Home Posts tagged "Postural Restoration Institute"

CSP Elite Baseball Development Podcast: Understanding Asymmetry with Ron Hruska

We're excited to welcome Ron Hruska, the founder of the Postural Restoration Institute, to the latest podcast. Ron shares some excellent insights on the origins of PRI; how polyarticular chains impact human movement; and what to do when we observe some of the common postural adaptations we see in athletes - particularly baseball players.

A special thanks to this show's sponsor, Marc Pro. Head to www.MarcPro.com and enter the coupon code CRESSEY at checkout to receive an exclusive discount on your order.

Sponsor Reminder

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Podcast Feedback

If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.

And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.

Thank you for your continued support!

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What Do You Think of XYZ Method?

Often, I'll get inquiries that go something like this:

What do you think of yoga?

How do you feel about Pilates?

I have a friend who liked MAT. Do you think it's legit?

These are always challenging questions to answer because there are actually a number of variables you have to consider. To illustrate my point, let's try for some parallels in different industries. What do you think of real estate attorneys? Accountants? Veterinarians? Plumbers? General contractors?

As you can probably infer, there's going to be a high amount of variability in the delivery of each method, so you have to ask the following questions:

1. Is the method actually legit?

Sometimes, entire methodologies are based on bad science or bad people manipulating science for their own financial gain. A good example of this would be the thousands of different kinds of "cleanses" marketed in the nutrition/supplement industry.

2. Is the practitioner actually educated (and, where appropriate, licensed) in the method?

This is something that is near and dear to me. Each week, we get emails from young baseball players and their parents who say they train with a "Cressey guy" or someone "Eric has mentored." Then, they tell me that coach's name and I've never heard of him, and he's never even purchased one of my products or attended our actual baseball mentorship. Instead, he saw me give a one-hour talk in 2009. In describing himself, however, he positions himself on par with one of our interns who spent 3-5 months side-by-side with me six days per week. That's a markedly different level of education in our method.

As a good rule of thumb, think of the telephone game. The further away from the founder of a method, the more watered down the product becomes. As an example, Ron Hruska created the Postural Restoration Institute, and it's mostly disseminated through courses he's designed and by instructors he's trained himself. If an attendee then returns and teaches his/her staff the principles, then they teach their clients, and then the clients share their favorite positional breathing drill with a friend after a few adult beverages at a cocktail party, is it really representative of how impactful PRI can really be?

3. Does the practitioner actually have attention to detail?

Having just built a brand new Cressey Sports Performance facility, this is fresh on my mind. Not all contractors are created equal. Two can look at the exact same finished product and one person says it's beautiful, and the other says it's terrible work. No matter how great the method might be, if someone is lazy, it won't be positioned in a great light.

4. Does the practitioner understand how to "pivot" within a philosophy?

The back-to-wall shoulder flexion exercise is a central piece of our philosophy at Cressey Sports Performance. We think it's imperative to get the arms overhead without compensation at adjacent joints. Give this a video a watch to learn how we'd coach it under the three most common challenges one will typically encounter:

As you can see, these modifications rely on being able to do some basic, quick evaluations on the fly. If you don't have the ability to perform them, the client will likely just wind up banging on the front of the shoulder.

This is where a lot of group exercise methodologies can fall short. They don't understand how to pivot when someone can't perform a drill, so they wind up plowing through a bony block or exacerbating an existing movement fault.

5. Has the practitioner evolved with the methodology?

I tweeted this several years ago, but it still holds true:

 

If you look at CSP years ago versus now, it's easy to see how much we've evolved. What you would have learned in a single day of observation at the facility in 2010 is a lot different than what you'd learn on a 2020 visit. This might refer to the methodologies represented, coaching approaches, or equipment utilized.

6. Does the practitioner utilize one methodology exclusively?

As the hackneyed expression goes, "If you're a carpenter who only has a hammer, everything looks like a nail." For example, I'm very leery of chiropractors who only do adjustments when there are undoubtedly many other associated therapeutic interventions that could further help their patients. I'll always refer to multi-dimensional providers over one-trick ponies.

Pulling It All Together

As you can see, five of my six qualifications had nothing to do with the method, but rather the practitioner carrying out that method. That, my friends, is why I always refer to PEOPLE and not just methods. And, it's why you should always try to find good people - regardless of the methodologies they utilize - to help you get to your goals.

It's also why continuing education is so important: we need to understand the principles that govern how successful people can be within various methodologies. If you're looking to learn more about some of those principles and how I apply them to evaluation, programming, and coaching at the shoulder, be sure to check out my popular resource, Sturdy Shoulder Solutions.

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Strength and Conditioning Stuff You Should Read: 1/12/18

I hope you're having a good week. I'm shifting this series to later in the week because I'm doing more of my writing on Sundays these days, so look for Thu/Fri "round-up"posts from here on out. Here are some good reads from around the 'net over the past week:

EC on the Seams Legit Podcast - This is a two-part interview I did with Nick Friar. We discuss baseball development and our work with (among others) Corey Kluber, Max Scherzer, and Noah Syndergaard.

8 Lessons from Lab Assisting for PRI Courses - Miguel Aragoncillo offered some awesome insights on how to make the most out of your attendance at continuing education events.

What Your Doctor Never Told You About Arthritis - This was a good guest post from Dr. Michael Infantino for Tony Gentilcore's site.

Top Tweet of the Week

Top Instagram Post of the Week

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Performance Programming Principles: Installment 2

As I promised back in November, I've decided to dedicate a regular series to the principles that govern a lot of our program design at Cressey Sports Performance. Here's the second installment:

1. A few positional breathing drills can be a game changer, but don't let them take over the training session.

Positional breathing drills have really surged in popularity in recent years, largely thanks to the great work of the folks at the Postural Restoration Institute. Forceful exhalation in certain positions can both activate certain muscles and inhibit others. Take, for instance, TRX Deep Squat Breathing with Lat Stretch.

We're firing up several muscles of exhalation: rectus abdominus, external obliques, serratus anterior - and toning down our lats, rhomboids, lumbar extensors, and calves (to name a few). It's not uncommon for folks to get up from this exercise after 30 seconds and feel dramatically different.

