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How Limited Shoulder Flexion Relates to Elbow Injuries in Pitchers

Written on August 28, 2014 at 8:14 pm, by Eric Cressey

Today, I want to introduce you to one of the screens we do with all our throwing athletes - and what the implications of "failing" this test are.  Check out this six-minute video:

If you're looking for more information along these lines, I'd encourage you to check out one of our upcoming Elite Baseball Mentorships, with events running in both October and November.

Sign-up Today for our FREE Baseball Newsletter and Receive Instant Access to a 47-minute Presentation from Eric Cressey on Individualizing the Management of Overhead Athletes!

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Long-Term Baseball Development: Part 2

Written on May 10, 2014 at 12:40 am, by Eric Cressey

Today is the second part of Cressey Performance Pitching Coordinator Matt Blake's article on long-term athletic development for baseball players. In case you missed it, check out Part 1.

blakeindexIn the first installment of this two-part article, I outlined the problem with respect to youth baseball injuries, discussed some of the causes, and emphasized the need for age-appropriate, individualized training programs over the course of the "baseball lifespan." Today, I want to look closer at this step-by-step developmental process.

I think it’s paramount to first teach young pitchers about rhythm, tempo and direction in the throw, before they learn how to just “air it out.” If they understand how to play catch with intent and focus for every throw on a daily basis, the velocity will usually take care of itself. One way to do that is to use drill constraints to create feel for these qualities, such as in this stride drill progression below:

If the velocity doesn’t begin to develop as you matriculate into your adolescent and teenage years, you have to begin to ask why? Is it a problem with athleticism, strength, delivery issues, or something else? Typically speaking, it will be a little bit of all these, but it’s not usually because the kid isn’t trying to throw the ball hard enough. More often than not, the players that I see getting hurt at a young age have an excessive amount of effort in a poorly sequenced throw, and no awareness for how to take care of their body or how to explain to an adult/coach what they’re feeling when they throw. They need a larger framework to understand movement, so they can understand what feels good and what doesn’t outside of simply throwing to get better.

If you can teach these kids simple concepts regarding core control, how to do a proper lunge, or how to do a proper un-weighted shoulder external rotation, you’ll go a long way towards opening up pathways to throw the ball harder. A great example of this is the exercise demonstration below, which you could certainly use to help educate your athletes:

They don’t need to know what joint centration is, or why adhering to certain muscular length/tension relationships are essential in creating force and resisting fatigue, but they’ll be able to feel it and move towards these positions more frequently on their own. To be honest, we very rarely even use a radar gun at our facility, and without trying to sound conceited, we have some of the hardest throwers in the country at every level of development. It all starts with a foundation that adheres to movement quality over quantity. Owning a routine that allows you take care of your body on a daily basis by taking inventory of tissue quality and adhering to a thorough warm-up and recovery process every time we throw is essential at every level of baseball. Something as simple as implementing the use of a foam roller on a day-to-day basis could go a long way in aiding this process.

Once the athlete understands movement quality, then we can begin to layer on force production, whether it be through a more general application like strength training or a more ballistic action like throwing a baseball. They need to understand how the force is generated, and where it’s dissipated; if they can’t decelerate or disperse what they’re producing, it’s unusable. There’s a laundry list of athletes in every town who threw harder than their peers, but couldn’t use it because they couldn’t throw strikes or couldn’t avoid pain. And, it’s not unusual to see the guys who don’t throw strikes to be more likely to end up in pain, because it’s a byproduct of having reckless motor control, which creates more stress by hitting joint end ranges more frequently, and in turn, creates more tissue damage than you’d see with a strike-thrower with a higher level of coordination.

As the athlete continues to advance through the high school and college years, there only comes more societal pressure to perform at a high level, so, if you don’t have a sound base of movement, you better bear down now. This 16-20 age group is probably the most at-risk population because of how strength really begins to come into the mix, how the wear and tear of poor deliveries and overuse in the youth development systems start to reach threshold, and the increased level of exposure at year round events fuels the fire. This is usually when the majority of players begin to realize that they want to be baseball players and start to specialize in the sport at a higher rate, and with that comes an even more detrimental aspect: not clearly identifying your developmental calendar.

If baseball is the only sport you play in the HS/college years, it’s essential that you understand what the year-long developmental calendar looks like. If you don’t, and you live in a warm weather region, you could theoretically start playing “spring season” games in January for your HS or college team and play into May/June. Once that season’s done, you would naturally transition right into your summer season, whether it be travel ball or a collegiate summer league and play another 45-60 games through July/August.

Once that season is over, the HS players who would normally shut it down and play another sport are now inundated with showcases and camps from every different angle, as well as fall leagues that run into November. The college athlete has his fall season, which is usually another six weeks of competitive baseball activity somewhere between September and November, and that leaves us with the window of November to January. This is where we’d normally be dormant, but now we have showcases and tournaments to attend to make sure the scouts and schools know who we are. And, college coaches are reluctant to shut pitchers down less than 10-12 weeks out from the start of a season.

Is it really a surprise that pitchers are getting hurt?

