"You told me there would be smoothies." A Gorinski
"Okay, but we're still on the clock for this?" -D Valdez
"Like a boss." -B Gorinski
- - - - -
Allegations of banned substances cut through the air like horsefeathers after Bob Gorinski's dominating performance at Health & Wellness Day 2010. At a post-game press conference, Gorinski admitted to a large group of reporters that he recieved treatments from the Kazakhstanian doctor charged with smuggling and supplying Strengthogen into the US.
When probed further, Gorinski attempted to fend off accusations by humming We Are The Champions a bit louder than he was previously. After another member of the press asked if his domination could be related to the fact that he created the events, Gorinski said "hello," putting his index finger in the air as he pretended to answer his cell phone.
"Let the beginning commenculate."
Otherwise, wellness day was pulled off in grand fashion. There were no injuries, blood doping, or any other kind of doping, unless you count water- and nectarine-hyperhydration overdose.
Heart rates and VO2 climbed, trash talk elevated, tomfoolery attended, and laughter reigned. Now that's some wellness right thar - I don't care who y'are.
This 5-part series is about not missing the forest for the trees when it comes to injury prevention and training of pitchers. Focusing on the shoulder and elbow "trees" often causes neglect of the "forest" of relevant factors throughout the rest of the body. This installment explores some areas not directly related to anatomy and physiology at all.
Planning
I'm not going to give you a structured and straightforward evidence-based decision tree on not doing stupid things. The majority of shoulder and elbow injuries are due to the same thing that causes injuries in softball and judo and shuffle board and tight rope walking over Niagara Falls.
Whatever happens, it's not his fault.
The root of this multisport epidemic is non-organic (i.e. mental), and should be labeled Stupid Choices Syndrome (SCS). SCS is closely related to Common Sense Deficit Disorder (CSDD) and Too Much Too Soon Syndrome (TMTS), not to be confused with Teenage Mutant Ninja Turtles (TMNT).
These clinical diagnoses are especially prevalent in young men and may also be passed down genetically from overzealous parents. Whatever the case, shift the blame onto the syndrome and off the behavior of the athlete (and parents). Here's an actual clinical picture of a young man suffering with SCS:
Now of course all injuries are not due to taking on too much too soon or doing stupid things. But when they are, please don't feel bad. I've been stupid with you. The ulnar collateral ligament of my right elbow is an excellent case study in SCS.
During grad school I appeared to pitch in a Twilight League game after one whole week of preparation. I made it two innings. A few years later, without warming up, much less training my body to throw hard, I attempted to throw out a runner tagging for home plate. Last fall I tried to beat Bret Wagner in a walnut throwing contest in my backyard, and prior to that separated my right AC joint falling off my mountain bike.
All of these injuries and re-injuries resulted in elbow pain when throwing, and none of them were the "fault" of my UCL. My scapular stability and core rotational strength and hip range of motion were certainly not to blame. I've since self-diagnosed myself with a pretty cut and dry case of SCS, but many times the clinical picture is much less clear:
If you love baseball and try to pitch 11 months out of the year, you're diagnosed.
If you take a few months off like you should and then expect to gun the ball on a cold day in March, you're diagnosed.
If you're a player or coach who stretches the truth about pitch- and Ibuprofen counts, because it's the playoffs - you're diagnosed.
If you throw very hard and love to prove it at pitching "showcases" and especially at the local fair "Guess Your Velocity" game...
If you think you can get away with sitting 16 hours per day at school/work and in the car and on the X-box and not perform regular hip, scapula, and thoracic mobility work - you're diagnosed.
If you think it takes weeks and not months to condition your body to max out and withstand repeatedly throwing as hard as possible...
If your arm is sore and you always want to blame it on the curve balls you threw as a 12 year old, you're diagnosed.
As I wrote about here, curve balls don't injure developing arms. Pitching injures developing arms (1, 2). The factors strongest associated with injury in adolescents pitchers have nothing to do with pitch type or stretching routine or technical delivery technique. Instead, the primary risks include pitching more than eight months out of the year, often throwing more than 80 pitches per game, participating in "showcases", pitching with arm pain and fatigue, and frequently using anti-inflammatory drugs and ice (2).