That said, as is often the case in the fitness industry, if a little is good, then a lot must be better, right? It didn't take long for us to find the zealots who are spending 30 minutes doing positional breathing at the start of every training session. It's somewhat analogous to the folks who foam roll for an hour every day.

You're better off doing 1-2 breathing drills at the start of a warm-up (and possibly as a cool-down) and then following it up with good resistance training technique to make those transient changes "stick." Patience and persistence always win out over short-term "overindulgence."

2. Follow these two great Selective Functional Movement Assessment (SFMA) strategies.

SFMA was one of the better courses I've taken in the past few years, and two programming principles they discuss really stand out:

a. Chase dysfunctional, non-painful patterns first.

Let's say someone walks in with a cranky shoulder that's limited into internal rotation: a dysfunctional, painful pattern. If you just throw caution to the wind and stretch that shoulder into internal rotation, more often than not, you're going to flare things up even further.

Let's say that individual also has a pronounced scapular anterior tilt and very limited thoracic extension and rotation. If you do some soft tissue work on pec minor and work in some thoracic spine mobilizations, there is a  very good chance that when you go back to retest shoulder internal rotation, it'll be improved and pain-free. Sometimes, the best way to get from A to B is through C or D.

b. Find and address areas were passive range-of-motion far exceeds active ROM.

There's a reason a lot of gymnasts and dancers retire with stress fractures in their lower backs; they have a lot of passive range-of-motion, but not always much motor control to stabilize those ranges of motion. This is why it's important to have assessments that test both passive and active ROMs (straight leg raises and supine vs. standing shoulder flexion are great examples). And, you need to have training initiatives that build control in those passive ranges.

3. Check out the Acumobility Ball.

I posted this on my Instagram and thought it might be of interest. The Acumobility Ball has been a game changer for us. You can save 10% on it at www.Acumobility.com with the coupon code cressey.

Here's a little example of how we'd use it on the pec minor/coracobrachialis/short head of biceps attachments on the coracoid process.

4. There's nothing that says you have to progress or regress programming - and there are many different ways to make lateral moves.

As few years ago, Charlie Weingroff coined the term "lateralizations" for times when you don't progress or regress an exercise, but rather, move laterally.

An example would be something along the lines of going from a standing 1-arm cable row to a split-stance 1-arm cable row. There really isn't any change to exercise complexity, but it does give the trainee some variety in their programming.

I'd say that lateralizations are the most useful with adult clients who don't have crazy lofty fitness goals - and therefore aren't interested in taking on a ton of risk in their training programs. They might not crave being sore all the time from all the innovative new exercises you can throw at them. Lateralizations can keep training fun via novelty without adding a steep learning curve.

Additionally, remember that exercise selection isn't the only way to progress or regress the challenge to the athlete or client in front of you. You can increase or decrease volume, alter the tempo, modify the load, or adjust the rest intervals.

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Pitching Injuries: Should Lat Strains Even Be Happening?

In a 2016 meta-analysis, researchers examined the existing body of research on latissimus dorsi and teres major strains in professional baseball pitchers. While the collective sample size was small (30 total athletes), one resounding theme was present:

Lat strains can be pain in the butt to rehabilitate.

In these studies, 29 pitchers were managed conservatively, while one pitcher required surgery for the issue. In the conservative group, the average return-to-pitching timeline was 100 days, whereas the surgical case was 140 days." Perhaps of more significance, though, the researchers noted that "five patients in the conservative group suffered from complications and/or setbacks during their treatment and rehabilitation."

We have to keep the sample sizes in these studies in mind, too. They haven't had a large pool from which to draw, and many researchers might not appreciate how different "return-to-pitching" is than "feeling like your old self." The general consensus among guys I know who have had the surgery seems to be that it's 8-10 months before you're back to feeling 100% in games. 

Let's face it: if you're missing 3.5-5 months with an injury - and adding even more time to get back to 100% - you might as well just cash in an entire season. That's not only a lot of money wasted on disabled list time at the Major League level, but also a lot of lost developmental time in the minor league ranks.

To make matters worse, the rehabilitation process can be delayed because lat strain diagnoses can be somewhat challenging. According to Dr. Leon Scott, a sports medicine physician and Assistant Professor of Orthopaedics & Rehabilitation at Vanderbilt University, "Because lat strain diagnoses aren't all that simple to make, especially if a physician’s exam is limited and relies heavily on an MRI, they are often a missed diagnosis. A standard MRI may not be distal enough to capture the area of injury. Arthrogram images are an even smaller field, leading to a missed diagnosis." He also notes that in one acute lat injury he saw in the past, "With a wide field shoulder MRI, there was acute edema, hematoma seen at the bone-tendon interface. It was hard to miss." In short, ordering physicians may be trying to use a narrow imaging technique for a shoulder injury when they should be painting with a broader brush that would also pick up an upper arm injury.

 Latissimus_dorsi_muscle_animation

 Source: By Anatomography (en:Anatomography (setting page of this image)) [CC BY-SA 2.1 jp (http://creativecommons.org/licenses/by-sa/2.1/jp/deed.en)], via Wikimedia Commons

One professional player I saw struggled with getting a definitive diagnosis that his lat strain needed surgery for two years. At first, they suspected his anterior shoulder pain was occurring because of a labral tear, but a labral "clean-up" surgery didn't change his symptoms. Perhaps more interesting, though, the surgeon didn't even see the lat tear while he was doing the arthroscopic intervention. Five months later, another surgeon went in to repair the lat - which was actually significantly detached from the bone.

The first take-home message here is that if you're a thrower and you have shoulder pain, you need to make sure that you see a sports medicine physician who sees a lot of throwing injuries. A lat strain can be a tricky diagnosis, and even the most well-intentioned physicians may not know to look for it. This is especially because it often presents as pain in the front of the shoulder, in the event of a tendinous injury. You can see this clearly demonstrated by the attachment points in the image above, but I'll take more about this later when we get to functional anatomy.

As I pondered the research article and actually discussed it with a few of my staff members, I realized that we have literally never had a lat strain happen with one of our regular clients at Cressey Sports Performance - and we see a lot of pitchers. I say this not to brag (or jinx us), but rather to just bring to light that success leaves clues - which I'll also get to later on in this article.

That said, I should note that my ideas in this article also draw heavily on our experiences working with a lot of frustrated pitchers who have come to work with us after the injury has occurred because they need help bouncing back. Failures (in this case, injuries) also leave clues.

