Baseball is one of the sports that puts the most stress on your joints, especially if you’re a pitcher; the throwing shoulder is under tremendous stress.  With the crazy velocities at which you throw a baseball, and with the volume of pitching that accumulates over the years, by the time a pitcher gets to the professional level, he probably has a lot of overuse damage to it (soft tissue restriction, ligament laxity, partial labral damage, etc).

Last Saturday I played in a fund raising dodge ball tournament in Philadelphia.  Having not played dodge ball since middle school, and not being a natural thrower (my main sports growing up were hockey and basketball) made me a little worried about my dodge ball performance.  As expected I sucked pretty bad, but at least I stole the show with my purple cobra entrance before every game…

A little less glorious when you get hit in the face 30 seconds later, though!

If you’re wondering where I’m going with this, here it is: I was so freakin’ sore the next day it was unreal!  My whole shoulder and arm, starting from the attachment of my rhomboids on my spine going all the down to my fingers, were as sore as I’ve ever been in my upper extremity.  Rhomboids, levator scapula, rotator cuff, biceps, and all of my forearm muscles were completely smoked.

Is that a coincidence that these muscles all have fascial connections?

That just made me realize all the stiffness and soft-tissue restrictions that can build up in a baseball pitcher’s arm when he throws around 100 pitches every time is on the mound.  Of course there are some adaptations taking place; the body becomes more efficient at it as you build up your arm strength, stamina and improve your technique, and you don’t get sore (like I did playing dodge ball) every outing.  But it still makes you think about all the stress that the shoulder and arm are taking on a weekly basis.  And when young baseball pitchers throw with their high school team in the spring, play summer league and fall ball on top of that, the accumulated stress on your arm builds up pretty fast.

That’s why taking care of your pitching arm, using injury prevention strategies, and having an smart (and planned) training program are going to be important factors in the longevity and durability of your arm over time.  Soft-tissue work on the rhomboids, levator scapula, rotator cuff, biceps, and forearm muscles is going to be an important part of that ‘arm care’ program.

Try and not cry the first time you dig a lacrosse ball in your rotator cuff muscles

If I got stiff and extremely sore in these muscles by playing 6 games of dodge ball (realistically ~10 throws per game), I can guarantee you that any baseball pitcher will build up severe restrictions in those same muscles over time, whether they feel it or not.

Do your dedicated self soft-tissue work on a daily basis, go see a qualified active release therapist on a regularly (once a month, as a bare minimum- but College and professional players probably need more) and you’ll increase your chance of staying pain and injury free, and give yourself the best chance to perform at the highest level.

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There are bunch of different injuries that occur in every sport.  If you look carefully at the injuries in each sport you’ll notice that there are injuries that are common in each one of them.  In fact, you could probably identify 3-4 different injuries in a given sport that you keep hearing about from athletes.  Hockey, like every sport, has its common injuries.  Before we go any further in this injury prevention discussion, it’s important to acknowledge that there are 2 different types of injuries:

1. Trauma injuries (e.g. shoulder dislocations, concussions, etc) that usually happen with some type of contact.  These injuries are not really preventable (the only thing you can really do is beef up the surrounding muscles to limit the effect of the impact).
2. Overuse/Under-recovery injuries (e.g. tendinopathy, muscle strains, etc) .  These injuries are largely preventable and can become pretty much completely absent if taken care of the right way.

Unfortunately, nothing you can do to prevent that.

Knowing that there is little we can do to prevent trauma injuries, we’ll focus on the preventable injuries.  Appropriate training and recovery methods can almost always prevent those injuries.  If we want to help prevent those injuries, we need to know what they are in the first place.   In hockey players, the common preventable injuries are:

• Adductor/Hip flexor strains
• Hip labral tear
• Sports hernias

If you are a hockey player or train hockey players, you’ll know that these injuries are VERY common among the hockey community.  The nature of the sport and the large amount of stress placed on the hips can explain in part why those injuries occur.  But it’s also important to understand that common doesn’t mean that it’s OK and that we shouldn’t do anything to prevent them.

To prevent the injury, you need to understand the injury mechanism.  In hockey the hip abductors (glutes) get a lot stress from the skating motion.  Conversely, the adductors and hip flexors are elongated with every stride of the skating motion.  That certainly creates imbalances across the hip musculature; some muscles get weak, some muscles build up a lot of adhesions and trigger points and some muscles are just overused.  Re-establishing that muscle balance in your training program is crucial to keep your athletes healthy.

