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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.

Baseball_pitching_motion_2004

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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The Best of 2013: Baseball Articles

Written on December 31, 2013 at 10:50 am, by Eric Cressey

This section is a new addition to the "Best of EricCressey.com" series.  Check out the top 5 baseball articles from the past year:

1. The Truth About CC Sabathia's Weight – I couldn't seem to stop typing this response to a New York Times piece on Sabathia's weight, and the result was a 3,700 word thesis!

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2. 7 Ways to Get Strong Outside the Sagittal Plane – These movements are beneficial for anyone, but particularly for baseball players.

3. Regaining Scapular Control: Always Good Intentions, Often Bad Technique – Here's a detailed video on how to train the prone 1-arm trap raise.

4. Improving Thoracic Mobility in Throwers – Check out these great thoracic spine mobility drills we use with our throwers.

5. 21 Reasons You're Not Tim Collins - This was a fun piece to write; I'm glad my readers have a good sense of humor!

I'll be back tomorrow with the last installment of our "Best of 2013" series.

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Improving Thoracic Mobility in Throwers

Written on November 5, 2013 at 8:35 am, by Eric Cressey

It goes without saying that all rotational sport athletes need adequate thoracic spine (upper body) mobility in order to create appropriate separation as they work to transfer force from the lower extremity to the upper extremity during swings, throws, shots, and changes of direction.  In a throwing population, however, you need to take some special precautions as you work to build it.

One thing we know about pitchers is that their shoulder external rotation improves over the course of a season, and this likely takes place because the ligamentous structures in the front of the shoulder become looser. In this image of a left shoulder, it would be the area labeled "capsular ligaments:"

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Effectively, the looser one's anterior capsule is, the more external rotation one will have.  The problem, however, is that if this area becomes too loose, the biceps tendon must pick up the slack as an important anterior stabilizer during external rotation.  Additionally, there are many nerve structures at the anterior shoulder that can be irritated because the humeral head isn't controlled.  This is yet another reason why it's not a good idea to stretch a throwing shoulder into external rotation.  In this video, I go into greater detail:

This knowledge gives rise to two thoughts:

1. If we lack thoracic rotation, our arm will drag during the pitching delivery, as it's a means of creating better separation (albeit in the wrong places).  Guys who have quick arms can often make up for it, but still inevitably irritate the anterior shoulder over time.  So, if your thoracic rotation stinks, you'll need to try to find more external rotation in the wrong places.  Additionally, if we lack thoracic extension, we often substitute lumbar extension (lower back arching) to maintain an upright torso.  These guys wind up with low back pain, oblique strains, and hip issues.

2. We can't just throw any thoracic mobility drill at throwers, particularly in the early off-season, when the anterior shoulder is all stretched out and it may be the path of least resistance.  As an example, the kettlebell arm bar might be a great drill for many folks in the population, but I would never use it with a thrower:

Instead, particularly in the early off-season, we need to pick drills that heavily emphasis thoracic movement independent of humeral (arm) movement. Here's a progression we might use over the course of the off-season:

Off-Season Months 1-2 (and during the in-season phase): Supine Alternating Shoulder Flexion on Doubled Tennis Ball, Thoracic Extension on Roller, Rock-Back Quadruped Extension-Rotation

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Off-Season Months 3-4: Side-Lying Windmill, Bent-Over T-Spine Rotation

You'll notice that these options integrate a lot more humeral movement.  In many cases, you can use them earlier in the off-season, but only if they're coached really meticulously to ensure athletes are moving in the right places.

We use these exercises right after our foam rolling and positional breathing drills during the warm-up, and before anything we'd do to directly work on scapular stabilization and rotator cuff strength/timing.  Hopefully, this article gives you a little feel for not just some of the exercises we may use, but also the way we'd program them throughout the competitive season.

If you'd like to learn more about how we manage throwers, be sure to register for one of our Elite Baseball Mentorships.  The next one will take place December 8-10, with the early-bird registration deadline just a few days away.

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Pitching Performance: Understanding Trunk Position at Foot Strike – Part 3

Written on October 11, 2013 at 6:50 am, by Eric Cressey

Today marks the third installment of this series on trunk position at foot strike during the pitching delivery.  In case you missed them, be sure to check out Part 1 and Part 2.  In those installments, we outlined the problem of early and excessive lumbar (lower back) extension, and how to address it with drill work.  In today's final installment, we'll introduce some drills we like to use with our athletes to teach them about proper positioning and build stability within those positions.

