Talent is Overrated

Written on December 18, 2008 at 9:25 am, by Eric Cressey

At the seminar in Houston last weekend, both Brent Strom and Ron Wolforth had high praises for the book Talent is Overrated.  These guys know their stuff, so I just ordered four copies (three books as gifts for players/coaches, and one unabridged audio for me to check out in the car).  Sounds like it is worth a read; I’ll give it a review down the road.

A Great Weekend in Houston

Written on December 15, 2008 at 7:37 am, by Eric Cressey

As I mentioned last week, this past weekend was Ron Wolforth’s Ultimate Pitching Coaches Bootcamp just outside of Houston, TX.  To say that it was an awesome experience would be an understatement.  I considered myself really lucky to be presenting alongside the likes of Brent Strom (St. Louis Cardinals), Phil Donley (Philadelphia Phillies consultant who has rehabbed loads of million-dollar arms), Perry Husband (Downright Filthy Pitching), and Ron himself.  These guys are not only getting important information out there for coaches, but also getting their hands dirty in the trenches to take athletes and coaches to the next level with new information.

Just as great as the presenters were the 100+ attendees.  In addition to many enthusiastic high school and private sector coaches and a few physical therapists, you had pitching coaches and/or baseball strength coaches from big-time colleges like Vanderbilt, South Carolina, Auburn, Kennesaw St., Savannah College of Art and Design, Michigan, Virginia Tech, Columbia, and Trinity.  These guys immediately earned a ton of respect in my book for thinking outside the box, and it makes me want to encourage a lot of my stud athletes their way post-high school because I know that they’re going to get coaches who are always looking for ways to help them succeed.

The title of my presentation was “Building the Complete and Superior Pitching Athlete.”  In my introduction to the coaches, I tried to make it very clear that my goal wasn’t to try to teach them everything there was to know about S&C for baseball players, but rather to give them the knowledge (and resources, in the form of my handouts) to become informed consumers in dealing with the folks who carry out their players’ programs.  I wanted them to know that you CAN give a pitcher a tremendous training effect without injuries to the throwing arm or interfering with velocity by losing pitching-specific mobility.

I think that the secret to appreciating what it takes is understanding that baseball strength and conditioning is not just about lifting and running.  Sure, these are components of the overall process, but if you only address these two components, you DO run the risk of impairing a pitcher’s development.  Sure, you’ve got to pay attention to these issues, but you also have to strategically address flexibility and mobility (yes, they are different), optimize soft tissue quality, and appreciate that you can use medicine ball work to maintain pitching-specific mobility during down-periods from throwing without all the stresses that come with throwing itself.

I also tried to get folks to think about what they already are doing with respect to distance running, “core” training, upper and lower body lifting, assessments, warm-ups (check out the Monster Mobility Pack for ideas), and post-throwing flexibility work.  I discussed the difference between inefficiency and pathology and how your can have a terrible-looking MRI and/or x-ray and still be pain free.

You can still get all the information from the event by purchasing the DVDs of the entire weekend.  I’d highly recommend them, as they include some great pitching analysis and recommendations from Brent Strom, awesome information on glenohumeral internal rotation deficit (GIRD) by Phil Donley, intriguing thoughts on “effective velocity” from Perry Husband, and excellent ideas on “blending” by Ron Wolforth.  Just head over to Pitching Central’s UPCBC page and pick up a copy now.

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The Truth About Shoulder Impingement: Part 2

Written on November 30, 2008 at 6:36 pm, by Eric Cressey

In Part I, I went into some detail on why I really didn’t like the catch-all term “shoulder impingement.” This week, I’m going to talk about the different kinds of shoulder impingement: external and internal.

External impingement, also known as outlet impingement, is the one we hear about the most. Here, we’re dealing with compression of the rotator cuff – usually the supraspinatus, and over time, the infraspinatus (and biceps tendon) – by the undersurface of the acromion. This impingement can lead to bursal-sided rotator cuff tears – and happens a lot more with ordinary weekend warriors and very common in lifters (not to mention much more prevalent in older populations.

External impingement can be further subdivided into primary and secondary classifications. In primary impingement, the cause is related to the acromion – either due to bone spurring or congenital shape. As you can see in the photo below, hook (II) and beak (III) are worst than flat (I), as there are marked difference in “clearance” under the acromion.

