You probably noticed that the newsletter is a day late this week. I have been absolutely swamped with the goings-on at Cressey Performance on top of heading to a big baseball seminar in Houston this weekend (fly out Thursday night). Fortunately, though, this full schedule provided me with the idea for this newsletter.
With the chaos of the past week, I didn't have time to do my normal cooking and food prep for the week on Sunday night. So, Tuesday morning (had already had a normal breakfast), with about twenty minutes left before I needed to head out to work, I looked in the fridge in hopes of pulling together a few meals from a stir fry or casserole. Nothing was there.
As a result, I just wound up grabbing a half-empty tub of cottage cheese and added a tablespoon of psyllium husk powder for fiber. Later in the day, I'd add some Superfood and a scoop of low-carb Metabolic Drive, and had that concoction with a handful of almonds from the stash in the top drawer of the desk in my office. Another meal was a Metabolic Drive bar, and a third was simply a shake with Superfood and some Flameout (fish oil) and almonds. Obviously, it wasn't an ideal daytime meal plan - and it certainly wasn't an aesthetically-pleasing culinary masterpiece like you'd see in John Berardi's Gourmet Nutrition Cookbook, but it got me through the 8-10 hours.
I had a shake with my evening training session, and then came home to cook up a legitimate, whole food meal.
This certainly wasn't optimal, but it was a nutritional "out" for me: it got calories in, kept my energy levels up, and did so without blowing my diet with unhealthy convenience foods. Having good food easily accessible to me is huge when things get busy; I'll roll with mixed nuts, protein powders, protein bars (homemade and Biotest ones), Superfood, and beef jerky. We're also lucky to have a cafeteria in our building, and a good take-out place with awesome salads just about three miles down the road. So, in my eyes, there is never a reason for me to eat garbage - even if I haven't had time to cook up good stuff for myself.
Obviously, this can be applied to diet, but it also has applications in other facets of your healthy lifestyle.
From a training logistics standpoint, what happens if you walk in to your gym to squat, and find that the only squat rack is occupied and there is a long line waiting to use it. Do you stand in line, or do you go to trap bar deadlifts (option A) or walking dumbbell lunges (option B)?
Also along the training lines, but with more of injury perspective, what do you do if your shoulder starts acting up when you go to barbell bench press? Do you try to push through it, skip it altogether, or move to neutral grip dumbbell bench presses (option A) or a push-up variation (option B)? (As an aside, I just wrote an article covering these situations; check it out HERE)
How about professionally? If you're a trainer or a strength coach, if something stumped you, who do you contact? Have you built a good network of health care professionals with both general expertise and specializations? Case in point, one of my current clients started up with me in December of 2006, and he came to me with a C5-C6 disc hernation that had left him with numbness in the tip of his middle finger for the previous ten years - and none of the neurologists and physical therapists he'd seen could do anything about it. I introduced him to John Pallof, PT, COMT, and John had complete feeling back in his finger within two sessions from a combination of manual therapy and neural flossing.
Nowadays, John sees every neck issue that comes to Cressey Performance. Likewise, Dr. Bill Morgan sees all our significant wrist and elbow issues - and the list goes on and on. So, it's not just about having a network; it's about having a network of great people, some of whom specialize in certain areas. I had dinner with Dave Tate a while back, and I recall him saying that he was less concerned with knowing everything and more concerned with knowing who to call to find out everything. Dave was right on the money.
What about easily accessible resources? What books, DVDs, journals, and newsletters do you consult on a regular basis to stay on top of things and research new issues that cross your path? Improving your own abilities is just as important as expanding your network. If you haven't seen it already, a while back, I compiled a Recommended Resources page outlining my recommendations for both free websites and products you can use to stay ahead of the game.
At risk of sounding overconfident, I think that the Building the Efficient Athlete DVD set is something that every trainer and strength coach should watch, as it covers everything from functional anatomy, to static and dynamic assessments, to troubleshooting common resistance training technique mistakes.
Food for thought - and hopefully a little something for everyone.
1. I have seen a lot of guys who have hamstrings pulls in their health histories, but I don't recall ever coming across any studies that show that shooting yourself in the leg expedites recovery time.