If you don’t step back and be sensible about this developmental process, your train will get derailed somewhere, so you have to set some clear boundaries.

For all of our athletes, it starts by encouraging them to get the ball totally out of their hand for 8-12 weeks of no-throwing each year. Now, this might sound excessive to some, but it still leaves you approximately 300 days of the year to work on your throwing. If you can’t get better in the other 300 days, you’re probably misusing this other 8-12 weeks anyways!

Aside from that, we typically try to adhere to keeping our high school pitchers under 100 competitive innings on the mound, and hopefully more like 80. So, as a HS athlete, if you compete from Feb/March until July/August as your two main competitive seasons, that allows you to shape your September-Feb/March in a multitude of ways. If college camps/showcases are an important aspect of your development so you can reach the next level, then make sure you give yourself adequate time to prepare for them. Going 0-60mph in these events is a recipe for injury, as we know the kids who attend more showcases end up getting hurt at a higher rate. If you’re aware of this and use the lead-up time and structure your throwing schedule properly, and understand the drastically different warm-up component at these events, you can likely head off some of these issues.

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If you’re a college athlete, you have to consider where your most important development is going to come. Obviously, the spring is a constant, but depending on how many innings you throw, and what level of development your college team offers, the fall season may be more important than simply adding another 60 innings in a summer league. So, you have to weigh out what makes more sense. Take the summer months and work on your strength base, while allowing your body to recover from a heavy workload, so you can be ready to continue developing in the fall; Or, play competitively in the summer for increased exposure and in-game development in a competitive summer league and then take the fall off from throwing. Too many times guys will throw 80+ innings for their college team in the spring and then another 50+ in the summer and now you’re carrying 130+ innings into the fall, which is a crucial time for your college pitching coach to develop your throwing ability or work on pitching skills in a controlled environment unlike the spring schedule or even the consolidated winter build-up.

The pro side might be the most cut and dry schedule wise, because you’re typically starting spring training in Mid-Feb/March and playing until September/October. It only becomes a little murky when you consider that some prospects have to attend instructional leagues in September/Oct or play in the Arizona Fall league, leaving a smaller window of off-season development. They may also need to pay bills so a winter league becomes more attractive. With that said, they have a nice window of time from September through February, which is crucial for them to get the ball out of their hand for an extended period of time and get their cuff strength back, while working on a general foundation of movement before they start the slow build-up back towards the season.

Obviously, there are some different concerns in the world of professional development where you’re constantly weighing the risk/reward for implementing certain training stimuli on both the strength training front and throwing program design side of things since these guys are generally already very successful at their craft. But, with how long their season is, and how quick they ramp up bullpens in spring training, it becomes essential they make good use of their window from September through February to avoid being a victim of the early season wrath we see unfold every year, as depicted by the charts below (click to expand):

chart
Sources: Epidemiology of Major League Baseball Injuries and
Incidence of Injuries in High School Softball and Baseball Players, respectively.

We could obviously go on and on here and not cover all of our bases on specific developmental concerns, so it’s important we reiterate the main driver behind all of this.

We’re going to continue to have arm issues in the sport of baseball if we insist on pushing the boundaries of the human species to see how much performance we can get out of these players. The money in the game is so large, and velocity has become such a huge component of success for these players and organizations, that the industry of baseball from top to bottom will constantly be looking to develop more of it.

The only problem is that the means for attaining this beloved velocity needs to be individualized and it’s such a complex recipe that goes beyond what you’re looking at in the present moment. It keeps every outing on short rest or poor warm-up before a cold rainy start on file, so you need to follow the body of work as best as you can to know where the next step needs to be for each athlete. Too many people are treating this like it’s a sprint from one MPH checkpoint to the next.

Slow down, be sensible about the developmental process, and just realize that this day and age, if you want to throw hard, there’s enough information out there to point you in the right direction. The key to all of this though, isn’t necessarily who can simply throw hard anymore, it’s who can stay on the field the most consistently while doing it, and for some reason, people don’t seem to be as willing to listen to that information.

In the meantime, if you're looking for more detailed information on long-term management of throwing athletes, be sure to check out our Elite Baseball Mentorships. The early-bird price for our June mentorship is May 15.

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Long-Term Baseball Development: Part 1

Written on May 7, 2014 at 2:38 pm, by Eric Cressey

Today's guest post is the first half of a two-part article from Cressey Performance Pitching Coordinator, Matt Blake.  Matt is a key part of the Elite Baseball Mentorships team.

Unless you’ve been living under a rock, I assume you’ve heard that there seem to be a lot of pitchers getting hurt lately. Well, in light of the media spotlight recently shining on the injury epidemic we’ve been watching evolve over the last few years, I figured there’s no better time to contribute to this discussion.

This media attention has discussed a plethora of incredible information regarding some of the most relevant research and statistics pertaining to these arm injury rates. You can see experts call into question usage rates among amateur pitchers, pitch selection among youth/amateurs, recovery rates, mobility deficits, too much or too little strength, length of season, delivery flaws, and a host of other factors. In short, there’s clearly no one right answer in solving this issue, as there are just so many variables in this multi-factorial problem, and as a result, it is quickly making Tommy John the most famous pitcher of all time for all the wrong reasons.

