Dr. Stephen Osterer and Dr. Michael Chivers
Twitter: @drsosterer / @drmchivers
It’s the middle of August and for some of us, the summer season is coming to a close. As such, high school and collegiate players are beginning to face some tough questions.
What am I going to do for off-season training?
Where am I going to accomplish this?
What should it be composed of?
In a world with an infinite number of ‘Ultimate Strength and Conditioning Programs” flying around social media, answering these questions can often be a confusing and difficult task for the uninformed.
On the positive side, as a collective whole, baseball is finally accepting that we can develop players off of the baseball field. Developing physical tools like acceleration and reactive change-of-direction with the correct program is widely accepted. There is also an upward trend in average throwing MPH each year, and a good chunk of it may be the result of an increased attention towards strength and conditioning programming.
On the flip side, undertaking a strength and conditioning program improperly can have a serious impact on the occurrence of future injury.
Let us try and explain.
Every athlete is different, from how they move and adapt to their environment to how they think and process information. They are unique biological systems. It follows that each athlete requires a certain level of individualization to their programming (how much depends on a number of constraining factors – time, age, facility, resources etc). Without first searching for and identifying the needs of our athletes, including their emotional and psychological profiles, we are simply intervening with a shotgun approach. Throw something at them and hope it works. This strategy may lead us down the wrong path, even pushing them closer to injury rather than performance gains.
A good strength and conditioning coach, ideally in conjunction with a performance coach, will build a needs list prioritizing off-season goals. This will include and not be limited to overall physical competency, capacity, psychological and emotional factors.
Take Home: Get a proper needs analysis done
Developing a plan from the collected information will vary from coach to coach. How he or she decides what areas to focus on may not be the exact same as another, but for the most part, we generally all abide by the same philosophy. “Primum non nocere” – first do no harm. Performance enhancement, although also a priority, comes second and usually results directly from our injury reduction strategies.
Having said that, reducing the occurrence of injury is obviously not a simple task. If it was, we wouldn’t see the rising rate that we currently do in todays game. In the performance world, and especially the baseball one, we have yet to master this concept. As we have said ad nauseum in the past, there are numerous variables that come into play here – much, much more than just simple biomechanics.
Over the last few years, however, there has been a concerning trend which may be an overlooked contributor to the injury rise.
In our opinion, baseball players have become too concerned with generalized strength and power development and do not pay enough attention to focused specific joint health (used interchangeably as articular health). Unfortunately this trend continues to be evident in many of the articles and blogs that are populated by youth players. Often this is promoted with the promises of improved velocity, bat speed or some other performance variable that is loosely based on these particular strength factors.
Moreover, it is our philosophy that a large part of our goal in injury reduction and performance enhancement should be to provide as much room for variability of movement as possible. Letting athletes explore the movement environment with specific drills and exercises will allow them to formulate their own movement responses. This is a complex and fascinating topic to be covered in depth in a future post.
We want to be clear.
We are not saying that there is no place for appropriate strength training for baseball athletes. However, as our athletes embark on that journey we must help them establish and continually preserve baseline mobility requirements. The best way to do so is to maintain appropriate levels of joint health (articular health). If we are to look at the body from a general systems perspective, the hardware (joints) should be continually monitored and upgraded as needed to accommodate the software (CNS) that allows the system to run.
What this means is not simply to achieve pain-free passive range of motion as most people choose to account for. This, by definition, is flexibility and can easily be adapted and for the most part is not under direct nervous system control. The ability to achieve passive range of motion is important (to a small degree), but if you cannot control a range of motion actively then what’s the point in having it? We want to have control and stability throughout a wide range of motion – what we define as mobility.
An example to demonstrate this concept would be the basic bodyweight squat. There are a lot of athletes who can’t actively perform this movement without some direct movement dysfunction (in whatever sense you choose to deem ‘dysfunction’). However if the same athlete were to perform a passive squat by holding onto something, they can easily achieve the desired end range. This begs the question, if I can only get into a range, and not out of it, am I not in a compromising position? If a pitcher can only achieve 50 degrees of internal rotation at their glenohumeral joint, by way of a friend holding their arm, how can we expect them to control 7000 degrees / second of internal rotation in a game?
This line of thinking SHOULD bring up some thoughts.
When heading into the off-season and building a program, what should we be prioritizing?
IE – If we cannot control and express strength in max external rotation at the glenohumreal joint, should we be trying to improve rotational power?
Are we safe to lift overhead if we cannot demonstrate a healthy integration of the glenohumeral and scapulothoracic articulations as well as achieve a level of thoracic spine extension?
Does throwing a weighted baseball make sense if we have no strength or capacity to handle 120+ degrees of external rotation?
Can we develop strength and power qualities while simultaneously improving articular health?
What are the risks?
What are the benefits?
Take Home: It should be apparent that off-season work is not as simple as printing off the latest vogue S & C program and getting after it. There are many factors at play here, and in a sport which boasts a majority of it’s injuries as non-contact, we need to be better at practicing Primum Non Nocere.
