Spring A Pain in the Neck

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April rains bring May pains, as we do typically treat more back and shoulder pain when yard work comes back in season. We also seem to see more neck pain this time of year. Why is that?

TEST YOUR KNOWLEDGE:

Everyone has heard about lifting mechanics. Say it with me now, "lift with the legs and not the back." Few actually do that and do it correctly. Sometimes other lifting strategies are more practical. For the sake of illustration, here's a quick video quiz on lifting.

And the correct answer is...

...

...

...let's pause for a commercial break.

[Waiting patiently, looking at the clock...]

What's the best way to lift? Final answer?

The answer is:

It depends.

Some lifting strategies are better than others.

None of them suit all situations.

All of them can easily be performed incorrectly.

Here's why:

A - The CLASSIC. You know rounding the spine is hard on the back. Lifting with the arms while flexed over may also cause a lot of compression on the lower neck. Yet The Classic may be needed when space is limited, if you have a sore knee, or when you need to reach over an electric fence.

B - The ROBOT is lifting with the legs to keep the spine in a strong neutral position. But do you have the strength and range of motion to get down there like that? I often see The Robot done in a manner that's killer on the knees when hip or ankle flexibility is lacking:

The Robot gone wrong causes a lot of strain on the knees and neck.

Even if you can do The Robot correctly, is it worth the effort; the sacrifice of time and efficiency? Anyone who performs repetitive lifting at work will tell you that The Robot is not always practical.

The Robot is essential when you have to perform heavy lifting. It's also a killer move to break out at your next 80's dance party.

C - THE SWAN causes minimal loading to the back and neck, but at what cost? Do you think grandma has the balance to pull this off while standing on a sloped yard full of tree roots? Is The Swan good for lifting a heavy rehab stick or a moving target, like, say, a toddler?

A bad idea.

The Swan can't handle heavy lifts. Here Kim demonstrates The Swan in the appropriate technique and setting:

D - The LUNGE distributes the lift over the entire body. I like the lunge. A little bend at the knee and hip and back allows for lots of leg loading without extreme postures at any one joint. While the lunge is likely your best bet for picking up sticks in the yard, it still requires balance, strength, and flexibility of the ankle, knee, hip, and trunk.

That's where the sore neck comes in. The point is that any of these lifts can result in neck irritation when there's weakness or inflexibility elsewhere in the body. The neck is sore, but it's not the necks "fault."

If you need some incentive to maintain your body, train for yard work as if you were an athlete. Work on your trunk and leg flexibility, strength, and balance. It takes a whole body to save a neck.

If you don't have a good rehab stick, while supplies last, they're available in my backyard for free.

Happy Spring!

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Spare the Arm III: Training

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Following Parts I HERE and II HERE, this concerns strength training and conditioning for pitchers. Traditional training may be worse than useless. These are strong words because I feel pretty strongly that training "like a pitcher" may in fact increase the chance of injury.

HERE'S WHY:

The traditional training of pitchers focuses an awfully lot on the arm, often to the exclusion of other critical elements in the total body effort of throwing. While certain precautions and modifications are needed to maximize benefit and minimize risk, pitchers are often treated far too gently in their training.

The conventional bodybuilding formula of training isolated body parts is not best for specific performance gains. Leave it to baseball guys to go ahead and do exactly that with their rotator cuff and core. The Throwers 10 is a series of shoulder and wrist exercises that are still referenced and used as the thing for getting and keeping a healthy arm. Traditional ab training is one or two steps removed from increased arm strain.

Lastly, what's with all the distance running? When close to 60% of pitchers suffer injury each season, should they be using their time running poles and shagging fly balls? Plodding along may even add to the typical imbalances that result from the repetitive asymmetrical forces involved in throwing. That's not even to speak of the peak power reductions that occur when endurance training is added to strength training (1).

Not hitting 90 m.p.h.

Baseball requires repeated doses of TNT, not a flow of kerosene; drag racers exploding on jet engines, not a Prius brigade. The very best thing we can do to spare the arm of a pitcher is to make the rest of the body more powerful, symmetrical, and athletic.

HERE'S HOW:

It happens by challenging the entire athlete with safe and effective ways to become rotational monsters.

The majority of the body's muscle mass is not in the rotator cuff. Tugging on rubber tubing in a manner that isolates the infraspinatus does not help pitchers create a huge amount of force in the legs and core. It does not help them efficiently transfer that force through the core and into the throwing arm. The upper back, lower back, and lead leg quadriceps muscles relieve the puny rotator cuff muscles from the entire duty of decelerating the arm.