- the.arm.is.not.a.robot -
And again I say prepare your entire body to throw. For example, my SCS resulted in tremendous strain to the UCL. Had I allowed sufficient time for the supportive elbow, wrist, shoulder, and scapular muscles to be conditioned for their role of significantly unloading the UCL, it likely would have been capable of handling the strain (3).
My advice to not do something stupid seems pretty obvious until you consider that SCS truly is a common diagnoses, and then it's very hard to steer out of a rut once you've been injured. As listed in part one of this series, the chance of the arm surviving to even get to the point of high level pitching (much less succeeding) is slim, even when you don't do something stupid (4, 5, 6).
So now that you're going to try not to catch SCS, I'm going to ask that you don't do something ignorant in your training. While the right conditioning can be extremely beneficial for pitchers, training sometimes gets a bad "rap" because many of us trainer type people have difficulty remembering that working out is not the end, but only a means to an end (lots of Ks and/or Ws).
We must take extra precaution to make sure the cost/benefit ratio is in check. Is it worth the time and risk involved for a high level pitcher to perform power cleans and heavy overhead presses? I don't think it is. Does the potential payoff justify the time and risk involved to perform some form of deadlifts and plyometrics? I think so. This type of cost/benefit analysis is critical for fitting the training to the individual athlete and not vice-versa.
And of course, when it comes to training, there is a ton of Misinformation Disorder and Just Plain Bad Idea Disease going around:
If you think muscle confusion, P90-X, and Cross Fit are good, pitching specific off season training programs - you're diagnosed. [Although the lower body plyo portion of P90-X does have merit.]
If you think that upright rows and dumbbell kickbacks are great exercises and needed for isolating the anterior deltiod and long head of the triceps...
If you think that pitchers must avoid all overhead exercise and yet persist in benching three times per week...
If you think that a handful of wimpy rubber tubing exercises are the key to safely decelerating an arm that the entire body has accelerated to over 7200 degrees per second...(7)
If you think jogging is a good way to condition your legs to repeatedly, explosively accelerate and decelerate the body and won't negatively effect peak power production...(8, 9). David Wells errored a little too much on the safe side of overdoing cardio.
If you think you can pitch for a number of years without routinely revisiting corrective stretching and strengthening exercises...
Train like a baseball player for total body strength and power. Perform specific corrective stretches that will counter the asymmetries that pitching creates, and warm up well with rotational total body activities as outlined here.
In the spring, be patient and allow time to taper into throwing gradually. During the season, resist the urge to pitch the best players too frequently for too long, and to cover it up with Advil. Make sure the body gets an off season from actual throwing to focus on other sports or at least a period of hard cross training.
These are the things that spare the arm.
- - - - -
1. Fleisig GS, Kingsley DS, LofticeJW, Dinnen KP, Ranganathan R, Dun S, Escamilla RF, Andrews JR.Kinetic comparison among the fastball, curveball, change-up, and slider in collegiate baseball pitchers. Am J Sports Med 2006;34(3):423-30.
2. Olsen SJ, Fleisig GS, Dun S, Loftice J, Andrews JR. Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. Am J Sports Med 2006;34(6):905-12.
3. Fleisig GS, Andrews JR, DillmanCJ, Escamilla RF. Kinetics of baseball pitching with implications about injury mechanisms. Am J Sports Med 1995;23(2):233-9.
4. Thigpen, CA, Gill, T, Schneider RE, DiStefanoMJ, Reinold MM, and Seitz AL. Adaptations in 3D scapula position of professional baseball pitchers over one season. Presented at the 2009 Sports Physical Therapy Section Meeting.
5. Ouelette, H, Labis J, Bredella M, Palmer WE, Sheah K, Torriani M. Spectrum of shoulder injuries in the baseball pitcher. Skeletal Radiol 2007;10:3.
