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Hip Anteversion – Assessment and Implications for Strength and Conditioning Programs

Written on February 29, 2012 at 7:31 am, by Eric Cressey

Today, we have a guest blog from former Cressey Performance intern Eric Oetter, who is well on his way to a great career in physical therapy. Eric is an extremely bright up-and-comer from whom you’ll be hearing a lot in the years to come.  Here’s a little sampling.

 

As part of the “pre-launch” phase for his new collaborative project, Elite Training Mentorship, Eric posted an outstanding video covering the lower-extremity assessment protocol he uses at Cressey Performance. For those who haven’t yet seen it, follow the link here; you won’t regret it.

In the video, Eric mentions three different factors that can contribute to mobility deficits at the hip: muscular restrictions, capsular restrictions, and bony restrictions. While the first two – muscular and capsular – can be relatively easy to decipher based on the test position of the hip, identifying bony restrictions can be tricky unless you’ve got access to a client’s radiological imaging. For this reason, it’s important to appreciate any structural variations in the skeletal system that can underlie joint malalignment at the hip.

The focus of this piece is a structural variation called hip anteversion. We’ll be covering the joint morphology associated with anteversion, along with a quick orthopedic test and some implications for programming.

What is hip anteversion?

Excerpted from the 2002 text Diagnosis and Treatment of Movement Impairment Syndromes, Shirley Sahrmann describes hip anteversion as the following:

“ … the angle of the head and neck of the femur is rotated anteriorly, beyond that of the normal torsion with respect to the shaft. The result is a range of medial hip rotation that appears to be excessive, whereas the lateral rotation range appears to be limited.”

Essentially, clients who present with this structural abnormality were born with, or have acquired, a more internally oriented neutral position for their femurs as they sit in the acetabulum (or hip socket). To be classified as anteverted, the femoral head and neck must be rotated more than 15° anteriorly with respect to the plane of the femoral condyles (Sahrmann 2002). (Conversely, a posterior rotation of the femoral head and neck would constitute a retroverted hip.)

When observed standing, clients with hip anteversion will often present with femoral adduction and genu valgum – the classic “knock-kneed” posture. As kids, these clients likely eschewed “indian-style” for W-sitting – a position much more congruent with their natural femoral alignment.

 

While some might also classify “pigeon-toes” as an indicator for anteverted hips, this is not always the case. In the presence of anteversion, some clients – especially athletes – will develop a tibial torsion as a result of the applied stresses to the lower extremities. This adaptation allows for a neutrally aligned sub-talar joint in the face of morphological changes up the kinetic chain.

The largest implication of hip anteversion or retroversion is a significant discrepancy between hip internal and external rotation. As described in the Sahrmann quotation above, hip anteversion creates an apparently large amount of internal rotation (IR) with a reciprocal loss of external rotation (ER).

I liken these morphological changes to those seen in the retroverted shoulder of an overhead throwing athlete.  The total hip range of motion (IR + ER) can present at around 90°, or “normal”, but these measures are drastically skewed in one direction of rotation.

Whereas a retroverted shoulder presents a favorable adaptation in baseball, the same cannot always be said for the athlete with anteverted hips.

If undiagnosed or mismanaged, hip anteversion can create pathology.  Expect issues like knee pain, back pain, and hip instability (Sahrmann 2002). For this reason, it’s imperative to recognize anteversion when it presents and apply the programming modifications necessary to accommodate this structural abnormality.

So how can I test for it?

Although checking IR and ER in both supine and prone can highlight limitations in the capsule or surrounding hip musculature, you’ll need an extra orthopedic test at your disposal to clear the skeletal system. For this purpose, we’ll use the Craigs’s test.

Assuming you’re following the assessment outlined in Eric’s video, the best time to perform a Craig’s test is immediately after you’ve assessed a client’s hip rotation in prone, especially if you detect a glaring asymmetry between IR and ER.

Note the client in the photos below – here, we see an excessive amount of IR (~50°) met with limited ER (only ~20°). With a rotational deficit of ≥30°, this client may have some torsional issue at play; thus, a Craig’s test indicated.

With the client remaining in prone the knee held in flexion, the Craig’s test is performed by first palpating the same side greater trochanter, a landmark on the femur that protrudes laterally about 5 inches below the iliac crest. Make sure to apply flat-hand contact with the pads of the fingers – this posture allows for greater sensory feedback and precision. Once this position is assumed, begin internally and externally rotating the femur through its full range of motion.

As you rotate the leg, you’ll notice the greater trochanter tracking against your fingertips, becoming more or less prominent depending on the direction of rotation. Start shortening your oscillations until you determine the position at which the trochanter is most prominent laterally and pause once you locate it. At this range of rotation, the femoral head is optimally situated within the acetabulum.