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This is probably exacerbated by the fact that I can almost guarantee you every single MLB pitcher whoever existed would fall into one of the categories deemed “detrimental” to healthy development at one point or another during their career. I’m sure they’ve been at risk of throwing too much, pitching on short rest, having a red flag in their delivery, lacking necessary range of motion, etc. It’s all part of the game, unfortunately. Beautiful game, isn’t it?

So, if this is the case – and I’m sorry to sound so negative about the future of this game and the problem that we’re currently experiencing – but this injury issue has way more to do with our society at large and the values we’re pushing into the game of baseball than simply little Johnny throwing too many pitches in his Babe Ruth game or throwing 95mph when he’s 17.

It’s not too dissimilar from the global climate discussion we’re having (apologies in advance if you don’t believe in global warming), where we seem to understand what the problem is and potentially what some of the solutions are. However, because these issues have huge monetary implications and there are large organizations and cultures set in their ways behind a lot of this, it’s very hard to change the direction of this tsunami that’s been building out at sea and is now crashing onto our shores.

UCL
Percentage Growth of ASMI Youth/High School UCL Reconstruction Surgeries (Original Article)

In order to narrow the discussion, though, I’m going to try to pick a couple key points out to help give the general population something to chew on and digest without burying them in a sea of research, stats and mechanical jargon. In my mind, there are two main social factors that are fueling this:

1) the burning desire as a culture to see and reach for more velocity at every level of development

2) the digital age giving us enough information to be dangerous in so many different ways

I can promise you neither of these will be going away, so we better learn how to manage them effectively.

When I talk about this insatiable desire for velocity at every level of development and this information age, I’m encompassing a lot of different thoughts. It could be Johnny Rocket throwing 70mph in the Little League World Series at 12yrs old while being broadcasted to the world on ESPN, or it could be the fact that we have a generation of fathers armed with a Pocket Radar at the backstop, and an Ipad in the dugout with up-to-the-minute strike % rates at all of Little Billy’s games.

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Once these players get out on the travel ball circuit, online scouting resources do their fair share to rank every single player/team that comes through their tournaments and showcases, so every kid knows where he stands against his peers. Like it or not, this encourages them to make it to as many events as they can, regardless of the time of year, which we know from the research carries a larger injury risk as well. These issues are a microcosm of this media blitz, and are simultaneously creating our greatest strength and becoming our biggest weakness.

Now, don’t get me wrong, these same reasons can also be tremendous developmental qualities, by allowing for more information to be processed, we can speed up the developmental curve. We know that fastball velocity is an important predictor of strikeout rate and success at any level of baseball. If that’s the case, why wouldn’t we want to speed up the developmental curve in an attempt to throw harder?

With that said, I’m sure there are people out there who point the injury bug finger at me in thinking I offer “Pitching Lessons” all year round, or point it at Eric Cressey for developing these athletes into physical monsters too soon, which allows them to throw the ball harder than the human species is supposed to do so. So, if we’re going to frame the discussion, we need to look at the process for how these athletes are being developed, because I think this becomes the crucial determinant.

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We have to have a big picture look at how we get Johnny Rocket to sustain his standard deviation of dominance at each level or how we get little Billy to have enough fastball so he can move from level to level and stay in the game he loves to play. But, if everything is causing problems, and you can’t play too much because you’ll get hurt, and if you don’t throw enough, you won’t be any good…How do we shepherd these athletes from level to level until they reach the promised land of the Big Leagues? Ultimately, it comes down to a few main principles for me.

At CP, we’ve had a lot of tremendous athletes and baseball players come through our doors ranging from Little Johnny Rocket at 10yrs old all the way to Curt Schilling on his last go round in the Big Leagues and everything in between. The three qualities that have resonated through all of the successful athletes regardless of level are – general athleticism, competitive instinct and an above average fastball that they can command.

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I’d also include a caveat that the ability to be consistent and adhere to a plan is the glue to these qualities. We’ve had good athletes who were great competitors who sucked at simply showing up, or following the program as it was written, etc…and, it’s ultimately what keeps them from being reliable performers. It’s what can separate a guy who doesn’t have natural athleticism from a guy who doesn’t make the most of his athletic talents. Our most diligent and successful athletes don’t just randomly disappear for three weeks, or skip their warm-up for the heck of it. This can be a major separator if you’re willing to show up day in and day out and be diligent about executing your process.

Now, this may sound overly generic, but I think it’s important to consider what falls in each bucket and how it affects each developmental stage.

If you’re looking at the youth level – say 10-14 year-olds – who ends up pitching the most? Typically, your best athletes (because they’re coordinated enough at that age to throw strikes), or the kids who throw the hardest (because they generally miss more bats). Often, these two categories occur in the same kids, too, so they’re extra likely to throw every inning of every game. I don’t think anyone would question that.

youthpitcher

The same begins to take shape when you look at who gets recognized at the high school and college level. The best pitchers again end up being the guys who throw the hardest and strike the most guys out, and ultimately, end up with the college scholarships and are drafted the highest.

