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

Written on May 31, 2011 at 8:12 am, by Eric Cressey

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

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

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

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

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

Me: “Elbows, too, I’m sure.”

Him: “Yep.”

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

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

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

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

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

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

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

2. Scapular Retraction/Posterior Tilt

3. Thoracic Spine Extension/Rotation

4. Valgus Carrying Angle

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

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

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

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

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

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

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

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

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

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

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

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

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Stuff You Should Read: 5/29/11

Written on May 29, 2011 at 4:14 am, by Eric Cressey

It’s been a while since I sent out a few recommended reading ideas, so here goes…

Cracking the Code on Muscle ImbalancesMuscle Imbalances Revealed has become a continuing education mainstay for our interns when they start with us, and with a new class about to get underway, it made me realize that this recap of the product I wrote a while back has slipped into the archives of my site.  There is a lot of good information here; check it out.

Why Bodybuilders are More Jacked than Powerlifters – Trust me when I say that the writing and research in this T-Nation article is far superior to what the title implies.  Bret Contreras and Brad Schoenfield did an excellent job with it.

Coaching Neutral Neck, Spine, and Wrist – This three-part series by Mike Robertson was very well done, as it includes a lot of valuable coaching cues for your strength training programs.  It includes several videos for those of you who are visual learners.

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Show and Go for Baseball Strength and Conditioning?

Written on May 26, 2011 at 8:54 am, by Eric Cressey

In the past few months, I’ve gotten quite a few inquiries about whether Show and Go: High Performance Training to Look, Feel, and Move Better is a good fit for baseball players.

While I never wrote the book with the intention of training this athletic population, it can be quickly and easily modified to fit the unique needs of baseball.  The principal changes are going to be:

The big differences are going to be:

1. Use more front squatting, and little to no back squatting (we do use a lot of giant cambered bar and safety squat bar variations at Cressey Performance).

2. Eliminate barbell bench pressing and overhead pressing, instead plugging in some dumbbell bench pressing and pushup variations, as seen here and here.

3. In the off-season, we usually do medicine ball work 2-3x/week.  The medicine ball volume is higher in the early/mid-off-season and lower during the late off-season and in-season phases.  For some exercise ideas, you can check out this post of mine, as well as my YouTube Channel.

Usually, this medicine ball training is incorporated before lifting or movement training.

4. I’d add some rhythmic stabilization work 2x/week – as seen here.

All in all, the program is surprisingly versatile for the baseball player.  In the off-season, the 4x/week template works great.  Then, as the late off-season and pre-season get underway, the 3x/week program is a better fit.  In-season, you’ll see more position players and relief pitchers using the 2x/week approach, whereas starters can get in 3x/week lifting.  Obviously, the volume may be reduced, but the exercise selection, overall training schedule, training stress fluctuations, core training, and warm-up sequences are all very applicable. It won’t be perfect, but it’ll be markedly better than any of the cookie cutter or football lifting programs you’ll see out there.

For more information, check out Show and Go: High Performance Training to Look, Feel, and Move Better.

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An Awesome Resource for Healthy Food Options

Written on May 25, 2011 at 9:15 am, by Eric Cressey

Based on the overwhelmingly positive response to my two blogs on Metabolic Cooking recently (you can find them HERE and HERE), I thought I’d do my best to incorporate a little more nutrition flavor (no pun intended) to this blog.

Fortunately for me, Cara Lyons is a Cressey Performance client who just so happens to write a fantastic blog on healthy food options: Cara’s Cravings.

She also just had a recipe for Banana Curry Chicken Foil Packets with Cashew Raisin Quinoa featured in Clean Eating Magazine.

Check out her site; you’ll find a lot of tasty (and free) recipes to make summer eating healthier.

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Weight Training Programs: The Basics, but with Variety

Written on May 24, 2011 at 7:16 am, by Eric Cressey

Our puppy, Tank, is about nine months old now.  And, he’s getting more mellow with each passing day.