The sad truth is that you'll probably have dozens of kids around the country with hamstrings strains shoot themselves in the leg in hopes of returning to play sooner because "Burress does it." I'll stick with soft tissue work, glute activation, and sprint mechanics training...
2. I got a question the other day about how we approach rest periods for our medicine ball work, and while it could be somewhat of a long, detailed response, I can probably respond even better with a simple, "We are always trying to slow guys down because they rush through them." Usually, our rest intervals are in the ballpark of one minute between sets. So, here's a little sample of what one of our professional pitchers did yesterday:
A) Side High Box Step-ups w/Leg Kick: 2x4/side
B1) Overhead Med Ball Stomp to Floor: 4x8 (5kg)
B2) Side-Lying Extension-Rotation: 3x8/side
C1) Recoiled Shotput: 3x3/side (4kg)
C2) Wall Hip Flexor Mobilizations: 2x8/side
D1) Recoiled Shotput: 3x3/side (2kg)
D2) Lying Knee-to-Knee Stretch: 2x30s
E1) Crow Hop to Overhead Med Ball Throw: 5x2 (2kg)
E2) Multiplanar Hamstrings Mobilizations: 2x5/5/5/side
So, as you can see, we use mobility work between sets to slow the guys down and address range-of-motion deficits they might have at the same time. A lot of these drills can be found on Magnificent Mobility (lower body) and Inside-Out (upper body).
4. For some good reading - particularly with respect to nutrition - check out Brian St. Pierre's blog.
5. I'm going with Joseph Addai over LenDale White this weekend. Thanks to everyone for the feedback from Tuesday. Fingers crossed...
6. Happy Birthday to Cassandra Forsythe-Pribanic! Cass and I go way back, and she's been a great friend and resource for me all along the way. If you're looking for top-notch female-specific nutrition and fitness resources, you definitely ought to check out The New Rules of Lifting for Women and the Women's Health Perfect Body Diet, both of which Cass or co-authored.
That'll do it for this week. I've got some sweet content in line for next week, so stay tuned. Have a great weekend!
Q: I'm a personal trainer who just started training a couple of baseball catchers. I understand that your facility specializes in training baseball players. I just want to know if you guys have any tips, or recommend any resources to find out common structural issues that occur with this position. Perhaps what you guys have found through training catchers? What lifts they should avoid, more specifically?I have begun doing a ton of research and just wanted some ideas from you guys to help me out. Any information would be greatly appreciated.
A: Well, first, there are certain things that none of my baseball guys do:
-Overhead lifting (excluding pull-up/chin-up variations)
-Straight-bar benching
-Upright rows
-Front/Side Raises
-Olympic Lifts (aside from the occasional high pull)
-Back Squats (we use safety squat and giant cambered bars instead, plus front squats)
I could go on and on with respect to the reasons for these exclusions, but for the sake of this blog, suffice it to say that it's for shoulder and elbow protection reasons. Fortunately, I wrote about my rationale in an old newsletter.
Catchers are obviously different than pitchers and position players in that they spend a lot of time squatting, so we have particular concerns at the knees and hips.
Whether or not I squat my catchers is dependent on age, training experience, time of year, and - most importantly - injury history. If a guy is older and more banged up, we aren't going to be squatting much, if at all. However, if we're talking about a younger athlete who has a lot more to gain from squatting (particularly if he isn't specialized in baseball yet), I definitely think there is a role for it.
That said, regardless of age and injury history, I don't squat my catchers deep in-season. We'll do some hip-dominant squatting (paused or light tap and go) to a box set at right about parallel, but for the most part, it's deadlift variations. We get our range-of-motion in the lower body with these guys with single-leg work.
As for structural issues, always check everything at the hip and ankle, as you should with any baseball player; it isn't just about shoulders and elbows (although you will want to screen those, too, obviously). Believe it or not, a lot of the pitching flexibility deficits about which I've written also hold true in catchers.
Additionally, I've found that a lot of catchers tend to lean to one side (adduct one femur), and over time, it can lead to some noteworthy imbalances in hip rotation range-of-motion. You'll also see a lot of catchers who lack thoracic spine range-of-motion because they spend so much time slumped over (not necessarily ideal catching posture, but it does happen when you're stuck down there for nine innings).