At the minor league level, there’s less of an emphasis on winning games, but there is definitely a premium placed on competing in the strike zone with an above average fastball in order to advance at each level through the system, regardless of organization. Finally, you have your big leaguers, who have made it to where everyone wants to go, and in this day and age, its few and far between the guys that don’t have premium stuff or aren’t voracious competitors with at least “average” stuff. Mark Buerhle and Jamie Moyer are the 0.01% of professional pitchers who were able to compete with below average fastball velocities, but they were able to compete at every level – including the big leagues – by relying on good movement, changing speeds, and impeccable command. So how does this factor into our greater discussion? You have to find what each athlete does well and find a way to maintain those strengths while filling in the weaknesses. You’d be foolish to give guys on opposite ends of the spectrum - say, Aroldis Chapman and Jamie Moyer - the same developmental plan.

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If you bring that thought further down the developmental chain, and have a 12yr old who throws hard, but doesn’t have a “sound delivery” or isn’t a good athlete, he probably needs to work really hard on his general athleticism first to provide a sound movement base for him to repeat his delivery. This can mean playing another sport, such as basketball or soccer, or simply riding his bike or playing at the park with his friends. It doesn’t mean he needs to engage in the 10,000 hours theory and practice pitching more. Could this help? Sure, but is it the best long-term solution or does it attack the greatest window of adaptation? I doubt it. If anything, he just needs to keep playing catch with his dad, brother, or a buddy and continue throwing a lot on his own to learn more about himself, but pitching in more games is just going to exacerbate the problem. Games are fun, and obviously one of the principles of long term success is developing that competitive spirit, but with what we know about the stress of throwing a baseball and what happens to kids who throw hard at an early age, this kid is seriously at risk for hurting himself down the road, if he doesn’t find other ways to develop.

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Too often, we see parents who think that the best way to get Johnny to become Nolan Ryan is to bring him to the local pitching instructor and get him signed up on the local travel ball team. Also, obviously, he still has to play with his town buddies, so now he’s on multiple teams, etc. This is not the answer. Let Johnny figure out a world of movement and compete with different people in different venues and you’ll be surprised what that does for his confidence and motor control. Having the ability to relate to other social environments, and physically move through different patterns will drastically shape Johnny’s ability to repeat his delivery and create force in the throw in healthier ways. With that said, below, I’ve provided a “Developmental Lifespan” for how successful athletes have generally progressed in their athletic focus:

Up to Age 10 – Complete fun, wide variety of activities
Ages 11-15 – Multiple (3+) organized sports with “seasons,” integration of strength and conditioning
Age 16-17 – Hone in on 1-2 sports
Age 18+ - Specialization

When they do play baseball, let’s not worry so much about velocity just yet, but let’s focus on establishing good daily routines - sound warm-ups, arm-care processes, and movement patterns – as well as focusing on the yearly calendar. These will have long-term implications for the athlete’s health and continued progress – and I’ll focus specifically on these things in Part 2, so stay tuned!

In the meantime, if you're looking for more detailed information on long-term management of throwing athletes, be sure to check out our Elite Baseball Mentorships.  The early-bird price for our June mentorship is May 15.

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Exercise of the Week: Half-Kneeling 90/90 External Rotation Hold

Written on April 27, 2014 at 6:08 am, by Eric Cressey

Today’s guest post comes from my friend and colleague, physical therapist Eric Schoenberg. Eric is an integral part of our Elite Baseball Mentorships.

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I have yet to meet a high level baseball player that hasn’t done some form of rotator cuff strengthening exercise. The interesting part is that a high percentage of these athletes don’t actually know where their rotator cuff is and where they should be feeling these exercises. The most common response is the athlete will point to the front of their shoulder. This is also the same spot (biceps tendon, labrum) where all of their pain is when they throw!

In other words, the athlete is doing a “rotator cuff” exercise to help decrease or reduce the risk of shoulder pain, but in turn, ends up actually causing more stress and overuse to their already irritated anterior shoulder.

The ability to properly recruit the rotator cuff works hand in hand with being able to relax/shut down the posterior deltoid, latissimus, and lumbar extensors from overcompensating as an athlete “lays back” into external rotation.
We commonly see athletes/coaches performing the right exercises, but executing them improperly due to faulty recruitment, poor timing, or compensation. In these cases, the athlete looks the part and even appears stable and strong, but are not actually receiving the intended benefit of the exercise. In fact, more times than not, they are potentially making themselves worse.

Enter the ½ kneeling 90/90 External Rotation (ER) Hold. It is a great exercise to teach the baseball player (pitcher or position player) what they should feel and maybe more importantly, what they shouldn’t feel when attempting to build stability and proper alignment in their shoulder.

This exercise is one of many concepts that we discuss in our Elite Baseball Mentorships. With the continued rise in baseball injuries, we have made it our mission to help create an environment for collaborative learning among the leading strength coaches, health care professionals, and pitching instructors/coaches in the world.