When we first got him, my wife and I didn’t allow him to come upstairs, as we wanted him to gradually adjust to the downstairs of our house and slowly introduce him to more space.  Accordingly, to him, upstairs became the “great beyond,” a place where unicorns played and milkbones rained down from the heavens.  He would try like crazy to get up there when we took our eyes off him.

Then, one weekend in January, my wife and I were out of town to visit friends in Florida, so one of my minor leaguers and his wife watched Tank and the house.  With us gone, he barked and cried at night – so they let him come upstairs to sleep with them in their bed.  When we returned home, there was no turning back; he now sleeps in our bed – a change that he’s made very clear is for good.

What’s more interesting, though, is the fact that he’s still infatuated with the upstairs portion of the house.  He’ll go up and take naps on the bed when my wife and I are downstairs, and if either of us goes upstairs to grab something, he’ll race up after us to ensure that he doesn’t miss a unicorn sighting or the opportunity to score a treat.  Meanwhile, all the cool stuff – food, treats, his toys, cool scents of other people, stuff to chew, things to pee on, space to run around (including the door to the back yard) – are all still downstairs.  If I was a dog, upstairs would be pretty boring – and the downstairs would be “where it’s at.”  Puzzling, huh?

In case you couldn’t tell from the title of this piece, there is a strength and conditioning parallel to this story.  A lot of lifters start with the basics (the downstairs) and make great progress – only to abandon the “staple” strength exercises in favor of something new, unproven, and gimmicky (the upstairs).  Then, even when they realize that the flavor-of-the-week stuff isn’t all that it’s cracked up to be, they don’t go back to what worked in the first place.  Why?  They’ve convinced themselves that novelty is more important than efficacy, and that it’s easier to do the fun new stuff than it is to get good with the basics.  It’s the kind of logic that makes me wonder if a lot of people eat paint chips.

The question, of course, becomes “How can we ‘sell’ the basics to a beginner who appreciates variety and novelty?”  My response would simply be that variety and novelty can be synonymous with progression.  I’ll give you an example.

On the first day at Cressey Performance, just about every new client learns the trap bar deadlift (assuming no injury that would contraindicate the exercise).  As I outlined last week, it’s an entry-level teaching progression that best allows lifters to grasp the concepts of hip hinging, vertical shin, neutral spine, and optimal hip extension patterning in spite of their mobility restrictions.  It’s the basic arithmetic before we get to calculus.

Once they’ve sufficiently learned the lift and progressed in the weight they’ve lifted, we can transition them to other deadlift variations, including sumo deadlifts, rack pulls, and trap bar with chains.  Then, eventually, they may graduate to conventional and snatch grip deadlift technique.  This set of progressions and regressions are combined with other strength training program variables – sets and reps, training frequency, exercise pairings, and the like – to give them the novelty they need – but without compromising the training effect.

I’ve seen football strength coaches who use the squat, bench press, and clean as their primary lifts for years on end.  Do kids get stronger?  Absolutely.  Do they get bored as hell and absolutely disinterested in their less-than-optimal training programs?  Absolutely.  And, do they miss out on the rich proprioceptive environment that all young athletes should have?  Absolutely.

So, there is a balance that must be discovered.  On one hand, you need to stick to the basics so as to not compromise the training effect.  On the other hand, you need to implement variety so as to not bore folks to death.  The solution is to use variations of the basics.

To that end, at Cressey Performance, we change the strength training program every four weeks to modify exercise selection, regardless of a trainee’s age and experience level.  In our eyes, it provides the best balance of the basics and the novelty to keep folks motivated and progressing in their strength and conditioning programs.

Looking for an example of how this looks in a real-world weight training program? Check out Show and Go: High Performance Training to Look, Feel, and Move Better.

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Long Toss Debate Heating Up!

