All Young Athletes are “Injured” – even if they don’t know it

Written on January 7, 2011 at 7:27 am, by Eric Cressey

I’ve written quite a bit in the past about how one should always interpret the results of diagnostic imaging (MRI, x-ray, etc.) very cautiously and alongside movement assessments and the symptoms one has.  In case you missed them, here are some quick reads along these lines:

Preventing Lower Back Pain: Assuming is Okay
Who Kneeds “Normal” Knees?
Healthy Shoulders with Terrible MRIs?

While some of these studies stratified subjects into athletes and non-athlete controls, not surprisingly, all these studies utilized adult subjects exclusively.  In other words, we’re left wondering if we see the same kind of imaging abnormalities in asymptomatic teenage athletes, which is without a doubt our most “at-risk” population nowadays.

That is, of course, until this study came out: MRI of the knee joint in asymptomatic adolescent soccer players: a controlled study.

Researchers found that 64% of 14-15 year-old athletes had one or more knee MRI “abnormalities”, whereas those in the control group (non-athletes), 32% had at least one “abnormality.”  Bone marrow edema presence was markedly higher in the soccer players (50%) than in the control group (3%).

Once again, we realize that just about everyone is “abnormal” – and that we really don’t even know what “healthy” really is.  So, we can’t hang our hat exclusively on what a MRI or x-ray says (especially since we don’t have the luxury of knowing with every client/athlete we train).  What to do, then?

Hang your hat on movement first and foremost in an asymptomatic population.  Do thorough assessments and nip inefficiencies in the bud before they become structural abnormalities that reach a painful threshold.

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High Performance Training without the Equipment: Installment 2

Written on January 4, 2011 at 11:03 am, by Eric Cressey

It goes without saying that some of the absolute posterior rotator cuff exercises are cable external rotation variations.

Unfortunately – as you may have inferred from the title of this post – not everyone has access to a cable column or functional trainer where exercises like this can be performed.  To that end, I thought I’d devote today’s post to a few exercises one can substitute to get a very similar training effect without cable access.

Option 1: Elbow-Supported DB External Rotation

This movement parallels that of the cable option, but all you need is a dumbbell and something to prop your upper arm.  The only downside is that the resistance just isn’t as “continuous” throughout the range of motion – but it’s still a good option.

Options 2 and 3: Horizontal Abduction Variations

While the recruitment patterns aren’t going to be exactly the same, it’s safe to say that you’re getting almost all the same benefits when you do horizontal abduction work as with true external rotation work (and likely a bit extra scapular stabilization benefits).  Two variations I like:

Prone Horizontal Abduction off Table

Side-Lying Horizontal Abduction (I like to load this one up more eccentrically and focus on really controlling the load on the way down)

Option 4: Side-Lying External Rotations – arm abducted 30 degrees

This movement might not be the most “specific” of all rotator cuff exercises because of the position in which it occurs, but it does give you the best posterior cuff EMG of just about any drill.  We use it a ton, especially in those who may have pain with positions requiring more shoulder elevation.

These drills are just the tip of the iceberg in terms of the modifications you can use – and, indeed, what should comprise a comprehensive shoulder health program.  However, they should be enough to help you work around the lack of a cable in your resistance training arsenal.

For more information, check out our Optimal Shoulder Performance DVD set.

Related Posts

High Performance Training without the Equipment: Installment 1
Clearing up the Rotator Cuff Controversy

Lose Fat, Gain Muscle, Get Strong: Eric Cressey’s Best Articles of 2010

Written on December 31, 2010 at 4:46 am, by Eric Cressey

Show and Go: High Performance Training to Look, Feel, and Move Better – This was obviously my biggest project of 2010.  I actually began writing the strength and conditioning programs and filming the exercise demonstration videos in 2009, and put all the “guinea pigs” through the four-month program beginning in February.  When they completed it as the start of the summer rolled around, I made some modifications based on their feedback and then got cracking on writing up all the tag along resources.  Finally, in September, Show and Go was ready to roll.  So, in effect, it took 10-11 months to take this product from start to finish – a lot of hard work, to say the least.  My reward has been well worth it, though, as the feedback has been awesome.  Thanks so much to everyone who has picked up a copy.