At the end of the day, there are a few things that can contribute to a pitcher drifting into excessive extension from the time he begins his leg kick all the way through when his front foot strike.  Obviously, the foremost concern is what cues the athlete has been given that may be leading him in this direction.  Once those have been cleaned up, though, we have to look to see how physically prepared an individual is to get to the right positions. I think the first question you have to ask in this case is, "Where does the posture start?"  If an athlete looks like this at rest, he's going to at least look like this dynamically – and this heavily extended posture is going to be much more exaggerated.

APT

With that in mind, step 1 is to educate athletes on what acceptable resting posture is.  In this case, we need the athlete to learn to bring the pelvis and rib cage closer together, most notably through some posterior pelvic tilt.  Once that has been established, here are some of my favorite warm-up drills for athletes with this heavily extended posture. You'll notice that exhaling fully and learning to get the ribs to come down are key components of these drills.

In addition to these low-level core stability exercises, we'll progress to some balance drills, especially in the early off-season.  Effectively, we're teaching athletes to resist extension and rotation in single-leg stance.  Yes, it's static balance training, but I firmly believe these drills have carryover to bigger and better things at higher speeds. And, you're certainly not going to overtrain on them, so you've got nothing to lose.

With all these exercises out of the way, it takes a lot more high level core stability for this posture to carry over to the high level throw.  You need to improve both anterior core control (your ability to resist excessive extension/arching) and rotary stability (your ability to resist excessive rotation at the lower back).  I've outlined loads of options on these front, but here are two to get the ball rolling for those who aren't up to speed on my writings just yet:

And, remember that the different types of core stability never work in isolation – especially during the basebal throw.  Check out this video for more details:

The core stability you build must, however, be accompanied by a strong lower half.  Candidly, I don't think having a huge squat is necessary.  Athletes seem to get much better carryover from deadlift variations, in my experience – likely due to the fact that the deadlift does such a tremendous job of teaching good hip hinging.  We see so many athletes who drift (LHPs toward 1st base, and RHPs toward 3rd base) early in the leg kick and subsequent movement toward home plate in part because they can't hip hinge at all.  Once you've gotten that hip hinge back (in part with the toe touch video from above), you have to strength train in that pattern to get it to stick.  For the most detailed deadlift technique video tutorial out there, check out my free one here.

Additionally, single-leg strength is insanely important, and there are lots of ways to attack it. 

I think it's equally important to be able to build and maintain strength outside the sagittal plane, especially when it comes to carrying that good hip hinge over to movements when a pitcher is starting to "ride his hip" down the mound.  With that said, definitely check out an article I wrote previously, 7 Ways to Get Strong Outside the Sagittal Plane.

Once you've established hip and shoulder mobility, core stability, and lower half strength, you can really start to make the most of your medicine ball training.  As you can see, I think Tim Collins is a great example from which young throwers can learn a lot, as he has built up a lot of these qualities to make the most of a smaller frame in order to consistently throw in the mid 90s.  That said, I couldn't ask for a better demonstrator for our medicine ball drills for a few reasons.

First, he always throws the ball with intent; there are no half-speed reps. If you want to develop power, you have to try to be powerful in each throw during training.  Second, his direction is outstanding.  You never see him drift forward as he builds energy to apply with aggressive hip rotation. Third, he's got a great hip shift, which is necessary to get the most out of his posterior chain.

As a follow-up to that video, CP coach Greg Robins has a great tutorial here to teach you how to get "in and out" of your hip on rotational medicine ball exercises:

As you can see, there are a lot of different factors that contribute to an athletes being in excessive extension – but also allowing that extension to carry over to their pitching mechanics to the point that trunk position will be out of whack at foot strike.  Additionally, these exercises should demonstrate to you that athletes who land in a very extended position – but still have success and don't want to change things – will need to take special precautions in terms of physical preparation to make sure that their bodies don't break down over time with this delivery style.

