4 Keys to Staying Healthy During the Baseball Season

The latest Inner Circle webinar recording on my 4 Keys to Staying Healthy During the Baseball Season is now available.

4 Keys to Staying Healthy During the Baseball Season

4 Keys to Staying Healthy During Baseball SeasonThis month’s Inner Circle webinar is on 4 Keys to Staying Healthy During the Baseball Season.  In this webinar I’ll discuss:

  • How and why injuries happen in baseball
  • What you should watch out for in regard to loss of mobility
  • My criteria you should achieve before picking up a ball everyday
  • The #1 thing I see youth players do wrong that causes injuries
  • How to maximize performance by minimizing overuse

To access this webinar:

How to Improve Overhead Shoulder Mobility

The latest Inner Circle webinar recording on my How to Improve Overhead Shoulder Mobility is now available.

 

How to Improve Overhead Shoulder Mobility

Improving Overhead Shoulder MobilityThis month’s Inner Circle webinar is on how to improve overhead shoulder mobility.  In this webinar I’ll discuss:

  • We we are losing overhead shoulder mobility
  • Why it matters
  • The 4 main reasons why we lose overhead mobility
  • How the body compensates when we lose overhead mobility
  • How to assess for a loss of overhead shoulder mobility
  • What you MUST stop doing immediately with people that have lost overhead mobility – you are making them worse!
  • Corrective exercises to enhance overhead position
  • Manual therapy techniques to improve mobility

 

To access this webinar:

4 Ways to Improve Overhead Shoulder Mobility

4 Ways to Improve Overhead Shoulder MobilityOne of the most common areas we attempt to improve in clients at Champion PT and Performance is overhead shoulder mobility.  If you really think about it, we don’t need full overhead shoulder mobility much during our daily lives.  So our bodies adapt and this seems to be an movement that is lost in many people over time if not nourished.

I’m often amazed at how many people have a significant loss of overhead mobility and really had no idea!

That’s not really the issue.  The problem occurs when we start to use overhead mobility again, especially when doing it during our workouts and training.  Exercises like a press, thruster, snatch, overhead squat, kipping pull up, toes to bar, handstand push up, wall ball, and many more all use the shoulder at end range of movement.  But here are the real issues:

  • Add using the shoulder to max end range of overhead mobility and we can run into trouble
  • Add loading during a resisted exercise and we can run into trouble
  • Add repetitions of this at end range and we can run into trouble
  • Add speed (and thus force) to the exercise and we can run into trouble

 

4 Ways to Improve Overhead Shoulder Mobility

In this video I explain the 4 most common reasons why you lose overhead shoulder mobility and can work on to improve this movement:

  1. The shoulder
  2. The scapula
  3. The thoracic spine
  4. The lumbopelvic area

The first three are commonly address, but not so for the lumbopelvic area, which is often neglected.  I’m going to expand on this even more in this month’s Inner Circle webinar.  More info is below the video:

 

Improving Overhead Shoulder Mobility

This month’s Inner Circle webinar is going to expand on this topic and discuss how and why you want to improve overhead shoulder mobility.  In this webinar I’ll discuss the importance of overhead mobility, how to assess the 4 most common causes of loss of mobility we discussed above, what corrective exercises to perform, and tips for manual therapy.  The live webinar will be on Monday April 20th at 8:00 PM EST, however will be recorded for those that can not attend live.

 

 

 

How to Enhance Recovery Beyond Nutrition

Today’s guest post comes from Kamal Patel and the team at Examine.com.  If you haven’t heard of Examine.com just yet, you’ve been missing out!  Examine.com is the web’s best resource for evidence-based information on nutrition and supplementation.  They are completely unbiased and only report on scientific fact, not speculation.  The nutrition and supplement fields are filled with anecdotal information, false beliefs, and downright inaccurate claims about efficacy.  Examine.com helps us sort through what is fact and fiction.  Be sure to check out the special offer from Examine.com at the end of this article.