Our next Upper Extremity course will be June 15-17, and the early-bird registration deadline is May 15; to learn more, click here

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Destroying Baseball Dogma: Installment 1

Written on April 21, 2014 at 7:48 am, by Eric Cressey

Today, I'm going to kick off a new series about common myths from the baseball world.  I'll tackle one of these each month.  In this first installment, we're going to have some fun with this quote that I hear all too often:

       "Guys are working too hard in the off-season,
    and all this strength training is leading to injuries."

I've heard this muttered hundreds of times, but this is this quote by Lou Piniella in the NY Times last year stands out for me:

“The season is so long now and so strenuous, you need to rest your body for two-three months after it’s over,” said Sweet Lou. “But today, these players all have their personal trainers and they work out all winter and put on more muscle. When I played, we didn’t have a weight room or a strength coach and everybody took the team bus to the ballpark. We never heard of an oblique. Now guys are going out on their own, five or six hours before the game, going right to the batting cages and taking hundreds of swings a day. It’s overdone. The body can’t take it. If you ask me, that’s where all these oblique injuries are coming from.

I'm going to respond to this in bullet point fashion, as I think there are a lot of gems in here:

1. You'll be surprised to know that I partially agree with Piniella on a few different fronts.  First, the season is absurdly long.  Guys may play 200 games in 230 days - with a lot of travel mixed in - and that makes it incredibly hard to maintain strength, tissue quality, and mobility. Interestingly, though, a lot more injuries occur at the beginning of a season than at the end. It makes you wonder if some guys are showing up unprepared and then benefiting from the adherence the team environment forces.

Second, setting the lazy off-season guys aside, there are a lot of players who are doing absolutely idiotic stuff with their training. As recently as a few years ago, a few teams were still recommending P90X to MLB players for off-season conditioning.  I'm not making that up.  How can we say strength training is the problem if most organizations still haven't even made it a priority?

EpicF

Third, guys getting bigger and stronger is leading to injuries...but doing so in an indirect.  You see, average body weight in Major League Baseball increased by 12% from 1990 to 2010; this time period parallels the rise in popularity of strength training. With the increase has come a huge increase in average fastball velocity, too - especially over the past 6-7 years.  And, the aforementioned body weight study also showed that offensive leaders were more likely to be heavier than their "normal" MLB counterparts. Obviously, the steroid era played into this, but the message doesn't change: being stronger increases your likelihood of success - even if it means you are playing with fire with respect to injuries.  Swinging quicker, throwing harder, and running faster will increase your likelihood of injury - regardless of whether you strength trained to get to that point in the first place.

The alternative, unfortunately, is to throw 88mph or have subpar bat speed - neither of which will help you compete in the modern game.  At the highest level, sports will always be a balancing act between high performance and injury risk.  To this point, I'd also subjectively note that most of the guys who have wound up with injuries this spring were not massive dudes; I'd argue that they really weren't that strong or heavy

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2. With respect to the comment about taking 2-3 months off at the end of the season, one has to really do the math on this to realize how silly it would be. The big league season ends in early October for most teams, whereas playoff teams will play all the way through the month of October. If a player takes off all of October, November, and December, he wouldn't do anything until January 1.  If he make the playoffs, he wouldn't do anything until (potentially) February 1.  If players report in mid-February, that would give them 2-6 weeks to prepare. 

If you think that's enough, good luck dealing with the media scrutiny that comes when a load of the players are on the disabled list, and all the pitchers' fastball velocities are down.

I'd also ask: is it healthy for anyone to take 2-3 months off from exercise altogether?  Let's just make them obese in hopes of cutting back on our oblique strains!

3. I think it's important to recognize that not all lifting is created equal.  The problems usually stem from incorrect technique, poor exercise selection, excessive loading, or a number of other common mistakes. If one athlete burns himself on a cup of coffee because he wasn't careful with how he prepared or drank it, do you vilify coffee for an entire team? Of course not!  So, why vilify strength training because there are some idiots out there applying it incorrectly?

Taking it a step further, lifting sometimes "displaces" other important components of a successful training program - because lifting heavy stuff is "sexier" to many athletes. You simply can't lift at the exclusion of other key physical preparation strategies; it has to complement them.

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4. To build on the last point, in many cases, lifting may become a problem because it's "ingraining" poor movement quality.  As Gray Cook has often said, "you can't put fitness on top of dysfunction."

The key word here is "fitness."  Many things - not just lifting - could bring these issues to threshold.  Throwing, swinging, and sprinting could all bring movement flaws to a painful threshold, too.  However, unlike strength training, these approaches can't be used to correct the fundamental problem - even if they're implemented perfectly. General training can correct movement dysfunction, whereas specific training usually exacerbates it.

5. Most obviously, if lifting was really the only problem, wouldn't we see a lot more guys getting hurt while lifting? Truth be told, the injury rates in strength training participation are remarkably low - even with crappy programming.

Bringing all these points together, the truth is that injuries have always been, are, and will continue to be multi-factorial.  Short of traumatic instances like being hit by a pitch, or fouling a ball off your foot, everything is something that has built for days, weeks, months, or years.  There are far too many different variables involved that have constantly changed over the past few decades to truly determine what causes injuries, so it's short-sighted to make strength training the scapegoat - especially when we know the value it has in enhancing performance, reducing injury risk, and facilitating injury rehabilitation.