Just like isolated forearm training does nothing to increase bat speed (2), wrist curls do not help in the acceleration and immediate deceleration of the violent "whip" that just produced a 60, 70, 80, even 90 mph fastball. Thick forearms are simply an indication of a heat throwing or long ball hitting person. How many athletes can perform 20 chin-ups or 70-pound "lawn mower" rows with weak forearms?

Check the massive 1 rep-max wrist curl! Surely he can hit 90 m.p.h.
.

Pitchers should spend 10 minutes or working the tubing exercises that support balance and fine-tuning of the scapula and humerus. Then get down to business. The legs the legs the legs. The legs. Train the legs for increased force generation (strength training) and power (plyometrics).

Leg training ties nicely in with lower back and core training. As mentioned above, traditional core training may actually contribute to injuries of the shoulder (and low back and oblique strains, too). Do pitchers need more activities that influence the scapula and ribs slumped down and forward toward the pelvis? That's exactly what crunches promote.

Uh, okay. And your fastball?

Weight training and core stabilization exercises on a big ball look fun and imaginative. Too bad they don't help with performance in a healthy population (3). Placing the body in unstable "environments" does cause increased activation of core muscles because the body shifts into "get by and survive this" mode. Sometimes this is a desired effect in a rehabilitative setting, but it comes at the cost of coordinating efficiency for peak power.

Gravity and firm earth underfoot are the athletes greatest activity-specific allies for core training. Hit those single leg squats, deadlift variations, plank variations, medicine ball throws, and activities that cause the core to resist rotational forces.

Conditioning is another good example of how traditional methods may actually promote injury and decreased performance. The jogging and pole running that pitchers do to "flush" muscles and keep them "in shape" enough to last seven or nine innings may promote imbalance and "flat" legs. Where did this distance running for pitchers come from? I've attempted to trace the orginal rationale for pitchers doing long drawn out cardio (4, 5). [1985, people!]

In the 80's. And I don't mean 80 m.p.h.!

Another recent report found that only power performance tests (and not endurance tests) could identify elite from average basketball players (6). In other words, elite hoopers are no more or less aerobically fit than average players. But they are far more powerful. And if power is a primary factor in a sport like basketball, imagine how it applies to baseball?

Not hitting 90 m.p.h.

Do pitchers have in mind the torso of a Roger Clemens or a (marathon champion) Kipruto Kirwa? Keep in mind that the few elite athletes who can pull off high power and decent endurance are not the norm. Whatever our genetic potentials are, we can cause the one body that we're given to be maximally adapted for only one thing at a time. The guys who "make" their body best suited to bench press 800 pounds (huge force generation) or run 800 meters (anaerobic endurance) have intentionally left behind their own maximum genetic potential for throwing hard (rotational power).

Pitching demands sporadic short distance sprints and regular short duration, high velocity bursts of rotational movement. Weak, immobile bodies will break down the fastest. While honed athletes are not made from hot-dog eating between innings, no amount of cardio will make up for laziness and poor eating habits. Intense plyometrics, sprinting, sprint training, and power training will provide plenty enough physical conditioning to get the far majority of young men through the ninth inning.

For a relatively thin 17-year old, let's concern ourselves with not getting shelled (and therefore keeping the pitch count relatively lower) before we worry about his ability to endure seven innings of baseball.

Go hard with sprints and resistance training. Go slow; like with low intensity dynamic warm ups and corrective movements that provide mobility benefits. But all power athletes need to avoid that middle area where they don't go slow and don't go fast. They need to condition their bodies to explode with muscular and elastic energy.

Or for elastic energy, they could go the traditional route and strap on the big rubber band shaking machine (7).

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1. Effect of Concurrent Endurance and Circuit Resistance Training Sequence on Muscular Strength and Power Development. J Strength Cond Res 22:1037-1045, 2008

2. Effect of Wrist and Forearm Training on Linear Bat-end, Hand Velocities, And Time to Ball Contact of High School Baseball Players. J Strength Cond Res 20(1):231-240. 2006.

3. Trunk Muscle Activation During Dynamic Weight-Training Exercises and Isometric Instability Activities. J Strength Cond Res 21(4): 1108-112. 2007.

4. Recovery from short term intense exercise: it's relation to capillary supply and blood lactate concentration. Eur J Appl Physiol Occup Physiol 52:98-103. 1983.

5. Programming and Organization of Training. Sportivny Press, 1988.

6. Physiological Testing of Basketball Players: Toward a Standard Evaluation of Anaerobic Fitness. J Strength Cond Res 22: 1066-1072, 2008.

