wondering what your opinion is about when a child should start muscle strength training (not weight training) for baseball? I have a 10-year old son who pitches and I always worry about his shoulder since I have had to have surgery on both of mine. He is playing up in age so he is pitching from 50 feet and pitches a consistent 48 mph. I always ice him down after for 30 minutes, but what do you recommend him to do to prevent injuries? A: This is a great question, and the timing is actually perfect (as I'll explain in the last paragraph). In a nutshell, assuming good supervision, I'd start as early as possible. While most of our work is with athletes in the 13+ age range, we run a group of 9-12 year olds every Saturday morning at Cressey Performance. There is a lot you can to with kids at that age to foster future success - but, more importantly, have fun. It was actually started by popular demand of some of the kids who had older brothers in our program; they wanted to jump in on the fun. Now, we look at it as a feeder program of sorts; by teaching things effectively early-on and exposing them to a wide variety of movements, it makes it easier for them to become athletes down the road. We work on squat technique and/or deadlift technique, with the majority of the time aimed at just keep them moving by performing various circuits that include things like jumping jacks, med ball throws, lunges, and wheelbarrow medleys, etc. We also have tug-o-war battles and SUMO wrestling where we have them grab onto a SWISS ball and try to maneuver each other outside of a circle. All in all, we have fun while at the same time improving their motor skills. That is what's most important. I don't want the kids to dread coming to the gym, which is what I think happens when trainers and parents start taking it too seriously. There's going to come a time when things will get more specialized, but ages 9-12 isn't that time. Truth be told, kids nowadays are more untrained and unprepared than ever - yet they have more opportunities that ever to participate in spite of the fact that they are preparing less. It's one of several reasons that youth sports injuries are at astronomical rates. As perhaps the best example, you can now see glenohumeral internal rotation deficit (GIRD) in little leaguers, as this study shows. The GIRD isn’t the problem; that’s a natural by-product of throwing. The problem is that kids throw enough to acquire this structural and flexibility anomaly, but have no idea how to manage it to stay healthy. So, in a nutshell, find someone who understands kids both developmentally and psychologically - and make it fun for him. Looking for someone affiliated with the IYCA (www.iyca.org) would be a good start. Also, among the products out there, Paul Reddick's stuff is a great start if you're looking for things to do with up-and-coming baseball players.

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Training around Elbow Issues in Overhead Athletes

We see a lot of baseball players, so a lot of these guys come to use with elbow problems. In most cases, the doctors they’ve seen have said, flat-out, “NO LIFTING WEIGHTS.” This drives me nuts for a variety of reasons: 1. They’ve still got two good legs, one good arm, and a bunch of core musculature that needs to be strong and functional. 2. This recommendation implicitly means “Stay away from personal trainers and strength coaches.” It’s probably due to the fact that there are a lot of bonehead personal trainers out there who could do more harm than good, but the truth is that these services comprise more than just lifting weights. We do a lot of mobility and activation work and self-myofascial release on the foam roller. Collectively, #1 and #2 demonstrate that this blanket recommendation includes an insanely ignorant omission, as the majority of elbow problems can be attributed to mobility and strength deficits at the shoulder. You can train a shoulder a thousand different ways without even involving elbow motion – let alone challenging it sufficiently to cause a problem. In fact, I'd estimate that you could prevent 90% of elbow problems in baseball guys if we simply taught all of them how to sleeper stretch in their early teenage years: I'd strongly encourage you to check out this article I wrote, where I go over the common mistakes folks make when performing the sleeper stretch. 3. This recommendation flat-out ignores the specific nature of the overwhelming majority of elbow problems in throwing athletes. Let me elaborate.. In my estimation, 95% of baseball players with elbow pain couldn’t elicit their pain in a weight room if they wanted to; seriously! The reason is that this elbow pain is typically mechanical in nature; that is, it’s only aggravated by specific activities (in their case, throwing). Believe it or not, I have had guys do everything from pull-ups, to dumbbell bench presses, to rows, to push-ups, to grip work just days out from elbow surgery. It isn’t true in every case, but it’s definitely the majority. And, they can all get diesel in the lower body during this time period. Some great related reading for you: Inefficiency vs. Pathology Lay Back to Throw Gas

