Are We Missing the Boat on Core Training?

A lot of attention has been placed on core training over the last several years, both in the rehab and fitness industry.  I recently watched my friend Nick Tumminello’s latest product Core Training: Facts, Fallacies, and Top Techniques and it made me think (more on Nick’s product, which is on sale this week, below).

We’ve made exceptional progress in our understanding of the core and have shifted away from isolated ab training to integrated core training.  My DVD with Eric Cressey on Functional Stability Training for the Core discussed this at length and showed a nice system to effectively train every aspect of the core.

However, the more I read on the internet the more I wonder if we are still missing the boat a little bit.  I’ll chalk this up as a another pendulum swing, but while we have progressed away from isolated abdominal exercises like sit ups, I wonder if we have swung too far to an extreme and started to focus only on isometric anti-movement exercises for the core.

 

Anti-Movement Core Exercises

Realistically the core helps stabilize the body and allow a transfer of energy.

Anti-movement exercises, such as planks for anti-extension, should be the foundation of the basic levels of core training.

Plank - core training

Once your baseline ability to maintain an isometric posture with the core is obtained, the next progression is to control limb movement with a stable core.  This involves combining upper body and lower body movements while maintain a stable core.  An example of this would be an anti-extension drill with TRX Rip Trainer.

However, the core does need to “move” during normal function.  It rotates, bends, flexes, extends, and all of these at once!  Should we train this?

 

Don’t Forget the Trunk is Designed to Move

I would say we should.  I think the difference here is to train these movements within a stable range of motion.  We should be training the body to work within it’s normal mobility, but to stabilize at end range of motion.

We get into problems with core movements, like rotation, when we depend on our static stabilizers, like the joints and ligaments, to control end range instead of our muscular dynamic stabilizers.

Perhaps the goals should be to train to control the core at end range of motion.

 

End Range Core Stability

These types of drills would include chops, lifts, push-pull movements on a cable or Keiser system, and medicine ball drills.  You are probably doing these already, right?

They all involve a transfer of energy from the limbs through the core.  The core needs to move during these exercises, but you are working in the mid ranges of motion and controlling end range.  These should also progress to include functional movements patterns like swings, throws, and kicks.

In the video above, I combine the act of throwing and decelerating in the half kneel position.  This takes the lower half out of it and requires the core to stabilize.

I guess the point is that we shouldn’t be afraid to move the core.  That is not beneficial to teach our patients, clients, and athletes.  Rather, train the core to move and stabilize at end range of motion to take stress off the structures of the spine.

 

Core Training: Facts, Fallacies, and Top Techniques

If you want to learn more about training the core, Nick’s program Core Training: Facts, Fallacies, and Top Techniques is on sale this week.  I watched Nick’s presentation last week and enjoyed it.  Nick does a great job discussing some of these concepts.  Click below for details:

 

How to Cue the Scapula During Shoulder Exercises

In today’s video, I share my thoughts on the common cue of retracting your scapulae together while performing shoulder exercises.  I’m not sure this is the most advantageous cue, despite it’s popularity.  Instead, I focus on facilitating normal scapulohumeral motion.  I don’t want to restrict the scapula while moving the arm.

Learn more about how to cue the scapula during shoulder exercises in the video below.

 

How to Cue the Scapula During Shoulder Exercises

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Learn How I Evaluate and Treat the Shoulder

Want to learn exactly how I evaluate and treat the shoulder?  My 8-week online seminar at ShoulderSeminar.com covers everything you need to know from evaluation, to manual dynamic stabilization drills, to manual therapy of the shoulder, to specific rehab for stiff shoulders, instability, SLAP tears, and rotator cuff injuries.

ShoulderSeminar.com is on sale this month for $150 off.  This huge sale goes until the end of October 31st at midnight EST.  Sign up today and also get access to RehabWebinars.com for free for 1-month.  Click here to enroll in the program today, the sale ends at the end of the month!