Destroying Baseball Dogma is one reason we introduced our Cressey Performance Elite Baseball Mentorships; we want to teach baseball coaches, strength and conditioning professionals, and rehabilitation specialists to learn more about how to best prepare players to handle the unique demands involved in baseball. Our next Upper Extremity course will be in June; to learn more, click here.

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Common Arm Care Mistakes: Installment 5

Written on March 6, 2014 at 7:33 am, by Eric Cressey

It's been over a month since I posted an update to this series, so with the baseball season underway, I thought I'd get back to it – and focus on something we see as an in-season problem:

Pitchers not being advocates for themselves with respect to playing other positions games on non-pitching days.

Absolutely nothing drives me crazier than when I hear about a player throwing 6-7 innings, and then being asked to come back and play shortstop or catcher in the next few days. In fact, it might be the very definition of insanity, as it defies a lot of what we know about recovery, fatigue management, and arm stress.

To be clear, pitchers absolutely do need to throw throughout the week to optimize performance and develop.  You can't just pitch, then sit around for six days and expect to get better or stay sharp.  However, I think we do need to approach what guys do on non-pitching days on a very individualized basis.

If we're talking about starters who are going to throw 60+ pitches at least once a week, they need to stick to playing DH, 1B, 3B, 2B, or OF in the 2-3 days after a start – and preferably throughout the entire week.  Sure, there will stil be the possibility for intense throws, but the volume is much lower, and they'll be able to get their legs under them better, as compared to off-balance throws from shortstop, or rushed throws from the catching position.

If we're talking about relievers who just get innings here and there, it's a totally different story.  If they're only throwing 15-20 pitches a few times a week, they can play anywhere they're needed.  The volume just isn't enough on the mound to make it a very valid concern. The only exception to the rule might be early in the season; if guys are really sore in the 24-48 hours after they pitch, they're probably better off somewhere other than shortstop or catcher.

Now, all this seems well and good – until you realize that just about every 12-year-old in the country says that he plays "pitcher and shortstop."  Seriously, I get excited when I hear a young kid who is a catcher, second baseman, or just an "all over" utility guy.

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So, as you can see, players don't just need to be counseled on this; they need to be counseled on this at a young age.

A big part of developing starting pitchers over the long haul is helping them to build work capacity, the ability to throw more innings.  This obviously gets a lot of attention in the professional ranks with young pitchers who are on strict innings limits.  However, it's equally important at the youth levels; you have to build work capacity gradually, especially in athletes who are skeletally immature. The problem with throwing them at shortstop or catcher is that it immediately puts you in a position where you underestimate how much wear and tear is on the pitcher's arm over the course of a season.

Looking for more in-depth baseball insights?  Check out one of our Cressey Performance Elite Baseball Mentorships; we'll have events in June, October, and December.

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Baseball Strength and Conditioning: In-Season Insights

Written on February 24, 2014 at 8:50 am, by Eric Cressey

Spring training is underway. College baseball has two weekends in the books. High school teams in warm weather climates have been going for a month, and some schools in the Northeast actually start today. So, it should come as no surprise that we're now getting a lot of inquiries about what to do for in-season training.

With that in mind, rather than reinvent the wheel, I wanted to reincarnate a series I wrote on in-season baseball strength and conditioning.  Check it out!

In-Season Baseball Strength and Conditioning – Part 1: What You Need to Know

In-Season Baseball Strength and Conditioning – Part 2: High School Baseball

In-Season Baseball Strength and Conditioning – Part 3: College Baseball

In-Season Baseball Strength and Conditioning – Part 4: Professional Baseball

Put these tips into action and you'll be healthy and high-performing throughout the season.

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Baseball Training: Are Shoulder Dislocates Appropriate?

Written on February 10, 2014 at 4:28 am, by Eric Cressey

I received the following email the other day, and thought my response would make for a good Q&A here:

Q: I recently heard a national level gymnastics coach speak on how he believed shoulder dislocates with a dowel rod (working up to weighted dislocates) are a panacea for shoulder health and strength. I was wondering if you use them with your clients/players, and why or why not?

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A: Thanks for your question.  In short, the answer would be NO, I would never do shoulder dislocates with a throwing athlete.  I discussed why in a previous video that goes into great detail, so rather than reinvent the wheel, here it is!   Effectively, shoulder dislocates replicate some of the movements that I outline as problems here.

As a general rule of thumb, as a thrower, it's always better to be too tight than it is to be too loose.  WIth that in mind, you always need to ask why you're stretching an area out.  If the front of the shoulder feels "tight," it may be from a number of different causes:

1. Protective tension of the biceps tendon (secondary to rotator cuff weakness) – just stretching it out would remove what little anterior stability remains.

2. An injury to the anterior capsule, latissimus dorsi (humeral attachment point), subscapularis, supraspinatus, or biceps tendon – just stretching these areas out will likely exacerbate the injury.