Getting some soft-tissue work done on your glutes and adductors, stretching your glutes, strengthening your adductors in a shortened position and re-establishing neutral pelvic position (getting out of anterior tilt, which is way too common among hockey players) are just a couple of examples of strategies to help restore muscle balance across the hips for hockey players.

Kevin Neeld has a full chapter in his book Ultimate Hockey Training dedicated to those common hockey injuries and how to prevent them.  If you haven’t already, I strongly suggest you pick up a copy of his book.

Injury prevention strategies are an important part of a strength and conditioning program.  How important is it to get bigger, faster, stronger and more powerful if you’re sidelined with a preventable injury?  Not that important I would think…

But when including injury prevention strategies in your program or the ones of your athletes, you can face a couple challenges, mainly:

• how exactly to program those injury prevention strategies in your training
• how to not completely turn your training program into a rehab program
• not make your athletes feel like patients
• how to maintain a training effect while still working on injury prevention

Not Exactly how you want to make your athletes feel like

These are legitimate concerns in my opinion because there is a fine line between too much and too little corrective exercises.  And it’s also not easy to know where to include them in your program so you still end up with an optimal result, both from from an exercise prescription and a time management perspective.  Here are a couple of tips to help you program your corrective exercises better into your own program or the ones of your athletes.

1. Your warm up.  There is a decent amount of injury prevention strategies that can be included in your warm up, especially if they’re mobility exercises.  A warm up is the perfect time to work on soft-tissue restriction and mobility to improve range of motion.  And you’re going to use your lifting to reinforce that new found mobility with appropriate lifting exercises.

Your warm up should be a little more specific than that…

2. Your cool down.  Soft-tissue work and static stretching are great to include at the end of your training session.  It will promote recovery and limit the possible range of motion loss from tight muscles.

3. Fillers.  This is probably my favorite way to include injury prevention strategies in a training program.  Fillers are basically a corrective exercise that you include between sets of a lifting exercise.  It can help reinforce a movement pattern of your main lifting exercise, it can be a stability exercise or it can be a mobility exercise that doesn’t affect the part(s) of your body you’re training.  The reason I like fillers so much is because from a time efficiency perspective, it really doesn’t get any better.  It saves time so yo don’t have to do all of that corrective work at the beginning or at the end of your training, which would make your session time longer by at least 10-20 minutes.  It also makes your training more productive; you spend less time (if at all, when programed thoroughly) waiting and doing nothing between your sets of your main exercises.  This is something very common among most gym enthusiasts; they spend an awful lot of time doing nothing (most of the time talking, and losing focus) between their working sets.  No wonder why most people hate going to the gym and lifting weights!  I would hate training too if I had to wait 1-2 minutes between every single set of every exercise I’m doing; this is boring as hell!  Putting fillers in between your sets makes you move more, reduces your down time between sets, and makes you feel like your training was much more productive and that you got a lot more done in the same amount of time.  And you took care of the injury prevention side of things on top of that!

Here’s what a hypothetical upper body day could look like with the use of filler sets if we wanted to include shoulder injury prevention strategies (filler exercises are highlighted in green) :

Notice that you’d still get a decent training effect from the rest of the exercises while simultaneously working on lower trap and serratus anterior activation, t-spine mobility, breathing patterns and anterior chain muscles extensibility, which all play an important role in injury prevention for the shoulders.

As I mentioned above, fillers can be a tremendous addition in your training program.  Give it a shot and play around with your corrective exercises that you want to include in your program.  As long as your filler exercise doesn’t interfere with your main exercise, you should be fine.  But you might need some time to play around and find good combinations that will work for you.

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If you haven’t heard about the benefits of foam rolling to improve soft-tissue quality, you have probably been living under a rock for the past 5-10 years.  Even with all the benefits of foam rolling though, sometimes it’s just not enough to take care of your soft-tissue quality.

There are a couple reason why foam rolling might not be enough:

1. The trigger point is too hard to reach with a foam roller

2. The pressure applied by the foam roller is not enough to effectively target the trigger point

3. The trigger point area is just too stubborn and won’t go away

Let’s go into a little more details for each of those 3 reasons and see the possible alternatives:

1. Sometimes, you’ll want to foam roll an area of your body that’s not exposed as much as your quads and upper back for example.  Getting to smaller areas, close to the joints and the mid-line of the body can be a difficult task.  A couple example could be the pecs, the high adductors, the long head of the triceps, the plantar fascia, the levator scapula and upper trap among others.  These areas are located in spots where it is difficult to access with a foam roller.  A good alternative would be to use a smaller surface like a medicine ball or a lacrosse ball.  The lacrosse ball works particularly well on the pecs and the plantar fascia, and the medicine ball work really well for the high adductors.