Optimal Shoulder Performance – This was a seminar that Mike Reinold and I filmed in November of 2009, and our goal was to create a resource that brought together concepts from both the shoulder rehabilitation and shoulder performance training fields to effectively bridge the gap for those looking to prevent and/or treat shoulder pain.  In the process, I learned a lot from Mike, and I think that together, we brought rehabilitation specialists and fitness professionals closer to being on the same page.

Why President Obama Throws Like a Girl – A lot of people took this as a political commentary, but to be honest, it was really just me talking about the concept of retroversion as it applies to a throwing shoulder – with a little humor thrown in, of course!

Overbearing Dads and Kids Who Throw Cheddar – This one was remarkably easy to write because I’ve received a lot of emails from overbearing Dads asking about increasing throwing velocity in their kids.

What I Learned in 2009 – I wrote this article for T-Nation back at the beginning of the year, and always enjoy these yearly pieces.  In fact, I’m working on my 2010 one for them now!

What a Stressed Out Bride Can Teach You About Training Success – I wrote this less than a month out from my wedding, so you could say that I had a good frame of reference.

Baseball Showcases: A Great Way to Waste Money and Get Injured – In case the title didn’t tip you off, I’m not much of a fan of baseball showcases.

Cueing: Just One Piece of Semi-Private Training Success – Part 1 and Part 2 - These articles were featured at fitbusinessinsider.com.  I enjoy writing about not only the training side of things, but some of the things we’ve done well to build up our business.

Three Years of Cressey Performance: The Right Reasons and the Right Way – This might have been the top post of the year, in my eyes. My job is very cool.

How to Attack Continuing Education in the Fitness Industry – Here’s another fitness business post.

Want to Be a Personal Trainer or Strength Coach?  Start Here. – And another!

The Skinny on Strasburg’s Injury – I hate to make blog content out of someone else’s misfortune, but it was a good opportunity to make some points that I think are very valid to the discussion of not only Stephen Strasburg’s elbow injury, but a lot of the pitching injuries we see in youth baseball.

Surely, there are many more to list, but I don’t want this to run too long!  Have a safe and happy new year, and keep an eye out for the first content of 2011, which is coming very soon!

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Weight Training For Baseball: Best Videos of 2010

Written on December 30, 2010 at 4:55 am, by Eric Cressey

I made an effort to get more videos up on the site this year, as I know a lot of folks are visual learners and/or just enjoy being able to listen to a blog, as opposed to reading it.  Here are some highlights from the past year:

The Absolute Speed to Absolute Strength Continuum – Regardless of your sport, there are valuable take-home messages.  I just used throwing velocity in baseball pitchers as an example, as it’s my frame of reference.

Should Pitchers Overhead Press? - This was an excerpt from Mike Reinold and my Optimal Shoulder Performance seminar (which became a popular DVD set for the year).

Shoulder Impingement vs. Rotator Cuff Tears – Speaking of Mike, here’s a bit from the man himself from that seminar DVD set.

Thoracic and Glenohumeral Joint Mobility Drills – The folks at Men’s Health tracked me down in the lobby at Perform Better in Providence and asked if I could take them through a few shoulder mobility drills we commonly use – and this was the result.

Cressey West – This kicks off the funny videos from the past year. A few pro baseball players that I program for in a distance-based format created this spoof video as a way of saying thank you.

Tank Nap – My puppy taking a nap in a provocative position.  What’s more cute?

Matt Blake Draft Tracker – CP’s resident court jester and pitching instructor airs his frustrations on draft day.

1RM Cable Horizontal Abduction – More from the man, the myth, the legend.

You can find a lot more videos on my YouTube page HERE and the Cressey Performance YouTube page HERE.