We get a positive Craig’s test when the hip rotation at the point of ideal femoral alignment is ≥15° into IR. Also, we can now classify the hip as anteverted, providing useful insight for the dexterous coach.

Check out the video below to see a Craig’s test performed on our client from above.

 

One thing worth noting – a 1992 study by Ruwe et al. showed the Craig’s test to be more reliable than radiological techniques in the assessment of femoral torsion. So, even if you have client X-rays available, a Craig’s test is still worth administering.

If the Craig’s test is positive, how should I alter programming?

Now that we’ve performed a Craig’s test and determined whether or not any torsional qualities exist, it’s time to write an effective program that respects our findings. Here are a few do’s and don’ts to consider when programming:

DON’T stretch the hip into external rotation – this only creates impingement. We wouldn’t force the retroverted shoulder of a pitcher into an end-range sleeper stretch, so we need to take the same approach with an anteverted hip. Even though the hip is a much more durable joint, there’s no reason to drive motion that a client simply doesn’t have, as this only serves to jam the femoral head against the acetabulum.

DO increase the amount of core work in clients with femoral torsion. When someone is stuck in internal rotation at the hip, the kinematics of the lower-extremities become predisposed towards a pronation pattern (sub-talar pronation, tibial/femoral IR, and anterior pelvic tilt).

The hip external rotators often become excessively stiff and overused, as they are constantly checking motion into adduction, internal rotation, and flexion. While increasing external rotator strength will improve the first two, we can employ the posterior fibers of external oblique and rectus abdominis to aid in flexion control, creating a more stable pelvis. By doing so, we’re also increasing stiffness at the lumbar spine, fighting any compensatory motion created by the hip external rotation deficit.

As far as exercise selection goes, focus on half-kneeling chops/lifts and anti-extension – both integrate the hips and core simultaneously to check hip flexion ROM. I especially like rollout variations for clients with hip anteversion, which are highlighted in Eric’s video below.

DON’T introduce quad-dominant lifts until the client shows dramatic improvements in hip stability. The pronation pattern I described above is essentially a cookbook for ACL and MCL injuries. In a population that is likely anteriorly tilted at the pelvis and anterior weight bearing, the last thing we want to do is make them even more reliant on their quads. An adroit posterior chain should precede any anterior chain-focused movement.

DO hammer the posterior chain as if your life depended on it. While this statement could serve as a mantra for most general population programming, it is even more important when dealing with anteversion of the hip. These clients sometimes present with femoral control so poor, our first goal is to simply get them to baseline.

Mastering stability in the sagittal plane takes precedence. Start bilateral with deadlift and box squat variations and increase stability demands as the client advances. Great second tier progressions include single-leg RDLs, single-leg hip thrusts, and bowler squats, all of which introduce frontal and transverse plane stability.

Lastly, exercises that force the femur into an abducted and externally rotated state are contraindicated – sumo deadlifts provide a great example. Even though pulling sumo is a fantastic variation for hip strength, it can create malalignment in the acetabulum if the hip is anteverted. In this case, it’s safer to stick with either trap bar deadlift or conventional deadlift variations.

Conclusion

Hip anteversion isn’t something you’ll likely see in every client. Johns Hopkins Medical School reports the prevalence to be ~8-10%, but that number varies based upon cultural norms and neurodevelopmental patterns, which can alter skeletal growth.

Regardless, it is an important structural variation to recognize and program for, especially in an athletic population. Taken as supplement to Eric’s lower-extremity video, I hope this article provides you another piece towards building a better assessment.

About the Author

Eric is currently a senior at the University of Georgia majoring in Exercise and Sport Science, with plans to pursue a Doctorate of Physical Therapy. After concluding a Division-1 football career at the Georgia Institute of Technology, Eric has ardently pursued his passion for coaching, garnering experience with clients of all ages and ability levels through internships at both Indianapolis Fitness & Sports Training and Cressey Performance. His articles can be found on EricCressey.com, 8weeksout.com, and in Fighting Fit magazine.  You can follow him on Twitter or reach him via email at ecoetter@gmail.com.

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Strength and Conditioning Stuff You Should Read: 2/27/12

Written on February 27, 2012 at 1:27 am, by Eric Cressey

Here’s a list of recommended strength and conditioning reading to kick off you week.

The Prevalence of Radiographic Hip Abnormalities in Elite Soccer Players – This recently published study in the AJSM shows us just how common hip issues are in soccer players – even if they’re asymptomatic.  You can apply this to hockey players as well – and possibly on an even more pronounced level.  This goes hand-in-hand with some of my writings in the past about knees, shoulders, and lower backs.  Just because someone is asymptomatic does not mean that they are “healthy” – and this is why assessment and an understanding of population-specific norms are so important!