2.  When you’ve been foam rolling for a decent amount of time (usually 6 months or more), you’ll find that the traditional foam roller will not work your trigger points as hard as you would like (a.k.a. it doesn’t hurt anymore).  There are a couple different ways to solve this problem.  The first one would be to move to a denser foam roller; they sell rollers of different densities, with the foam roller plus (a PVC pipe warpped around a thin layer of foam) being the hardest one.  If you feel really tough, or if even the foam roller plus doesn’t do anything for you, you can try a straight PVC pipe (which ends up being really cheap if you just get it a your local hardware store) or the rumble roller.  I have yet to try the rumble roller, but I have had great comments on it.

Are you game?

Using a smaller, denser surface like a lacrosse ball might be appropriate in this situation as well.  You’ll have more pressure applied on a smaller surface, which will increase the pain factor for sure!

3. That happens very often that all self soft-tissue tools won’t work to get rid of a trigger point.  In this case the only option left is to consult a qualified massage therapist that will work your trigger points more in depth.  An ART or Graston certified practitioner is recommended, as I feel it 2 of the most efficient soft-tissue methods available.  A couple of visits might be necessary to get rid of your tight spots.  And if you’re a high level athlete that imposes a lot of stress on his body, I would even recommend that you go see one on a regular basis, at least once a month; that will help keep you healthy in the long run.

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I wrote on Tuesday that you may not have to stretch your hip flexors, even if they feel “tight”.  I also showed how easy it is to screw up a hip flexor stretch.  If you missed it, make sure to read it HERE.  But how does someone knows if he needs to stretch his hip flexors if we can’t rely on the fact that they feel “tight”?  Those who are familiar with muscle testing a bit will say to use the Thomas test (or one of its variations) to assess hip flexor length.  The Thomas test is a commonly used test among strength coaches, physical therapist and other rehab/training professionals.  Here is what it looks like:

 
By letting one leg hang down, you can usually know if the person has short/stiff hip flexors if the knee of the down leg hangs higher than the hip.  In the case of a shortness in the rectus femoris the knee will also stay extended over 90 degrees of flexion.  A positive Thomas test (knee staying above hip level) usually is good indications that your hip flexors are short or stiff, but as I mentioned before it might mean that the problem is neurological, and stretching your hip flexors won’t solve the problem.  To add to the confusion, a negative Thomas test (knee dropping all the way down) doesn’t mean that your hip flexors aren’t short/stiff.  It could mean that your anterior capsule and ligaments are overstretched.  One way to prevent this is to make sure that you stretch your hip flexors the right way, like I mentioned in my last post.  But how do you know if it’s a capsule/ligaments issue or not?

Using the adduction drop test in conjunction to the Thomas test might be a good option.  Here’s what it looks like:

The adduction drop test is something I picked up from the Postural Restoration Institute.  They commonly use this test to identify what is called a left AIC (Anterior-Interior Chain) pattern, which implicates that most human beings are stuck in external rotation and abduction, and hip flexion in the left hip.  The combination of a positive adduction drop test and a positive Thomas test usually points in the direction of a left AIC pattern because of the lack of hip extension and adduction on the left side.

We can also use the combination of these two tests to identify anterior capsule and/or ligament laxity.  A positive adduction drop test and a negative Thomas test would be indication of anterior laxity in the hip capsule and/or ligaments.

Assessing before you prescribe a hip flexor stretch and making sure it is performed correctly if you need to prescribe it are the two keys here.

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I’m not breaking any news to you if I tell you that the hip flexor group is usually a problematic area in many people.  There are numerous reasons for that, including the fact that nowadays we sit way too much and the hip flexor muscles can get short or stiff from spending so much time in that shortened position.  Because of that, we prescribe a lot of hip flexor stretches in hope of getting some slack to those muscles.  But there are a couple of problems with that.

First of all, sometimes the cause of the stiffness in the hip flexors might be neurological, rather than just muscular (I’ve talked about that in a previous blog post).  If it’s the case, you’re not going to win that battle by stretching your hip flexors because the brain will always win and your hip flexors will keep stiffening right back.