7. Big rubber band shaking machine does not promote athleticism or loss of body flab. J of Fitness Gimmicks Bob Likes to Joke About, 2010.

A Curveball on Throwing Curveballs

Throwing curveballs puts Little League pitchers at risk for injury. And they’ll need that arm someday. Right?

Reputable sources have blamed pitching injuries on curveballs ever since I can remember. You would think that twisting the wrist while throwing amplifies strain to the elbow. You would think that pitchers who throw more curveballs are more likely to suffer injuries and undergo surgery. You would think that parents, coaches, and medical professionals have plenty of good evidence for their safety recommendations.


But that's not the case. While it's true that pitchers of all ages are at increased risk, evidence is mounting that the curveball is not guilty in the case for sore arms. When researchers measure the mechanical forces placed across the shoulder and elbow of pitchers, they find that curveballs are actually less stressful than fastballs.

If curveballs are not to blame, what's going on here?

While researchers do not really put it in these terms, the data clearly shows that the problem is...pitching. Imagine that! It looks like we finally have to admit that pitching may not be great from a health perspective. The number of pitches is the most significant predictor of injuries. Just like it hurts to be kicked in the shins, whether by a slide tackle or roundhouse kick, the type of pitch is of relatively little importance.

Science proves that kicks to the

shins are harmful to the shins.

Is it any surprise that an asymmetrical, maximal effort, high velocity activity like pitching is hard on the body when performed for ninety repetitions at a time?

Participating in baseball showcases, where young athletes overreach in order to light up a radar gun, has been identified as a contributing factor to arm injuries. Playing year-round with less than 3 months of rest from competitive baseball is also a predictor of injuries.

Little League Baseball has embraced these findings and revised the rules on pitch counts. The Little League Safety Advisory Committee further recommends that athletes rest from competitive baseball for three months out of the year; that parents and coaches watch for signs of fatigue before pain sets in; and that players with pain be evaluated by a sports medicine professional.


Will there be a time when rules dictate a hitting T until 18 years of age? Hopefully not. Beyond the above noted recommendations, it may be good to reconsider the traditional preparation and rehabilitation of serious pitchers.

Taking time develop overall athleticism is undoubtedly more beneficial than getting in another eight or twelve games. It may be good to go beyond vague notions of "pitching mechanics" that everyone speaks of. Throwing is a total body effort. In order to spare the arm as much as possible, the athlete must identify and correct underlying issues in strength, flexibility, and bad habits that only add to the strain.

"Should young athletes throw curveballs" is another question altogether. Implementing rules proves challenging. "No breaking pitches unless the game is tied and there are runners on base" does not sound reasonable. The point of this writing is not to encourage or discourage the curve, but to shift the emphasis of our attempts to serve young athletes.



Little League revised pitch count limits for 2010

League Age - Pitches Allowed Per Day

17-18 105
13 - 16 - 95
11-12 - 85
9 - 10 - 75
7 - 8 - 50


Details of many of these recommendations and scientific studies can be found at littleleague.org and the website of the American Sports Medicine Institute (amsi.org).

Move It While They're Little

Looks like I'll be doing a six month stint with the Patriot News, hopefully more. I've changed a few of the pieces below to be more newspaper appropriate (i.e. no links, etc.), but my first, uh, assignment, was to contribute something for their immediate upcoming focus on childhood obesity.

"mmkay."

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The recent introduction of the national health campaign "Lets Move" is exciting for physical therapists. The phrase "Move Forward" was branded by the American Physical Therapy Association over two years ago, and I hope the resemblance is not coincidental. As a professional, I'm well aware of the physiological effects of the Madagascar Move It - Move It theme song. But for now I remove that hat and write as an everyday parent.

What can I do to help my young kids want to move in five or fifty years? What practical steps can I take to exemplify and encourage an active lifestyle?

We should move nutrition and exercise way up on our list of priorities. We will surely benefit from greater access to healthy foods. But beyond the endeavors of Lets Move, we should also give attention to subtle but significant sneak attacks on the health of children and parents alike.

Yes parents need to move, all right. Some of the moves I'm trying to make are more painful than sweating at the park or gym.

Electronic Media

Last week I watched a teenager text her friend while doing a "side plank" core stability exercise in my clinic. It has been said that there are always gains and losses to innovations. The gains are obvious and the losses are far more subtle.

Lets move on limited use of these gadgets formally known as cell phones. If your child is too young to operate a TV or computer, now is the time to lay the foundation. Lets move TVs and computers out of their bedrooms to begin with.