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In Part I, I went into some detail on why I really didn’t like the catch-all term “shoulder impingement.” This week, I’m going to talk about the different kinds of shoulder impingement: external and internal.
External impingement, also known as outlet impingement, is the one we hear about the most. Here, we’re dealing with compression of the rotator cuff – usually the supraspinatus, and over time, the infraspinatus (and biceps tendon) – by the undersurface of the acromion. This impingement can lead to bursal-sided rotator cuff tears - and happens a lot more with ordinary weekend warriors and very common in lifters (not to mention much more prevalent in older populations.
External impingement can be further subdivided into primary and secondary classifications. In primary impingement, the cause is related to the acromion – either due to bone spurring or congenital shape. As you can see in the photo below, hook (II) and beak (III) are worst than flat (I), as there are marked difference in “clearance” under the acromion.
Secondary impingement, on the other hand, is usually related to poor scapular stability (related to both tightness and weakness, as described in last week’s newsletter), which alters the position of the scapula. In both cases, pain is at the front and/or side of the shoulder and is irritated with overhead activity, scapular protraction, and several other activities (depending on the severity of the tissue problems). You’ll also generally see a lack of external rotation range-of-motion, as these are folks who do too much bench pressing and computer work (both of which shorten the internal rotators).
Conversely, internal impingement, also known as posterosuperior impingement, really wasn’t proposed until the early 1990s. This form of impingement is more common in younger individuals who are involved in overhead sports, making it more of an “athletic impingement.” Adaptive shortening and scarring of the posterior rotator cuff in these athletes causes a loss of internal rotation and an upward translation of the humeral head during the late cocking phase of throwing (or swimming): external rotation and abduction. These issues are magnified by poor scapular control, insufficient thoracic rotation, and weakness of the rotator cuff.
When the humeral head translates superiorly excessively in this position, it impinges on the posterior labrum and glenoid (socket), irritating the rotator cuff and biceps tendon along the way. So, pain usually starts in the back of the shoulder, as you are seeing irritation of the posterior fibers of the supraspinatus and anterior fibers of the infraspinatus tendons. Gradually, this pain may “shift” toward the front as the biceps tendon, and that implies labral involvement. At least initially, the pain is purely mechanical in nature; it won't bother an athlete unless the "apprehension" position (full external rotation at 90 degrees of abduction) is created.
We often hear about SLAP lesions in the news. This refers to a superior labrum, anterior-posterior injury. In reality, when we are talking about labral injuries in overhead athletes as they relate to internal impingement, it’s mostly just posterior (although serious cases can eventually affect the anterior labrum, too). There are different kinds of SLAP lesions (1-4). Every baseball pitcher you’ll meet has a SLAP 1, which is just fraying. SLAP 2 lesions are far more serious and often require surgical intervention. SLAP 1 issues become SLAP 2 lesions when poor mobility and dynamic stability aren't established.
So, just to bring you up to speed, we’ve got two different kinds of impingement, one of which (external) has two subcategories that mandate different treatment strategies (primary = surgery, secondary = corrective exercise). We also have two separate areas where pain presents (external = front/side, internal = back). That’s just the tip of the iceberg, though, as we have two more considerations…
First, symptomatic internal impingement tends to be "mechanical pain." Unless you’re dealing with a more advanced case, athletes with symptomatic internal impingement only have pain when they get into the late cocking phase (and sometimes follow-through). It usually isn’t present when they’re just sitting around – and for this reason, they can usually be more aggressive in the weight room with upper body training. Keep in mind that I use the term “symptomatic” because I think that internal impingement is a physiological norm, just like I observed last week with external impingement. You're essentially just going to go out of your way to avoid this "apprehension" position in the weight room by omitting exercises like back squats. An apprehension test - illustrated in the most enthusiastic video in internet history - is a quick and easy assessment many doctors and rehabilitation specialists use to check for symptomatic internal impingement, as it reproduces the injury mechanism.