Another problem I can see with that is that it is easy, very easy to screw up a hip flexor stretch.  In fact, a lot of people stretch their hip flexors the wrong way and put all the stress on the anterior capsule and ligaments.

Hip flexor stretch done the WRONG way

The first problem with the picture above is that there really isn’t that many people, if at all that have that amount of hip extension, or hip extension should I say at that point.  What happens with this position is the pelvis will anteriorly tilt, the the lower back will arch and even if the hip flexors will be stretched a little bit, it is the anterior hip capsule and ligaments that will be stretched.  This can further cause hip instability and other issues you really don’t want to deal with.

Because of that, you need to be careful when prescribing a hip flexor stretch.  You want to make sure that your client or your athlete is doing it the right way; you can’t assume that just getting in the position will be good enough.  When getting down in a half-kneeling position, you want your back knee (the side you’re going to stretch) to be right underneath your hip.  You want to initiate the stretch with a posterior pelvic tilt and a contraction of the glute on the side you want to stretch.  By doing this, there are little chances that you’ll get into hyperextension.  You’ll also notice that you won’t be able to get your hips forward much (assuming your maintaining the posterior tilt and the glute contraction).

Notice the posterior tilt in the half-kneeling position

Is there any ways to know if you’ve been stretching the wrong way? Yes.  There are a couple of simple tests you can do to check if you have lax anterior ligaments.  I’ll go over them in  my next blog post on Thursday. Stay tuned!

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I read Charlie Weingroff’s blog post 2 days ago that was called Putting Manual Therapy Into Perspective (make sure you read it, as it is one of the most enlightening thing I’ve read recently).  For those who might not know Charlie, he is one of the smartest minds in this business and he has a unique perspective on things (I guess that’s what happens when you put physical therapy, strength and conditioning, powerlifting and manual therapy in the same person!).  That being said, Charlie was discussing different manual therapy options in his blog post and when each one might be appropriate.  The part of his blog post that really caught my attention though is the first part where he explains why we lose mobility in the first place.

Muscles are rarely, if ever, short.  When a muscle feels stiff, it’s not necessarily short and it definitely doesn’t automatically means that you should stretch it.  Stiffness can be created for many different reasons, and sometimes the cause of the problem may be somewhere else. For those who’ve been reading my stuff for a while, you know that I’m a big advocate of stretching, so that might sound confusing coming from me, but bare with me you’ll understand why I’m saying this (because it is not ALWAYS appropriate to stretch).

One other thing to understand is that a muscle that feels tight might be short, or it might actually be long.  This might be a complex thing to understand, but here is a simple example: think about someone in an anterior pelvic tilt.

When your pelvis is tilted forward, your hamstrings are going to be put on a stretch.  Because of that, your hamstrings might feel stiff and if you use a straight leg raise to assess their length, they will most likely test short.  But if you think about it, in this specific example, your pelvic position is what causes your hamstring to test short.  If the pelvis is reposition correctly with appropriate strategies (read: not stretching your hamstrings), your hamstrings will get some slack and they most likely won’t feel stiff anymore (or less stiff).

This is just one example of why muscles that feel stiff might not need to be stretched.  Another reason might be when muscles get stiff as a protective mechanism or a compensation pattern.  Never forget the brain-muscle connection and its importance, especially when it comes down to “stiff” muscles.  Your brain might send the signal to the muscle to stiffen up because there is something going wrong around the area.  This might happen to prevent a muscle to overstretch or that might even prevent you from pulling a hammy or a quad while you sprint or play hockey or whatever else you’re doing.  And when you’re performing a task at high or near-max intensity, your body will always compensate in the easiest way possible.  And unfortunately this is not something we have control over; your brain is the boss and he’s the one sending the signal to the muscles if they should activate, stiffen, shut down, etc.  So you can stretch all you want, but the muscle in question will never loosen up.

This is why assessing and addressing imbalances is key.  It’s really important to address the underlying issues to whatever problem one might have.  If you don’t, you might be studying for the wrong test.  You can stretch a muscle all you want and it’ll always feel tight.

This is really just the tip of the iceberg when talking about short/stiff muscles and the implications of stretching and how the brain has so much control over what’s happening.  And there are so many other things to consider.  Hopefully that opened your eyes a little bit on how stretching stiff muscles might not always be the solution to everything.

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Band tractions are a great tool to use to help with shoulder health.  It helps mobilize the shoulder joint and you can use them in different planes of motions.  The added tension from the band that kind of “pulls” the humeral head out of the socket while mobilizing the joint really helps loosening up the soft-tissue around it.