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The Influence of Pain on Shoulder Biomechanics

The influence of pain on how well the shoulder moves and functions has been researched several times in the past.  It is often though that impaired movement patterns may lead to pain the shoulder.

A recent two part study published in JOSPT analyzed the biomechanics of the shoulder, scapula, and clavicle in people with and without shoulder pain to determine in differences existed between the groups.  Part one assessed the scapula and clavicle.  Part two assess the shoulder.

The subjects with pain were not in acute pain, but rather had chronic issues with their shoulders for an average of 10 years.  The authors used electromagnetic sensors that were rigidly fixed to transcortical bone screws and inserted into each of the bones to accurately track motion analysis.

The studies were interesting and worth a full read, but I wanted to discuss some of the highlights.

 

The Influence of Pain on Shoulder Biomechanics

In regard to the scapula, the authors found:

  • Upward rotation of the scapula less in subjects with pain
  • This decrease in upward rotation was present at lower angles of elevation, not in the overhead position

It is important to assess scapular upward rotation in people with shoulder pain, particularly emphasizing the beginning of motion.  Realize that no differences were observed in upward rotation past 60 degrees of elevation, implying that the symptomatic group’s upward rotation caught up to the asymptomatic group.  This may imply that there is a timing issue, more than a true lack of scapular upward elevation issue.  They are upwardly rotating, but perhaps just too late?

The study also found the following in regard to shoulder motion:

  • Shoulder elevation was greater in subjects with pain
  • This increase in shoulder elevation was present at lower angles of elevation, not in the overhead position

Noticed how I intentionally presented it similar to the scapula findings?  if you put the two finings together, it appears that people with shoulder pain have a higher ratio of shoulder movement in comparison to scapular movement at the beginning of arm elevation.  The shoulder caught up again overhead, so it appears that the timing between shoulder and scapular movement may have an impact.

The Influence of Pain on Shoulder Mechanics

As you can see, it is important to assess both shoulder and scapular movement together, and not in isolation, as movement impairments at one join likely influence the other.  The brain is exceptionally good at getting from point A to point B and finding the path of least resistance to get there.

I should note that in studies like this, it is impossible to tell if the pain caused the movement changes or the movement changes caused the pain.  So keep that in mind.  Regardless of causation, our treatment programs should be designed with these findings in mind.

There are so many other great findings in the study that I encourage everyone to explore these further, but I thought these findings were worth discussing.  Based on these findings, it appears worthwhile to assess the relative contribution of scapular and shoulder movement during the initial phases of shoulder elevation.

Interested in advancing your understanding of the shoulder?  My extensive online program teaching you exactly how I evaluate and treat the shoulder at ShoulderSeminar.com is on sale now for $150 off!  That is a huge discount that you don’t want to miss!  Click here to enroll in the program today, the sale ends at the end of the month!

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A New Exercise for Shoulder, Scapula, and Core Control

Today’s post in a guest post from my friend Tad Sayce, who is a strength coach in the Boston area that specializes in swimmers.  Tad shares a great exercise video that works shoulder, scapula, and core control.  I’m a big fan of “big bang for your buck” exercises that promote strength and stability in one exercise, which is something we talk a lot about in Functional Stability Training.  Tad came up with one that I am going start trying with my athletes.

Band Resisted Horizontal Abduction with a Press

As a former competitive swimmer, I can closely relate to the overhead athlete and the complications that can arise at the shoulder. As a strength and conditioning coach working predominately with swimmers, I am constantly looking to improve the durability of the shoulder. It is widely accepted that the shoulder operates at maximum efficiency in the presence of a stable base at the core. While I am a believer in the use of isolated exercises, today’s focus will be that of a more integrated effort. The video below demonstrates an exercise that facilitates shoulder, scapular and core activation: Band Resisted Horizontal Abduction with a Press. 

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As the name implies, the exercise combines resisted horizontal abduction with an anti-rotation press. It is encouraged to first master each exercise in isolation before attempting to combine them. This exercise is great for educating athletes about proper scapular movement, and also demonstrating the ability to maintain position in the presence of increasing tension. I particularly like this exercise because it incorporates both dynamic and static efforts. I typically program this exercise for sets of 5 holding for 5 seconds, or sets of 8 holding for 2 seconds.