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Inefficency vs. Pathology

In Newsletter 95, I wrote about how pathologies often don’t become symptomatic until inefficiencies get to be too bad. Here is a perfect example of a guy who has basically learned how to work around a pathology to remain competitive at a high level. New Twist Keeps Dickey’s Career Afloat You can bet that he’s got a lot of efficiency working in his favor. Thanks, Paul Vajdic, for passing this along!
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Public Access: Not Just for Wayne and Garth

Click the link below to view an hour-long interview I did on the Audrey Hall Show alongside Rich Gedman (former Red Sox catcher and current manager of the Worcester Tornadoes) and Bunky Smith (head coach of Framingham's American Legion Team) on the topic of youth baseball training.

http://link.brightcove.com/services/link/bcpid1137806189/bclid1408993191/bctid1424672868?src=rss
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Newsletter #95

Inefficiency vs. Pathology

Q: I read with great interest your baseball interview at T-Nation, as I have two sons who play high school baseball. More interestingly to me, though, was this statement:

“Pathology (e.g., labral fraying) isn't as important as dysfunction; you can have a pathology, but not be symptomatic if you still move well and haven't hit "threshold" from a degenerative or traumatic standpoint.”

Is this something that can be applied to the rest of the body?

A: Great question – and the answer is a resounding “Absolutely!”

Many musculoskeletal issues are a function of cumulative trauma on a body with some degree of underlying inefficiency. People reach threshold when they do crazy stuff – or ignore inefficiencies – for long enough. Here are a few examples:

Lower Back Pain

As I touched on in a recent newsletter, we put a lot of compressive loading on our spines in the typical weight-training lifestyle – and you’d be surprised at how many people have spondylolysis (vertebral fractures) that aren’t symptomatic. But there’s more…

A 1994 study in the New England Journal of Medicine sent MRIs of 98 "healthy" backs to various doctors, and asked them to diagnose them. The doctors were not told that the patients felt fine and had no history of back pain.

80% of the MRI interpretations came back with disc herniations and bulges. In 38% of the patients, there was involvement of more than one disc.

It’s estimated that 85% of lower back pain patients don’t get a precise diagnosis.

Shoulders

You’d be amazed at how many people are walking around with labral fraying/SLAP lesions, partially torn rotator cuffs, and bone spurs. However, only a handful of people are in debilitating pain – and others just have a testy shoulder that acts up here and there. What’s the issue?

These individuals might have a fundamental defect in place, but they’ve likely improved scapular stability, rotator cuff strength/endurance, thoracic spine range-of-motion, soft tissue quality, cervical spine function, breathing patterns, mobility of the opposite hip/ankle, and a host of other contributing factors – to the point that their issues don’t become symptomatic.

Elbows

They do a lot of Tommy John surgeries and ulnar nerve transpositions for elbow issues that can often be resolved with improving internal rotation range-of-motion at the shoulder, or cleaning up soft tissue restrictions on flexor carpi ulnaris, flexor carpi radialis, pronator teres, etc.

According to Dr. Glenn Fleisig, during the throwing motion, at maximal external rotation during the cocking phase, there is roughly 64 Nm of varus torque at the elbow in elite pitchers. This is equivalent to having a 40-pound weight pulling the hand down.

The other day, I emailed back and forth with my good friend, physical therapist John Pallof about elbows in throwing athletes, and he said the following:

“Over the long term, bone changes just like any other connective tissue according to the stresses that are placed on it.  Most every pitcher I see has some structural and/or alignment abnormality – it’s just a question of whether it becomes symptomatic.  Many have significant valgus deformities.  Just disgusting forces put on a joint over and over and over again.”