Second, and perhaps more importantly, you are dealing with two rotator cuff tears that are fundamentally different. It’s these differences that make me think doctors need to get rid of the term “impingement.” Here’s the scoop:
Let’s say that we have two guys with partial thickness tears of the supraspinatus – one from external impingement and one from internal impingement.
With external impingement, we’re usually dealing with a bursal-sided tear, as the rubbing comes from the top (acromion). These issues will generally heal more quickly because the bursa actually has a decent blood supply.
With internal impingement, on the other hand, we’ve got an articular-sided tear, meaning that the wear on the tendon comes from underneath (glenoid). The tear is more interstitial in nature. Blood supply isn’t quite as good in this area, so healing is slower (or non-existent).
Traditionally, articular has been an athletic injury, and bursal has been a general population issue. This is not always the case, though.
Factor in the activity demands of overhead throwers, and they have more challenging tears and greater functional demands. Fortunately, they also typically have age and tissue quality on their sides, so things tend to even out.
With all these factors in mind, if a doctor ever tells you that you have "shoulder impingement," ask:
1. Internal or external?
2. If external, is it primary or secondary? (It’ll probably be both)
3. If internal, is there labral involvement? Biceps tendon?
4. If internal, what is the internal rotation deficit? (They should measure it, as this will begin to dictate the rehabilitation plan)
5. Given my age, activity level, and the nature of the tear, do you feel that surgical or conservative treatment is best?
Click here to purchase the most comprehensive shoulder resource available today: Sturdy Shoulder Solutions.
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I'm writing this blog on Tuesday night, as I'm pretty sure that my mind will be a bit hazy after the insulin-induced coma that follows my Thanksgiving feast.
1. While I've had a week-long argument with my new website set-up, I have to say that one of the cool features I now have is a really detailed analytic panel to look at hits, referring sites, and the keywords people used in their searches to find my site. Believe it or not, 6.8% of my readers can't spell my last name correctly in a web search. So, just to be clear, it's "CRESSEY," not "CRESSY." The extra "E" stands for excellence, in case anyone was wondering. Stop laughing.
2. I work with two pro ballplayers who were drafted out of Harvard, and the other day, we got to talking about how I had finally gotten DVR on my TV (mostly for my girlfriend, to be honest). They started talking about how it'd be nice to be able to fast-forward through the commercials, and I commented on how that parallels what I do with educational DVDs. You see, I just push fast-forward and listen to things in about half the time it would take to hear the entire thing. I still comprehend everything - kind of like this guy:
They were kind of floored that I could do that - although I'm really not sure why. I'd be willing to bet that there were a lot of students at Harvard who are a lot more cyborg-ish than I am.
3. For the record, this strategy comes in handy when listening to presenters with Midwestern and Southern accents. I employed it with great success when viewing the 2008 Indianapolis Performance Enhancement Seminar DVD Series, as that Robertson character is one........sloooooooowwwww......talker.
Kidding aside, this was a fantastic seminar; I'd highly recommend you pick up a copy. I actually reviewed it in detail in a previous blog entitled The Best Thing I've Seen All Year.
4. Eric Chessen has a new blog about Autism Fitness. Definitely check it out at www.Autism-Health.com if that's your cup of tea. Eric's at the head of his field in this regard.
5. I'm going to be writing a new article for T-Nation this weekend. And, while I have some ideas on what I am going to write, I'm always open to suggestions. If you have one, please post it as a comment on this blog and I'll see what I can do.
6. HERE is an interesting new study I just read that talks about performance decrements with subtle sleep deprivation. These results seem to suggest that if you're going to miss hours of sleep, it is better to do so by going to bed later than it is to do so by rising earlier. We always teach our athletes that one hour of sleep before midnight is worth two after midnight, so these results would seemingly fly in the face of our recommendations. However, these recommendations assume no sleep deprivation. In other words, I'd rather have an athlete sleep 11pm-7am than I would have him sleep 2am-10am.
Just a quick one this week in light of the holiday. Have a great weekend!
This past weekend, I attended a great seminar here in Boston with Dr. William Brady. In fact, it was among the best I've seen. I was the only non-chiropractor/manual therapist in attendance, but walked away from the seminar with some tremendously valuable insights that'll help me with each and every one of my clients moving forward.