6. Conte S, RequaRK, Garrick JG. Disability days in major league baseball. Am J Sports Med 2001;29:431-6.
7. Fleisig GS, Barrentine SW, Zheng N, Escamilla RF, Andrews JR. Kinematic and kinetic comparison of baseball pitching among various levels of development. J Biomechanics 1999;32:1371-5.
8. McCarthy JP, AgreJC, Graf BK, Pozniak MA, Vailas AC. Compatability of adaptive responses with combining strength and endurance training. Med Sci Sports Exerc 1995;27:429-36.
9. Bell GJ, Syrotuik D, Martin TP, Burnham R, Quinney HA. Effect of concurrent strength and endurance training on skeletal muscle properties and hormone concentrations in humans. Eur J ApplPhysiol 2000;81:418-27.
- - - - - - National Employee Health And Wellness Day is May 19th. We'll be partaking of it on the 25th, due to scheduling issues and Kim's training regimen.
I'll skip the part here where I wonder if a person can be healthy without being well. ... ...
Nonetheless, it's Health AND Wellness Day. Sooooo...
NEHAWD is one day out of the year when employers across the nation promote wellness by including lunch time walks and blood pressure screens and making mostly untasty snacks available. Over the last few years, we've decided to not do that. We've (mostly) gotten away with giving convention and liability and lameness the middle finger.
Well yeah, there's a message going on here, serious as a NOT heart attack. We bond and laugh a lot, scarcely noticing that our heart rates are well within the target zone. NEHAWD is an hour of sanctioned goofing off at work, so long as we're not sitting around on the internet eating Brusters Ice Cream.
This year's NEHAWD events have been meticulously structured to cover all 7 components of health and fitness:
1. Stool Floor Hockey - tests manual dexterity and shin whacking capacity
2. Physioball Golf (*no golf cart)- muscular power and awesomeness
3. Physioball Gulp - balance control and bladder fortitude
4. Asparagus eating contest - cardiovascular capacity of the jaw
5. Treadmill volleyball - tests social skills and analytic capabilities
Okay, so come out and compete with us next Tuesday. I dare you. Yes, there will be prizes and no gross "health" snacks.
"What we do is, if we need that extra push over the cliff, you know what we do? Eleven, exactly! One louder."
-Nigel Tufnel
- - - - - -
I never met a weight I could lift for 10 reps but couldn't do for 11.
I suppose that weight exists. In theory. It's really a matter of effort. Intensity. Will.
I DON'T DO 10.
Myself.
I don't force the madness on my poor clientele, but a long time ago, when I first "caught" resistance training, I decided to do one more. Because I could.
It's just that I always thought the whole decimal numeral system was way overrated, physiologically. While I'm glad that humans weren't made with six fingers to a hand, I highly doubt that after 10, muscle fibers suddenly become suspicious of your training goals.
"What? Wait! Forget fast and powerful, because now we're on 11 and that's just toning."
Blleeaacchh: toning. Hmmmph.
What if that eleventh rep is performed with a resistance that you would have loved to stop (or a more sane person would have stopped) at 7 or 9 with?
Eleven is not for beginners. I mean, sure, anyone can do an exercise for eleven reps, but that has nothing to do with Eleven. Eleven is for when you're willing and able to truly pay for results. It takes years, certainly not weeks or months, to perfect form and generate the kind of intensity that allows you to even approach Eleven.
You can't test the Theory of 11 too soon after a big meal.
A side note for less-than beginners: exercise is not boring! Yeah, it's boring when you look at exercise and functional performance like this:
Really, when you have only one machine to work with? Thankfully, most of us are given many opportunities to get things in order.
Is the economy uncertain? Are the kids learning the hard way? Another environmental disaster got you down? Need something you can feel? Well, how about treating it with some sets, reps, time, and other variables that you DO have some control over? Exercise doesn't fix everything, and it certainly can be taken too far. But it's way better than another 10 hours at the office or 3rd bowl/bag/drink over Golden Girls reruns.
Okay, where were we?