Band-Assisted 1-arm Push-ups: A Better Alternative – My buddy Shon Grosse outlines a good progression for those looking to build up to a one-arm push-up.

Causes InternationalThis isn’t so much fitness-related, but I think it’s a great organization worth checking out. The folks at Causes International provide an opportunity for you to help raise money for your favorite charities by donating your used electronics (a process known as upcycling).  Most people have old gadgets kicking around the house, and these can easily be upcycled to benefit others and protect the environment.

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Strength Training Programs: Are Pull-ups THAT Essential?

Written on February 24, 2012 at 10:45 am, by Eric Cressey

The pull-up is among the most sacred strength exercises in the history of weight training programs, ranking up there with squats, deadlifts, and bench and overhead presses.  This is one reason why I expect there to be burning Eric Cressey effigies in various strength and conditioning circles after they read the following sentence:

Some people would be wise to leave out pull-ups - at least temporarily.

Before you rip me a new one, please give me a few minutes to explain.

First off, I get it: pull-ups train the lats, and the lats are huge players in athletic function and the quest to get strong and gain muscle.  They’re the biggest player in force transfer between the lower and upper body, and play key roles in core stability and breathing.  Specific to my baseball work, lat recruitment is higher during acceleration in professional pitchers than amateurs, showing that reliance on this big muscle helps generate increase pitching velocity, too.  I actually wrote an entire article back in 2006 about just how extensive the lat’s role is, if you’d like to read more: Lats: Not Just for Pulldowns.

However, the “expansive” presence of the lats – running from the thoracolumbar fascia all the way up to the humerus – can make them a problem as much as they are a solution.  To that end, here are four reasons you may want take a break from pull-ups/chin-ups/pulldowns in your strength training program:

1. Heavy pull-ups can make the elbows very cranky – This is really the shortest and least complex of my arguments, so I’ll get it out of the way early.  My personal best three-rep max chin-up is 321 pounds, at a body weight of about 188 pounds (so, the external load was 133 pounds).  My best raw three-rep max bench press is about 330 pounds, but what you might find surprising is that going heavy on the bench press is dramatically easier on my joints (particularly my elbows) than pull-ups/chin-ups are.  What gives?

First, when you bench press, you’re doing a full-body movement.  There is leg drive and loads of core stability involved on top of the upper extremity activity that’s taking place – so the stress is more easily distributed.  When you do a pull-up, your upper extremity is relatively isolated, so the stress is more concentrated.

Second, a pull-up is a traction exercise; it pulls the humeral head out of the socket, and essentially pulls the lower and upper arm apart at the top. When you lose bony congruence – one of the most important, yet overlooked components of joint stability – you have to pick up the slack with the active restraints (muscles/tendons) acting at the joint.  Low-level traction can be tremendously helpful in situations like external impingement at the shoulder, or intervertebral disc issues.  However, under extreme load, it can be pretty darn stressful to the soft tissue structures around the joint.  Conversely, a bench press is an approximation exercise, so you can actually draw some stability from the joint alignment itself to take some of the stress off the soft tissue structures.

I remember Jason Ferruggia writing recently about how heavy chin-ups/pull-ups can really beat up on older lifters – and it’s safe to say that the reason isn’t so much tissue degeneration, but simply that it took time for them to build appreciable enough strength to get to the point where the overall stress was too much.

2. The lats overpower the lower traps - The overwhelming majority of the baseball athletes I see (and most extension/rotation sport athletes, in general) live in lordotic postures.  The lat is a strong extensor of the spine – but it also attaches to the rib cage and scapula on the way to the upper extremity.  The end result is that many lordotic athletes wind up with a very “gross” extension pattern.

The rib cage flairs up, and the lower traps do little to pull the shoulder blades back and down on the rib cage – because the lats have already gotten an athlete to the position he/she wants to be in via lumbar extension.  You can see from the picture below that the line of pull of the two muscles is actually very comparable – but given cross sectional area and length, the lat will always have the upper hand, especially if it’s constantly being prioritized in a strength training program due to exercise selection and faulty lifting technique.

Effectively, we need to learn to move our scapulae on our rib cage, as opposed to just moving our entire spine into extension.  Interestingly, you’ll find a lot of flexion-bias in the Postural Restoration Institute (PRI) and Dynamic Neuromuscular Stabilization (DNS) schools of thought because they clearly appreciate that getting folks out of “gross extension” is a way to get/keep people healthy.  Having ultra short/stiff lats can cause issues ranging from extension-based back pain (e.g., spondylolysis) to shoulder pain (e.g., external or internal impingement).  As I’ve written previously, too, this global dysfunction may also be the reason we’re seeing more femoroacetabular impingement in athletes.