The first lesson of the day is that those of you who have an opportunity to see Dr. Brady speak should absolutely, positively check him out: Integrated Diagnosis. Diagnostically, he's among the best I've ever seen - and that includes his ability to teach others.
The second lesson of the day revolves around an important concept Dr. Brady extended - and my take on how you can modify this message to accommodate your role as a coach, trainer, or fitness enthusiast/athlete. There is a reason that almost any doctor or physical therapist gets results - and it resolves around understanding where symptom threshold occurs. To illustrate this, let's examine a shoulder problem purely from a soft tissue perspective.
Dr. Brady talked about how you have building blocks to threshold. Let's say that after an accurate physical examination, this particular shoulder problem (supraspinatus tendinosis, for example) presents with soft tissue restrictions at the infraspinatus, teres minor, subscapularis, inferior capsule, and pec minor. So, symptom threshold (the dotted line) might look like this relative to baseline (straight line):
Pec Minor
- - - - - - - - - - -
Inferior Capsule
Subscapularis
Teres Minor
Infraspinatus
BASELINE - NO SYMPTOMS
So, imagine a therapist who just addresses pec minor. He gets that patient below threshold, but doesn't necessarily "fix" him; he might be back in with the same problem weeks later. This is confounded by the fact that "overuse" is actually one of the building blocks, too. So, even if you leave all the soft tissue restrictions alone, simply resting will get someone below threshold - even if the therapist has done ZERO to address the underlying problems.
This is one reason why a MRI might not tell you much at all about someone's problem. With this problem, the MRI would probably just say "supraspinatus tendinopathy" and recommend physical therapy and rest from painful activities. So, in the "full picture" - where soft tissue work is one of several components (assume they are equal contributors, for the sake of our argument) - the building blocks to threshold might look something like this:
Overuse
Rotator Cuff Weakness
Scapular Stability
Poor Glenohumeral (Ball-and-Socket) Range of Motion
- - - - - - - - - - - - - - - -
Soft Tissue Restrictions
Poor Thoracic Spine Mobility
Type 3 Acromion (non-modifiable, without surgery)
Poor Exercise Technique
Poor Cervical Spine Function
Opposite Hip/Ankle Restrictions (baseball pitchers are great examples)
Inappropriate Structural Balance in Programming (e.g., pressing more than pulling)
Faulty Breathing Patterns
BASELINE - NO SYMPTOMS
So, we've got 12 factors, and it's been my experience that conventional physical therapy only treats the first four - which would, in fact, bring a patient below symptom threshold. Put that patient back in the real-world with the other eight factors still present (seven of which are modifiable), and as soon as he gets back to bench pressing with terrible technique Monday, Wednesday, and Friday, he's going to be back in for more physical therapy sooner than later.
So, what do we do in an ideal scenario (not always possible with today's insurance plans)?
1. More time with patient education (exercise technique, programming strategies - or just outsource it to a qualified professional or good book/article or DVD).
2. Address Thoracic Mobility (Assess and Correct is a great resource for this)
3. When present, address Hip and Ankle Mobility
4. Retrain some breathing patterns with initial instructions home exercises
5. Provide some take-home neck drills and get people out of chronic forward head posture
All told, I think this could be as simple as 4-5 extra drills in each shoulder rehab program plus a brief sit-down conversation with each patient on exercise program modifications; it really is that simple. Unfortunately, it rarely happens - and that's when things become chronic.
So, fitness professionals and coaches need to step up as advocates for their clients and athletes, respectively, and fitness enthusiasts need to be relatively informed "consumers" to look out for themselves.
1. This is my first post on the new blog, so apologies in advance if:
a) the font style or color is out-of-whack
b) it comes up in Portuguese (meaning that you’d have no idea what I am saying, anyway)
c) your computer freezes up on account of the complete and utter awesomeness that you’re beholding with the new site
Kidding aside, it’s been a royal pain in the butt thus far and I’m just anxious to have it done so that I can just go back to writing.