Written on May 23, 2011 at 5:31 am, by Eric Cressey

The question of whether or not teams will allow pitchers to long toss as part of their throwing programs between/before outings has become a hot topic that could really impact the MLB draft on June 6-8.  Jeff Passan of Yahoo Sports did an excellent job of outlining the entire situation in this article:

Long Toss Debate Shakes up MLB Draft

Additionally, I gave a quote for this article on the subject at PineTarPress.com.  Needless to say, I’m a big long toss advocate and have seen its efficacy over and over again when it comes to increasing throwing velocity. I’m glad that these issues are being brought to the forefront.  If you’d like to read more about the who, what, when, where, why, and how of long toss, check out these three articles:

Making the Case for Long Toss in a Throwing Program

Throwing Programs: The Top 4 Long Toss Mistakes

Long Toss: Don’t Skip Steps in Your Throwing Programs

Just some food for thought to kick off the week!

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EC Turns 30, So You Save $50

Written on May 19, 2011 at 7:32 am, by Eric Cressey

Friday is the 9th anniversary of my 21st birthday my 30th birthday.

Normally, I’d write a long post for the occasion, but truthfully, now that I’m getting old and decrepit, I figured I’d better conserve my waning energy and get right to the point.

Show and Go: High Performance Training to Look, Feel, and Move Better will be on sale for $77 from now through Sunday, May 22th, at midnight.

That’s $50 off the normal price – and this is a price that was previously only been available during the initial launch of the e-book.  And, it won’t be around again for a long time, because 31st birthdays just aren’t at all memorable.

Plus, it stands to reason that I’ll probably spend the entire next decade driving a minivan, changing diapers, wondering where my hair went, and playing awful defense in an old man basketball league while wearing Croakies and high tube socks.  Come to think of it, this might be my last blog post ever.  I guess you’d better purchase a copy of Show and Go as soon as possible to preserve my legacy before I slip into internet obscurity.

You can read loads of testimonials on the Show and Go website, but in case you’d like a few more examples of happy customers, check out these reviews:

Show and Go Review: Get Strong and Destroy Clothes
Show and Go Review: A Personal Trainer’s Experience
Review of 8 Months of Show and Go and Maximum Strength

Show and Go Training Review: THE Way to Get Strong

I’m off to enjoy the last few hours of my 20s, but in the meantime, you can head over to www.ShowandGoTraining.com and take advantage of this great offer on an extremely versatile strength and conditioning program that can be implemented for just about any goal! Remember, this offer expires on Sunday at midnight.

Already a Show and Go customer?  I’d love to hear your feedback in the comments section below.

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Pitching Injuries: It’s Not Just What You’re Doing; It’s What You’ve Already Done

Written on May 18, 2011 at 6:22 am, by Eric Cressey

A while back, this article on pitching injuries became the single-most popular piece in EricCressey.com history:

Your Arm hurts?  Thank Your Little League, Fall Ball, and AAU Coaches

In that feature, I made the following statement:

We can do all the strength training, mobility work, and soft tissue treatments in the world and it won’t matter if they’re overused – because I’m just not smart enough to have figured out how to go back in time and change history. Worried about whether they’re throwing curveballs, or if their mechanics are perfect?  It won’t matter if they’ve already accumulated too many innings.

While athletes might be playing with fire each time they throw, the pain presentation pattern is different.  You burn your hand, and you know instantly.  Pitching injuries take time to come about. Maybe you do microscopic damage to your ulnar collateral ligament each time you throw – and then come back and pitch again before it’s had time to fully regenerate.  Or, maybe you ignore the shoulder internal rotation deficit and scapular dyskinesis you’ve got and it gets worse and worse for years – until you’re finally on the surgeon’s table for a labral and/or rotator cuff repair.  These issues might be managed conservatively if painful during the teenage years (or go undetected if no pain is present) – but once a kid hits age 18 or 19, it seems to automatically become “socially acceptable” to do an elbow or shoulder surgery.

Sure enough, just yesterday, reader Paul Vajdic sent me this article from the Shreveport Times. The author interviews world-renowned orthopedic surgeon Dr. James Andrews about the crazy increase in the number of Tommy John surgeries he’d performed over the past decade.

