Common Arm Care Mistakes: Installment 1
Written on December 13, 2013 at 8:30 am, by Eric Cressey
As you probably already know, I see a ton of baseball players on a weekly basis. And, the majority of them come in with some pre-existing perceptions on what good arm care really is. These ideas relate to exercise selection, coaching cues, frequency, timing, load, and a host of other factors. I'm a firm believer that just about everyone does some things that are appropriate, and some things that are wrong.
This may be "right vs. wrong" in a general sense. An example would be that it's always right for baseball players to strengthen their rotator cuff and scapular stabilizers. And, it's always wrong to do so many arm care exercises before throwing that the cuff is actually fatigued before a thrower picks up a ball.
There are, however, specific cases of right and wrong. For instance, if someone has a ton of congenial laxity (joint hypermobility), it's wrong to stretch their shoulders out, as you're making unstable joints more unstable. However, if it's a very stiff individual, stretching may very well be completely indicated and productive.
To that end, I want to kick off this series to educate my baseball audience on how to evaluate arm care options so that you can ensure that they're the best fit for you. Here's our first mistake:
Assuming all shoulder blades start in the same position.
There are tens of millions of throwing shoulders around the world, and each one of them responds slightly differently to a throwing stimulus - and this has been well documented. The problem, however, is that when creating arm care programs, not a lot of people take into account that scapular (shoulder blade) position is going to differ - sometimes dramatically - from one throwing athlete to the next. As examples, check out these two resting scapular positioning photos:
 
On the left, you have an anteriorly tilted, abducted, and depressed scapular presentation. This is what we often expect to see with throwers (usually with a bit more asymmetry, though). On the right, though, we have a very adducted scapular posture; the shoulder blades are almost touching the spine (the medial border of the scapula should be roughly three inches away from it).
The classic "down and back" cue that gets thrown out to just about everyone for every exercise could give both of these guys issues, but for different reasons. The left example would potentially preferentially recruit lat (which is already cranking the shoulder girdle down) over lower trapezius, so we'd get more scapular depression instead of the posterior tilt and adduction we're seeking. The right example would yank aggressively toward the spine with the rhomboids and "fight" the shoulder blades as they try to upwardly rotate. Down and back isn't a good cue for this scapular presentation because he's literally as far back as he can possibly go.
This goes to show you that resting posture governs function, and function (or lack thereof) governs whether or not you're going to get hurt. If you don't take resting posture into account, how can you be sure that you're creating the type of movement that you seek?
Thsi is just one more reason why I don't believe in "organizational arm care programs." If every posture presentation and subsequent functional performance is different, why are we painting them all with the same broad stroke instead of giving them the individual attention they need? Check out this video example, where I talk about how different folks might need different cues for the prone 1-arm trap raise, a commonly prescribed arm care exercise.
Looking for more insights like this? Check out one of our Elite Baseball Mentorships, where we discuss scapular posture and movement evaluation techniques (along with many other topics) in great detail. We just announced our next Phase 1 (Upper Extremity) event: June 14-16.
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December 14th, 2013 at 10:31 am
great point about the YTW circuit!
December 14th, 2013 at 4:29 pm
Great info as always, Eric. I agree that we need to be more consistent and thorough in our examination of overhead athletes (PTs, Trainers, ATCs, MDs, etc) to ensure we are prescribing the correct treatment approach and cueing.
One small note I wanted to make about the article is that laxity does not indicate instability. I surely acknowledge you know this, but want to make sure we are all speaking the same language, specifically in our young throwers. The big difference between laxity and instability is: pain.
December 16th, 2013 at 7:39 am
100% correct, Preston. Well said.