2. Believe it or not, as some of you probably have noticed, I haven’t blogged for a full week.There was just a ton of stuff to get gone for the new site as well as loads of other projects on my plate.
Interestingly, though, it was by far my best week of training since the spring.I had a great front squatting session on Tuesday, and although Wednesday was supposed to be a day off, I got antsy later in the day.So, I did a little sprint work – and it felt great.So, I figured what the heck: I might as well test my vertical jump and broad jump.I wound up jumping a personal best of 34.7 inches and then tying a personal best on the broad jump with 114 inches.As a cooldown, I wrestled a grizzly bear and then did walking lunges in the parking lot with an intern over each shoulder.Those whippersnappers will learn!
Random digressions aside, it’s very clear that this blog is completely counterproductive for my strength, power, and physique goals.In fact, I’d say that is roughly on-par with distance running as a competing demand for my attention and physiological recuperation.I’m going to take one for the team and keep writing, though; winners persevere.
(and in case you folks didn’t pick up on it, that was a joke)
Essentially, this is a survey of all the available research on the topic, and here is what they determined: “Only one trial was found that investigated the efficacy of PUFAs and antioxidants on tendinopathies. The findings suggest that some (low level) evidence exists to support the supplementation in the management of tendinopathies. Any conclusions based on this one article should be reached with caution. Subsequently, there is a distinct and clear need for well-planned randomized controlled trials that aim to investigate the efficacy of supplements in the management of tendinopathies including those of the rotator cuff.”
Meanwhile, we spend BILLIONS on NSAIDs, cortisone shots, and surgeries.Don’t you just love the medical model?While these options are certainly warranted in some situations, we’re studying for the wrong test by ignoring the role of PUFAs and antioxidants in the treatment of tendinopathies.
Chances are that the NIH won’t soon fund anything to look at this, though, as they are too busy doing the 38,736th study in history on creatine.
4. A good cartoon, in light of the week ahead:
5. Speaking of turducken, is anyone looking forward to listening to John Madden on Thanksgiving as much as I am? I mean, this is quite possibly the greatest broadcasting spectacle in football history, as Madden will be bouncing off the walls try to slip in as many Brett Favre references as possible - even if Favre and the Jets don't play until the following Sunday.
And, Frank Caliendo as Madden is awesome. They played this on the airplane on the ride back from Georgia a few weeks ago and everyone on board was laughing hysterically.
6. Another interesting study that ought to make you think:
Basically, the researchers found that college baseball players and swimmers were 3.23 and 2.95 times more likely (respectively) than their non-athlete counterparts to have disk degeneration.And, there was a clear association between disk degeneration and lower back pain.
Now, here is something to consider…I would be willing to bet that if you took these athletes and actually trained their “cores” the right way, they would be better off long-term than the nonathletes – in spite of the amount of disc degeneration that’s present already.I feel very strongly that multidirectional lumbar stability goes a long way in overcoming any structural flaws – from vertebral fractures (spondylolysis) to disc issues; there are a lot of structurally jacked up backs out there that are completely asymptomatic.
To me, it’s the folks who do nothing that are most at-risk of debilitating back pain long-term.When s**t hits the fan for them, they are playing behind the 8-ball, as they’re older and completely untrained.So, they are starting from scratch when it’s the hardest to start from scratch.Food for thought.
In the meantime, pick up a copy of Combat Core and save yourself.It’s the best “core training” program out there.
7. That last thought was pretty heavy with techy stuff, huh?Did it blow your mind?You know, kind of like it blew your mind when David Hasselhoff talked to that car – and the car actually talked back?
Yeah, that was crazy.
Anyway, that's all for this week. Did you miss me?
Roughly 10-15 times per week, I get emails from folks who claim that they have "shoulder impingement.” Honestly, I roll my eyes the second I read these emails.
Don’t get me wrong: I’m not making light of their pain. It’s just that it drives me crazy when doctors throw this blanket statement out there. I will be completely and 100% clear with the following statement:
Shoulder impingement is a physiological norm. Everyone – regardless of age, activity level, sport of choice, acromion type, gender, you name it – has it.
Don’t reach up to touch that mouse on your computer; you’ll aggravate your impingement and your supraspinatus will explode!