 

How to Enhance Recovery Beyond Nutrition

Training sounds pretty simple on paper. Just eat right, sleep well, and lift a little bit more weight every workout. But every workout takes place in real life, and real life can make training pretty hard.

To improve at the rate that you read about on internet forums – hitting a 315 pound squat or 225 pound bench press after a year of training – you need to train like an athlete. That doesn’t just mean going to the gym three times a week and downing a protein shake afterward. Optimal training only occurs when daily life doesn’t get in the way.

Training like an athlete while working a full time job or going to school is not easy, but fixing weak points in your habits and lifestyle can help avoid training setbacks and plateaus.

Alleviating Soreness and Joint Pain

Exercise causes muscle and joint pain. The severity of the soreness and how long it takes to recover depends on diet and lifestyle, as well as the kind of exercise performed.

The basics

A high-carbohydrate diet is the first step to alleviating post-workout joint pain. A low-carbohydrate diet, while potentially useful for fat loss, is not ideal for resistance training.

People on a low-carb diet should eat the majority of their carbohydrates in the post-workout period. Going into a workout with low glycogen is not ideal for strength training, but if joint pain is interfering with exercise, fixing the problem should be a priority.

Magnesium deficiencies can also exacerbate joint pain and cause muscle cramping in athletes. The lack of other electrolytes, like potassium, can contribute to pain. Potassium deficiencies must be alleviated through dietary changes, since too much potassium on an empty stomach can cause potentially fatal cardiac arrhythmia.

 

Troubleshooting Joint Pain

If dietary changes don’t alleviate persistent joint pain, anti-inflammatory supplements may be able to help.

Anti-inflammatory supplements are not as potent as pharmaceuticals like aspirin, acetaminophen, and aleve. However, curcumin and fish oil are both used to alleviate joint pain in athletes. Though the research on these two supplements is done in the context of arthritis, the benefits should theoretically extend to athletes as well. More research is needed to confirm this effect.

Cissus quadrangularis can alleviate the joint pain that results from specific injuries. If your post-exercise joint pain has persisted for years, you may want to consider consulting with a physiotherapist.

Do not supplement high amounts of anti-inflammatory supplements to dull injury pain. Continuing to work out after an injury can exacerbate tissue damage and increased recovery time, leading to overuse of pain-reducing supplements and permanent damage.

 

Alleviating Fatigue and Lethargy

There’s nothing like proper rest and nutrition to facilitate training, but sometimes you can’t avoid staying up late to finish a paper or getting up extra-early to beat the boss to the office.

 

The basics

Running a caloric deficit is great for weight loss, but not as great for energy levels. Though some people can go for long periods of time on reduced calories, a crash is inevitable. If your diet is interfering with your daily energy, consider a less drastic deficit.

The occasional all-nighter won’t have a long-term effect on gym performance, but consistently poor sleep will. Aim for six to 10 hours of sleep every night, and make sure your sleep environment doesn’t affect your recovery.

A healthy sleep environment is:

  • A slightly cool room tends to facilitate sleep, while a puddle of sweat is awful to wake up in.
  • Smart phones and tablets just before bed will disrupt melatonin secretion, leading to a more difficult time falling asleep.
  • Ears don’t close like eyes do. Even if you sleep through the night, loud noises can still impair sleep quality.
  • Caffeine-free. Any compounds that impair sleep will lower sleep quality, even for veteran coffee drinkers that can drink a pot of coffee at 8:00 p.m.
  • Where you sleep and how long you sleep for should be the same from night to night.

A good sleep environment actually makes it easier to get out of bed in the morning, since improved sleep quality leaves you feeling more rested.

 

Troubleshooting sleep quality

Some sleep issues can be alleviated through supplementation. People that have issues with sleep latency, meaning they have trouble falling asleep, can supplement melatonin or lemon balm.

Melatonin is a hormone that regulates sleep, but people with no difficulty falling asleep will not experience any further sleep benefits.

Lemon balm is a light sedative used to alleviate intrusive thoughts that can interfere with sleep.

Supplements that improve sleep quality, as opposed to sleep latency, include glycine and lavender.