About Tad Sayce

tad-sayceTad Sayce, Head Coach and Owner of Sayco Performance Athletics, located in Waltham, MA. Tad is a Strength and Conditioning specialist with a strong interest in the sport of swimming. Formerly, Tad was a competitive swimmer in the Big 10 Conference and Olympic Trials qualifier, as well as a USA Swimming club coach.  For more information please visit www.saycoperformance.com.

Assessing Shoulder and Scapular Dynamic Mobility

Assessing Shoulder and Scapular Dynamic MobilityA thorough assessment of the shoulder must look at the posture and dynamic mobility of both the shoulder and scapula.  More importantly, we need to assess the interaction between the shoulder and scapula and not look at the two in isolation.

Assessing Shoulder and Scapular Dynamic Mobility

Altered scapular dynamic movement can be influenced by many things, so a thorough assessment is needed.  Here is a clip from my brand new educational program with Eric Cressey, Functional Stability Training for the Upper Body. This is part of a lab demonstration of Eric Cressey and I assessing overhead arm elevation and the quality of shoulder and scapular mobility.  In this clip you can clearly see a side-to-side difference and we discuss some of the potential implications:

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This is just a very small clip of some of the great information we cover in our new program, which is on sale for $20 off this week (sale ends Sunday May 18th at midnight EST).   Click here or the image below to order now before the sale ends!

Functional Stability Training for the Upper Body

Functional Stability Training for the Upper Body

My latest educational program with Eric Cressey, Functional Stability Training for the Upper Body, is now available!  

FST for the Upper Body is the third program in out Functional Stability Training system, adding to the popular Core and Lower Body programs.  When Eric and I started to brainstorm what we wanted to teach with these programs, we wanted to share our approaches to rehabilitation and performance training, but more importantly how we integrate the two together.  This makes the FST products a great resource for any rehabilitation, fitness, or performance specialist.

 

Functional Stability Training for the Upper Body

Functional Stability Training for the Upper BodyIn order to function properly, our body needs to be strong and mobile, but control and stabilization of this mobility is often less than optimal.  Unfortunately, stabilization is often overlooked in the design of rehabilitation and performance programs.  Traditional program design relies too much on mobilizing what is tight and strengthening what is weak.  We are missing the boat on stabilization and it’s effect on enhancing optimal movement patterns.

Proper function of the upper extremities is complicated and requires the arm to work in conjunction with the scapula, thorax, cervical spine, and core to provide mobility, strength, and power to the entire body.  Any deficits in stability throughout the body’s kinetic chain can lead to injury, dysfunction, and a decrease in performance in the upper body.  FST for the Upper Body aims to help formulate rehabilitation and training programs designed to optimize how the upper body functions.

By addressing alignment, strength, mobility, and dynamic motor control, you can maximize your rehabilitation and training programs to reach optimal performance.

Think about a few of these:

  • Can the lumbopelvic and thoracic regions impact shoulder function?
  • Can the cervical spine impact the elbow?
  • Can scapular position decrease shoulder performance?

The answer to all of these questions is ABSOLUTELY!  Functional Stability Training for the Upper Body discusses all this and more, showing you exactly how you can assess and correct issues within the kinetic chain to optimize stability and performance of the upper extremity.

Here is an outline of the presentations and lab demonstrations that we perform.  Eric and I combine presentations with real life examples so you can see how we both manage specific individuals based on our assessments.  You get to see Eric and I at work together working with people:

  • How posture and position influence upper extremity function
  • Understanding and managing joint hypermobility
  • Understanding the elbow: functional anatomy, common injuries, and conditions
  • Elbow injuries: evaluation and management
  • Assessment and management of thoracic mobility restrictions
  • Assessment and management of muscles imbalances of the shoulder and scapula
  • Assessment and management of scapular position
  • Assessment and management of elbow epicondylitis

 

Optimal Shoulder Performance

For those that are familiar with Eric and I’s other education program Optimal Shoulder Performance, Functional Stability Training for the Upper Body takes this information to the next level by showing how we integrate the entire body to optimize upper body function.  