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Weight Training for Baseball: Featured Articles

Written on December 29, 2010 at 7:24 am, by Eric Cressey

I really enjoy writing multi-part features here at EricCressey.com because it really affords me more time to dig deep into a topic of interest to both my readers and me.  In many ways, it’s like writing a book.  Here were three noteworthy features I published in 2010:

Understanding Elbow Pain - Whether you were a baseball pitcher trying to prevent a Tommy John surgery or recreational weightlifter with “tennis elbow,” this series had something for you.

Part 1: Functional Anatomy
Part 2: Pathology
Part 3: Throwing Injuries
Part 4: Protecting Pitchers
Part 5: The Truth About Tennis Elbow
Part 6: Elbow Pain in Lifters

Strategies for Correcting Bad Posture – This series was published more recently, and was extremely well received.  It’s a combination of both quick programming tips and long-term modifications you can use to eliminate poor posture.

Strategies for Correcting Bad Posture: Part 1
Strategies for Correcting Bad Posture: Part 2
Strategies for Correcting Bad Posture: Part 3
Strategies for Correcting Bad Posture: Part 4

A New Paradigm for Performance Testing – This two-part feature was actually an interview with Bioletic founder, Dr. Rick Cohen.  In it, we discuss the importance of testing athletes for deficiencies and strategically correcting them.  We’ve begun to use Bioletics more and more with our athletes, and I highly recommend their thorough and forward thinking services.

A New Paradigm for Performance Testing: Part 1
A New Paradigm for Performance Testing: Part 2

I already have a few series planned for 2011, so keep an eye out for them!  In the meantime, we have two more “Best of 2010″ features in store before Friday at midnight.

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Shoulder Pain vs. Neck Pain

Written on December 8, 2010 at 10:30 am, by Eric Cressey

Here are a few recommended reads for the week:

Shoulder Pain vs. Neck Pain – This old post highlights a simple, but very accurate observation from Mark Comerford.

28 Synergistic Factors for Success – I wrote this article at T-Nation back in 2005, but it still holds water and will make you appreciate how many differen factors are impacting your progress.

Too Much Vitamin D? – This great Q&A from Brian St. Pierre addresses this new question that seems to be popping up quite a bit.

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Disc Herniations, Normal Shoulders, and Workout Routine Overhauls

Written on December 2, 2010 at 7:48 am, by Eric Cressey

Here are a few good reads from the archives for you for today:

Things I Learned from Smart People: Installment 1 – This features some stuff Bill Hartman taught me about the diagnosis of disc herniations.

Shoulder Range-of-Motion Norms – What’s normal – if there is such a thing?

Avoiding the Workout Routine Overhaul – This piece talks about the problem with people that jump completely from one workout routine to another at the drop of the hat – and outlines a better strategy.

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Strategies for Correcting Bad Posture – Part 2

Written on December 1, 2010 at 7:51 am, by Eric Cressey

Today, we move forward with more strategies for correcting bad posture. In case you missed it, be sure to check out Strategies for Correcting Bad Posture: Part 1.  We pick up with tip #5…

5. Don’t overlook a lack of glenohumeral (shoulder) joint internal rotation. When it comes to bad posture, everyone thinks that the glenohumeral joint is only a “player” when it’s stuck in internal rotation; that is, the ball – or humeral head – is rotated too far forward on the socket – or glenoid fossa – meaning that the individual just doesn’t have adequate external rotation.  And, this is often true – especially in non-athletic populations.

However, you’ll also very commonly see poor posture folks who present with big glenohumeral internal rotation deficits (GIRD), particularly on the right side (for very legitimate reasons that go well beyond the scope of this article).  This is much more common in athletes, particularly overhead throwers (read more: Static Posture Assessment Mistakes).  When the posterior rotator cuff is stiff/short and there is an internal rotation deficit, we have to substitute excessive scapular protraction (winging) or thoracic flexion/rotation each time we reach for something.