About three grams of glycine taken thirty minutes before bed will improve sleep quality, but the supplement becomes less effective after prolonged use. To use glycine in the long term, avoid taking it daily.

Lavender, used in aromatherapy, is associated with improved sleep. Rubbing lavender oil on a pillow before bed can also improve sleep, but some people may experience skin irritation due to long-term exposure of skin to oil.

If stress is causing reduced sleep quality or poor sleep latency, supplements called adaptogens can help the body adapt to stress, resulting in fewer stress-related side effects, like fatigue and anxiety.

The most popular adaptogens are ashwagandha, Rhodiola rosea, and Panax ginseng. Ashwagandha is sometimes supplemented by athletes because it may improve cardiovascular performance and muscular strength. Siberian ginseng is another adaptogen option for people that get sick often, though it has very little effect on physical performance.

Breaking through plateaus

There’s a lot of factors to keep track of during long term training. Hitting a plateau can be frustrating because it takes time to isolate the factor responsible.

 

The basics

Daily caloric intake is the biggest influence on physical performance. Carbohydrates are more effective for strength training than fatty acids, but both are necessary for busting through plateaus.

Addressing general energy levels, fatigue, and joint pain is also a vital aspect of breaking through a plateau.

 

Troubleshooting plateaus

Supplements that improve physical performance can be useful for breaking through training plateaus. Creatine is the go-to recommendation, while caffeine (400mg) can be used once or twice a week as a pre-workout supplement.  Please note that although 400 mg is listed as a low dose in some studies, this would be a relatively high dose for someone who is caffeine naive.

There is preliminary evidence that suggests cholinergics like CDP-choline and Alpha-GPC may improve physical performance in a non-stimulatory way, but more research is needed to confirm this effect.

 

Identifying Lifestyle Weaknesses

To facilitate effective training, learn to isolate the weak points in your habits and work to improve them. Start with obvious factors, like staying up too late, and address others as they arise, whether in training, at work, or in life.

 

Examine comKamal Patel is a nutrition researcher with an MPH and MBA from Johns Hopkins University, and is on hiatus from a PhD in nutrition in which he researched the link between diet and chronic pain. He has published peer-reviewed articles on vitamin D and calcium as well as a variety of clinical research topics. Kamal has also been involved in research on fructose and liver health, mindfulness meditation, and nutrition in low income areas.

Special Offer for Inner Circle Members

Examine.com was kind enough to extend two special discounts for my Inner Circle members:

  • Examine Supplement Goals Refernce GuideExamine.com Supplement Goals Reference Guide – This is the ultimate resource on supplements, and what they call “the cheat sheet” to better health, a better body, and a better life.  They’ve done all the work and analyzed over 33,000 research studies to discuss over 300 supplements and 180 health goals.  Within seconds you’ll be browsing around, identifying health goals you want to improve, and finding supplements that will help you get there.  Best of all, this is a lifetime eBook.  Every morning the guide is updated based on the latest scientific evidence!  It’s really unbelievable.  This is normal $49 but they have a special offer for Inner Circle members of $39.99.
  • Examine.com Monthly Research Digest – For this looking for even more, Examine.com has a monthly research digest that reviews all the latest nutrition and supplement articles for you to stay on top of the evidence.  Inner Circle members get $5 off the monthly price or $50 off the yearly price.

How to access the special offers:

 

 

How to Perform Self-Myofascial Release

The latest Inner Circle webinar recording on my How to Perform Self-Myofascial Release is now available.

 

How to Perform Self-Myofascial Release

Self Myofascial Release SystemThis month’s Inner Circle webinar reviews my system of performing self-myofascial release.  As with anything else, there is a right way, wrong way, and a better way to perform self-myofascial release.  In this webinar I will:

  • Discuss why we use self-myofascial release
  • Review the different types of tools you can use and my recommendations on what I think is best
  • Overview how I perform self-myofascial release with my clients, patients, and athletes
  • Discuss when to perform self-myofascial release

To access this webinar:

Should We Stop Blaming the Glutes for Everything?