This wraps up our series on understanding trunk position at foot strike during the pitching delivery; we appreciate you following along for all three articles!I If you'd like to learn more about how we manage throwers, be sure to register for one of our Elite Baseball Mentorships.  The next one will take place December 8-10.

 

 

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Upper Body Self Myofascial Release Precautions

Written on October 1, 2013 at 10:32 am, by Eric Cressey

If you've read just about any of my writing, you likely know that I'm a big fan of various forms of soft tissue work. Obviously, there's foam rolling for our more "diffuse" work, but a lot of people also use a baseball, tennis ball, or lacrosse ball to get a bit more "focal."  While this can definitely be helpful, there are a few precautions you want to take.  Check out this video to learn more:

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Training Athletes with Funky Elbows: What a Valgus Carrying Angle Means

Written on September 23, 2013 at 8:34 am, by Eric Cressey

I talk a lot about how there's a difference between simply "training baseball players" and actually training baseball players with a genuine appreciation of the unique demands they encounter – as well as their bodies' responses to those demands.  Today's post will be a great example of how you can't just throw every throwing arm into a generic program.

One of the adaptations you'll commonly see in throwers is an acquired valgus carrying angle at the elbow.  For the laymen in the crowd, take note of how the throwing arm (in this case, the right arm, which is to the left side of the picture) has a "sharper" angle: 

 

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This is an adaptation to the incredible valgus stress during the lay-back portion of throwing.

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While the research on the subject isn't really out there, it's widely believed that a sharper valgus carrying angle predisposes throwers to elbow injuries, particularly ulnar collateral ligament (UCL) tears.  My good friend Mike Reinold actually has a lot of very good unpublished data on the topic, too. In my eyes, this verifies that we need need to treat throwers like this with extra care in light of this increased susceptibility to injury. 

From my perspective, I think it means more time off from throwing each off-season in order to regain passive stability, as the UCL is already stretched out more than in the normal pitcher.  Additionally, it may take longer for these athletes to regain good soft tissue quality, as the musculature at the medial elbow is likely working harder to make up for this loss of passive stability and the increased range-of-motion demands.  Another key point is that this valgus carrying angle may increase the likelihood of ulnar nerve hypermobility (snapping back and forth over the medial epicondyle during flexion/extension) or ulnar neuritis (irritation of the nerve from excessive stretch). If this nerve only has a limited number of flexion/extension cycles before it really gets irritated, then we need to use each throw wisely to put off the possibility of needing an ulnar nerve transposition surgery to set it where it needs to be.

Additionally, I think it means less aggressive throwing programs, particularly with respect to extreme long toss.  I think long toss has a ton of merit for a lot of throwers, but one concern with it is that it does increase valgus stress slightly as compared to throwing on a line at shorter distances.  With that in mind, these folks might respond better to other throwing initiatives, or simply less long toss than they otherwise might do.

From a training standpoint, we need to work to gain more active external rotation to ensure that more of the range-of-motion is occuring is at the shoulder than the elbow.  This should not be confused with simply stretching the shoulder into external rotation, which does much more harm than good in 99% of cases.  Rather, we need to educate athletes on how to get to lay-back without compensation. I like supine external rotation – an exercise I learned from physical therapist Eric Schoenberg – as a starting point.

Once we've been successful working with gravity, we'll progress this drills to prone to work against gravity, and then add in various holds at end-ranges of motion to strengthen athletes in external rotation closer to end-range.  Here's an example you can try at home:

In terms of contraindications, I can't say that it changes much as compared to what we avoid – back squats, Olympic lifts, etc. – with the rest of our throwers.  However, I think the fallout could be even more dramatic; just imagine these elbows catching a snatch overhead in the off-season after 200+ innings of wear and tear.

crazyvalgus

This picture also teaches us that one can simply be born with a more significant valgus carrying angle, but throwing during the adolescent and teenage years would make it more extreme.

Beyond training implications, for the reasons I noted above, it's also extremely important to take care of tissue quality at the common flexor tendon and pronator teres. I like a combination of instrument-assisted soft tissue mobilization and hands-on work like Active Release.

I hope this post brings to light an additional assessment and follow-up training principles you can use to give your throwers the quality training and (p)rehabilitation they need. If you're looking for more insights on training throwers, I'd highly recommend you check out our Elite Baseball Mentorships; the next course takes place on December 8-10.

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