Secondary impingement, on the other hand, is usually related to poor scapular stability (related to both tightness and weakness, as described in last week’s newsletter), which alters the position of the scapula. In both cases, pain is at the front and/or side of the shoulder and is irritated with overhead activity, scapular protraction, and several other activities (depending on the severity of the tissue problems). You’ll also generally see a lack of external rotation range-of-motion, as these are folks who do too much bench pressing and computer work (both of which shorten the internal rotators).

Conversely, internal impingement, also known as posterosuperior impingement, really wasn’t proposed until the early 1990s. This form of impingement is more common in younger individuals who are involved in overhead sports, making it more of an “athletic impingement.” Adaptive shortening and scarring of the posterior rotator cuff in these athletes causes a loss of internal rotation and an upward translation of the humeral head during the late cocking phase of throwing (or swimming): external rotation and abduction.  These issues are magnified by poor scapular control, insufficient thoracic rotation, and weakness of the rotator cuff.

When the humeral head translates superiorly excessively in this position, it impinges on the posterior labrum and glenoid (socket), irritating the rotator cuff and biceps tendon along the way. So, pain usually starts in the back of the shoulder, as you are seeing irritation of the posterior fibers of the supraspinatus and anterior fibers of the infraspinatus tendons. Gradually, this pain may “shift” toward the front as the biceps tendon, and that implies labral involvement.  At least initially, the pain is purely mechanical in nature; it won’t bother an athlete unless the “apprehension” position (full external rotation at 90 degrees of abduction) is created.

We often hear about SLAP lesions in the news. This refers to a superior labrum, anterior-posterior injury. In reality, when we are talking about labral injuries in overhead athletes as they relate to internal impingement, it’s mostly just posterior (although serious cases can eventually affect the anterior labrum, too). There are different kinds of SLAP lesions (1-4). Every baseball pitcher you’ll meet has a SLAP 1, which is just fraying. SLAP 2 lesions are far more serious and often require surgical intervention. SLAP 1 issues become SLAP 2 lesions when poor mobility and dynamic stability aren’t established.

So, just to bring you up to speed, we’ve got two different kinds of impingement, one of which (external) has two subcategories that mandate different treatment strategies (primary = surgery, secondary = corrective exercise). We also have two separate areas where pain presents (external = front/side, internal = back). That’s just the tip of the iceberg, though, as we have two more considerations…

First, symptomatic internal impingement tends to be “mechanical pain.” Unless you’re dealing with a more advanced case, athletes with symptomatic internal impingement only have pain when they get into the late cocking phase (and sometimes follow-through). It usually isn’t present when they’re just sitting around – and for this reason, they can usually be more aggressive in the weight room with upper body training. Keep in mind that I use the term “symptomatic” because I think that internal impingement is a physiological norm, just like I observed last week with external impingement.  You’re essentially just going to go out of your way to avoid this “apprehension” position in the weight room by omitting exercises like back squats.  An apprehension test – illustrated in the most enthusiastic video in internet history – is a quick and easy assessment many doctors and rehabilitation specialists use to check for symptomatic internal impingement, as it reproduces the injury mechanism.

Second, and perhaps more importantly, you are dealing with two rotator cuff tears that are fundamentally different. It’s these differences that make me think doctors need to get rid of the term “impingement.” Here’s the scoop:

Let’s say that we have two guys with partial thickness tears of the supraspinatus – one from external impingement and one from internal impingement.

With external impingement, we’re usually dealing with a bursal-sided tear, as the rubbing comes from the top (acromion). These issues will generally heal more quickly because the bursa actually has a decent blood supply.

With internal impingement, on the other hand, we’ve got an articular-sided tear, meaning that the wear on the tendon comes from underneath (glenoid). The tear is more interstitial in nature. Blood supply isn’t quite as good in this area, so healing is slower (or non-existent).

Traditionally, articular has been an athletic injury, and bursal has been a general population issue. This is not always the case, though.

Factor in the activity demands of overhead throwers, and they have more challenging tears and greater functional demands. Fortunately, they also typically have age and tissue quality on their sides, so things tend to even out.

With all these factors in mind, if a doctor ever tells you that you have “shoulder impingement,” ask:

1. Internal or external?

2. If external, is it primary or secondary? (It’ll probably be both)

3. If internal, is there labral involvement? Biceps tendon?

4. If internal, what is the internal rotation deficit? (They should measure it, as this will begin to dictate the rehabilitation plan)

5. Given my age, activity level, and the nature of the tear, do you feel that surgical or conservative treatment is best?

Click here to purchase the most comprehensive shoulder resource available today: Optimal Shoulder Performance – From Rehabilitation to High Performance.