Eleven is for when you decide to quit screwing around with muscle confusion and fall head-over-heels in love with the idea of approaching your limits. What ever happened to the good old fashion value of devoting yourself to something? While muscle confusion can leave you tired and sore and maybe even regretful the next morning, doing one rep more with even just one pound more than what almost killed you last time - that's lasting, sacrificial love. Baby.
And to keep it simple, let's set just one ground rule. Bench press doesn't count. Do it with just about any other multijoint "big" movement, because applying the bench press to the Theory of 11 is like putting make-up on your butt.
Er, something like that. It's just not made to work that way, okay?
So forget your drop sets and supersets and trisets and complex high-threshold inverse periodized supercalifragilistic regimen and get down to freakin' business.
Eleven is done with 10 pounds more than your current "8-rep max," which you would really be able to do for 20 reps if you would only let go the umteen sets of whaa-whuu reps of "assistance" waste of time isolation exercises. Use those for specific corrective movements, if needed. Otherwise save the "chiseling" for the day when you have heaps and heaps of lean material for sculpting.
Because this one goes to 11.
- - - - - -
REFERENCES:
-References? What do you think this post is? Is it serious? Absolutely! Empirically PROVEN? Hell no.
-Talk to your MD and all that disclaimer stuff if you haven't started on your path to the Theory. Eleven can be modified to suit you, ya know?
-You're probably not over trained. You're just tired and have a lot going on. Short-term: no big deal. Long-term, make some adjustments to life.
-Other miscellaneous backpedaling:
-Even during your best, most consistent periods of training, not every day will hold a new personal record. It doesn't work like that. But getting some training in, at say, 80% of your best, when you're not feeling completely up to snuff, is paramount to getting those days where you create new limits.
-The more you truly realize the potential of 11 (i.e. the more intensely you train), the less margin of error you have with good form and missing workouts and such. The equation looks like: The Theory of 11 - Lots of Discipline = Injury. Yeah, I know about that too.
[Cue the THIS SONG. Seriously, go listen for the full effect.
[Oh, you're back. Thanks. Okay then.]
- - - - -
Ladies and gentlemen, please give a warm welcome to the latest addition to First Choice Rehab in Bowmansdale.
Coming out of some metal shop in Mechanicsburg, standing zero feet, four inches tall, playing "guard,"...
DOOR - SPRING - TENSIONER DEVICE!!!
[cheers and applause]
Marv Albert: Just listen to the roar of the welcoming crowd.
Steve Kerr: Yeah Marv, big things are expected from the little guy. Door Spring Tensioner Device is expected to pay a pivotal role this season and beyond.
M.A.: Well the team was sorely lacking in the of area of people physically getting IN to physical therapy.
S.K.: Yeah, I mean, c'mon. It's supposed to be rehab, with little old ladies and such straggling toward the clinic, fumbling with crutches and walkers and purses and MRI films, and then you have to battle this two-ton steel behemoth.
M.A.: That's right Steve, and that's before you get a chance to get better.
Both: Ha ha...
S.K.: Can we get an image of the team in action prior to the acquisition of Spring Tensioner Device? Marv, just how hard was it to get into that clinic?
S.K.: But no more, Steve! Look at the team chemistry, clicking on all cylinders.
M.A.: Sure is, and look here at Debbie Valdez opening the door with just one of her fifth metacarpals.
S.K.: Yeah just call it a pinky Merv.
S.K.: We'll have to watch out for First Choice as a prime contender in the playoffs. ...
Coaches and trainers often test strength, power, speed, and sport specific skill. Radar guns, bench press, vertical jump, and 40-yard dash times are meaningful to them. But there are other less glamorous but essential components to peak performance.
No athlete has dominated a game or set any personal records while standing on the sidelines.
Comprehensive Training
Gray Cook and his associates have devised the "Performance Pyramid" to help coaches and athletes understand comprehensive performance training. The pyramid explains three distinct levels of training, their prioritization, and how to integrate them.