Before we get to all these observations and potential countermeasures to prevent lat strains, I think it's incredibly important to discuss the functional anatomy of the latissimus dorsi and teres major. And, as an extension, we'll discuss how this functional anatomy understanding needs to be put alongside biomechanics research and anecdotal observations of injured athletes to pull together a hypothesis for the "perfect storm" of lat injury risk.

Functional Anatomy

The latissimus dorsi is a big muscle with huge functional implications.

Latissimus_dorsi

It attaches on the thoracolumbar fascia (lower back) and runs all the way up to the intertubercular groove of the humerus (front of the upper arm). This is why it has to be considered as a differential diagnosis for anterior shoulder pain in throwers - alongside everything from biceps and rotator cuff tendinopathy or tears, to labral injuries, to anterior capsule injuries, to thoracic outlet syndrome.

As an interesting aside, there are a number of anatomical variants present along this lengthy anatomical course. In a small percentage of people, the lat actually attaches on the ilium (top of the pelvis). In just under half of individuals, it has a direct attachment on the scapula. The number of costal (rib) and vertebral attachments also varies from person to person.

Everyone knows about the functions of the lat at the shoulder - extension, adduction, internal rotation, and horizontal abduction - but in consideration of this expansive functional anatomy profile, we have to appreciate that it has several other key roles to consider.

Lat is a key core stabilizer - to the point that it can be heavily overused and pull athletes into a "gross extension" pattern. Notice the big anterior pelvis tilt and lordosis here - but also take note of the position of humeral extension (and the indirect effects on forward head posture).

Ext4

Given its attachment on the scapula in some individuals - and the indirect impacts of "crossing" the scapular region - the lat also contributes to scapular depression. 

Finally, it's been theorized that an aberrant, extension-biased posture would interfere with optimal diaphragmatic function (via loss of the zone of apposition). Because the lat is also an accessory respiratory (inhalation) muscle, you could say that it has to pick up the slack for a problem it actually helps create! My favorable experiences with the Postural Restoration Institute and my own anecdotal observations definitely support this theory.

Zone-of-Apposition-300x220

Source: www.PosturalRestoration.com

For all intents and purposes, you can view teres major as a "mini-lat." It shares the same scapula-to-humerus functional relationship and actions, but doesn't impact the rib cage or lumbar spine directly.

 

Teres_major

 

Implications for Throwers

By appreciating the functional anatomy of the lat, we can recognize just how vital it is to throwing a baseball hard. In short, it connects the lower body to the upper body to allow for force transfer that ultimately leads to arm speed and ball velocity.

Not surprisingly, a 1987 study from Gowan et al. observed that lat recruitment during the acceleration phase of throwing was substantially higher in professional pitchers than in amateurs. Not surprisingly, experienced, accomplished athletes know how to use big-boy muscles (prime movers) to do big-boy jobs (accelerate the arm, which is the fastest motion in all of sports). The amateur pitchers actually continued to heavily rely on smaller, stabilizing muscles - the rotator cuff, biceps, and posterior deltoid - during acceleration. That's not a safe or effective long-term strategy.  

This is likely why we rarely see lat strains in younger athletes; you probably have to throw 90mph+ to effectively "use" the lat, and muscles that don't get used usually don't get strained. The younger kids are more likely to have rotator cuff pain, irritation of the long head of the biceps tendon, or proximal humeral growth plate issues.

There's a bit more to "lat overuse" than just the acceleration phase of throwing, though. During the lay-back (extreme cocking, or maximum external rotation) portion of throwing, the lat and teres major are two of several muscles (including notables like subscapularis pectoralis major) that are working eccentrically to prevent the humerus (upper arm) from flying off the body.

layback

This eccentric pre-stretch also helps to store elastic energy that is subsequently released during the acceleration phase to create ball velocity. Most muscle strains occur - whether it's acutely or chronically - as muscles and tendons are stretched during the eccentric phase of activity. Hamstrings strains usually occur at the terminal swing phase of sprinting. Middle-aged men rupture Achilles tendons when they land on dorsiflexed ankles - where the calves are maximally stretched. The lats and teres major are the most overstretched at this lay-back phase of throwing.

On a chronic note, repeated exposures to aggressive eccentric stress can lead to muscle shortening. Reinold et al (2012) demonstrated this with respect to elbow extension and shoulder internal rotation. My experience has been that pitchers who trend toward the "tight" end of the continuum also lose shoulder flexion and "true" external rotation over the course of the season. As I describe in the video below, this is very likely related to stiffness or shortness in the lats - and the research has demonstrated that it is associated with an increased risk of elbow injuries in pitchers.

Beyond just the specific roles of the lats during the throwing motion, we have to also appreciate that they're heavily overused during daily life because of their roles as core stabilizers and accessory respiratory muscles. And, given that we don't spend a lot of time in our daily lives with our arms overhead and shoulders externally rotated, they aren't afforded a whole lot of length throughout the day. Take a chronically shortened muscle, overuse it, and then throw it into the fastest motion in all of sports, and you've got a recipe for strains. However, you can't throw hard without it. Hence, this Tweet from me a few years ago:

Why Do These Injuries Take So Long to Heal?

Having established the injury mechanisms, it's important to also consider why lat strains in throwers take so long to rehabilitate. I see four primary reasons that differentiate lat strains from just "any other muscle strain:"

First, as we noted earlier, early diagnosis may not happen. This can occur because the athlete just ignores the issue as normal soreness, or they manage it as "biceps tendonitis." Or, a physician may not recognize that a lat injury could create anterior shoulder symptoms. Finally, a typical MRI might just miss the injury altogether. All these factors can potentially lead athletes down the wrong rehabilitation path.

Second, my experience has been that many of these injuries are far more chronic than they are traumatic. More often than not, when you dig deeper into the history of a pitcher who has a lat strain, he's thrown through some kind of extended soreness/discomfort for weeks, months, or years. Eventually, it becomes too much to stand and begins to significantly interfere with pitching performance. Given that the issue developed over an extended period of time, it isn't going to go away overnight. 