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The Truth About Shoulder Impingement: Part 1

Written on November 11, 2008 at 4:27 pm, by Eric Cressey

Shoulder Impingement….Yes, We Get It.

Roughly 10-15 times per week, I get emails from folks who claim that they have “shoulder impingement.” Honestly, I roll my eyes the second I read these emails.

Don’t get me wrong: I’m not making light of their pain. It’s just that it drives me crazy when doctors throw this blanket statement out there. I will be completely and 100% clear with the following statement:

Shoulder impingement is a physiological norm. Everyone – regardless of age, activity level, sport of choice, acromion type, gender, you name it – has it.

Don’t reach up to touch that mouse on your computer; you’ll aggravate your impingement and your supraspinatus will explode!

And, don’t scratch that itch on the back of your neck; your impingement will go crazy and your labrum will disintegrate!

Don’t believe me? Check out research from Flatow et al. from 1994.

Yes, this has been out for 17 years now.

So, the next logical question is: why do some people have pain with impingement while others don’t?

In reality, there are several factors that dictate whether or not someone is in pain, including:

1. Tissue quality – the most “impinged” structures are more likely to break down in older age than they are in earlier years.  Younger individuals can regenerate faster even when overall stress on the tissues is held constant, so how you handle a 50-year-old with “impingement” is going to be somewhat different from how you handle a 15-year-old with “impingement.”

2. Degree of elevation – the more one abducts or flexes the humerus, the greater the degree of impingement. This is why folks need to start in a more adducted (arm at side) position early on in rehab.  Those that impinge early in their arc tend to be dealing with subacromial impingement, whereas those who hit it at the absolute top tend to be more AC joint impingement.

3. Acromion type – flat acromions have significantly less contact area with the rotator cuff tendons than hooked or beaked acromions. These structures may change over time due to…

4. Bone Spurs – bone spurs on the underside of the acromion will increase the amount of impingement.

5. Strength of the rotator cuff – the stronger the cuff, the better its ability to depress the humeral head and minimize this impingement

6. Scapular stability – the more stable the scapula, the more likely it is to posteriorly tilt and upwardly rotate effectively when the humerus is raised into the zones of greater impingement. This scapular stability includes adequate length of the downward rotators (pec minor, levator scapulae, and rhomboids) with adequate strength of the upward rotators (lower traps, serratus anterior, upper traps).

7. Thoracic spine mobility – the posture of the thoracic spine dictates the position of the scapulae, which in turn affects impingement as noted in #6.  Assess and Correct is an awesome product for improving thoracic spine mobility – and you can also find some good drills in my recent post, Shoulder Hurts? Start Here.

8. Increased internal rotation – Certain movements that lock the humeral head in internal rotation increase the degree of impingement during dynamic activities. It’s why some people can’t bench press early-on in their rehabilitation programs, yet they can do dumbbell bench presses with a neutral grip pain-free. It’s also the reason why upright rows are a stupid exercise, in my opinion.

9. Breathing patterns – think about what happens when someone has poor diaphragmatic function and becomes a “chest breather:” the shoulders shrug up, and you get extra tightness in the levator scapulae, scalenes, pec minor, and sternocleidomastoid (among other supplemental respiratory muscles). In the process, the degree of impingement can increase.

10. Other issues further down the kinetic chain – I could go on and on about a variety of issues in this regard, but it’s impossible to be exhaustive – so I’ll just give an example. If someone has poor core stability in the sagittal plane that is manifested in an inability to resist the effects of gravity during a push-up, the hips will “sag” to the floor. As this happens, and the upper body remains strong, the scapulae are shifted into an anterior tilt –which increases the amount of impingement on the rotator cuff. So, weakness and/or immobility in other areas can certainly predispose an individual to shoulder problems.

This can also be carried forward to pitchers. We know that shoulder problems are more likely to occur in throwers who have poor lead leg hip internal rotation, as it causes the stride leg to open up early, leaving the arm “trailing behind” where it should be.

Speaking of pitchers, a phrase that has been coined with respect to the “unique” kind of impingement you see in them is “internal impingement.” In next week’s newsletter, I’ll discuss the different kinds of impingement – and why it’s still a cop-out diagnosis for any health care professional to just say you have one or the other rather than tell you explicitly what dysfunctions need to be addressed.

Click here to purchase the most comprehensive shoulder resource available today: Optimal Shoulder Performance – From Rehabilitation to High Performance.

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Can Little Leaguers Strength Train?