Level one is Functional Movement. This simply refers to the symmetry, flexibility, body control, and movement awareness that is the required base of higher level movement. Here we get finicky about flexibility or strength imbalances that lead to faulty body mechanics in fundamental movement patterns. For example, an athlete that cannot correctly execute a body weight deep squat has no place trying to squat with a loaded barbell across their shoulders.
You would be surprised at how many young athletes cannot execute a proper body weight squat.
The second level of the pyramid is Functional Strength. Compound total body exercises like dumbbell rows, chin ups, deadlifts, and plyometrics give the athlete a stronger, more powerful engine. Sport skill will only take an athlete so far if they lack strength and power. Athletes who haven't served time under the iron will often find that they have difficulty applying new skills at "game speed" and quickly hit a plateau in skill progression.
The final level of training is Functional Skill. Whether it's pitching mechanics, blanketing a wide receiver, or pole vault technique, the largest gains in sport performance occur when athletes have invested time developing the base levels of the pyramid. Over use of skill practice and other high level training methods can actually hinder development of the athlete when their primary "limiting factor" lies on another tier of the pyramid.
Inertia
It seems that athletes young and old typically like to work on their strong areas and neglect weaker links. Bench pressing 350 pounds is overrated if rotational range of motion is lacking. Being able to balance on your head is overrated if your reaction time is horrible. Good reaction time and flexibility are overrated if you don't have sufficient strength and core stability to squat your body weight.
A strong and powerful athlete with a high level of specific skill is the perfect recipe for injury when the body is lacking in fundamental movement patterns.
Athletes should periodically revisit and solidify the base of the pyramid in order to prevent injury and to realize the greatest gains from higher level strategies. Sustainable improvement requires a structured, long-term approach with an eye on safety.
You're Hurting. So Now What?
It's hard to resist the impulse to twist and turn and contort the body into different positions in order to "hit" a painful area. I see this all the time. "Gotta work that thing out," as the person makes some kind of circle with the painful area in question.
An athlete with a hamstring strain or history of hamstring strains does 12 renditions of hamstring stretches to work out the "tight" hamstring. But what if the problem is not the hamstring at all? What if weak gluteal muscles are doing a poor job of extending the hip? What if the knee is taking on a lot of rotational force when the athlete runs? That can happen for a number of reasons.
Both of these issues can cause the hamstrings to work overtime, and all the stretching in the world won't improve the faulty movement patterns at the root of the injury. While there are certainly times when stretching isolated muscles or joints is called for, for the most part, these have not been effective in reducing pain and preventing the occurrence of injury. To reduce injury risk and improve rehabilitation to game speed, athletes should focus more on improving movement patterns. The term regional interdependence has been used to explain why dysfunction in one body region may contribute to injury and pain elsewhere.
As compared to testing balance, strength, and flexibility individually over one part of the body, testing these simultaneously with functional movements improves the accuracy of identifying athletes at risk for injury during repetitive, complex movements that often occur in sports.
The Functional Movement Screen consists of a series of 7 tests designed to assess functional movements. The real "magic" in the protocol is that the tests are fairly easy and quick to apply in any location and they really do cover the entire body.
Recent research has shown a relationship between an athlete's functional movement characteristics, as measured by the FMS, and injury risk in professional football players. The FMS was applied in the preseason then injuries were tracked. Those who scored less than 17 out of 21 in the preseason had significantly more injuries during the season than those who scored 17 or greater.
Individualized How?
The FMS allows athletes to identify weak areas that may predispose them to injury and customize their training accordingly. Doing time in the basement of the Performance Pyramid with corrective flexibility and strengthening exercises is critical for both peak performance and injury prevention. Coaches and athletes would both be served well by using a passing score on the FMS to "qualify" for the weight room leader board.
post-game press conference, Gorinski admitted to a large group of reporters that he recieved treatments from the Kazakhstanian doctor charged with smuggling and supplying Strengthogen into the US.
post-game press conference, Gorinski admitted to a large group of reporters that he recieved treatments from the Kazakhstanian doctor charged with smuggling and supplying Strengthogen into the US.
"Let the beginning commenculate."