Third, as I discussed in my functional anatomy musings earlier, the lats are heavily involved in multiple planes of motion. I've theorized in the past about how muscles that play crucial roles in multiple plans are more likely to be stubborn rehabilitation projects:

Pull a quad (rectus femoris), and you’ll usually bounce back really quickly. Pull an oblique and it’s much more stubborn. What’s the difference? The rectus femoris is really all about the sagittal plane, whereas the obliques have a big role in controlling excessive motion in the sagittal, frontal, and transverse planes. The more complex the job of the muscle, the more significant the injury – and the longer the rehab. Hamstrings have roles outside the sagittal plane and can be equally stubborn, too.

Fourth, the proximal humerus (upper arm) area really seems to scar down faster than almost any other region in the body - and this is particularly true of throwing shoulders because of the eccentric stress pitchers encounter. There are 17 muscles that attach to the scapula, and most of these structures cross the glenohumeral (ball-and-socket) joint. Perhaps more significantly, eight of these tendons attach in close proximity to the insertion of the latissimus dorsi and teres major. Throw eight tendons in a very small area that experiences a lot of eccentric stress, and you'll wind up with a gritty, fibrotic mess eventually.

Injury Risks

Whether it's a chronic or traumatic onset lat issue in a pitcher, one theme always seems to hold true: symptoms emerge after a dramatic increase in throwing stress.

On multiple occasions, I've seen lat strains that have come about because a reliever pitcher was moved into the starting rotation without a gradual increase in pitch count. 

In other instances, the lat got cranky after a big velocity jump in a single off-season. This is usually the case in a high school kid who jumps from 84 to 94mph in a single winter. As my friend Derek Johnson, the pitching coach for the Milwaukee Brewers has said, the "arm is writing checks the butt can't cash."

delivery5

Sometimes, it may come about after a single outing with an abnormally high pitch count. The pitcher just can't bounce back in time for the next start, and the subsequent start becomes the straw that breaks the camel's back. y experience has been that when you throw the typical "high arm speed" (90mph+) high school pitcher out for back-to-back outings of 100+ pitches - even on a seven-day rotation - things often start to head down the wrong path. This doesn't happen nearly as frequently in the college game, and I think this speaks to the fact that there is clearly something really important that's occurring in terms of work capacity and/or strength improvements for pitchers in the 16-19 age range.

Finally, lat issues seem to be particularly common when you see high school and college starters switch from a 7-day rotation to a 5-day rotation when they enter professional baseball. It isn't as much of a dramatic increase in stress as it is a significant loss in recovery time or capacity. I've heard many guys over the years say that they have to learn to pitch with only 90% of what they're typicaly capable.

Movement Quality 

Beyond just the increase in throwing stress, there are a few things I've found to be common in the lat strain pitchers I've seen in recent years.

1. The lower traps can't keep up with the lat.

The lower traps are very important for providing posterior tilt (slight tipping back) of the scapula and assisting in upward rotation. These two functions make it essential for a pitcher to get his scapula in the right position during the lay-back phase of throwing.

Conversely, the lat has more of a "gross" depression effect on the scapula; it pulls it down, but doesn't contribute to posterior tilting or upward rotation. This might help with an adult rotator cuff pain patient who has an aggressive scapular elevation (shrug) substitution pattern, but it's actually problematic for a thrower who is trying to get his scapula up and around the rib cage to make sure that the ball-on-socket congruency is "flush" when it really matters:

baseball-97898_960_720

As such, you can say that the lat and lower trap "compete" for scapular control - and the lat has a big advantage because of its cross-sectional area and multiple attachment points. It's also much easier to train and strengthen - even if it's accidentally.

To this end, we'll often hear throwers cued "down and back" during their arm care drills. The intention - improving posterior tilt via lower trap activation - is really good, but the outcome usually isn't. Unless athletes are actually put in a position of posterior tilt where they can actually feel the lower traps working, they don't get it. Instead, they pull further down into scapular depression, which feeds the lat-dominant strategy. This is why we teach almost all our throwers to differentiate between depression and posterior tilt on their first day in the gym.

2. The rotator cuff can't keep up with the lat.

As I noted earlier, the lat has numerous functional roles at the shoulder. Because the attachment point of the lat is on the shaft of the humerus and not the ball, the lat really can't have any direct control on the positioning of the ball in the socket. In fact, it actually indirectly destabilizes the throwing shoulder because it contributes to an anterior (forward) gliding of the ball on the socket during the lay-back phase of throwing. This anterior glide is counteracted by the rotator cuff musculature.

image412

Whenever we evaluate movement, we have to consider both osteokinematics (gross movements - flexion, extension, etc. - of bones at joints) and arthrokinematics (subtle movements - rolling, rocking, gliding, etc. - of bones at joint surfaces).

To paraphrase something that physical therapist Shirley Sahrmann has noted many times, whenever you see a strained or overworked muscle, look for a dysfunctional synergist. In this case, the synergists to the lat and teres major are the rotator cuff muscles. We just rarely consider lat strains as a consequence of rotator cuff weakness because it's usually the biceps tendon, labrum, capsule, or rotator cuff itself that winds up cranky before the lat starts barking.

3. Guys usually have a history of doing a lot of lat dominant lifting.

In a baseball population, throwing is lat dominant. Breathing is lat dominant. Core stabilization is lat dominant. When you add in a lot of lat dominant lifting to the mix - particularly during the in-season period - things don't usually go well. I'm just going to put this out there:

[bctt tweet="I've never met a high-level thrower who had weak lats."]

I'm speaking with respect to both relative and absolute measures. Relatively speaking, I've never looked at a guy and said, "Well, if he added 50 pounds to his best weighted chin-up, he'd definitely throw harder and be healthier. His rotator cuff and lower traps are too strong." Absolutely speaking, I have yet to see any research examining the relationship between lat strength and throwing velocity. I'm very confident that there is a point of diminishing returns where getting stronger doesn't help add any more velocity. Moreover, it may actually interfere with improvements - and increase susceptibility to injury. This includes elbow irritation, as heavy weighted pull-ups and chin-ups are brutal on the medial elbow in lifters who don't even throw a baseball for a living.

Just like you don't have to squat 800 pounds to have an elite vertical jump - but you probably won't jump high if you only squat 200 pounds - your lats just need to be strong enough to throw hard.