Movement Variability and Functional Mobility
Our philosophy, as touched on above, is that we should prioritize the health of our athletes articulations first and foremost. We must strengthen, and not shy away from, the articular ranges that are present during in-game movements. If we observe massive amounts of glenohumeral external rotation on the bump, why aren’t we attempting to strengthen that position of ‘vulnerability’ in the off-season? Unless articular health – active control of a large amount of range – is apparent and accounted for, then aren’t we just building a greater ability to develop and transfer force onto joints that will inevitably be in non-reinforced positions?
So how do we assess and develop articular health?
Step #1 – Creating Differentiation
Differentiation – assessing all joints involved in a movement for proper kinematics without closing angle pain (impingement pain) or compensatory movement in another joint.
Our first step, essentially, is ensuring that all of our joints are in fact behaving as joints. What this means is that all of the joints should have appropriate ranges of motion without pain on the closing side of the joint or without compensatory movement dysfunction. As an example, in assessing the kinematics of the glenohumeral joint, elevation of the arm with pain on the top of the humerus (impingement) is a prime example of closing angle pain and is definitely not normal. Excessive scapular protraction and shoulder girdle translation in assessing internal rotation in 90 degrees abduction is an example of movement compensation and is definitely not normal. Both of these situations are very common and are examples of a lack of appropriate differentiation and are amenable to specific articular training. From a motor control perspective it is imperative that we give our athletes progressively challenging movement tasks and observe for abnormal motor strategies. A very basic and common example would be inappropriate scapular loading (upper corner moves upward instead of lower corner moving downward) in a simulated throwing position.
Step #2 – Integrating Differentiation
Integration – the process of incorporating new boundaries in joint kinematics into coordinated movements that are to be specifically trained.
The assessment of each articulation involves a process of observing for appropriate kinematics as well as appropriate motor control. If our athletes can demonstrate an adequate level of motor control competency (control) of their articulations, then we can begin to integrate articulations together and build up the neuromuscular and tissue CAPACITY to handle load within that range. As I have mentioned before, all connective tissue (including bone, tendon, ligament, fascia, and even up to 80% of nerves) respond and adapt to their environment; particularly load (force). Again, using the glenohumeral joint as an example, there is a prevailing thought process whereby we don’t want to push our throwing athletes into further external rotation for fear of creating instability in a joint that may already have micro-instability. This is evident in some training paradigms whereby any exercise that involves external rotation is simply not allowed. To me this is counterintuitive and is exactly why we should safely and progressively load glenohumeral external rotation so that we can achieve a positive adaptation that is protective and allows for the creation of resiliency within the anterior shoulder connective tissues.
Step #3 – Continue Pushing Boundaries
The human body is an open biological system – there is continual energy going into and out of the system and it is in constant negotiation with its environment as per what it needs to be able to handle to survive. To produce purposeful and coordinated movement the central nervous system relies heavily on information that is provided by sensory feedback from our proprioceptive system. A large part of that system are the mechanoreceptors that are embedded within the overlying capsular tissues of the articulations. From a basic neurological perspective, at the initiation of movement and continuing throughout the range of the movement, there is a constant relay of information from the receptors in the joints to the central nervous system concerning things such as spatial awareness, velocity of movement and the amount of force acting on the joint to name a few. With this information the central nervous system selects the appropriate motor solution for the task at hand. If there is a situation whereby there is a limited amount of motion in the capsule of a particular joint, then our nervous system has a limited amount of sensory awareness regarding that joint and all the necessary information provided to it is limited. The resulting motor output becomes faulty and the movement and control of that articulation will not be as fluid or well established. Thus, from an articular point of view it is imperative that we must continually push our athletes’ boundaries for new range, more control, and increased capacity with specific training strategies. As soon as we stop training, or providing a reason to maintain a healthy joint, our nervous system will put the brakes on movement. We cannot let that happen.
Take Home: Differentiate articulations – make sure the joint is actually a joint – before integrating them in movements. As soon as you stop training for control, the body will dismiss newly acquired ranges.
Where and When Do I Implement This?
It is beyond the scope of the article, but this is where the art of programming comes into play. One must be cognizant of the fact that articular health is a priority, but that we can still build general strength and power simultaneously. Systems like the FMS can provide a roadmap for what positions the athlete can and cannot get into for training. It’s a great route to avoid compromising articular health. Done properly, it would not load an articulation in a vulnerable position and would continue to build general strength and power, while simultaneously allowing for motor control correction and building functional range.
My argument here is simple: control of range >> just having the range > improved strength of a limited range. Adding strength on top of a dysfunctional joint, or elsewhere in the system, is a potential recipe for disaster. The greater the range that is under our control, the safer we inherently become. Having said that, our nervous system is limited in it’s ability to adapt. At some point we are forced to prioritize. Whether that is building more range and control versus general strength and power needs depends on the particular athlete, their goals, and their risk tolerance.
We believe that we have swung the pendulum too far and that we need to shift back towards building articular health.
Dr. Stephen Osterer and Dr. Michael Chivers
Twitter: @drsosterer / @drmchivers