So, for many folks, posterior shoulder mobility and soft tissue work is an important inclusion in cleaning things up in terms of appearance, function, and shoulder health.  If – and only if – you’ve been assessed and it’s been determined that you have an internal rotation deficit that compromises your total motion at the glenohumeral joint, you can integrate some gentle sleeper stretches (scapula stabilized!) to get a bit more ROM in the posterior cuff.

6. Don’t overlook a lack of glenohumeral (shoulder) joint flexion. The shoulder is a tremendously mobile joint, so we need to appreciate what goes on outside the transverse plane as well. In particular, I see shoulder flexion limitations as a big problem. These limitations may come from the lat, teres major, long head of the triceps, or inferior capsule.  Another overlooked cause can be posterior cuff restrictions; it’s not uncommon to see both GIRD and major shoulder flexion limitations on the same side.  As the picture below shows, the infraspinatus and teres minor run almost vertically when the arm is abducted a mere 90 degrees – which means that they’re struggling to lengthen fully to allow full shoulder flexion (and abduction, for that matter).

These restrictions that can contribute to both faulty compensation patterns in certain positions, as well as overall bad posture chronically.  Let’s have a look at what these issues look like in the real world. First, in someone with a shoulder flexion limitation, you’d first want to check them in the supine position, with the knees flexed and back flat (to avoid substituting lumbar extension for shoulder flexion).  Ideally, the arms should rest flat on the table – so this would be a “not-so-hot” result (especially since the arms “fall” to the sides a bit instead of staying in “attempted flexion”):

Next, let’s take this same shoulder flexion limitation, and look at what would happen actively.  In the first three reps of the video below, take note of the position of our subject’s head at the start and finish of each rep; you’ll see that as he “runs out” of shoulder flexion, he substitutes forward head posture.  On the next three reps, after I cue him to keep his cervical spine in a more neutral posture, he has to arch his back excessively (lumbar hyperextension) to complete the movement.

Now, imagine taking this walking disaster (only kidding; I had Dave fake it for the video, as he’s actually a finely tuned trained killing machine who can’t be stopped by conventional weapons – and he’s single, ladies) taking up overhead pressing, Olympic lifting, or just reaching for a glass on the top shelf.  Then, imagine him doing those tasks over and over again. Obviously, the posture will get worse as he reinforces these compensation schemes – but something is going to surely break down along the way; it’s just a question of whether it’s his low back, shoulder, or neck!

Correcting these issues is easier said than done; as I noted, there are several structures that could be the limiting factor.  However, for those looking for a relatively universal stretch they can use to get a bit of everything, I like the wall lat stretch with stabilization, one piece of a comprehensive (but not excessive and boring) static stretching program included in Show and Go.

7. Don’t ignore the thoracic spine. The previous two examples focused exclusively on the glenohumeral joint, but the truth is that it is tremendously dependent on thoracic spine positioning.  Ask any physical therapist, and they’ll tell you that if they can get the thoracic spine moving, they can instantly improve glenohumeral joint range-of-motion without even touching the shoulder (this is incredibly valuable with folks who may have stiff glenohumeral joints that can’t be mobilized aggressively following shoulder surgery; they need ROM in any way possible).  And, truthfully, you can substitute a lack of thoracic spine extension for the shoulder flexion problems and compensation schemes above, and a lack of thoracic spine rotation can work in much the same way as a GIRD (substitute excessive scapular protraction with reaching tasks).

If you ever want to quickly check to see what limiting thoracic extension does to someone’s upper body posture, just put them in supine position and push the sternum/rib cage down – which will bring the thoracic spine into flexion. Watch what happens to the position of his chin, and the size of the “gap” between his neck and the table:

Now, just consider what kind of “yank” this puts on the sternocleidomastoid chronically…

…and you’ll understand why a lack of thoracic spine mobility can give people enough neck pain and tension headaches to make Lindsay Lohan’s hangovers look like a walk in the park.  And this doesn’t even consider what’s going on with scalenes, suboccipitals, levator scapulae, subclavius, and a host of other muscles that are royally pissed off!  Also, think about all those folks in your gym doing hours and hours of crunches (especially while tugging on the neck).  Ouch.