A comment he made really jumped out at me, in light of my point from above:

“”I had a kid come in, a 15-year-old from Boca Raton, (Fla.), who tore his ligament completely in two,’ Andrews said. ‘The interesting thing is when I X-rayed his elbow with good magnification, he has a little calcification right where the ligament attaches to the bone. We’re seeing more of that now. He actually got hurt with a minor pull of the ligament when he was 10, 11, 12 years of age. That little calcification gets bigger and, initially, it won’t look like anything but a sore elbow. As that matures, it becomes more prominent. It turns into an English pea-size bone piece and pulls part of the ligament off when they’re young.’”

In other words, it takes repeated bouts of microtrauma over the course of many years to bring an athlete to threshold – even if they have little to no symptoms along the way.  Injury prevention starts at the youngest ages; otherwise, you’re just playing from behind the 8-ball when you start training high school and college players.

In addition to walking away with the perspective that young kids need to be strictly managed with their pitch counts, I hope this makes you appreciate the value of strength and conditioning programs at young ages, too.  For more information, check out my post, The Truth About Strength Training for Kids.

We can’t prevent them all, but I do think that initiatives like the IYCA High School Strength Coach Certification in conjunction with pitch count implementation and coaching education are a step in the right direction.

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“The Physics of Pitching” Review

Written on May 17, 2011 at 6:07 am, by Eric Cressey

I just wanted to quickly mention that a book to which I contributed will be out shortly. The Physics of Pitching will be released on June 6 and can be pre-ordered at Amazon.

Len Solesky, a local pitching instructor who works with quite a few of our athletes, co-wrote the book with James Cain. The Physics of Pitching also features contributions from orthopedic surgeon Dr. Scott Silverberg, physical therapist Rob Ackerly, former MLB pitcher Rusty Meacham, and some schmuck named “Cressey.” My chapter is, of course, focused on strength and conditioning for baseball.

This is an excellent read for parents and kids alike. It won’t appeal quite as much to higher level players and coaches, but if you’re looking to learn the basics of pitching and become a better teacher (or student), it’ll help you to do so. I especially like the fact that the guys went to great lengths to focus on the mental side of pitching.  In all, it’s 192 pages with loads of photographs and an accompanying instructional DVD…not too shabby for a resource that only costs $16.49.  Check it out HERE.

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Shoulder Hurts? Start Here.

Written on May 16, 2011 at 7:45 am, by Eric Cressey

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

The problem is that pain can throw a wrench in your plans and limit you in your ability to get to exactly where someone needs to improve movement-wise.  For instance, you might have someone who has a significant glenohumeral (ball-and-socket) internal rotation deficit, but it’s hard to manually stretch them into internal rotation without further irritating a cranky AC joint.  Or, someone with a partial thickness rotator cuff tear may be dramatically limited in shoulder flexion, but even shoulder flexion with assisted scapular posterior tilt and upward rotation exacerbates their symptoms.  Very simply, you can’t just pound round pegs into square holes when it comes to dealing with a delicate joint like the shoulder – and that applies to both asymptomatic and symptomatic shoulders.

To that end, there are three initiatives that I think are the absolute most important places to start in just about every case.

First, I’m a huge advocate of soft tissue work with a skilled manual therapist.  In our office, we have a massage therapist and chiropractor who performs both Active Release and Graston.  And, we make sure that any physical therapist to whom we refer clients uses manual therapy as an integral part of their treatment approach.  Whether you’re a regular exerciser or not, tissues can get dense, nasty, and fibrotic, and integrating some hands-on work on the pec minor, posterior rotator cuff, lats, scalenes, sternocleidomastoid, and several other areas can dramatically reduce an individual’s symptoms and improve range-of-motion instantly – and that allows us to do more with a corrective exercise program.

Understandably, not everyone has access to a qualified manual therapist all the time, so you can always utilize self-myofascial release in the interim.  Here, in a video from Show and Go: High Performance Training to Look, Feel, and Move Better, CP massage therapist Chris Howard goes over a quick and easy way to loosen up the pecs:

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

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

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

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

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

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

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

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

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

Michael Ranfone BS, CSCS, LMT, ART
Owner, Ranfone Training Systems



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