As another interesting aside, I see a lot of throwers with low right shoulders and incredibly short/stiff lats on that side.

This is secondary to faulty rib positioning and the scapular anterior tilt that ensues (as per the PRI school of thought), but one additional thing we’ve found (thanks to great feedback from physical therapist Eric Schoenberg) is that overhead shrugging variations on the low shoulder have helped these throwers to not only feel better, but minimize these asymmetries.  Effectively, creating a bit more stiffness in the upper trapezius helps it to counterbalance the aggressive downward pull of the lat on the scapula.

These folks sit in scapular depression, and for that reason, we’ll often leave out any exercises (e.g., deadlifts, dumbbell lunges) that involve holding heavy weights in the hand until scapular positioning is better controlled.

3. The humeral attachment portion of the lat is part of a significant zone of convergence at the posterior shoulder – The back of your shoulder is another one of those claustrophobic areas in your body.  You’ve got tendons for the lat, teres major, teres minor, infraspinatus, long head of the triceps, and posterior deltoid all coming together in a very small area, creating friction over each other as their individual forces come together (regions like this are called “Zones of Convergence” by myofascial researcher Luigi Stecco.

The latissimus dorsi is, without a doubt, the largest and strongest of all the involved structures.  It also has the longest tendon, which makes it the biggest candidate for nasty tissue quality in the region.  The problem is that muscles/tendons don’t deform evenly; rather, they move a lot where the tissue quality is good, and very little where it is dense.  So, when you’re super dense in the posterior shoulder and try to go do pull-ups, as I noted earlier, the entire shoulder girdle wants to move (humeral extension and internal rotation, and scapular depression) together, as opposed to a nice synergy of the humerus with the scapula on the rib cage.  When some is stiff in the posterior shoulder and wants to use the lat for everything, a seated cable row looks like this.  Notice how the elbow winds up behind the body, and the scapula anterior tilts – and also how old the video is; I look like I am 12 years old and weigh 120 lbs.

Rowing like this over time will eventually irritate the anterior shoulder.  However, watch this standing one-arm cable row where the humeral head (ball) maintains a good alignment with the glenoid fossa (socket) as the shoulder blade moves on the rib cage.  The humerus doesn’t extend unless the scapula moves with it.

4. Overactive lats can decrease the subacromial space – The lat extends, adducts, and internally rotates the humerus.  In order to get overhead the right way, we need flexion, abduction, and external rotation of the humerus.  So, you can see that it’s a direct antagonist to healthy, overhead movement.  If you think about your biggest players for pain-free overhead movement, two of them have to be the posterior rotator cuff and lower trapezius.  The lat overpowers both of them in a “gross” extension pattern.

Here’s a test: position yourself supine, bend the knees, flatten the lower back, and then let your arms hang freely overhead.  Then, have someone take a picture looking down at the top of your head.  A “pass” would be full shoulder flexion with no arching of the back, and no shoulder pain along the way.  A fail would be pain, or something that looks like this:

If your photo looks like this, you better hope that you have outstanding posterior rotator cuff and lower trapezius function (adequate stiffness) to overpower some very short lats if you intend to train overhead pain-free (especially with overhead pressing).  Otherwise, your shoulder flexion will really just be lumbar extension and forward head posture substitutions (this one has a nice left rib flair, too).

In other words, you need adequate anterior core stability and good recruitment of the deep neck flexors, too, but those are blogs for another day.

Closing Thoughts

This post has gone on far too long, and to be honest, I’ve probably just used the last 1300+ words to piss a lot of you off.  You’ll be happy to know, however, that we still use a ton of pull-ups/chin-ups in our strength training programs at Cressey Performance.  In fact, they’re a mainstay.  Here are some modifying factors, however:

1. The risk:reward ratio gets a little out of whack once you get very strong with pull-ups.  You’d be better off adding sets and reps, as opposed to adding load – and you may want to push the heavy stuff less frequently than you would with compound exercises.

2. Get regular manual therapy at the posterior shoulder and entire elbow to stay on top of tissue quality. At the very least, make sure you’re foam rolling a ton and using The Stick:

3. Strengthen the anterior core and deep neck flexors so that you don’t substitute lumbar hyperextension and forward head posture, respectively, for shoulder flexion.

4. Strengthen the lower traps so that the lats can’t overpower them.  I like wall slides at 135 degrees abduction, as it allows one to work in the direct line of pull of the lower traps.  Make sure to cue “glutes tight, core braced” so that folks can’t substitute lumbar extension (“gross extension”) for movement of the scapulae on the rib cage.  Make sure there is no forward head posture, too.