Today’s guest post comes from John Snyder, PT, DPT, CSCS.  John, who is a physical therapist in Pittsburgh, has a blog that has been honored as the “Best Student Blog” by Therapydia the past two years.  He’s a good writer and has many great thoughts on his website.  John discusses some of our common beliefs in regard to the role of the proximal hip on knee pain.  I’ll add some comments at the end as well, so be sure to read the whole article and my notes at the end.  Thanks John!

 

Should We Stop Blaming the Glutes for Everything?

should we stop blaming the glutes

Anterior cruciate ligament (ACL) rupture1,2 and patellofemoral pain syndrome (PFPS)3,4,5 are two of the most common lower extremity complaints that physicians or physical therapists will encounter. In addition to the high incidence of these pathologies, with regards to ACL injury, very high ipsilateral re-injury and contralateral injury have also been reported6,7,8.

With the importance of treating and/or preventing these injuries, several researchers have taken it upon themselves to determine what movement patterns predispose athletes to developing these conditions. This research indicates that greater knee abduction moments9,10, peak hip internal rotation11, and hip adduction motion12 are risk factors for PFPS development. Whereas, for ACL injury, Hewett and colleagues13 conducted a prospective cohort study identifying increased knee abduction angle at landing as predictive of injury status with 73% specificity and 78% sensitivity. Furthermore, as the risk factors for developing both disorders are eerily similar, Myer et al performed a similar prospective cohort study finding that athletes demonstrating >25 Nm of knee abduction load during landing are at increased risk for both PFPS and ACL injury14.

 

Does Weak Hip Strength Correlate to Knee Pain?

With a fairly robust amount of research supporting a hip etiology in the development of these injuries, it would make sense that weakness of the hip musculature would also be a risk factor, right?

A recent systematic review found very conflicting findings on the topic. With regards to cross-sectional research, the findings were very favorable with moderate level evidence indicating lower isometric hip abduction strength with a small and lower hip extension strength with a small effect size (ES)15. Additionally, there was a trend toward lower isometric hip external rotation and moderate evidence indicates lower eccentric hip external rotation strength with a medium ES in individuals with PFPS15. Unfortunately, the often more influential prospective evidence told a different story. Moderate-to-strong evidence from three high quality studies found no association between lower isometric strength of the hip abductors, extensors, external rotators, or internal rotators and the risk of developing PFPS15. The findings of this systematic review indicated hip weakness might be a potential consequence of PFPS, rather than the cause. This may be due to disuse or fear avoidance behaviors secondary to the presence of anterior knee pain.

 

Does Hip Strengthening Improve Hip Biomechanics?

Regardless of its place as a cause or consequence, hip strengthening has proved beneficial in patients with both PFPS16,17,18 and following ACL Reconstruction19, but does it actually help to change the faulty movement patterns?

Gluteal strengthening can cause several favorable outcomes, from improved quality of life to decreased pain, unfortunately however marked changes in biomechanics is not one of the benefits. Ferber and colleagues20 performed a cohort study analyzing the impact of proximal muscle strengthening on lower extremity biomechanics and found no significant effect on two dimensional peak knee abduction angle. In slight contrast however, Earl and Hoch21 found a reduction in peak internal knee abduction moment following a rehabilitation program including proximal strengthening, but no significant change in knee abduction range of motion was found. It should be noted that this study included strengthening of all proximal musculature and balance training, so it is hard to conclude that the results were due to the strengthening program and not the other components.

 

Does Glute Endurance Influence Hip Biomechanics?

All this being said, it is possible that gluteal endurance may be more influential than strength itself, so it would make sense that following isolated fatigue of this musculature, lower extremity movement patterns would deteriorate.

Once again, this belief is in contrast to the available evidence. While fatigue itself most definitely has an impact on lower extremity quality of movement, isolated fatigue of the gluteal musculature tells a different story. Following a hip abductor fatigue protocol, patients only demonstrated less than a one degree increase in hip-abduction angle at initial contact and knee-abduction angle at 60 milliseconds after contact during single-leg landings22. In agreement with these findings, Geiser and colleagues performed a similar hip abductor fatigue protocol and found very small alterations in frontal plane knee mechanics, which would likely have very little impact on injury risk23.