3. Irritate of the nerves that run anterior to the humeral head – nerves don't like to be stretched.

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4. True muscular shortness of pectoralis major or another structure – Effectively, in doing shoulder dislocates, you're throwing all your eggs in this basket.

The only problem?  Most throwers already have an insane amount of horizontal abduction and external rotation range-of-motion on their throwing shoulders.  They aren't even close to having legitimate tissue shortness that would benefit from stretching.  This is something we work hard to drill home in our Elite Baseball Mentorships as one of the most important takeaways from the events.

Now, if we're talking about a regular ol' desk jockey who doesn't throw a baseball (or other sporting implement), play tennis, or swim, then dislocates might have some merit.  These individuals likely have some muscle/tendon stiffness that can be stretched out before they get to a point where they might crank on their joint capsule or nerves.  I would never use it as a "blanket" recommendation for everyone, though.  The only way to know is assess the individual and then plan accordingly.

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Common Arm Care Mistakes: Installment 4

Written on January 30, 2014 at 7:32 am, by Eric Cressey

It's time for another installment of "Common Arm Care" mistakes, and in this go-round, I'm going to be talking about volume management.  This mistake can be summed up in one sentence:

If you keep adding things without taking something else away, you'll eventually wind up with overuse problems.

Effective, there is a "give and take" that is involved with the training of any throwing athlete.  The more throwing these athletes do, the less supplemental training they can incorporate. This can occur in a number of different contexts.

First, on the throwing side, you'll often see pitchers who are always seeking out the latest, greatist throwing programs.  However, they don't "program hop;" they just keep adding.  Before you know it, they're making 300 throws in every session – and throwing seven days a week – because they have to get in their long toss, weighted balls, underweight balls, mound work, and towel drills.  If you told them that practicing their nunchuck skills would help, they'd add that in, too.

Second, you have to be cognizant of the rest of your strength and power training volume.  When your pitch count goes up, you need to pare back on your upper body lifting volume; banging out a bunch of chin-ups isn't going to feel so hot after a 60-pitch outing.  Additionally, your medicine ball work volume needs to go down as the throwing volume goes up.

To give you some frame of reference for this, here's a little excerpt from Marlins closer Steve Cishek's off-season medicine ball programs.  Keep in mind that the total throws equals left-handed throws, plus right-handed throws, plus overhead throws.

October: break from rotation, no aggressive medicine ball or overhead work
November: 156 total throws
December (started throwing mid-December): 138 total throws
January (ramped up throwing): 66 total throws

Once spring training rolls around and he's throwing even more, he'll have even less.  A minor leaguer whose season wraps up a month earlier would actually be able to get an additional month of aggressive medicine ball work in.

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Third, pitchers often forget that throwing itself is a huge challenge to the rotator cuff.  So, if your throwing volume goes up as the season approaches, you should be doing less arm care work than you would have done in the off-season.  You can get away with this reduction in arm care work because you've already put in a great off-season to build things up.  Of course, if you throw year-round, then you're already behind the 8-ball when the season starts.

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Is Thoracic Spine Extension Work Necessary? – Part 3

Written on January 24, 2014 at 5:58 am, by Eric Cressey

Today marks the third and final installment of Eric Schoenberg's series on thoracic mobility drills – and whether or not they're indicated.  In case you missed them, be sure to check out Part 1 and Part 2.

In the final piece of this series, I want to tie things together with a few foundational concepts that we use in the daily management of our athletes and emphasize in our Elite Baseball Mentorships.

Eric C. has written about the concept of relative stiffness on this blog on numerous occasions.  So, feel free to refer back to his articles for more background information.  Relative stiffness or relative flexibility was introduced to me by Shirley Sahrmann and the incredible faculty at Washington University in St. Louis. This is a pillar of their Movement System Impairment model

Today, I am going to discuss how relative flexibility impacts the thoracic spine and shed some more light on why T-spine extension work is not always necessary in the baseball athlete.          

Relative flexibility describes the relationship of how the amount of stiffness (or tension) in one area of soft tissue (muscles, ligaments, tendons, etc.) results in compensatory movement at an adjoining joint that is controlled by less stiffness.  This relationship can change (positively or negatively) based on the exercises we choose and the manner in which we perform them.

There are countless examples of relative stiffness in the body.  One of the most common examples that we see involves the lumbar spine.  If the lats are stiffer than the anterior core, then the athlete will be more prone to an extended posture. The athlete will compensate with lumbar extension with overhead activity.  The video that I included in part 2 of this series is a good example:

In this video, Lats, lumbar extensors > (stiffer than) Anterior Core = Lumbar extension tendency.

Note: Clearly, there is a lot more involved (fascia, ligaments, structural issues, motor control, relative position of adjacent joints, etc.) than just this simple math problem, but for the scope of this article, we will leave it at this.  This example is fairly straightforward and I think we are all on the same page here.  We would not program activities that would further encourage lumbar extension and drive the improper recruitment and motor pattern.