Prone 1-arm trap raises off the table are also a popular one.  Just make sure you continue to cue “glutes tight, core braced, and no forward head posture.”

4. Maintain adequate length in the lats. In warm-ups, I like the bench t-spine mobilizations and side-lying internal external rotation as a means of getting some shoulder flexion.

In terms of static stretching, a lat stretch in the power rack is great.

If this gives you an impingement feeling, regress it a bit, stabilize the scapulae with the opposite hand, and gently dip into a wall lat stretch with stabilization.

Many folks will also benefit from this classic overhead stretch in order to reduce stiffness in the long head of the triceps, a synergist to the lats in humeral extension.

5. Make sure you’re including plenty of horizontal pulling (rowing) strength exercises as well – and executing them with the correct form.  This means moving humerus and scapula together on rib cage, not just yanking the humerus into extension on a fixed scapula.

6. If you have terrible shoulder flexion and can’t get overhead without substituting forward head posture and lumbar hyperextension, spend some time addressing the underlying issues before you start cranking on pull-ups.  We actually don’t do any pull-ups/chin-ups with some of our professional baseball players for 4-8 weeks following the season, as we need to spend time building rotator cuff, lower trap, and anterior core strength. I like to use the back-to-wall shoulder flexion exercise as a “pass/fail test.” If you can get the thumbs to the wall without losing the flat-back posture on the wall or bending your elbows, then you can probably start going to pull-ups.

7. Above all else, listen to your body, and hold back if pull-ups/chin-ups hurt.

I’d love to hear your thoughts on this post and your experiences with heavy and/or high-volume pull-ups/chin-ups in the comments section below.

For more information on the role of the lats in upper extremity health and function, I’d encourage you to check out our Optimal Shoulder Performance DVD Set.

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Some Fitness Business Advice: Get on Twitter!

Written on February 23, 2012 at 1:12 pm, by Eric Cressey

I stubbornly resisted having a Twitter presence (@EricCressey) for a long time.  My perception was always that it was just a bunch of schmucks notifying the world that they were watching TV or going grocery shopping.  It was only after a friend convinced me to give it a shot that I realized that Twitter was only stupid if you used it for stupid things.

This discussion might not seem applicable to this site, but the truth is, I’ve always prided myself on making EricCressey.com a place where you can get outstanding training, nutrition, supplementation, and motivational information.  It’s grown in popularity because a lot of the best information you can find in these realms is condensed in one place to make your life easier.  And, this is one of the many reasons Twitter has been successful: you can condense the important stuff in one place by picking and choosing who you follow.  For instance, I generally only follow folks in our industry, my athletes, and a host of baseball reporters around the country.

Conversely, imagine turning on the local news to hear about the weather for tomorrow.  Chances are that you’ll have to watch some segments about politics, crime, sports, and religion as you wait for them to get to the weather.  This is fine if you’re interested in being well-rounded, but not very ideal if you’re just trying to figure out whether or not you should wear a long- or short-sleeved shirt the following day.  I’ll take Twitter every day of the week over this – especially since it doesn’t force me to look at 15 different websites to get the information I need.

Additionally, it’s a quick and easy way to interact with people – friends, customers, readers – concisely.  I’ve also found our CP Twitter account (@CresseyPerf) to be a great way to build camaraderie among our staff and clients; they are constantly busting each other’s chops and building a stronger sense of community with each new day. Plus, it’s a great way to share client success stories with the rest of the crowd so that everyone can feed off each other.

So, take it from a guy who fought it for the longest time, but is now regretting getting on Twitter sooner: join today!

For more Fitness Business Information, I’d encourage you to check out the Fitness Business Blueprint.

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CP is Hiring!

Written on February 22, 2012 at 9:20 pm, by Eric Cressey

Yes, you read that correctly; we are hiring another strength and conditioning coach at Cressey Performance!

This is the first time we’ve ever posted a job externally, as all previous hires have been from our internship program. In this case, we’ll be opening this opportunity up to the masses.  A few quick notes:

1. The application deadline is March 10.

2. We’ll be selecting a candidate by April 15, and the position will begin on May 15 (this date is negotiable).

3. Please, please, please read the application instructions carefully!  We have a specific email address in place for all job-related submissions and inquiries, and it will be a big bottleneck if applicants start emailing and calling us directly via our normal business email and phone number.  Thanks for understanding in this regard.

You can learn everything you need to know by downloading the application instructions and job description PDF at the following link: CP Job Description and Application Info

Hope to hear from you soon!