Band tractions are widely spread among powerlifters and really strong guys who bench press loads of weight.  A lot of them, swear by it and say it makes their shoulders feel better.  And honestly, until you try it you don’t understand how much better it makes your shoulders feel.  Whenever my shoulders feel beat up I’ll just add a couple of sets of band tractions at the end of my training sessions.

Here are a couple different movements you can do with them in different planes of motion.

It should never be painful, nor hurt your shoulder at all.  If this is the case, you probably have some bigger problems to deal with than just the need to mobilize your joint.

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We all know we should do more static stretching.  Some of us actually do it, some don’t.  But what do we generally do when comes the time to stretch?  Hold the stretch for 20-30 seconds, right?  I’m assuming that this is what most people do, and what most coaches/trainers recommend.

But when we really do need to lengthen a specific muscle group that has been shortened over time (e.g. hip flexors from too much sitting)  stretching 30 seconds every day is not gonna cut it; you need much more than that to overcome the effect of spending hours a day with some muscles in a shortened position.  Stretching multiple times a day is one option.  But the other option I really like is the long duration stretches.  You can use any stretching you like for a muscle that’s especially short and put it on a 5 minute stretch at least once a day.  The prolonged position of the stretch will cause the muscle to add more sarcomeres in series, therefore giving a more “permanent” effect to the stretch you just did.

Lon duration stretches is something I really like with hockey players of spend lots of of time in the skating position throughout their season and for people who work at a desk all day and sit too much.  Here’s my favorite stretch to use for long duration stretch for both of these folks:

Hip flexor stretches are just great to hold for 5 minutes for anyone who has short hip flexors.  This is something we use a lot at Endeavor with our athletes and general members as well.
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I will be the first one to admit that this is something I’ve been fighting against for years.  We all know that it was common practice among lifters and athletes through the 70s and the 80s to static stretch before a training session or playing a sport.

This was almost a whole warm up right there!

And that was accepted as a typical injury prevention strategy before an activity.  That concept has been challenged a lot in the last decade and a half or so.  Many researches came out suggesting that static stretching may negatively impact force production output (read: strength and power).  The idea that static stretching by itself as a warm up procedure was a good injury prevention strategy has also been challenged a lot.  The result of this being that strength coaches and fitness professionals alike who stay current with the literature have abandoned the static stretching concept as a warm up procedure almost completely.  I, myself, have been supporting this theory that static stretching as a warm up is not appropriate.

But in the last couple of years, different strength coaches, like Mike Boyle have been trying to re-introduce the concept of static stretching as being part of a warm up (as opposed to being a whole warm up in itself).  Knowing what we know now about static stretching it seemed kind of counter-intuitive to me to do that.

After resisting to the concept, I finally gave it a shot.  Now I embrace it.

There’s a couple of things to take into account though, when using static stretching before training or sport:

• Even if there might be some benefits to doing static stretching before training, it cannot be used by itself as a complete warm up.  Soft-tissue work, mobility, dynamic stretching and movement preparations are all important parts of a warm up, as well.
• You don’t want to stretch for too long.  It’s called a warm up, not a cool down, so try to avoid spending over 10-15 minutes static stretching where your body might fall in sleep mode.
• Try to avoid static stretching the areas/muscles you’re going to involve in your training activity, because of the possible force production loss linked to static stretching.  Mobility and dynamic stretching drills might be better suited for these areas.

The whole reason to re-incorporate static stretching in the warm up, in my opinion, is because we spend so much time sitting in a day that there are many muscles and joint that suffer from that.  Therefore it’s important to give them length back before a training session; the last thing we want is to feel stiff and restricted from sitting all day before an activity.

Personally, I have been feeling so much better since re-incorporating some static stretches in my warm-up, and I definitely don’t feel as stiff when I train.  Here’s how you might want to incorporate static stretching in your pre-workout routine:

1. Soft-tissue work (foam rolling, stick, lacrosse ball, etc)
2. Static stretching circuit (4-5 stretches that don’t target muscles involved in your training for that day)
3. Dynamic stretching/mobility (6-8 movements that will target joints involved in your training for that day)
4. Movement preparation (If you do any kind of sprint/plyo/power exercises you’ll want to do movement prep)

After fighting against the concept of static stretching as part of a warm up for so long, I now embrace it.  You should definitely give it a shot if you’ve been in the same boat as I was for the last couple of years.