For that reason, we need to get our thoracic spine moving – and more specifically, we need to get it moving in both extension and rotation.  I’ve mentioned in the past that the side-lying extension-rotation is one of my favorites (assuming no symptoms); remember that the overwhelming majority of the range-of-motion is coming from the upper back, not just the shoulder:

Here’s another we’re using quite a bit nowadays in our folks who have good internal rotation (which we want to keep!):

8. Watch your daily habits and get up more frequently. I’m at 1,140 words for this post right now – plus several pictures and videos.  In other words, some of you might have been hunched over your computer screens trying to figure out what I’m saying for over 20 minutes now – and that’s when “creep” starts to set in an postural changes become more and more harmful (both aesthetically and functionally).

With that in mind, make a point of getting up more frequently throughout the day if you have to be sitting a ton.  Likewise, “shuffle” or “fidget” in your chair; as Dr. Stuart McGill once said, “The best posture is the one that is constantly changing.”  Now, shouldn’t you get up and walk around for a few minutes?

I’ll be back soon with Part 3 of this series, but in the meantime, I’d encourage you to check out Show and Go: High Performance Training to Look, Feel, and Move Better, a comprehensive program that includes many of the principles I have outlined in this series.

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Strategies for Correcting Bad Posture: Part 1

Written on November 29, 2010 at 1:00 am, by Eric Cressey

This week, I’ll feature several strategies for correcting bad posture; you should be able to insert these into your weight training programs quickly and easily for immediate results. Here we go…

1. Train more frequently.

Obviously, in many cases, those with bad posture often simply don’t exercise enough, so any motion is good motion.  However, this also applies to regular exercisers who hit the gym 3-4 times per week as well.  Why?

Well, I do a lot of my “corrective” work in my warm-up programming – and the more often you train, the more often you’ll have to do your foam rolling and mobility warm-ups.  So, breaking your training program up into smaller components on more frequent days might be the best way to force yourself to do the things that you need the most to correct bad posture.

2. Use daily mobility circuits.

Along the same lines as the “increase training frequency” recommendation, it’ll never hurt to repeat your mobility warm-ups during your daily life. If you are someone who is really in need of drastic changes, do your warm-ups twice a day, seven days a week (on top of any static stretching you do).

3. Strengthen the deep neck flexors.

When you get stuck in a forward head posture, the deep neck flexors (muscles on the anterior portion of your neck) really shut down as the sternocleidomastoid, suboccipitals, levator scapulae, scalenes, and upper traps get dense, fibrotic, and nasty.

You can start off by simply doing chin tucks against the wall (put the back of your head up against a wall, then make a double chin without the back of your head losing contact with the wall). Then, you can progress to quadruped chin tucks, a drill I learned from Dr. William Brady.  In this drill, you’ll work against gravity as you pull your head into a more neutral cervical spine posture.  Most people will butcher this on their first try by going into hyperextension as they get to the “top” of the movement.

When you get the technique down, you’ll actually notice some crazy soreness along the anterior aspect of your neck in the days that following. We usually go with sets of 5-6 reps and a 2-3 second hold at the top of each rep.

4. Go with a 2:1 pulling-to-pushing ratio.

This is a recommendation you see quite a bit, but nobody really talks about how to “smoothly” apply it to a weight training program.  Here are a few approaches I’ve used in the past:

a. Simply add an extra pulling exercise on the end of a day’s session.

b. Pair a bilateral pulling exercise with a unilateral pressing exercise – and do “halves” on each pressing set.  In other words, if I was doing 6×6 chest-supported rows (CSR) with 3×6/side 1-arm incline DB presses (IDP), here’s how I’d set it up: CSR, IDP-right, CSR, IDP-left, CSR, IDP-right, CSR, IDP-left, CSR, IDP-right, CSR, IDP-left.

c. Make the pulling exercises in your program the A1, B1, and C1 options, with the pressing as the A2, B2, C2.  And, simply have an extra set of each of the pulling exercises – meaning you just don’t return to the pressing exercise for a last set.  This might work out as more of a 3:2 pulling-to-pushing ratio, but you can always tack an extra set or two on at the end to make it work.