 


Increasing Pitching Velocity: What Stride Length Means and How to Improve It – Part 3

Written on February 22, 2012 at 8:06 am, by Eric Cressey

In part 1 of this series, I touched on some of the mechanical factors one must consider in relation to increasing stride length in pitchers.  Then, in part 2, I got discussed physical factors – hip mobility and lower-body strength/power – that govern how far you can stride.  In wrapping up today with part 3, we’ll work our way up the kinetic chain to discuss three more physical factors that control stride length.

3. Rotary Stability – As I discussed in my recent article at T-Nation, What I Learned in 2011, hip mobility “sticks” better when you have adequate rotary stability, so we’ve been doing more of our core stability exercises in more “extreme” positions of hip mobility.

If you’re going to push the limits of hip abduction, internal, and external rotation range of motion, you need to be sure that you have adequate rotary stability to be stable in these positions in weight-bearing and not destroy the spine.  Anybody can just get into these positions in slow speed, but not everyone can control the body precisely with a combination of isometric and eccentric muscle action at the high velocities we see with pitching.

Additionally, many of the big-time long stride guys rely heavily on controlling lumbar spine hyperextension as they ride the back hip down the mound.  This is something you’ll see if you watch the deliveries of smaller, athletic guys like Tim Lincecum, Tim Collins, and Trevor Bauer.  If they don’t maintain adequate anterior core function, they’ll wind up with extension-based back pain in no time.

4. Thoracic Mobility – Throwing and hitting (and really any rotational challenge like a hockey slapshot or tennis stroke) present a unique challenge to an athlete: the hips and shoulders are temporarily moving in opposite directions.  This creates separation, which allows an athlete to store elastic energy and create velocity via the stretch-shortening cycle.

The first issue to consider is that not all separation is created equal.  You can create separation with the hips and lower back – and jack up a lumbar spine over time.  The goal is to having adequate thoracic spine mobility to ensure that this separation occurs higher up (and engages the upper extremity well).

The second issue is that the more you push the limits of hip mobility, the more you must push the limits of thoracic mobility.  We’ve always heard “equal and opposite” when it comes to the throwing arm and glove arm, but the truth is that it probably apply to the lower half and thoracic spine as well.  You simply don’t see guys with terrible thoracic mobility getting way down the mound, as that lack of thoracic mobility would cause them to leak forward with the upper body.  I covered this in part 1, but the Cliff’s Notes version is that the head doesn’t stay behind the hips long enough, so throwers lose separation.

The third issue is that poor thoracic mobility will really interfere with getting an adequate scap load, so the arm speed will be slower.  Throwing with a poorly positioned scapula is like trying to jump out of sand; you just don’t have a firm platform from which to create force.

A very basic thoracic spine mobility drill that would be a “safe” bet for most throwers would be the quadruped extension-rotation.

This drill doesn’t crank the shoulder into excessive external rotation, which may be a problem for the really “loose” arms in the crowd. Progressions for the really stiff pitchers would be the side-lying windmill and side-lying extension-rotation.  I also like the yoga plex, a drill I learned from Nick Tumminello, as a means of syncing everything up with a longer stride.

Note: be sure to read this shoulder mobility blog on why not all thoracic spine mobility drills are created equal for throwers!

5. Quick Arm – When I say that you have to have a quick arm to have a long stride, I really just mean that you need some upper body power to make things work.  The longer the stride, the quicker your arm must be to catch up in time to create a downward plane and throw strikes.

You simply don’t see guys with long strides competing at high levels unless they have a quick arm that can catch up to the lower body.

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

This type of thrower would be better off shortening up his stride (at least temporarily) and spending more time on good throwing programs to increase arm speed.

This is one reason Justin Verlander is great.  If you watch him, he’s not an insanely long stride.  Rather, he’s shorter with it, and much stiffer on his landing leg to create an awesome downward plane.  Plus, he actually does have a ridiculously quick arm and outstanding secondary stuff.  A lot of pitching coaches would try to lengthen his stride – and while this might work, I don’t know about you, but I think overhauling a Cy Young winner’s mechanics is silly.

The “long stride, slow arm” issue is (in my experience) most common in young, lax players who have the joint range-of-motion and just enough stability to get a long stride, but don’t have adequate arm speed to catch up.  This is really common in the 14-17 age ranges, and I think it’s one reason why so many of these kids respond incredibly favorably to long toss; it teaches their arms to go faster and keep up with their strides.

Conversely, as you start to deal with 18-year-olds and older (or kids who have grown quickly), you start to see that preparing everything below the arm is arguably more important than arm speed.  You don’t pitch in college or professional baseball unless you have a reasonably quick arm, and getting more aggressive with the lower half to stride longer is often exactly what guys need to make the big velocity jump.  Likewise, when guys don’t take care of the lower half, but continue on aggressive throwing programs, they often wind up with velocity drops, injuries, or control issues because they’ve lost the separation that made them successful.