Makes you wonder who is really "healthy," doesn't it? Carpal Tunnel

I can’t tell you how many carpal tunnel surgeries can be avoided when people get soft tissue work done on scalenes, pec minor, coracobrachialis, and several other upper extremity adhesion sites – or adjustments at the cervical spine – but I can tell you it’s a lot.

Knee Pain

Many ACL tears go completely undiagnosed; people never become symptomatic.

I know several people who have ruptured PCLs from car crashes or contact injuries – but they work around them.

Some athletes have big chunks of the menisci taken out, but they can function at 100% while other athletes are in worlds of pain with their entire menisci in place.

Many knee issues resolve when you clear up adhesions in glute medius, popliteus, rectus femoris, ITB/TFL, psoas, and the calves/peroneals; improve ankle and hip mobility; and get the glutes firing.

I’m of the belief that all stress on our systems is shared by the active restraints and passive restraints. Active restraints include muscles and tendons – the dynamic models of our bodies. Passive restraints include labrums, menisci, ligaments, and bone; some of them can get a bit stronger (particularly bone), but on the whole, they aren’t as dynamic as muscles and tendons.

Now, if the stress is shared between active and passive restraints, wouldn’t it make sense that strong and mobile active restraints would protect ligaments, menisci, and labrums? The conventional medical model – whether it’s because of watered-down physical therapy due to stingy insurance companies or just a desire to do more surgeries – fixes the passive restraints first. In some cases, this is good. In other cases, it does a disservice to the dynamic ability of the body to protect itself with adaptation.

I’m also of the belief that there are only a handful of exercises that are genuinely bad; upright rows, leg presses, and leg extensions are a few examples. The rest are just exercises that are bad for certain people – or exercises that are bad when performed with incorrect technique.

With these latter two issues in mind, find the inefficiency, fix it, and you'd be surprised at how well your body works when it moves efficiently.

Teleseminar Series Reminder

Just a reminder that this awesome FREE offer from Vince DelMonte starts next week, so don’t wait to sign up! My interview will be Monday, April 7.

Ultimate Muscle Advantage Teleseminar Series

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Baseball: Shoulder Strengthening

Q: I have a client who is 38 and plays league baseball. After playing for a few years when he finished high school, his career took a hit due to shoulder, elbow and knee injuries/over use. So, he left baseball, started his own business and after 15 years started playing in two leagues again…and the same old injuries flared up and now I have him. Can you recommend some elbow strengtheners I can prescribe for him?
A: First, make sure it's not just a matter of too much, too soon. He should have progressed his throwing routine gradually from Day 1. Good thing to save... 1. Throw on a two-on, one off schedule. 2. Start with 25 throws at 25 feet per day. 3. Increase throws at 25 feet to 50 before extending the distance and breaking the volume down between distances (25 at 25, 25 at 50) and so on. 4. From a recent article I wrote: Incorporate posterior capsule stretching in overhead throwing athletes. There is considerable research demonstrating that glenohumeral internal rotation deficit (GIRD) is highly correlated with shoulder injuries in overhead throwing athletes. Incorporating a very simple "sleeper" stretch daily can dramatically reduce the risk of shoulder problems in such athletes; if you aren't including this stretch in your program, you shouldn't be allowed to train overhead athletes! I also like cross-body mobilizations, as this approach has proven more effective than the sleeper stretch for improving internal rotation range-of-motion. Sleeper stretches are preferred for those with shoulder problems, but if you're only dealing with an elbow issue, you'll be fine with the cross-body version. You’ll also want to include some prone internal rotations - really important for subscap function. You'll also want to beat up on his posterior shoulder girdle with a tennis/lacrosse ball. Start with the soft tissue work, then move to the sleeper stretch, and then go to prone internal rotations. This assumes that we're dealing with medial elbow pain. Lateral elbow pain could be related (generally seen early-on, especially in younger athletes), but it's often more related to myofascial restrictions in the forearm with older athletes, in my experience. Eric Cressey

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