Written on November 3, 2008 at 7:00 am, by Eric Cressey

Q: Mr. Cressey,

I was given your name and website from my massage therapist, who is a big fan of yours. I was wondering what your opinion is about when a child should start muscle strength training (not weight training) for baseball? I have a 10-year old son who pitches and I always worry about his shoulder since I have had to have surgery on both of mine. He is playing up in age so he is pitching from 50 feet and pitches a consistent 48 mph. I always ice him down after for 30 minutes, but what do you recommend him to do to prevent injuries?

A: This is a great question, and the timing is actually perfect (as I’ll explain in the last paragraph). In a nutshell, assuming good supervision, I’d start as early as possible.

While most of our work is with athletes in the 13+ age range, we run a group of 9-12 year olds every Saturday morning at Cressey Performance. There is a lot you can to with kids at that age to foster future success – but, more importantly, have fun.

It was actually started by popular demand of some of the kids who had older brothers in our program; they wanted to jump in on the fun. Now, we look at it as a feeder program of sorts; by teaching things effectively early-on and exposing them to a wide variety of movements, it makes it easier for them to become athletes down the road.

We work on squat technique and/or deadlift technique, with the majority of the time aimed at just keep them moving by performing various circuits that include things like jumping jacks, med ball throws, lunges, and wheelbarrow medleys, etc. We also have tug-o-war battles and SUMO wrestling where we have them grab onto a SWISS ball and try to maneuver each other outside of a circle. All in all, we have fun while at the same time improving their motor skills. That is what’s most important. I don’t want the kids to dread coming to the gym, which is what I think happens when trainers and parents start taking it too seriously. There’s going to come a time when things will get more specialized, but ages 9-12 isn’t that time.

Truth be told, kids nowadays are more untrained and unprepared than ever – yet they have more opportunities that ever to participate in spite of the fact that they are preparing less. It’s one of several reasons that youth sports injuries are at astronomical rates. As perhaps the best example, you can now see glenohumeral internal rotation deficit (GIRD) in little leaguers, as this study shows. The GIRD isn’t the problem; that’s a natural by-product of throwing. The problem is that kids throw enough to acquire this structural and flexibility anomaly, but have no idea how to manage it to stay healthy.

So, in a nutshell, find someone who understands kids both developmentally and psychologically – and make it fun for him. Looking for someone affiliated with the IYCA (www.iyca.org) would be a good start.

Also, among the products out there, Paul Reddick’s stuff is a great start if you’re looking for things to do with up-and-coming baseball players.

Random Thursday Thoughts: 9/11/08

Written on September 11, 2008 at 9:20 pm, by Eric Cressey

1. Hopefully you all can take at least a few minutes out of your schedule to remember those who were lost in 2001 and their families. (and we’re all sending good vibes your way, Steph)

2. I’ll start off with a bang; high-heels for babies and children is the single-most moronic thing I’ve ever seen. If a grown woman wants to absolutely destroy her lower extremities by wearing heels, that’s her choice. However, putting a baby in a pair of high heels as she’s learning to walk is certifiable. Be careful watching the interview with these people, folks; you will actually get dumber.

Oh, and Britta Bacon? That’s seriously your name? Are you a water filter or a pork product?

3. I finally got around to checking out Alwyn Cosgrove and Mike Roussell’s Warpspeed Fat Loss e-book. This thing is fantastic; I’m annoyed with myself for waiting this long to open it up after they sent it my way a while ago.

I’ll actually be doing an interview with Mike on this very topic next week in my newsletter, so stay tuned – or check out Warpspeed Fat Loss yourself in the meantime.

4. Maybe if we didn’t give out drugs so easily, they wouldn’t be contaminating our drinking water. I never heard of teaching people to eat right and exercise leading to pollution…

5. Great quote from an email exchange I had with pitching specialist Ron Wolforth the other day: “I have truly been blessed in having peers who are truly cutting edge and who are more interested in getting it right than being thought of as right.”

6. Speaking of Ron, I just confirmed this past week that I’ll be presenting two one-hour lectures and a hands-on portion at his Ultimate Pitching Coaches Bootcamp in Houston on December 12-14. If you’re a baseball coach or you train baseball guys, definitely check this event out; there is going to be a lot of great information and thinking outside the box.

7. Just a quick heads-up: if you have questions about the Maximum Strength program (or any of my products, for that matter), please post them HERE instead of emailing me. I figured a comprehensive thread over at T-Nation would be a good way to get everything in one place. And, for those of you who have purchased Maximum Strength, don’t forget to check out the online FAQ page to which we allude in the book.

Have a good weekend! I’ll be dominating Pete in Fantasy Football this Sunday/Monday.