Closing Thoughts

While a long stride can certainly be advantageous in the throwing motion, as I’ve shown in this series, forcing it when you don’t have the right physical preparation or mechanical coaching in place can actually hurt an pitcher’s performance and health.  Remember that the best changes are subtle ones; in other words, you might increase a stride by six inches over the course of a year, not in a single session.

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Strength and Conditioning Stuff You Should Read: 2/21/12

Written on February 21, 2012 at 9:10 am, by Eric Cressey

I’m back from a fun trip to California, but as you might expect, I’ve got quite a bit on my plate as I play “catch-up.”  Luckily, I’ve got some reading ready for you:

Q&A: Is Static Stretching Good? – This is an outstanding, thorough blog post from Mike Robertson; it’s definitely worth a read.

The Fascial Knock on Distance Running for Pitchers – With spring training and the college seasons underway, loads of ignorant coaches are forcing their pitchers to run long distances.  In this old post of mine, I review Thomas Myers’ presentation on fascial fitness and apply it to this debated point in pitching development.

Diamondbacks CEO Won’t Let His Cancer Change the Best Workplace in Sports – I think this is a fantastic article at Yahoo Sports for not just any baseball fan, but any business owner.  The D-Backs won 94 games last year (sixth most in baseball), but did it with the sixth lowest payroll.  It goes to show you that treating people right and building a strong culture in your organization really matters.

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What I Learned in 2011

Written on February 18, 2012 at 1:53 am, by Eric Cressey

This marks the fifth year that I’ve been writing this year-end series for T Nation. In my first installment, I was fresh out of graduate school, so I drew heavily from the research I’d seen.

Nowadays, while I still read a lot of research, more of my “findings” have come from being in the trenches (where I’ve also acquired a receding hairline). Hopefully this year, you’ll find a nice blend of the two.

Continue Reading…


Increasing Pitching Velocity: What Stride Length Means and How to Improve It – Part 2

Written on February 16, 2012 at 11:18 am, by Eric Cressey

In part 1 of this series, I discussed the fact that – all other factors held constant – increasing stride length will improve pitching velocity.  Unfortunately, when you simply tell a pitcher to stride further down the mound, there are usually some unfavorable mechanical consequences that actually hinder pitching velocity.  So, be sure to read that piece before continuing on here.

That said, sometimes, physical limitations can make it difficult to acquire a longer stride.  To that end, I wanted to use this second installment to begin to outline the top five limiting factors for those looking to get down the mound and throw harder.

1. Hip Mobility

If you’re going to really get down the mound, you need outstanding adductor length on both the lead and trailing legs.  That goes without saying.  While we outline several options on our Assess and Correct DVD set, the split-stance kneeling adductor mobilization is definitely my favorite, as it improves adductor length in both hip flexion and extension:

 Just as important, players need to stop “hanging out” in adduction in sitting and standing.  I wrote about this in a bit more detail in my What I Learned in 2010 article (point #3).  This is incredibly common in right-handed throwers, in particular.  If your resting hip posture looks like this, fix it!

We use a variety of drills from the Postural Restoration Institute to help address the issue, but suffice it to say that you’ll be swimming upstream unless you learn to stop standing/sitting like this!

Additionally, you need adequate length of the trailing leg hip flexors – particularly rectus femoris – to ensure that you don’t cut off hip rotation prematurely.  I like the wall hip flexor mobilization for this purpose.  Keep in mind that we perform the exercises on both the front and trailing leg, as many pitchers will have substantial knee flexion deficit on the front leg secondary to the stress of landing/deceleration.

Third, you need adequate hip internal and external rotation on both sides.  Hip external rotation range-of-motion on the trailing leg is particularly important to allow force to be applied over a longer distance.  Additionally, hip internal rotation is key on the front side, as enables a thrower to utilize the lower half more efficiently in deceleration.  Those without adequate internal rotation on the front side often cut their arm paths short and miss high with pitches – and put much more stress on their arm because the deceleration “arc” is shorter.

External rotation is best gained through glute activation drills (supine bridges, side-lying clams, x-band walks) in conjunction with simply externally rotating the femur during the split-stance kneeling adductor mobilization I featured earlier.  For internal rotation, I like a gentle knee-t0-knee stretch/mobs (assuming no medial knee issues) , and bowler squats as a follow-up to get comfortable with the pattern.

 Of course, all these mobility drills must be complemented by quality soft tissue work: foam rolling and, ideally, manual therapy with a qualified practitioner.