In this case, we know that simply “stretching” or foam rolling the lats will not work in isolation. We need to go ahead and “stiffen” the anterior core, while at the same time, downregulating the overuse of the lats.  We often will do this by using exericses that encourage a neutral alignment with overhead activity (i.e. wall slides, back to wall shoulder flexion) as well as limiting the amount of carrying by our sides (e.g. deadlifts, dumbbell lunges, farmer’s walks, etc.) and instead, focusing on options like bottoms-up kettlebell carries, landmine presses, and goblet variations.

In the case of someone that is in too much thoracic extension (or relative thoracic flexion), though, things can get a little more confusing.  The athlete will have increased stiffness of the thoracic extensors vs. flexors: Thoracic Extensors > (stiffer than) Thoracic Flexors = Thoracic extension tendency.

However, we often see the emphasis remain on bench T-spine mobs, quadruped extension/rotations, and side-lying windmill variations? This results in two problems:

  1. The athlete will actually become hypermobile (segmentally) and develop a local stability issue. (inverted U-curve)
  2. The athlete has difficulty “getting out of extension” due to increased relative stiffness of the thoracic extensors, lats, and scapulothoracic musculature.

This inability to properly flex the spine at ball release can result in a decrease in the required scapular upward rotation and elevation to maintain proper scapulohumeral and glenohumeral joint congruency.  This is a fancy way of saying that if your upper back isn’t positioned correctly, the ball won’t sit flush with the socket. This process can contribute to some of the shoulder and elbow pathologies that we so commonly see in the throwing population.

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There is one more point that needs to be addressed to complete this series – and that is the role of the rectus abdominus in thoracic spine mobility.  In this case, the athlete will present in too much thoracic flexion and may appear as though they would benefit from T-spine extension mobility drills.  However, this athlete will not benefit from these exercises unless we appreciate the following point.

When we cue an athlete to limit his extension or “rib flare” we often say “ribs down”.  This seems like a relatively benign cue to help promote a neutral spine and pelvic orientation.  However, we must be sure that the athlete is able to properly recruit external obliques (often with lower level exercises such as back to wall shoulder flexion or a dead bug variation) to help achieve this movement correction.

The reason for this is that increased stiffness of rectus abdominus (dominance) limits ability of T-spine to move out of flexion (or neutral).  Using our relative stiffness example from before, if: Rectus abdominus > (stiffer than) Thoracic Extensors = Thoracic Flexion Tendency.

Therefore, if an athlete is actually is in too much flexion… i.e. sway back (most commonly – posterior tilt and lumbar extension – hanging on rectus as their anti-gravity muscle), he will have a very difficult time getting out of flexion.  This occurs regardless of how many T-spine drills we prescribe.  This is akin to stretching rectus femoris when someone is stuck in a faulty thoracic and lumbopelvic position.

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The best approach in our case above is to “allow” t-spine mobility (extension) to occur by decreasing rectus dominance and getting someone out of T-spine flexion.  I am all for cuing the ribs down and establishing alignment, but HOW we get an athlete to do this is of the utmost importance.  The main point here is forcing T-spine extension in the presence of increased relative stiffness of rectus abdominus is not going to give us results.  In other words, weak external obliques will result in rectus overuse and thoracic “immobility” regardless of how many T-spine mobility drills we include in our programs. 

To summarize, this is a very important (and difficult) concept that – like everything else – requires a trained eye and an individualized approach.  If an athlete has too much thoracic and lumbar extension, this can result in scapular depression and downward rotation via, among others things, excessive lat dominance, which leads to a lot of our shoulder and elbow dysfunction.  On the other hand, too little thoracic extension results in scapular anterior tilt and decreased glenohumeral external rotation (“lay back”), also resulting in dysfunction and pathology. 

As a quick review, you want to be able to answer the following questions before prescribing T-Spine extension exercises:

  • Is there a lack of T-spine extension (or rotation). If not, then why prescribe T-spine extension mobility drills?
  • Where is the extension coming from (upper or lower T-spine, L-spine, C-spine)?
  • Is the athlete already at end-range extension and if so, is our attempt to “gain” extension at end-range creating unwanted motion elsewhere? (hypermobility)
  • Lastly, if an athlete presents with mal-alignment (too much thoracic extension or thoracic flexion): first, identify it, then determine why this is happening prior to simply prescribing a bunch of mobility exercises.

Conclusion

This point, along with many others, is a main reason why we chose to develop the Elite Baseball Mentorship program.  As we gather together in these groups, many conventionally accepted ideas and concepts are questioned and explored and the demand for proof (whether it be from research or experience) requires us all to think more critically.  Most importantly, with baseball-related injuries continuing to rise, this allows us to question the status quo of generally accepted baseball-specific protocols.  Ultimately, this collaboration allows us all to advance the bar and develop a better opportunity for our athletes to meet their goals through better health and performance.

Also, if you are interested in more information like this, we would love to see you at one of our Elite Baseball Mentorships. We'll be hosting these events in June, October, and December of 2014. Please click here for more information.

Author’s Note: I would like to thank Michele Ionno, MS, SPT (Wash U Program in Physical Therapy) for his contribution to the 3rd phase of this blog series.

About the Author

Eric Schoenberg, MSPT, CSCS is co-owner of Momentum Physical Therapy, located in Milford, MA.  He can be reached at eric@momentumpt.com

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