Also worthy of mention is the fact that exercises like deadlifts, farmer's walks, and dumbbell lunges, and any other drill where weights are held in the hands are actually very lat intensive. With the arms at the sides, the lats are almost fully shortened - and the lat is working hard as a core stabilizer against appreciable external loading.

The take-home message is that you really have to critically examine your entire strength training program for how much lat-dominant work your athletes are doing. My rule of thumb is that an athlete has to have full shoulder flexion and great cuff strength to "earn the right" to do pull-ups in his off-season programming, and we don't use any pull-ups or pulldowns with in-season programs. We can accomplish everything we need with horizontal pulling variations.

4. Guys usually accumulated a lot of innings or appearances without much, if any, manual therapy 

NASCARs require more upkeep that ordinary automobiles. If you're going to push a car to its limits, you better plan on changing the oil and tires more frequently. The same goes for a high level throwing arm. Manual therapy is a game-changer for maintaining or improving range-of-motion and bouncing back between outings.  

manual_therapy_page-300x206-2

The lats and teres major get pushed really hard during the throwing motion, and it's important to do regular routine manual therapy maintenance to keep them "supple" with a variety of soft tissue approaches. I've seen athletes that responded really well to cupping, some to Graston Technique, some to Active Release Technique, some to dry needling, and others to more traditional massage. Everyone is different - but everyone needs it.

Also worth of note, trigger points in the latissimus dorsi may actually relate to discomfort in other regions. Chris Howard, massage therapist at Cressey Sports Performance – MA, notes:

“Trigger points in the latissimus dorsi can refer pain and discomfort to the medial and inferior border of the scapula extending to the posterior shoulder, medial triceps region and down to the pinky and ring finger. Trigger points not only cause pain, but can also mimic nerve symptoms by causing numbness and tingling in their referral zone. Of particular interest to this article is the fact that trigger points, regardless of whether they are active or latent, have the ability to alter muscle activation patterns. In other words, once trigger points are present in muscles of the shoulder girdle, the normal activation pattern is altered, which can lead to abuse of some of the smaller muscles.”

5. Guys have insufficient anterior core control.

The stiffer (or shorter) your lats are, the more you need to have great anterior (front) core control to prevent this from happening:

When the core control isn't present, the lats are never really challenged to approach their end range - which is full shoulder flexion. Learning to add some good stiffness to lock the ribs to the pelvis during overhead motion obviously protects the lower back, but it also has the added benefit of making lats "healthier."

6. They turn all rowing motions into lat dominant movements.

Rather than reinvent the wheel on this point, check out this detailed rowing technique video I filmed a while back. In particular, points #1, #2, #4, and #6 are the most common findings in a very lat-dominant individual. I'd encourage you to watch the entire video, though, as it's not uncommon to see multiple mistakes at a time:

7. Guys have lost shoulder flexion.

If a muscle is fundamentally short, it's going to be more likely to strain. These are usually the ones who have failed miserably on points 1-6 over an extended period of time.

shouderflexion

Prevention

Several years ago, in the heart of the ACL prevention program craze, Mike Boyle made a bold statement, "ACL injury prevention is just good training." In short, if you teach athletes to move well with comprehensive, well-rounded programming and solid coaching to ensure good training technique, you're going to markedly reduce the incidence of ACL injuries. I couldn't agree more - and I'd argue that lat strain prevention training in pitchers is just good training, too. 

1. Maintain tissue quality with regular manual therapy, and complement it with daily foam rolling.

2. Make athletes earn the right to do pull-ups.

3. Don’t do pull-ups/pulldowns during the season.

4. Make sure that the rotator cuff, lower trap, and anterior core are strong enough to keep up with the lats.

5. Be cognizant of overdoing it on drills like deadlifts, farmers walks, and DB lunges/split squats. These are all great exercises that can have their place, but anything done to excess can be a problem.

6. Ensure appropriate training technique. Specifically, don't overuse the lats when you aren't supposed to use them at all.

7. Closely monitor athletes who have seen dramatic jumps in pitching velocity or workload - and avoid building up pitch counts too quickly.

8. Constantly solicit feedback from pitchers so that mild lat soreness is discovered before it can become a full blown injury.

Obviously, once an athlete already has a teres major or lat strain, things are a lot hairier. That's really the point of the article, though: as always, prevention is the absolute best treatment

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The Most Important Three Words in Strength and Conditioning

From 2007 to 2009, I was a big sleeper stretch guy. All our throwing athletes did this stretch at the end of their training sessions, and we meticulously coached the technique to make sure it accomplished what we *hoped* it would accomplish. I featured it in the program in my first book, Maximum Strength, and this picture of me even shows up in the first row of photos on Google Images if you search for "sleeper stretch."

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Then, in March 2010, I attended my first Postural Restoration Institute (PRI) event and "saw the light." I left the course with some great new positional breathing drills that often delivered quick results in terms of improving shoulder internal rotation - without having to actually stretch the shoulder, a joint that doesn't really like to be stretched. Looking back, we were probably trying to "stretch" out an alignment issue - and that never ends well.

We've since progressed our approach, complementing PRI exercises with thoracic spine mobility drills and manual therapy at the shoulder in those who present with true internal rotation deficits. Only after they've still come up short following these initiatives do we actually encourage stretching of the glenohumeral (ball and socket) joint. And, even when that happens, it's gentle side-lying cross-body stretching with the scapula stabilized; this has proven safer and more beneficial for improving internal rotation.

The three preceding paragraphs about my experiences with the sleeper stretch could really be summed up in three words:

                           I was wrong.

It's not the only time I've been wrong, either.

I wish I'd done more barefoot work and ankle mobility training with the basketball players with whom I worked early in my career.

I wish I'd not just assumed that all athletes needed more thoracic mobility when, in fact, there are quite a few who have hypermobile t-spines.

I wish I'd focused more on the benefits of correct breathing - especially full exhalation - with athletes sooner in my career.

TRXDeepSquatBreathingWithLatStretch

In my own powerlifting career, I wish I'd spent more time free squatting and less time box squatting. And, I wish I'd competed "raw" instead of with powerlifting equipment.

I've made some errors in the ways I evaluated, trained, and programmed for athletes. I've made dumb decisions in both my business and personal life. However, at the end of the day, I can attribute a lot of my improvements as a person and a professional to the fact that I was completely comfortable admitting, "I was wrong." Heck, I'm so comfortable recognizing my mistakes that I've written entire posts on the subject!