I’ll be back soon with more strategies for correcting bad posture, but in the meantime, I’d encourage you to check out Optimal Shoulder Performance at www.ShoulderPerformance.com, as this resource features loads of postural correction strategies to complement the ones featured in this series.

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Muscle Imbalances Revealed, Rotator Cuff Exercises, and Kids (and Puppies) Making it Big

Written on November 12, 2010 at 6:26 am, by Eric Cressey

1. First, I wanted to give you a quick heads-up that Rick Kaselj just released Muscle Imbalances Revealed 2.0 – and it’s on sale through tonight (Friday, 11/12) at midnight. Many of you probably already know that I raved about this product in a review when it was initially launched, as it provided an awesome resource that compiled expertise from some really bright folks in our industry.

Well, based on customer feedback, Rick tinkered with the product, added some sweet new content, including over 50 new corrective exercises for the lower body, a second presentation on fascial anatomy and its impact on spine function/back pain, and a detailed write-up on barefoot running – all in addition to the great content that was available in the first place.  I’d highly encourage you to check it out and take advantage of this great introductory offer by the end of the day today.

For more information, check out Muscle Imbalances Revealed 2.0.

*Also, as an added bonus, this product is available for CEU/CEC for the fitness professionals out there – and I didn’t even realize it until just now.  So, I guess you could just call these credits “gravy” on a product that would have been well worth it anyway!

2. While on the topic of muscle imbalances,  here’s a quick study to check out, as it highlights the overwhelming importance of scapular positioning (secondary to adequate strength of the scapular stabilizers) with respect to rotator cuff function.  This study saw reduced pain and increased rotator cuff strength following a program to restore strength of the peri-scapular muscles.  While the study in question was a chronic intervention (3- and 6-month follow-ups), the truth is that these benefits can be seen transiently as well – just by positioning the scapula correctly during rotator cuff exercises.  You’ll notice that in both the following videos, regardless of the amount of abduction present, the scapula remains retracted and depressed to allow for optimal performance of rotator cuff exercises:

For this reason, whenever anyone ever says that an external rotation drill causes shoulder pain (particularly the front), the first thing I do is reposition their scapula into posterior tilt and retraction.  In almost all cases, this will eliminate their shoulder pain instantly and they’ll start to feel rotator cuff exercises in the posterior shoulder musculature (where they should).  This is also one reason why many people will instantly go from painful shoulder movement to pain-free movement just by having soft tissue treatments on the pec minor; by getting some length in this muscle, the scapula can posteriorly tilt, which not only gives the rotator cuff tendons room to “breath” (less shoulder impingement), but also puts them in a more mechanically advantageous position to stabilize the humeral head (via the length-tension relationship).

3. If you’re like me, you could have used a good laugh to brighten your day yesterday – and that’s why we have puppies.  Here’s Tank’s weekly cameo (make sure you turn up the volume):

Speaking of Tank, thanks to several minor league baseball players at Cressey Performance who have too much time on their hands, you can now follow him on Twitter – and I must say that these tweets have been very entertaining thus far.  Check him out at http://www.Twitter.com/TankNasty.

4. Speaking of Twitter, you might notice the new addition to my blogs where you can tweet if you like what you read (and the same thing goes for clicking the “like” button for Facebook).  These little icons are located at the top of each blog.  If you enjoy a particular post and think others would benefit from reading, I’d appreciate it if you could help spread the word with just a quick click.  Thanks in advance!

5. Last, but certainly not least, a few people forwarded me this link of our old friend – who apparently actually has a name (Keenan Cahill):

It just goes to show how awesome he is that he can make 50 Cent look like a JV player just by showing up….no bling or flat-billed cap needed to be a real high roller.

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