 

Can We Really Blame the Glutes?

The biomechanical explanation for why weakness or motor control deficits in the gluteal musculature SHOULD cause diminished movement quality makes complete sense, but unfortunately, the evidence at this time does not agree.

While the evidence itself does not allow the gluteal musculature to shoulder all of the blame, this does not mean we should abandon addressing these deficits in our patients. As previously stated, posterolateral hip strengthening has multiple benefits, but it is not the end-all-be-all for rehabilitation or injury prevention of lower extremity conditions. Proximal strength deficits should be assessed through validated functional testing in order to see its actual impact on lower extremity biomechanics on a patient-by-patient basis. Following this assessment, interventions should be focused on improving proximal stability, movement re-education, proprioception, fear avoidance beliefs, graded exposure, and the patient’s own values, beliefs, and expectations.

 

John SnyderJohn Snyder, PT, DPT, CSCS received his Doctor of Physical Therapy degree from the University of Pittsburgh in 2014. He created and frequently contributes to SnyderPhysicalTherapy.com (Formerly OrthopedicManualPT.com), which is a blog devoted to evidence-based management of orthopedic conditions.  

 

Mike’s Thoughts

John provides an excellent review of many common beliefs in regard to the influence of the hip on knee pain.  While it is easy to draw immediate conclusions from the result of one study or meta-analysis, one must be careful with how they interpret date.

I think “anterior knee pain,” or even PFPS, is just too broad of a term to design accurate research studies.  It’s going to be hard to find prospective correlations with such vague terminology.  Think of it as watering down the results.  Including a large sample of people, including men, women, and adolescents and attempting to correlate findings to “anterior knee pain” is a daunting task.

Imagine if we followed a group of adolescents from one school system for several years.  Variations in gender, sport participation, recreational activity, sedentary level, and many more factors would all have to be considered.  Imagine comparing the development of knee pain in a 13 year old sedentary female that decided she wanted to run cross country for the first time with an 18 year old male basketball player that is playing in 3 leagues simultaneously.  Two different types of subjects with different activities and injury mechanisms.  But, these two would be grouped together with “anterior knee pain.”

What do we currently know?  We know hip weakness is present in people with PFPS and strengthening the hips reduces symptoms.  As rehabilitation specialists, that is great, we have a plan.  I’m not sure we can definitely say that hip weakness will cause knee pain, but I’m also not sure we can say it won’t.  Designing a prospective study to determine may never happen, there are just too many variables to control.

John does a great job presenting studies that require us to keep an open mind.  I’m not sure we can make definitive statements from these results, but realize that there are likely many more variables involved with the development of knee pain.  Hip strength and biomechanics may just be some of them.  Thanks for sharing John and helping us to remember that it’s not always the glutes to blame!

 

 

How to Prepare for and Perform a Throwing Program

The latest Inner Circle webinar recording on my How to Prepare for and Perform a Throwing Program is now available.

 

How to Prepare for and Perform a Throwing Program

How to Prepare for and Perform a Throwing Program

 

This month’s Inner Circle details the specific steps I take to prepare the body before throwing, followed by the steps I take to start performing a throwing program.  Far to often I see amateurs not really understand how to prepare and perform a throwing program.  They simple pick up a ball and start throwing.  This approach isn’t the most advantageous considering how dynamic and stressful the act 0f throwing is on the body.  By following these six steps, you’ll be putting yourself in a much better chance of success to reduce injury and get more out of your throwing session that day.

 

 

 

 

 

 

 

How to Prepare Before You Throw – Part 2: Prepare Your Throwing

As I said in part 1 of this 2-part article on How to Prepare Before Your Throwing Program, one common theme that I often hear when players describe how they got hurt was that they did not properly warm up and prepare themselves to throw.