FST for the Upper Body integrates the concepts learned from FST for the Core and FST for the Lower Body, and serves as the sequel to their previous educational program, Optimal Shoulder Performance.  FST for the Upper Body is perfect as a stand alone program, but also builds off Optimal Shoulder Performance to help take your knowledge to the next level.  Putting the information from all of these products together will give you a complete understanding of how we approach our integration of rehabilitation and performance.

We had great reviews from the live filming of this program:

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Special Sale Price This Week Only

Functional Stability Training for the Upper Body is available now and is on sale for $20 off to celebrate the launch.  

If you haven’t purchased any of the other FST products in the past, you can get all three FST programs for the Upper Body, Core, and Lower Body together in one bundle and save another $20.

These special sale prices are for this week only and end Sunday May 18th at midnight EST.  Click below to learn more and order before this sale price ends!

 

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5 Reasons Why There Are So Many MLB Tommy John Injuries

The baseball season is only a few weeks old and we’ve already seen an impressive amount of MLB pitchers need Tommy John surgery.  This pace could lead to a record breaking amount of injured pitchers.  While many have speculated about the causes of this rise, I wanted to share my perspective as someone that has worked with healthy and injured players from Little League to Major League Baseball.

 

Injuries Are Higher in the First Month of Season

It’s probably not going to be as bad as we think.  The big league trends have been studied and have shown that MLB injuries are higher in the first month of the season.  I feel like every year at this time we all comment on how Tommy John surgeries are on the rise and will reach new records.  Over the course of the season, this tends to slow down and even out.

baseball injury rates

Looking at the amount of Tommy John surgeries over the last decade, the number per year is fairly consistent, especially if you consider 2012 an anomaly.  Sports Illustrated showed a nice graph of this recently.  Perhaps this year does show another trend upward.  But I wouldn’t be surprised if we saw a slow down and ended up right around 20 Tommy John’s this season.

 

Preparation for the Season

So considering that injuries are higher during the first month of the season, what could be the reason for this?  I think there are probably two reasons why we see so many Tommy John surgeries near the beginning of the season: 1) poor preparation, and 2) lingering issues.

I think a big factor is preparation for the season.  Over the last two decades we have improved offseason strength and conditioning.  I don’t think it is that players are sitting around on the couch all offseason.  Rather, I think it has more to do with their throwing programs.

There are two ends of the spectrum, the established player that knows that they have a spot on the roster, and the player trying to make the team.  For the player trying to make the team, they need to show up on day one of camp ready to go and ready to impress.  This requires more throwing in the offseason and a more aggressive progression, knowing that roster cuts are just a week or two away.  These players also tend to throw through soreness, fatigue, and tightness in spring training and avoid the training room like the plague.

I’m not sure if this is fixable, though creating a more unbiased and proactive medical department may be a start.  Players shouldn’t fear coming into the training room, but many do.  It is the organizations job to assure players that treatment is preventative with the goal of staying on the field and enhancing performance.  This education starts in player development.

The established player, especially the veterans, may be trying to save some bullets and start throwing a little later, and ramp up a little slower.  I actually like this approach as the goal is to pitch all the way through October.  This is where spring training may need to be evaluated.

Spring training usually begins with several bullpens and live batting practice in the first week.  Some teams will throw up to 5 pens and live BP’s in 10 days.  The starters would then start pitching every 5th day for 1-2 innings.  That represents a huge jump, and then a huge slow down.

This was always my least favorite week of the year, and I think most of the pitchers agreed.  Guys arms were hanging every year. Players go from a casual offseason progression to an excessive amount of high intensity pitches in a short amount of time.  It is a grind.  This approach may be necessary for some, but I’ve talked to many MLB pitchers that disagree.  There are reasons for this progression that range from tradition, to roster decisions, to simply a lack of time to prepare all the pitchers.

I was always a fan of pitchers coming to camp a little early to ease into this progression.  Pitchers do not need to work through a “dead arm.”  That is just silly.  The goal is to avoid the dead arm.

I also feel that many players have been dealing with elbow issues in past seasons and hope that a good offseason will heal them up.  Realize that although it may come as a surprise to you when you hear of a MLB pitcher needing Tommy John surgery, many times both the team and the player have been following their elbow symptoms and trying to avoid the surgery.  They give it a good offseason but come to camp and still have symptoms.

 

Velocities are Increasing

Another interesting trend that we are seeing is a large jump in average velocity in MLB.  We know that velocity is one the factors that is associated with Tommy John injuries.  A recent article by Travis Sawchik of TribeLive noted the trend in MLB towards higher velocity.  In 2008, the average fastball in MLB was 90.8 MPH, in 2013 the average fastball was 92.0 MPH.  in 2003, Bill Wagner was the only MLB pitcher to throw 25 pitches over the speed of 100 MPH.  In 2013, there were 8.

Take this with a grain of salt as I tried to look at this myself using Pitch/FX data, but my data shows almost a 1 MPH increase in velocity from 2007 to 2013.  More interesting is that there has been a near linear increase in velocity each year (with the exception of 2010, as 2009 saw a large jump).  On average, as you can see with the straight line, velocity is trending upward each year.

Average MLB Fastball Velocity

When I was a kid playing Little League we would all wish we could throw 90 MPH.  90 MPH is close to unemployed now.

This comes down to simple physics.  F = M*A.  Force equals mass times acceleration.  If the trend in velocity continues to rise, the trend in Tommy John injuries will also continue to rise and pitchers will be experiencing these injuries earlier in the career.

Teams still want to draft for velocity, which isn’t surprising, we just need to realize that these guys are going to break down faster.  That is OK, just don’t be shocked when the 26 year olds all start getting Tommy John instead of the 32 year olds.

 

What Goes Around Comes Around

Tommy John InjuriesWe are starting to see the results of what these kids did 10 years ago.  The excessive pitching from youth and high school baseball is catching up.  There is a lifespan on your ligament.  Many kids are injuring themselves as kids and may not even know it.  Remember that week your elbow was soreness in High School?  Yup, that may have been the beginning.

In addition to avoiding overuse, which has repetitively been proved to be the #1 factor in youth pitching injuries, youth pitchers need to proactively manage their soreness and injuries.  Don’t ignore your symptoms, get them worked on by a physical therapist.

My friend Dr. Glenn Fleisig from the American Sports Medicine Institute said this to me once: “If you give a kid a pack of cigarettes in Little League, they probably aren’t going to get cancer right away, but they may down the road.”  What we do to our arms as youth carries over to our career.

If you ask a lot of MLB pitchers about a decade ago what position they played in Little League and High School baseball, many would have said shortstop or center field.  If you asked that same question now there is no doubt in my mind that most pitched throughout their youth.  We are specializing early.  You could argue that this creates a better pitcher, and I bet it does, however they are breaking down earlier.  Just like velocity, it is a trade off.  (photo credit)

 

Pushing Past Our Physiological Limits

MLB pitching injuriesSimilar to the overuse and early specialization we have seen in pitchers, we are now seeing a large trend towards focusing on velocity at an early age.  I get it, velocity is what gets you drafted.  Perhaps that is the actually problem.

However, I feel like we are excessively trying to push pitchers past their physiological limits to develop velocity.  But at what cost?  It is not advisable for youth players to begin aggressive long toss and weighted ball programs that are not customized to their unique body and goals.  Yet this is exactly what we are seeing.  Kids do not want to wait to grow, develop, get strong, and perfect their mechanics, they want velocity now.

So they start aggressive long toss and weighted ball programs on a weak frame, before their body matures, and with poor mechanics.

I am not against long toss and weighted balls, I am against the sloppy use of these training techniques.  These are tools in a system that absolutely must be customized for each player.

We are seeing a trend towards being too aggressive.  If throwing a 6 oz overweight ball has been shown to increase velocity, than throwing a 2 lb overweight ball will increase it even more!  If long tossing to 180 feet has been shown to increase velocity, then throwing to 300 feet will increase it more!  Realize there is always a diminishing return with a huge rise in risk.  I’ve written about this when discussing baseball long toss programs and the concept of the minimum viable exercise (your should read these both).

There are ways to safely and effectively increase velocity that do not require you to excessive push past your physiological limits.  I’ve written about this in the past and if you are a parent, coach or athlete you should read this article about how baseball players can enhance performance while reducing injuries.

 

 

To summarize, I don’t think Tommy John injury rates in general are going to slow down, as I don’t think any of the above factors are going to change anytime soon.  If what I wrote above is correct, we should see Tommy John surgies increase even more over the next decade.  Remember, what we are seeing now is the summation of the last 10+ years of players career.

I hate seeing all the articles in the media asking about why injuries continue to rise despite the greater focus on injury prevention.  It’s not the medical teams fault.  It’s not the strength coach’s fault.  It’s not the players fault.  It’s the nature of baseball right now.

 

The True Hip Flexor Stretch

The hip flexor stretch has become a very popular stretch in the fitness and sports performance world, and rightly so considering how many people live their lives in anterior pelvic tilt.  However, this seems to be one of those stretches that I see a lot of people either performing incorrectly or too aggressively.  I talked about this in a recent Inner Circle webinar on 5 common stretches we probably shouldn’t be using, but I wanted to expand on the hip flexor stretch as I feel this is pretty important.

I’ve started teaching what I call the “true hip flexor stretch.”  I call it the true hip flexor stretch as I want you to truly work on stretching the hip flexor and not just torque your body into hip and lumbar extension.  When performing, most people say they never felt a stretch like that before, hence the name “true hip flexor stretch.”

 

True Hip Flexor Stretch

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Key Points

  • There is a difference between a quadriceps stretch and a hip flexor stretch.  When your rationale for performing the stretch is to work on stretching your hip flexor, focus on the psoas and not the rectus femoris.
  • Keep it a one joint stretch.  Many people want to jump right to performing a hip flexor stretch while flexing the knee.  This incorporates the rectus and the psoas, but I find far too many people can not appropriately perform this stretch.  They will compensate, usually by stretching their anterior capsule too much or hyperextending their lumbar spine.
  • Stay tall.  Resist the urge to lean into the stretch and really extend your hip.  Most people are too tight for this, trust me.  You’ll end up stretch out the anterior hip joint and abdominals more than the hip flexor.
  • Make sure you incorporate a posterior pelvic tilt.  Contract your abdominals and your glutes to perform a posterior pelvic tilt.  This will give your the “true” stretch we are looking for.  Many people wont even need to lean in a little, they’ll feel it immediately in the front of their hip.
  • If you don’t feel it, squeeze your glutes harder.  Many people have a hard time turing on their glutes while performing this stretch, but it is key.
  • Guide your hips with your hands.  I usually start this stretch with your hands on your hips so I can teach you to feel posterior pelvic tilt.  Place your fingers in the front and thumbs in the back and cue them to posterior tilt and make their thumbs move down.

true hip flexor stretch

  • Progress to add core engagement.  Once they can master the posterior pelvic tilt, I usually progress to assist by curing core engagement.  You can do this by pacing both hands together on top of your front knee and push straight down, or by holding a massage stick or dowel in front of you and pushing down into the ground.  Key here is to have arms straight and to push down with you core, not your triceps.

 

I use this for people that really present in an anterior pelvic tilt, or with people that appear to have too loose of an anterior hip capsule.  This works great for people with low back pain, hip pain, and postural and biomechanical issues related to too much of an anterior pelvic tilt.  Give the true hip flexor stretch a try and let me know what you think.