So, as you can see, adequate hip mobility for optimizing pitching velocity must take place in a number of planes.  Additionally, you need to remember that mobility is always influenced by musculo-tendinous. capsular, ligamentous, and osseous (bony) restrictions, so no two pitchers will be the same in their needs.  And, some pitchers simply may not have the bone structures to get into certain positions that are easy for other pitchers to achieve.

2. Lower-Body Strength/Power

You can’t discuss lower-body mobility without appreciating the interaction it has with lower-body strength and power.

You see, mobility is simply your ability to get into a certain position or posture.  Flexibility is simply the excursion through which a joint can move.   What’s the problem?

Flexibility doesn’t take into account stability.  Just because you can get your joints to a certain position in a non-weight-bearing scenario doesn’t mean that you’ll be able to achieve that same position when you’re in a weight-bearing position, trying to throw 95mph as you move downhill.  So, I’ll put my point in big, bold letters:

Pitchers need strength to have mobility.

Truth be told, building lower body strength in throwers isn’t tough.  You use all the basics – single-leg work, deadlift variations, squat variations (when appropriate), sled work, pull-throughs, glute-ham raise, hip thrusts, glute bridges, etc. – but just work to make sure that they are safe for throwers (e.g., use the front squat grip instead of the back squat grip).

Strength isn’t just a foundation for mobility, though; it’s also a foundation for power.  You can’t apply force quickly if you don’t have force!  So, once players have an adequate foundation of strength, they can benefit more from rotational medicine ball exercises and plyos in the frontal/transverse planes to learn to better apply force outside the sagittal plane.

Make no mistake about it; having adequate strength/power to push off and rotate aggressively – not to mention decelerate the body on the front leg – is essential to outstanding pitching velocity.

I’ll be back soon with Part 3 of this series.  In the meantime, if you’re looking for more hip mobility ideas for baseball players, check out Assess and Correct: Breaking Barriers to Unlock Performance.

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Increasing Pitching Velocity: What Stride Length Means and How to Improve It – Part 1

Written on February 14, 2012 at 8:01 am, by Eric Cressey

Ask almost any pitcher, and he’d tell you that he’d love to increase his stride length on the mound in hopes of increasing pitching velocity.  And, this is certainly an association that has been verified by both anecdotal and research evidence for years.  Look back to the best pitchers of former generations, and they figured this out even without the benefit of radar guns.

On the anecdotal side of things, hitters often comment on how pitches “get on them faster” with a guy who strides further down the mound.  This is a no brainer: a pitcher who releases the ball closer to the plate has a competitive advantage.  That’s perceived pitching velocity.  However, what about actual velocity – meaning what the radar gun says?

The truth is that it’s somewhat tricky to prove specifically that a longer stride directly equates to better actual velocity, as it really depends on how the pitcher gets to that point.  You see, a pitcher can effectively delay his weight shift to create better “separation;” in fact, keeping the head behind the hips longer correlates highly with pitching velocity.  This separation is the name of the game – and he’d throw harder.

Or, that same pitcher could simply jump out – letting his body weight leak forward prematurely – and completely rob himself of separation and, in turn, velocity.  So, that’s the first asterisk to keep in mind: it’s not just where you stride, but also how you stride there.

Additionally, in that second scenario, this modification may cause a pitcher to shift his weight forward excessively and wind up landing too much on his toes.  While the point on the foot at which the weight should be centered is certainly a point of debate among pitching coaches, it’s safe to say that they all agree that you shouldn’t be tip-toeing down the mound!

Lastly, even if the weight shift is delayed perfectly, a pitcher still has to time up the rest of his delivery – when the ball comes out of the glove, how high the leg kick is, etc – to match up with it in “slightly” new mechanics.  These adjustments can take time, so the velocity improvements with a long stride may not come right away because other factors are influenced.

Of course, keep in mind that not every hard thrower has a huge stride.  Justin Verlander doesn’t get too far down the mound, but he’s still done okay for himself!  Verlander seems to make up the difference with a ridiculously quick arm, great downward plane at ball release, and outstanding hip rotation power.  There’s no sense screwing with someone who is a reigning Cy Young and MVP – and has two career no-hitters under his belt.  However, YOU have to find what works best for YOU.

So, without even getting to my list, you can say that mechanical proficiency is the #1 factor that influences whether a long stride will improve your pitching velocity.  Dial in what needs to be dialed in, and it could work wonders for you – if your body is prepared.

To that end, in part 2 of this series, I’ll outline five physical factors that will help you improve your stride length and increase pitching velocity.

Interested in learning more about the throwing shoulder? Check out Optimal Shoulder Performance: From Rehabilitation to High Performance!

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