And, don’t scratch that itch on the back of your neck; your impingement will go crazy and your labrum will disintegrate!
So, the next logical question is: why do some people have pain with impingement while others don’t?
In reality, there are several factors that dictate whether or not someone is in pain, including:
1. Tissue quality – the most “impinged” structures are more likely to break down in older age than they are in earlier years. Younger individuals can regenerate faster even when overall stress on the tissues is held constant, so how you handle a 50-year-old with "impingement" is going to be somewhat different from how you handle a 15-year-old with "impingement."
2. Degree of elevation – the more one abducts or flexes the humerus, the greater the degree of impingement. This is why folks need to start in a more adducted (arm at side) position early on in rehab. Those that impinge early in their arc tend to be dealing with subacromial impingement, whereas those who hit it at the absolute top tend to be more AC joint impingement.
3. Acromion type – flat acromions have significantly less contact area with the rotator cuff tendons than hooked or beaked acromions. These structures may change over time due to…
4. Bone Spurs – bone spurs on the underside of the acromion will increase the amount of impingement.
5. Strength of the rotator cuff – the stronger the cuff, the better its ability to depress the humeral head and minimize this impingement
6. Scapular stability – the more stable the scapula, the more likely it is to posteriorly tilt and upwardly rotate effectively when the humerus is raised into the zones of greater impingement. This scapular stability includes adequate length of the downward rotators (pec minor, levator scapulae, and rhomboids) with adequate strength of the upward rotators (lower traps, serratus anterior, upper traps).
7. Thoracic spine mobility – the posture of the thoracic spine dictates the position of the scapulae, which in turn affects impingement as noted in #6. Assess and Correctis an awesome product for improving thoracic spine mobility - and you can also find some good drills in my recent post, Shoulder Hurts? Start Here.
8. Increased internal rotation – Certain movements that lock the humeral head in internal rotation increase the degree of impingement during dynamic activities. It’s why some people can’t bench press early-on in their rehabilitation programs, yet they can do dumbbell bench presses with a neutral grip pain-free. It’s also the reason why upright rows are a stupid exercise, in my opinion.
9. Breathing patterns – think about what happens when someone has poor diaphragmatic function and becomes a “chest breather:” the shoulders shrug up, and you get extra tightness in the levator scapulae, scalenes, pec minor, and sternocleidomastoid (among other supplemental respiratory muscles). In the process, the degree of impingement can increase.
10. Other issues further down the kinetic chain – I could go on and on about a variety of issues in this regard, but it’s impossible to be exhaustive – so I’ll just give an example. If someone has poor core stability in the sagittal plane that is manifested in an inability to resist the effects of gravity during a push-up, the hips will “sag” to the floor. As this happens, and the upper body remains strong, the scapulae are shifted into an anterior tilt –which increases the amount of impingement on the rotator cuff. So, weakness and/or immobility in other areas can certainly predispose an individual to shoulder problems.
This can also be carried forward to pitchers. We know that shoulder problems are more likely to occur in throwers who have poor lead leg hip internal rotation, as it causes the stride leg to open up early, leaving the arm “trailing behind” where it should be.
Speaking of pitchers, a phrase that has been coined with respect to the “unique” kind of impingement you see in them is “internal impingement.” In next week’s newsletter, I’ll discuss the different kinds of impingement – and why it’s still a cop-out diagnosis for any health care professional to just say you have one or the other rather than tell you explicitly what dysfunctions need to be addressed.
Click here to purchase the most comprehensive shoulder resource available today: Sturdy Shoulder Solutions
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It's Halloween, and as you're reading this, I'm down in Georgia for baseball stuff. Because I'm actually writing this on Tuesday night, it's hard to get in the mood and be spooky, but I'll do my best.
1. I'll be doing a LOT of baseball seminars over the next few months: November 8-9 (NY), December 14-16 (TX), January 30 (MA), and February 14 (MA). For more information, check out my schedule page.
2. I actually think the Fat Tax is a good idea. While we're at it, can we institute an a**hole tax for guys who curl in the squat rack? My girlfriend was lifting at a gym down in Southern CT this week, and she told me a guy took up a squat rack all morning to do three curl variations - and then proceeded to set up two bars in the rack to do dips. The good news for him, though, is that the Horse's A** trophy he receives partially offsets the tax.