To prepare before your throwing program, you really need to do two things: 1) Prepare your body and 2) Prepare your throwing.  If you haven’t yet, please go back and read part 1 of this article to learn how to prepare your body:

 

How to Prepare Before Your Throwing Program – Part 2: Prepare Your Throwing

Now that your body is ready to roll and start your throwing program, I want to shift gears and talk about how to use your throwing program to prepare to throw.  I think it is really import to “prepare to throw, not throw to prepare.”

What I mean by that is that you need to make sure you are properly warmed up, even within your throwing program, before you can start your throwing “work.”  You shouldn’t just jump on the mound, or throw at full intensity, or quickly progress to long tossing.  That is throwing to prepare, and as I stated in part 1 of this article, I don’t want aggressive throwing to be the first things your body feels.

To prepare to throw, you need to prepare your body (again, in part 1) and then prepare your throwing program.  There is a BIG difference between your “warm-up” throwing and your “work” throwing.

Would you ever just throw your max weight on the bar and start squatting or deadlifting without doing warm up sets?  Never, right?  In strength and conditioning we usually incorporate a gradual increase in load with the weight of an exercise before getting to the weight we want to use to train.  You have warm-up sets and then work sets.  As an example, if you are supposed to perform 5 sets of 5 reps of deadlifts at 285 lbs, if you first set is 185, second set 205, and third set 225, those don’t count as your 5×5 work sets.

The same goes with throwing.

 

Prepare to Throw Step 4 – Ease Into Throwing

I’ve played catch with 100’s of professional baseball pitchers.  I honestly only remember one that would start throwing 90 MPH at my knees by the third or forth throw (and he’s been injured his entire career).  Big leaguers get it and gradually get loose.  You’d actually be surprised at how easy they actually play catch initially as they warm up.

On the flip side, one of the more common tweaks I make to my younger athletes is to ease into throwing.  Not a week goes by without someone gunning a ball at my ankles on the 3rd throw (I love you GD…).

This is extremely stressful on the body.  Remember throwing itself is stressful.  You have to gradually apply that stress to get the tissue used to the force.

Not all throwing has to be designed to gain arm strength or velocity.  Some throwing should be more similar to just riding a bike with your arm to get blood flow and gradually apply stress to the elasticity of the tissue.

 

Prepare to Throw Step 5 – Let The Distance Dictate the Intensity

The next step to prepare to throw builds on step 4.  Now that you’ve played light catch to get loose, it’s time to start walking back and increasing the distance.

Distance in your long toss program is a variable we use to adjust your intensity.  Realistically there isn’t much difference between throwing with full intensity at 150 feet or 200 feet.  Full intensity is pretty much full intensity.

Again, resist the urge to start throwing on a line at new distances.  Rather, I tell my athletes to “let the distance dictate the intensity,” meaning throw the ball with a bit of an arc to firmly hit your partner in the chest on the descent.

If the ball would sail past your partner another 100 feet if they missed your throw, you are throwing too hard for the stretch out phase of throwing.

baseball long toss arc

 

There will be time to throw on a line, that is next step…

 

Prepare to Throw Step 6 – Get Your Work In

OK, you’ve made it!  You prepared your body.  You’re mobile.  You activated your muscles.  You did a dynamic warm up.  You eased into throwing and long toss.  Congrats!  Now you can “throw.”

Just to reiterate, there is a difference between “warm-up” throwing and “work” throwing.  Step 6 is now incorporating your “work” throwing, whatever that may be for you that day.

It could be long toss, weighted balls, bullpen work, even throwing in a game.  That is your “work” throwing and you are now ready for it.

 

By going through the proper steps to prepare to throw you’ll find that you actually get better work in and throw better, plus you’ll be much more resilient to injuries.  These are some of the key steps I outline to all of my athletes and what we follow in the big leagues.

 

Want to Learn More?

I have an entire Inner Circle webinar dedicated to detailing these 6 steps to prepare for and perform a throwing program.

 

I also have a free 45-minute video on How Baseball Players Can Safely Enhance Performance While Reducing Injuries.  Enter your name and email below and I will send you access to the video as well as a handout of the above arm care warm-up exercises that you can take to the field: