Article on baseball, pitching, tendons, mechanics, oblique strains, etc

[Moose Milligan]

A lot of people on the board seem to want to know about arm use and damage.

I get weekly emails from this website t-nation.com. I'd post the link to the article, but I don't want little Johnny clicking on it and seeing the woman in the thong on the right hand side of the page. Instead, I'll paste the whole thing.

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The Round-Up Interviews: Eric Cressey

by Nate Green

Next Page | Pages 1 2

It's time to play catch-up with the T-Nation authors. Nate Green does the asking, and in this case Eric Cressey does the talking.

You may know him as the "mobility guy" or "that dude who hates Smith machines", but Eric Cressey can't be narrowed down into a label, unless he's the one who's doing the labeling, that is.

At 26 years old, Eric has effectively carved out his niche at the top of the fitness industry as the go-to guy for athletes. He understands them because he is one: a world-record holder in powerlifting, to be exact. His masters' degree in kinesiology from UCONN enables him to see what other coaches miss, and his under-the-bar experience provides insight into what his athletes can accomplish.

You can't argue with Eric Cressey's under-the-bar experience.

Simply put, this guy is good. Very good.

So take notes. Lots of 'em.

NG: You've penned over a hundred articles, coached tons of athletes and have effectively moved up as a well-respected strength coach. What the heck are you up to now, smart guy?

EC: Well, along with my two business partners Pete Dupuis and Tony Gentilcore, I opened up my own facility in mid-July. Located about 30 minutes west of Boston, the facility is roughly 4,800 square feet, including:

• Roughly 3,500 feet devoted to strength training equipment

• A 35-yard turf straightaway with a crash wall (we also do our sprinting, sled work, barefoot warm-ups, and movement training here)

• Two offices

• A hell of a lot of attitude

The facility itself is a subdivision of a 16,000 foot space we share with America's Pastime, a baseball-specific training facility that features eight batting cages and three pitching mounds. Yes, Tony and I can take batting practice 15 feet from our office. It just screams "productivity," doesn't it?

I work with a ton of baseball guys, so we've basically created a place where they can hit, throw, sprint, and lift all in the same trip. Since I arrived in Boston last year, my reputation has grown very quickly (in the baseball community, in particular), and we're actually in the process of setting up our second facility, a "satellite" location at another baseball academy in Framingham.

You see a lot of guys in the industry who have "fallen" into particular realms of expertise. Mike Boyle knows hockey better than anyone; he might be the only guy who can explain why hockey players smell worse than any other breed of athlete. Bill Hartman could look at a golfer's shoes and tell you he's got barnacles growing on his infraspinatus, and explain the goofy pants phenomenon to which Happy Gilmore alluded.

Goofy pants: yet another reason to take up golf.

I'm at the point where I could probably list off 75 things that I completely expect to see in baseball guys (especially pitchers), from foot callus patterns, to glenohumeral internal rotation deficit, to cervical rotation deficits arising from dominant-arm patterns.

Honestly, it's a blast. Effectively, with this "at-risk" population, I've been able to blend my two biggest passions: performance enhancement and corrective exercise. As an added bonus, I'm doing it in a proactive(preventing injuries) environment when most of the rest of the baseball world is stuck in reactive mode (wait until someone gets hurt and then fix it).

NG: Sounds awesome. What do you mean by "at-risk," though?

EC: Overhead throwing is unquestionably one of the single-most damaging exercises one's body can endure. During the acceleration phase alone, you're looking at 7,400°/second internal rotation, 2,400°/second elbow extension, and 650°/second horizontal abduction. Think of the muscle strength and coordination needed to produce that power, and more importantly, to decelerate it.

In a joint that has already sacrificed stability for mobility, you need a perfect soft tissue function, strength, and tissue quality — from head to toe — to stay healthy.

If you look at any pitcher's shoulder, you're going to find fraying in his labrum. With that much stress, only so much can go to the soft tissues (muscles, tendons) over which we have control. The rest is going to go on passive structures like the labrum and menisci. In a great interview with ESPN.com, noted surgeon Dr. James Andrews said:

"Do we have the answer to labral tears? No, a large percentage of these still don't heal. I think we have a long way to go." Still, though, he noted, "If you want an excuse to operate on a baseball pitcher's throwing shoulder, just do an MRI."

What does that tell us? Pathology (i.e., labrum fraying) isn't as important as dysfunction; you can have a pathology, but not be symptomatic if you still move well and haven't hit "threshold" from a degenerative or traumatic standpoint. If your labrum is screwy and you move like crap, though, you'll be booking an appointment with Dr. Andrews sooner-than-later.

Dr. Andrews examines Ryan Kochen's screwy labrum.

NG: Crazy stuff. I knew overhead throwing was rough on the body, but never realized it was that extensive. Anything else?

EC: Definitely. In my opinion (and that of many really bright therapists), asymmetry is the single-best predictor of injury in sports. Last time I checked, not many guys switch-hit, and certainly none "switch-throw!" When you think about baseball guys (pitchers in particular), it's one leg that's almost always propelling when throwing and hitting and the other leg that's always decelerating.

Additionally, when someone doesn't have appropriate mobility and stability at the hips/lumbar spine/thoracic spine, violent rotation will chew up a lower back faster than anything else. Pitching and hitting both involve a ton of rotation at high speeds. Look at the pitchers with the biggest rotation in their wind-up, and you'll see the guys with the biggest history of back problems. Kevin Brown was a great example; I think he spent 47 years on the disabled list during his career.

Look at the most successful pitchers, and aside from Johan Santana and Pedro Martinez, you aren't going to find many good pitchers who are shorter than 6'0". The most successful guys are in the 6'4" to 6'5" range, with some even more pronounced training challenges when you get up in Chris Young and Randy Johnson range.

With my basketball background, I've worked with eleven guys who are 6'9" or above since 2003, and I can assure you: that's a lot of spine to try to stabilize! Every 6'1" weekend warrior gymrat seems to complain that he's too tall to squat; just imagine how the bigger guys feel!

NG: How does the nature of the season and the culture of baseball affect training?

EC: Well, it is a very long competitive season. Professionally, with spring training, the regular season (162 games), and playoffs (potentially), you're looking at a competitive season that could comprise 200 games over the course of nine months (Feb-Oct). College ball isn't much different, with many guys playing their regular college season, then playing Legion ball (early college) or regional leagues (later college) before returning for fall ball. High school ball runs all spring and actually gets more involved in the summer, as guys around here play Legion or Babe Ruth, various showcases, and Bay State games. With a short off-season and an in-season where you play almost daily, building and maintaining strength, power, flexibility, and optimal soft tissue quality can be a difficult task.

And, to be honest, as is the case with many professional sports, while all teams have strength and conditioning professionals on staff, the athletes aren't required to work with them if they don't want to do so. So, you get guys who take yoga classes with their wives or just bench press with their entourage. The other day, one of my high school pitchers came in and told me that he saw a professional pitcher doing pressdowns in his condo health club the day before a start. Cutting edge, huh?

NG: So you're saying that they're getting babied?

EC: My good friend John Pallof is a great physical therapist who has done a lot of work with pitchers, and he pointed out to me that in spite of the fact that our pitchers pitch less than in the past, the injury rates are higher. Check out this comparison between Johan Santana and Nolan Ryan to which he alluded:

Pitcher

Cy Young Year

Starts

Complete Games

Innings Pitched

Strike-outs

ERA

Johan Santana

2006

34

1

233

245

2.77

Nolan Ryan

1974

42

26

332

367

2.89

NG: That's crazy!

EC: It gets better. John also pointed out that Ryan pitched 19 more seasons after this Cy Young year! Anyone want to bet that Johan Santana won't be around in 2015? And, that's even with the advent of the closer andset-up man working in his favor.

Ask Robin Ventura if Nolan Ryan's training program was effective.

Look at the Leo Mazzone, who is widely regarded as the best pitching coach in the major leagues. Now with the Baltimore Orioles, Mazzone was the mind behind the Atlanta Braves pitching staff that dominated in the early 1990s. A few of the names that worked with Mazzone for several years are Tom Glavine (300+ wins), John Smoltz (200+ wins and 150+ saves), and Greg Maddux (300+ wins), and they're all still pitching well at 41, 40, 41 years-old, respectively.

Now, let's consider a few pitchers who thrived in Atlanta under Mazzone for a year or two and then opted to go elsewhere:

Denny Neagle went 36-16 with a 3.26 ERA in Atlanta 1997-1998, and then left to go 58-46 with a 5.24 ERA over the following seven years, and had multiple elbow surgeries. At age 39, he's been retired since 2005 (missed the entire 2004 season due to injuries).

Jaret Wright revived his career by going 15-8 with a 3.28 ERA in 2004 with the Braves (on top of 11 relief appearances and a 2.00 ERA with them in 2003), then left to head to the Yankees for the 2005 and 2006 seasons. He went 16-12 with a 5.29 ERA and became a mainstay on the NY disabled list before being traded to Baltimore, where he only made three starts in 2007 due to shoulder problems. There is speculation that this shoulder problem will end his career at age 31.

Russ Ortiz went 36-16 with a 3.99 ERA in 2003-2004 with Atlanta, but has since had multiple stints on the disabled list while amassing a 7-22 record and 6.85 ERA in three seasons with three different teams. At 33, he's now scheduled for Tommy John surgery and will miss the entire 2008 season.

Sure, you can talk about Atlanta being a pitcher's park and the Braves' traditionally strong lineup being supportive of having a good W-L record, but that doesn't speak to injury rates, longevity, or the success Glavine and Maddux have had after leaving Atlanta. Maddux played ten seasons with the Braves, and Glavine played 19 (16 in the major leagues).

What's Mazzone doing differently than other pitching coaches? He's notorious for believing in having his guys throw quite a bit between starts: twice as much, in fact.

NG: So is throwing more on off-days the secret?

EC: It might be; it's tough to say. To be honest, they're making these guys move when in many cases, they're accustomed to just working every fifth day and then sitting around knocking back sunflower seeds and Gatorade.

I talked about Nolan Ryan earlier. Roger Clemens is notorious for his rigorous training programs, and he's pitching well into his 40s. Interestingly, Dr. Andrews operated on his shoulder in his second year in the majors; you have to wonder if that "wake-up call" early-on set him up for long-term success. He's also clearly very in-tune with his body. Just a few weeks ago, I read an article where Clemens commented on how he felt blisters on his right foot were the cause of some elbow troubles he was experiencing.

Roger Clemens with the 20-strikeout ball he wouldn't have thrown without Dr. Andrews.

So, I'd say active recovery and just moving is the best bet. I love to get my pitchers in to lift (lower body in particular) the day after they throw. We consolidate these two types of CNS intensive stress into 24-hour blocks; it gives them plenty of recovery before they throw a bullpen session and get another lift before their next start. And, in place of long jogs for recovery, I'd much rather see low-intensity resistance training circuits along the lines of what I wrote in Cardio Confusion. If you're going to do bloodflow work, it might as well help address muscular imbalances and provide injury prevention benefits.

NG: You alluded to the difference between pathology and inefficiency earlier; can you please go into a bit more detail? We want some practical information.

EC: Think of a car that people run and run and run without doing maintenance. Chances are that it's got tons of stuff wrong with it (movement dysfunction), but when it "goes," they just say it's the spark plug, heater motor, or radiator (specific pathologies: i.e., oblique strains, hamstrings strains, disc herniations, UCL injuries). Our medical model is much like the Average Joe mechanic; they just fix what is wrong with your car (ultrasound, NSAIDs, rest, blah, blah). If it was that mechanic's own car, though, it never would have gotten in such bad shape.

So, in a nutshell, we have a very REACTIVE model of training when, in reality, PROACTIVE is "where it's at." Multiple pathologies can come from the same inefficiency, so we have to work backward from what we see pathology-wise. A good example is the classic mindset regarding rotator cuff injury; everyone wants to just look at rotator cuff strength and do some stim + NSAIDs. The truth is that I can think of nine factors ahead of rotator cuff strength that optimize shoulder health and function:

1. Scapular stability

2. Thoracic spine range of motion

3. Cervical spine function

4. Breathing patterns

5. Mobility of the opposite hip

6. Mobility of the opposite ankle

7. Overall soft tissue quality (especially posterior capsule)

8. Glenohumeral (ball-and-socket joint) range of motion

9. Footwear optimization

10. Rotator cuff strength

Rotator cuff function is lower down on the ladder simply because the rotator cuff is reflexive and you don't have to worry about firing it in everyday life. Nobody actively tightens up infraspinatus to decelerate a baseball throw or pick up a suitcase.

Also, you can more easily compensate for a lack of rotator cuff function with added scapular stability (as evidenced by the number of people with internal impingement - a hypermobility problem - who can get by without surgery). I think I may need to rewrite my Cracking the Rotator Cuff Conundrum article!

Cressey demonstrates the Cuban press in 2003: he now prefers the dumbbell version.

NG: Hear that, everyone? I think it's time to strike that article from the record for good.

EC: Now, imagine taking that junk car out in a high-stakes setting: the Autobahn or a monster car show. It's an at-risk situation, just like overhead throwing sports (and baseball in particular, as it has a verylong competitive season). Think back to all the screwy labrums you'll see under a MRI; only some of those are going to be symptomatic. All of the above factors (especially internal rotation range of motion) are going to be criteria that separate those with pain from those without it.

1/3 of all athletes have disc bulges that go completely undiagnosed. The difference? The amount of stability they have at their lumbar spine, and dozens of other factors that I think of as I stare off into blackness at 3 AM every day. You're talking to the guy who looked at his girlfriend's pronator calluses on the third date!

"Hey, Eric, I'll show you my pronator calluses."

NG: Wow, that's smooth. You have about as much game as a third string water boy on the junior high B team. Change the subject before I make fun of you too badly.

EC: The point is that pathologies really don't mean jack; it's just an indicator that things have reached threshold and someone got a wake-up call. This year, we've seen a ton of oblique strains in professional baseball. Manny Ramirez, Carlos Beltran, Chris Young, Bobby Abreu, and Eric Bedard come to mind in this year alone, and those are just a few of the bigger names that I can list without even looking into it.

These oblique strains could have been a hammy, adductor, quadratus lumborum, lumbar disc issue, piriformis contracture, or fiery case of gonorrhea (okay, that last one was an embellishment). They all related to a lumbar extension-rotation syndrome. Imagine being rotated to one side too far at your lumbar spine. When you try to get back to your "ideal" end range on the OPPOSITE side, the oblique is going to have to stretch further than it normally ever would.

Optimal training programs, in my opinion, are based on establishing an ideal joint-specific mobility-stability set-up. Stabilize the knees, lumbar spine, scapulae, and glenohumeral joints and mobilize the ankles, hips, and thoracic spine. Once you've done this, start slapping down some maximal strength, reactive ability, and the sky is the limit.

When I start hearing about the "core stability" stuff many of these guys are doing, my bull**** meter goes through the roof when the words "sit-ups, Russian twists, hyperextensions, and side-bends" start coming up.

Eric Cressey doesn't want to hear about Russian twists for core stability.

To take it a step further, there are bits and pieces of Yoga that have merit, but embracing the entire collection of exercises is a big mistake for guys already involved in a high-velocity rotational sport. I played the politically correct card on that one, huh?

NG: Yeah, but it'll probably still get you a good 50 hate emails.

EC: Yeah, well, "what is popular is not always right, and what is right is not always popular." I know what I'd rather be.

Think about it; how does an in-place, extremely low-velocity training initiative like yoga help a guy who is expected to exert force maximally on a moment's notice, and usually without sufficient warm-up? And please don't give me the relaxation bit. If you want to relax, get a massage or sleep. Most athletes don't sleep enough as it is.

So, with that said, think stability at the lumbar spine, progressing to good rotational training (wood chops, med ball throws, land mines) where the rotation comes at the hips, thoracic spine, and shoulders. That's what you mobilize in a more dynamic context.

NG: You spoke earlier about asymmetries in baseball guys. How are you testing them?

[Moose Milligan]

(part two)

EC: While I've got a ton of "on the fly" tests we use, I'm a big believer in the single-leg triple jump as my prime indicator — both qualitatively and quantitatively — of symmetry (or lack thereof). When we perform the test, we're looking at several things:

1. Total jump distance: this is a good measure of overall athletic ability, as the more reactive the athlete, the better they'll get on each subsequent jump.

2. Side-to-Side differences: anything over 15% from side to side is very concerning, and I prefer to always see these differences below 5%.

3. Landing Mechanics: this is very subjective, obviously, but if the guy looks like he's going to fold up like a lawn chair on each landing, you've got a lot of work to do.

NG: Interesting, but that was never in the "Bigger, Faster, Stronger" mentality! So, working on symmetry and the related strength imbalances will dramatically change an athlete?

EC: Absolutely. Here's a good example for you.

Last October, I started working with a 6'1", 161-pound high school senior named Kevin Scanlan. As a junior, Kevin was throwing 78-80 mph and finished with a 4-5 record for a team that lost in the first round of the Division 1 playoffs.

When I first tested Kevin, he was a 16-inch side-to-side difference over the three jumps. A 5+ inch difference between right and left per jump is pretty significant.

So, we worked to address the inefficiency with work on soft tissue quality and joint-specific mobility and stability training, all the while slapping on some maximal strength and reactive ability. As spring rolled around, he also started throwing again with Sean O'Connor, a great local pitching coach.

When the season rolled around, Kevin was up 18 pounds to 179, and his fastball was regularly being clocked at 88 mph. His curve ball had become more effective largely because the drop-off from his fastball was even more significant, and he'd set himself up to develop a great change-up.

At the end of the regular season, he was 12-0 with a 0.19 ERA and Division 1 Massachusetts State Player of the Year hardware honors. He went on to go 4-0 with a save in the playoffs, leading Lincoln-Sudbury to its first Division 1 state championship.

Interestingly enough, Kevin actually batted right around .400 all year while hitting in the 4 and 5 spots in the lineup. Believe it or not, I had trained him all off-season under the impression that he would be sacrifice bunting every time he got up, or that they'd just DH for him. I guess moving efficiently will make you better at everything you do!

Good ball handler.

NG: Those are some nasty improvements, but as you told me earlier, there's more.

EC: Yeah, the funniest part is yet to come. Kevin, his coach, and even his parents took some heat from a local sports writer for his pitch count during the playoffs. It worked out to 509 pitches over the course of 17 days (an average of right about 30 per day).

His "argument" was that 28 orthopedic surgeons compiled a chart recommending pitch counts for 17-18 year olds:

• One day rest: 28 pitches

•Two days rest: 63 pitches

•Three days rest: 82 pitches

• Four days rest: 106 pitches

I'm certainly not saying that we should allow our pitchers to do this regularly, but I was present to know that a) Kevin's mechanics never changed (a common problem with fatigue), b) that his legs were more tired than his arm, and c) he was doing a lot of the stuff I'd showed him to keep himself healthy. And, in consideration of the fact that this little "burst" only exceeded recommendations by 10-15% at most, I thought it was a lame argument to make. I guess that's why he's writing columns and not training athletes.

NG: So you're saying that the research isn't legit?

EC: Not necessarily. I'm just saying that it's important to consider who the "average" 17-18 year-old pitcher is. He eats Lucky Charms for breakfast, a bagel and chips for lunch, and lives on Gatorade and sunflower seeds during his game. Afterward, he goes home and pushes the vegetables on his plate aside or just covers them in enough ranch dressing to drown a small village.

Breakfast of choice for the average American 17-18 year-old baseball player.

He doesn't sleep enough or consume enough calories. He's never worked with a pitching coach or even lifted a weight. He wears high top Nike Shox sneakers that weigh as much as a cinderblock. He's fragile, so these recommendations are good for him.

Kevin was paying attention to soft tissue quality with the foam roller and lacrosse ball. He was stretching his posterior capsule, mobilizing his thoracic spine and hips, and doing scapular stability work. He squatted, deadlifted, and did a wide variety of DB pressing, pull-ups, push-ups, single-leg work, and reactive training. Kevin bought Nike Frees within a week of me making the recommendation.

His catcher (another one of my athletes) approached me pre-season to help them put together a pre-game warm-up to keep them both healthy. He had great coaches, and was smart enough on the mound to know that he didn't always have to throw gas to be effective. He had learned to eat better, which was previously a huge weakness for him.

If most of the research is on untrained little league guys, why are we extrapolating it out to trained athletes and even major-leaguers?

I'm a guinea pig?! Say it ain't so!

If a resistance training research study used untrained subjects, it would be the mockery of the entire strength and conditioning industry. Hell, it never would make it to publication!

These recommendations are meant to protect the kids, not treat the more advanced like kids.

NG: How about training modifications? Are you doing anything differently with these guys?

EC: Absolutely. A few things you'll never see our baseball guys do are overhead pressing and straight-bar benching. We use dumbbells or multi-purpose bar for our heaviest pressing; this specialty bar allows us to use a neutral grip (easier on the shoulders), and has a greater stability component because of its tendency to wobble back and forth.

Our guys also do a lot of push-up variations: band-resisted push-ups, T-push-ups, blast strap push-ups, you name it.

There are tons of pull-up variations and horizontal pulling at least three times a week. We incorporate a lot of grip work with thick handles, wrist rollers, the Invanko Supergripper, DB hex holds, plate pinches, and regular old elbow and wrist curl variations.

We do a lot of reactive stuff with our guys and have specific warm-up protocols that address the imbalances of the throwing and hitting motions. All the warm-ups are done barefoot after the athletes spend time on soft tissue work with the foam roller and lacrosse ball.

In terms of lower body training, we do plenty of deadlift and squat variations. The majority of the squatting is front squats or back squats with the safety-squat bar or giant cambered bar.

These bars keep our baseball guys from the at-risk position (shoulder external rotation with abduction) under loading.

All of them do a ton of single-leg work. In a three-day set-up, we go static unsupported on Day 2, and a dynamic accelerative or decelerative on both Days 1 and 3.

We're big advocates of "fillers" between sets. Our guys are always incorporating scapular stability work, posterior capsule stretching, ankle mobilizations, and the like between sets of compound movements. These options don't interfere with rest intervals, but definitely help keep our guys healthy long-term.

NG: Good stuff, Eric. Thanks for the insight!

About Eric Cressey

Eric Cressey is a highly sought-after Boston-based strength and conditioning coach, and president of Cressey Performance in Hudson, MA. Eric has worked with athletes of all levels, from youth sports to the professional and Olympic levels. Contact him and sign up for his free newsletter at his web site, and check out the daily updates on his blog site.

[RShack]

Thanks for this... I've read it twice, and will do so again tomorrow...

ps: Exactly what does one do with "35-yard turf straightaway with a crash wall"? (Not that it matters... just curious...)

[Moose Milligan]

Thanks for this... I've read it twice, and will do so again tomorrow...

ps: Exactly what does one do with "35-yard turf straightaway with a crash wall"? (Not that it matters... just curious...)

I'd imagine it allows people to run sprints all out without fear of having to slow up at the end....but it if that's the case why not give them an extra 20 yards to slow down...?