3. When dealing with athletes post-ACL reconstruction, it's obviously important to get range-of-motion back quickly. However, the direction of that ROM can actually tell you quite a bit about what is going on. When someone is struggling to get knee extension, the problems are usually do to scarring. Flexion problems, on the other hand, are usually related to graft tensioning issues. In other words, when there is loss of flexion, it is usually surgical. When there is loss of extension, it is usually rehabilitative. When there is a loss of both flexion and extension, the problem is - you guessed it - Richard Simmons.
Yes, he's spooked, spooky, and stupid. I don't want your trick or your treat, Richard; I just want you to put some pants on and get a haircut.
4. Scientists recently confirmed a virgin birth in a shark. Apparently, the baby shark (called a pup, for reasons I can't explain) carried no male genetic material. Immediately upon its birth, the shark started bitching about how it didn't want to get too bulky.
Scientists fear for the pup's survival, as it refuses to swim fast enough to catch its prey because it doesn't want to get out of the "fat burning zone."
5. I went into quite a bit of detail on why I dislike the term "shoulder impingement" in my newsletter this week. Check it out HERE.
Just five this week, as I've got lots to do. Have a great weekend!
We are publishing this on Thursday night again, as I am going to be up early tomorrow to train, do an evaluation on a pro baseball pitcher who is in town from South Carolina, and then hit the road to get to Stamford, CT in time to speak on a roundtable at Ryan Lee’s Bootcamp. I’m looking forward to a great weekend and catching up with plenty of friends in the industry – including Mike Roussell and Alwyn Cosgrove, which leads me to…
1. For those who missed it, it isn’t too late to get the EricCressey.com subscriber-only discount on Warp Speed Fat Loss. Check out this week's newsletter for more details – or just head over to pick up a discounted copy through the following link (coupon code is embedded already):
Warp Speed Fat Loss
2. Still overpriced and lame.
3. Alan Aragon had a great article published at T-Nation yesterday. Definitely check it out:
A Musclehead’s Guide to Alcohol
4. Anyone who can find me a good study that shows that you can isolate the vastus medialis effectively gets a gold star. If you want to save yourself a few days of frustrating Pubmed searching, you’ll give up now, because you aren’t going to find it.
5. Someone asked what I thought the best substitute for front squats would be in the Maximum Strength program if one didn’t have access to a power rack. I’d probably go with walking dumbbell lunges – mostly because it’d be funny to see someone do clusters with lunges!
For the record, that was a joke, folks; lunge clusters would be stupid.
6. Some researchers say that we all would die of heart disease eventually if we “outlasted” everything else. I, on the other hand, would likely die from the monotony and pure frustration of trying to explain to baseball players and coaches why distance running is stupid. To tack a few years onto my life, please do me a favor; if you are a baseball player or coach, you need to read these two articles – and then forward them on to everyone you know who also plays or coaches.
Part 1Part 2
7. Someone asked me the other day if I thought all problems were related to anterior pelvic tilt. While it’s a big problem in athletes, I would not attribute any of the following problems to anterior pelvic tilt: gonorrhea, shingles, global warming, diarrhea, traffic jams, or that annoying cashier at Trader Joe’s who always insists on commenting on how I’m buying a lot of eggs. I do hope that bastard’s hip flexors are tight, though; he rubs me the wrong way. Michelle would probably kill him for a stupid comment like that.
8. I’ll be introducing a new product next week. While many of you might be disappointed that it won’t be the 2009 Mike Robertson Pin-up Calendar (March is the Funky Knee Surgery Scar Month; it drives the ladies wild), I’m sure you’ll be delighted with the content. This is absolutely, positively, a must-read for all personal trainers and strength and conditioning coaches. And, I suspect that a lot of you everyday gym-goers will like the content as well. If you aren’t already signed up for my free newsletter, sign up using the opt-in feature to the top-right of your screen (Name and Email Address) and you’ll be among the first to know.
Have a great weekend, folks!