This is trait just about every successful strength and conditioning coach generally shares. Humility is an essential trait for personal and professional advancement, especially in a dynamic field like strength and conditioning where new research and training techniques emerge on a daily basis.

This isn't just limited to strength and conditioning, though. If you asks a lot of the best surgeons in the country, they'd admit that they were wrong in doing a lot of lateral release (knee) surgeries and thermal capsule (shoulder) shrinkage procedures earlier in their careers. And, they'd probably admit that they misdiagnosed a lot of cases of thoracic outlet syndrome as ulnar neuropathy. If they aren't willing to admit their past mistakes, you probably ought to find a different doctor.

If you're an athlete, the same can be said of seeking out a strength and conditioning coach. If the person writing your programs hasn't learned from his/her mistakes, are you really getting a "modern" or forward-thinking program that has been tested in the trenches? We've all seen those programs - both in training and rehabilitation - that have been photocopied so many times over the years that they're barely legible.

Likewise, if you're an up-and-coming strength and conditioning coach, you want to seek out mentors that'll admit their past mistakes and reflect on how they learned from them. Only then can they help you avoid making them, too. You're better off learning under someone who has 15 years of strength and conditioning experience than someone who has 15 years of the same year of experience.

Finally, if you're an established professional, the only way to grow is to get outside your comfort zone. Five years from now, if you're not looking back on your current approaches and wondering what the heck you were thinking, then you're stuck in the bubble on the left.

comfortzone

You need to visit other facilities, talk with other coaches, and empower your employees/co-workers with a voice that challenges the norm. I learn a lot from my staff on a daily basis. And, looking back on that first PRI event I attended, I was the only "non-clinician" in the room. I was surrounded by PTs, PTAs, respiratory therapists, pelvic floor therapists, and ATCs. I got out of my element and it changed the course of my career dramatically.

Looking back on these experiences when I was clearly wrong, part of me wants to send individual apology notes to all the athletes I saw early in my career. By that same token, though, I feel like thank you notes might be more appropriate, as these mistakes played an essential role in my growth as a coach and person.

If you're looking for an up-to-date look on how we manage shoulders - including a look at identifying and addressing internal rotation deficits - be sure to check out my new resource, Sturdy Shoulder Solutions.

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6 Reasons Anterior Core Stability Exercises Are Essential

This time of year, I'm doing a lot of assessments on college baseball players who are just wrapping up their seasons.  One of the biggest issues that I note in just about every "new" athlete I see is a lack of anterior core control. In other words, these athletes sit in an exaggerated extension pattern that usually looks something like this:

APT-250x300

And, when they take their arms overhead, they usually can't do so without the ribs "flaring" up like crazy.

This is really just one way an athlete will demonstrate an extension posture, though. Some athletes will stand in knee hyperextension. Others will live in a forward head posture. Others may have elbows that sit behind their body at rest because their lats are so "on" all the time.

latsPosture

This isn't just about resting posture, though; most of these athletes will have faulty compensatory movement patterns, too. Once we've educated them on what better posture actually is for them, we need to include drills to make these changes "stick." Anterior core drills - ranging from prone bridges, to positional breathing, to dead bugs, to reverse crunches, to rollouts/fallouts - are a great place to start. Here's why they're so important:

1. Breathing

The muscles of your anterior core are incredibly important for getting air out. The folks at the Postural Restoration Institute often discuss how individuals are stuck in a state of inhalation, with each faulty breath creating problematic accessory tone in muscles like scalenes, lats, sternocleidomastoid, pec minor, etc. These muscles aren't really meant to do the bulk of the breathing work; we should be using our diaphragm. Unfortunately, when the rib cage flies up like we saw earlier, we lose our Zone of Apposition (ZOA), a term the PRI folks have coined to describe the region into which our diaphragm must expand to function.

Zone-of-Apposition-300x220

(Source: PosturalRestoration.com)

Step 1 is to get the ribs down and pelvis into some posterior tilt to reestablish this good zone. Step 2 is to learn how to breathe in this position, emphasizing full exhalation.

Step 3, as you may have guessed, is to strengthen these "newly rediscovered" patterns with good anterior core training.

2. Resisting extension.

This one is the most obvious benefit, as the muscles of the anterior core directly combat too much arching of the lower back. If you aren't controlling excessive lumbar extension, it's only a matter of time until you wind up with lower back irritation - whether it's just annoying tightness, a stress fracture, a disc issue, or something else.

3. Better force transfer and lower back injury risk reduction.

The research on core function is pretty clear: its job is to transfer force between the lower and upper body. Spine expert Dr. Stuart McGill has spoken at length about how spine range of motion and power are positively correlated with injury risk. In other words, the more your spine moves (to create force, as opposed to simply transferring it), the more likely you are to get hurt. How do you prevent your spine from moving excessively? You stabilize your core.

4. Indirect effects on rotary stability.

For a long time, I looked at control of extension as "separate" from control of rotation at the spine. In other words, we did our anterior core drills to manage the front of the body, and our chops, lifts, side bridges, etc. to resist unwanted rotation. However, the truth is that these two approaches need to be treated as synergistic.

As an example, every time I've seen an athlete come our way with an oblique strain, he's sat in an extension posture and had poor anterior core control - even though an oblique strain is an injury that occurs during excessive rotation. All you need to do is take a quick glance at the anatomy, and you'll see that external obliques (like many, many other muscles) don't function only in one plane of motion; they have implications in all threes - including resisting excessive anterior pelvic tilt and extension of the lower back.

Gray392

What this means is that you can't simply ignore coaching in one plane when you think you're training in another one. When you do your chops and lifts, you need to prevent lumbar hyperextension (arching) . And, when you do your rollouts, you can't allow twisting as the athlete descends. Finally, you can add full exhales (a predominantly anterior core challenge) to increase the difficulty on rotary stability exercises.

5. Improved lower extremity function and injury risk reduction.

Lack of anterior core control directly interferes with lower extremity function, too. If the pelvis "dumps" too far forward into anterior tilt, the front of the hip can get closed down. As I described at length here, this can lead to hip impingement.

With a squat variation, while some athletes will stop dead in their tracks with this hip "block," others will slam into posterior tilt to continue descending. This is the "butt wink" we've come to see over and over again in lifting populations. When neutral core positioning is introduced and athletes also learn to manage other extension-based compensations, the squat pattern often improves dramatically. This can "artificially" be created transiently elevating the heels, turning the toes out, or by having an athlete hold a weight in front as a counterbalance.

Additionally, athletes in heavy extension patterns often carry their weight too far forward, throwing more shear stress on the knees during lunging and squatting. The more we can keep their weight back to effectively recruit the posterior chain, the better.

6. Improved shoulder function and injury risk reduction.

The lats can be your best friend and worst enemy. On one hand, they have tremendous implications for athletic performance and aesthetics. On the other hand, if they're "on" all the time (as we often see in extension-based postures), you can't get to important positions with the right movement quality. Overactive lats will limit not only shoulder flexion (overhead reaching), but also upward rotation of the shoulder blades. I covered this in quite a bit of detail in Are Pull-ups THAT Essential?. Moreover, with respect to elbow function, overactive lats can be a big issue with allowing throwers to get true external rotation, as I discussed here:

If you're using your lats as an "all the time" core stabilizer, you aren't just at risk of extension-based low back pain, but also problems at the shoulder and elbow. If you can get your anterior core control under control and normalize the length and tone of the lats, your "healthy exercise pool" for the upper body expands dramatically. Getting overhead is easier, and you'll feel stronger in that position. The same goes for external rotation; not surprisingly, pitchers always say that their lay-back feels smoother after soft tissue work on the lats, as an example.

Wrap-up

These are just six benefits of training the anterior core, but the truth is that they could have been broken down in much more detail as they relate to specific injuries and functional deficits. If you're looking to learn more on this front - and get a feel for how I like to train the anterior core - I'd encourage you to check out my presentation, Understanding and Coaching the Anterior Core.

AnteriorCore

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Random Thoughts on Sports Performance Training – Installment 5

This week, I've been working my way through Mike Robertson and Joe Kenn's new resource, The Elite Athletic Development Seminar. It got the wheels turning in my brain, and the end result was a new installment of Random Thoughts on Sports Performance Training. Here goes...

1. Experiences are more important than stuff.

I had a good text message exchange with one of our pro athletes yesterday where we discussed how long-term happiness was really much more about the experiences you have than it is about the stuff you possess. When you're on your death bed, you'll look back a lot more fondly on time with family, lives you've positively impacted, and things you've accomplished. You won't be thinking about the nice car you drove, or overpriced watch that you wore.

New100front

I wish that this is a mentality that more young athletes would apply to their long-term athletic development.  An amazing coach and great camp can literally change a young athlete's life. As an example, I'm always psyched to see our young athletes getting the opportunity to "rub elbows" with our pro and college athletes, who have a ton of wisdom they can impart.

On the flip side, I can't say that I've ever seen an athlete's life change dramatically when he bought an expensive new bat or glove. Don't get me wrong; appropriate equipment and apparel are super important for athletic success. However, does a 12-year-old kid need a new glove and bat every single year? It's not like he grows out of them like he would a pair of cleats, and those funds could surely be better devoted elsewhere.

It goes without saying that many young athletes (and their parents) have limited financial resources. I wonder if they'd be in a better position to succeed if they applied the stuff vs. experiences logic to how they managed these resources in the context of long-term athletic development.

2. The process is often more of a reward than the destination.

This is an awesome video that does more justice to this point than anything I can write. These kids will take away important life lessons even though they might not have won their last game. Kudos to the head coach for a job well done.

3. People are asking the wrong questions about weighted baseball throwing programs.

At least 3-4 times per week, someone asks me what I think about weighted balls. I've written about this subject in the past (here), and while my approaches have evolved substantially over the years, I'm still a fan of weighted ball programs - as long as they're implemented with the right athlete, at the right time.

There is actually a ton of research supporting the efficacy of weighted ball programs; they've been around for a long time now, but only caught on in popularity in recent years. What's different about the ones out there now, though, are that they are much higher volume (number of throws) and performed with significantly heavier and lighter balls than ever before. If you crank up volume and use more extreme intensities, you'll get more extreme results - both in terms of fantastic improvements and in throwers who actually get hurt.

So, the question shouldn't be "do weighted balls work?" Rather, the question(s) should be, "Am I physically prepared enough to take on an aggressive weighted ball program, and how can I best fit it into my developmental calendar?"

If you're a 16-year old kid who just finished a 120-inning competitive year and your rotator cuff strength is terrible, weighted baseballs aren't what you need; rather, you need rest from throwing, and quality strength training work.

If you're a professional player with a perfect 14-16 week throwing progression spanning the course of the off-season, you have a great 8-12 week block with which you can work to "get after it." Using Indians pitcher Corey Kluber as an example, we started his 2013-14 off-season throwing program on December 9, and then integrated more aggressive weighted ball work in weeks 5-9 of his off-season throwing program. The big league off-season is so short that you can't get a ton of quality work in without compromising rest after the season or mound work going into the season.

CKluber_Indns

Conversely, many of our minor league guys will started throwing November 25, and got in about eight weeks of weighted ball work (as part of comprehensive throwing programs that also worked in long toss, flat grounds, and bullpens) before heading off to spring training. Each case is unique, so each program needs to be individualized to the player.

4. Postural Restoration Institute (PRI) drills are an "equalizer" for strength and conditioning professionals.

You've likely heard me allude to the Postural Restoration Institute here on the blog in the past - and with good reason: incorporating PRI drills into our training has been the biggest game-changer in our approach over the past 4-5 years. One of the key principles of PRI is "resetting" individuals to a neutral posture prior to training. We're all asymmetrical, but many folks take this asymmetry (and/or heavily extended posture) to an extreme, and we have to get their alignment back closer to "normal" before we squat, deadlift, sprint, jump, or take on any of a number of other athletic endeavors.

Historically, when folks were deemed to be "out of neutral," we'd need a manual therapist to do soft tissue work, joint manipulation/mobilization, or various hands-on stretching techniques. As Robertson noted in his first presentation of the EAD Seminar DVD set, PRI changed the game for strength and conditioning professionals by enabling them to re-establish neutral in clients and athletes with non-manual techniques, specifically positional breathing drills. Effectively, these drills provide for "self realignment."

Sure, PRI is just one of a few tools in the toolbox nowadays that can be used to accomplish this goal, but it's the one where I've seen the quickest changes.

5. Avoid movement redundancy within the training session.

One point I've made a lot in the past - and Robertson reiterated in one of his presentations - is the fact that many young athletes have a "narrow functional movement base." Basically, they've specialized in a particular sport so early that they've missed out on gross movement competencies (or lost ones they already had from early childhood development).

While we might not be able to change the tendency toward specialization, we can change how we manage athletes who do choose to specialize. In particular, we need to expose them to a broad range of activities that create a rich proprioceptive environment when they come in to train. Key to success on this front is making sure that there aren't redundancies within the training session in terms of movement challenges. For instance, you wouldn't want to have a half-kneeling overhead medicine ball stomp, then a half-kneeling landmine press, then a half-kneeling cable row, then a half-kneeling cable chop, and a half-kneeling cable external rotation. Rather, you'd be better off mixing and matching with tall kneeling, split-stance, standing (bilateral), and even single-leg.

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The same "redundancies" should be avoided throughout the training week, too, but I've found that if you do a good job of making sure there isn't this kind of overlap in each specific training day, the longer training periods seem to take care of themselves. If you look at how Joe Kenn structures his tier system style of training, you see that redundancies just don't happen because he rotates among total-upper-lower exercises in each of his training days. I'm a firm believer that exercise selection is the single most important programming variable, and this illustrates one more reason why that's the case.

Speaking of Kenn and Robertson, their Elite Athletic Development Seminar DVD set is on sale for $150 off through tonight (Friday) at midnight. I've really enjoyed watching them, and would consider them an outstanding investment for any strength and conditioning professional. It's an experience, not just stuff! Check it out HERE.

EADpackage1

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Assessments You Might Be Overlooking: Installment 5

Today's guest post comes from Greg Robins.

I have this weird habit. Although, the more I pick the brains of like-minded individuals the more I realize it’s just something everyone fascinated with human development does.

I like to watch people. I like to watch their curious reactions to their external environment. I like to watch people converse with other people. I like to watch how they move, how they breathe, how they settle into their default static positions. It sounds creepy, I guess, but it’s far removed from the image you have of me lurking in the window with binoculars.

I’ll watch sports and realize I’m no longer even keeping an eye on the ball; I’m lost in awe of the fluidity of an elite athlete’s movement capabilities. If I’m close up at a live sporting event, I’m analyzing the body type and physical development of players while they’re warming up.

I’m constantly looking at people, and conversing with people; trying to piece together who they are.

When Eric started this series I thought it was fascinating. It only made me more tuned in to the details of people, outside of any diagnostic tests I may eventually bring them through. Assessments became like an experiment of sorts. I would take all these clues from the first 20 minutes I met someone and see if the eventual tests gave some validity to the observations, and presumptions I was making.

I decided I had to contribute a one of my favorite assessments that you might be overlooking:

Hypertrophy and or tone of the accessory breathing musculature, coupled with primarily breathing through the mouth.

As I stated above, one thing I watch is how people breathe. However, even before I tune into watching individual breaths, I look at the muscularity and apparent tone of their accessory respiratory muscles. In particular, I’m looking at their neck. Often time people who are “stuck” in a faulty respiration strategy have necks that seemingly look to belong on a pro strongman, not a middle-aged weekend warrior, or an undertrained high school pitcher. Their scalenes, sternocleidomastoids, and levator costarum muscles are incredibly developed in comparison to the rest of their musculature. Bill Hartman posted a great video on this a few years back, if you'd like to see it in action:

This little tip off leads me to take a closer look at their respiration. I often notice the same person breathing primarily through the mouth, rather than the nose. I lay them on their back, have them remove their shirt (when appropriate) and cue myself in to the pattern of their inhalations and exhalations.

Not surprisingly these giants of neck development, are often the same folks who are stuck in inhalation, or a state of hyperinflation. They have poor function of their diaphragms, and generally take the form of our usual “over-extended” individual. In many cases, they present with a lack of shoulder flexion because their lats are constantly “on.”

shouderflexion

They take shallow, frequent breaths, which never allow for full exhalation. To take a page out of the Postural Restoration Institute’s respiration manual, hyperinflation does the following:

- Increase sympathetic “fight or flight” responses and anxiousness
- Impairs nerve conduction
- Vasoconstricts peripheral and gastrointestinal vessels
- Restricts circulation in cerebral cortex
- Shunts blood flow peripherally
- Impairs coronary arterial flow
- Promotes fatigue, weakness, irregular heart rate, etc.
- Impairs breathing and weakens diaphragm contractility
- Increases overuse of “thoracic breathing”
- Enhances peripheral neuropathic syptoms
- Enhances sympathetic adrenaline activity and hypersensitivity to lights and sounds
- Increases phobic dysfunction, panic attacks, restless leg syndromes, heightened vigilance, etc.
- Facilitates catastrophic thinking and hypochondria

As you can see, this simple observation leads us to a series of additional questions, and more times than not, the discovery that someone’s ailments are the cause of their respiratory dysfunction. Their autonomics are dictating much of their dysfunction, even voluntary movement dysfunctions.

This is an important assessment because acknowledging this discord means we can intervene. Including breathing drills to correct respiratory function can help to restore many of the qualities we aim to improve (i.e. movement patterns, recovery rate, performance qualities, etc.).

If you are keen to excessive tone in the accessory musculature, you can begin to dig deeper and more closely observe their respiration, as well as ask them about different conditions listed above. If the pieces fit together, use some of the following drills to help them correct the dysfunction.


 

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Strength and Conditioning Stuff You Should Read: 4/2/14

It's time for this week's list of recommended strength and conditioning.

Opening Day Musings: Are You Willing to Put in the Work? - I wrote this post on Opening Day, 2012.  It might be two years old now, but the message still holds true.

Interview with Carlo Alvarez - This isn't exactly "reading," but the content is fantastic.  Carlo Alvarez, the Director of Sports Performance for the Pittsburgh Pirates, shares some great insights on what professional baseball is really like, and what up-and-coming strength coaches can do to improve.

PRI Cervical-Cranio-Mandibular Restoration Course Review - Kevin Neeld recaps his experience with this Postural Restoration Institute course.  It's on my list of "things to attend" in the next year.

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