Would you send your child to bed every night with ice cream and sprinkles? The teenage years will be challenging enough without the extra fatigue and irritability, not to mention the intellectual side effects of Cribs. Physical lethargy and being stuck to the couch by day is yet another cost of nightly Xbox binges.

If you already hear objections about the TV in your bedroom, then maybe now is the time for mom or dad to move by example.

Hovering

While shadowing a child's every move is definitely a workout for parents, is it beneficial to the child? Does hovering interfere with learning the consequences of gravity when the stakes are still low? Does it snuff out or wildly amplify their need to move and learn body control?

Lets move back a bit here. If you can't get outside, have a good couch jumping, cushion bashing session. Limits are needed, of course. If you prioritize nice furniture then make sure to have an old couch in the basement. Most couches will be out of style before the kids are grown, anyway.

Kids fall and get seriously injured all the time. You may know a story about a kid who fell horribly from a piece of furniture. I haven't heard that story, but I do not take it lightly. The issue here is relative risk. Our children could suffer a freak accident while doing just about anything. Don't the risks of a sedentary lifestyle far outweigh that of a little roughhousing?

What patterns would emerge if we dug into the upbringing of extreme athletes who flip and tumble at ridiculous heights? I doubt that mom said "cool, go ahead and go as big as you want." I imagine that she hovered and dad pushed baseball (or any traditional sport). Some children learned to shun physical activity while a few others became billboards for Red Bull.

Besides, how do you rebel against "wow that was awesome?"

Engaged

What my young children want more than anything is their dad fully engaged in movement with them. It's not long that being engaged in the living room or on the front lawn beats a trip to Hershey Park. Who can afford to miss this chance to move the body and imagination?

The first move is always a period of playful trash talk. Power is claimed, demands are made, and resistance is rallied. Leaves or pillows are hurled between factions. There is a great charge and collision.

When the hunt, carry, wrestle, tickle, and toss of one victim is through, the others are recovered and raring to go. Being fully engaged is absolutely a workout. Kids know too well when your heart rate drops below the "target zone."

When my children watch me lifting weights in the basement, I often wonder how seeing their dad intentionally suffer under a heavy load will affect their attitude toward structured exercise. For now, I always slow play the formal exercise.

"I don't know if you can hang up there then run around the circle in 10 seconds. You can try if you want."

Are these suggestions idealistic, realistic, or effective? My oldest child is only six, so those questions will be answered in time. I'm sure many lessons will be learned, especially by the parents. Until then, lets pay attention to those going before us and see how our childrens physical condition is one product of larger issues at hand.

You like to - move it!

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Supplements III: Introducing STRENGTHOGEN

[With such an overwhelming response to the writings on sports supplements, I've decided to introduce my very own line of performance enhancers! Well, not really, and not really. Read on.]

Do you want wildly radical results from sometimes lackluster effort? You can’t afford to compromise on sports nutrition. Fuel the machine, if you will.

Numerous studies have proven that post-workout nutrients are critical for recovery as well as enabling athletes to exercise at a higher intensity during subsequent workouts (1). More recently, researchers have defined the precise nutritional profile that’s optimal for refueling tired muscles (2**).

Introducing Strengthogen. This great tasting formula delivers 40 grams of Flexamoo, a powerful blend of quality whey and casein protein isolates, delivered with the precise carbohydrate complex recommended in clinical trials.

Each serving of Strengthogen provides highly bioavailable essential, non-essential, and sometimes non-essential amino acids - that's where you get the power. Strengthogen also contains electrolytes, monosaccharides for immediately refueling muscle glycogen, and complex carbs for sustained energy.

Strengthogen is made of all natural ingredients that have been rigorously tested and approved by the Food and Drug Administration (3). Strengthogen is sanctioned by the International Olympic Committee, all professional sports organizations, and your mom. Strengthogen is caffeine free, low fat, and even safe for children and (especially) pregnant and nursing women.

And don’t miss Strengthogen Light; all the taste and nutrients of Strengthogen with 30% less calories (4).

For cutting edge sports nutrition on-the-go, try super convenient and specially formulated Strengthogen Bars ( 5).

IMPORTANT REFERENCES:

1. National Strength and Conditioning Association. Standards and Guidelines: Standard (9.1) Supplements, Ergogenic Aids, and Drugs

2. ** Barclay, L. Chocolate milk may improve recovery after exercise. International Journal of Sports Nutrition 16: 78-91, 2006.

3. Skim milk and chocolate syrup = IT'S CHOCOLATE MILK. The above study showed that chocolate milk was equally as good as high falutin "recovery drinks" for muscle recovery and function.

4. Strengthogen in a 30% smaller bottle.

5. PB&J cut into rectangles

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