Post 9: Prevalence of Oblique Strain in Rotational Sports

          Oblique strains have become a fad injury in the last year or two. More specifically, in rotational sports. This issue first sparked my interest in the ALCS last year when Victor Martinez injured himself hiting a homerun - intercostal strain. We talked a little the following morning about what it is that's causing these guys to blow out internal/external obliques, and in conjunction with a little reading, it's not so confusing anymore.

         Rotation (which only occurs upwards from T8 vertebra) and lateral flexion of the trunk is primarily achieved by engaging the internal/external obliques. So why not train them that way? Well, a few reasons actually. 

1.        It has been common practice for athletes to train rotation with resistance using the obliques on the general pretense that if you can rotate with a 20 pound med ball, imagine how fast you can rotate with a 31oz bat! Because of the crude logistics of this idea, many people have done it for a long time. Now, although this is far from the only contributing factor to oblique injury, consider the following: A serious baseball player spends the better part of his day on the field. He probably takes at least 150 swings a day. A pitcher probably throws just as often towards the ends of his conditioning weeks if you count anything equal and upward of warmup throws. Assuming 150 reps as the on-field volume, add that to the week's resisted rotations in the weightroom. Assume this is 400 reps weekly (50 per side for 4 days.) Unless our hitter is ambidextrous, he's now done 200 reps on his weak side (half the weight room volume,) and 350 reps on his dominant side (including on-field volume.) That's not even considering throws he makes on the field, assuming he's a position player. These left-right differences, or asymmetries are far beyond the ones that occur naturally in the body. Tightening, and subsequent shortening on the non-dominant side for Martinez (a left-handed hitter with a right-side strain) is simply an overuse injury.

2.        Now, it IS true that these muscles are involved in trunk rotation and lateral flexion. However, in the opinion of an AT, PT, or a good S&C coach, the most important function of the abdominal group is spinal stabilization. In light of this, take a look next time at how violent the rotations are in sports like tennis, baseball and hockey. The aggressive rotation of the shoulders and thoracic spine work with aggressive rotation of the hips. These are the ballistic book ends of the core and cervical spine. When these fast torsional forces are applied at either end of the core, as well as the cervical and lumbar spines. This puts the abdominal muscles where they need to RESIST rotation, not ASSIST rotation. Given that this is the case, the old method of training rotation with resistance, should be canned in favor of training against rotational resistance. This trains the core to keep the spine in a neutral and natural position during events involving powerful rotation. What I'm eluding to here is that neutral spine position doesn't allow for core muscles to become unnaturally long or short (providing training volumes are symmetrical, as well as compensation for left or right-handedness.) Consequently, preventing shortening and lengthening injuries (strains) of these rotational core muscles can be achieved by training resistance to rotation. (Sample exercises at the end of this post.)

          Eric Cressey released an article in March last year about oblique strains in baseball. In it, he also talks about training resistance to lumbar hyperextension. Cressey says: "While on the topic, it’s also important to resist lumbar hypextension, as poor anterior core strength can allow the rib cage to flare up (increases the stretch on the most commonly injured area of the obliques: at the attachment to the 11th rib on the non-throwing side) and even interfere with ideal respiratory function (the diaphragm can’t take  on its optimal dome shape, so we overuse accessory breathing muscles like pec minor, sternocleidomastoid, scalenes, etc)." Great Points.

            Cressey also touches on another interesting point in the same article regarding the ability of the hips to produce these torsional forces. He brings attention to the fact that rotational power is concentrically generated by the hip of the trail leg while the lead hip is responsible for eccentrically decelerating the same action. In a nutshell, the antagonistic relationship as it pertains to rotation in this case is identical every time a hitter swings from the same side of the plate. This ties in to today's article because the lead leg can not be expected, as Cressey says, to dissipate all the force generated by the trailing hip. Some of this force is relayed to the core muscles as they function to resist rotation and keep the spine where it wants to be. 

          So, out with the old, in with the new. Dump your rotation with resistance program, and adopt some resistance to rotation. Be creative, but keep the goal in mind. Here are a couple of exercises I like for these purposes. Half Kneeling Pallof Press Half Kneeling Cable Anti-Rotation Press. The second one there looks like rotation WITH resistance, however, pay closer attention. The rotation occurs at the T-SPINE and SHOULDERS, but the core is resisting the rotation that occurs in the shoulders and t-spine, that being said, these exercises still need to be performed on both legs. 

-Alex

Post 8: Mobility as A Component of Training

          To follow up on Post 6: "Foam Rolling & The Kinetic Chain," I decided to post about mobility drills. To re-cap on Post 6, the kinetic chain is basically the muscular connection that dissipates external loading throughout the entire body. This is an amazing natural phenomena that serves us well during training, competing, and generally living life. However, if we do not pay attention to what our bodies tell us, the chain can serve as a catalyst for chronic injuries and eventual sidelining. When we experience things like pain, tightness, and decreased joint range of motion, we need to step back and look at the big picture. For instance, when dealing with tightness or discomfort in the hips, how often do we recognize that the athlete has poor ankle mobility (elevated heels) during his squats in the weightroom? Unfortunately, not often enough. Although this is only one potential cause, it shouldn't be ruled out.

           So what is mobility? Mobility is essentially our capacity to move through voluntary (or active) range of motion about a joint, or a series of joints. Typical problem areas for athletes are ankle, shoulder, and thoracic spine range of motion. When joint ROM is compromised, the body accounts for deficiencies by redistributing the stress to typically less involved muscle groups and joints. The result is never pretty, and the root cause is often improperly diagnosed. Joint capsules have no direct blood flow and are therefore reliant on controlled movement to mobilize their natural lubricants (synovial fluid) and remove waste products and/or mineral buildups from inside them.

          It is unrealistic to expect that ALL athletes will address joint mobility in their warmup without supervision and nagging. So let's address what are (in my opinion) a few very useful movements that can help to get those joints moving the way they need to be. We typically have our athletes foam roll before they even look at a squat rack or platform. After this we spend a few minutes doing some simple ankle, and T-spine mobility. Ankle mobility drills can be as simple as elevating the toes 1 1/2 - 2 inches while standing and tracking the knees over the toes. Basic T-spine mobility can be performed in a 4-point position, and lifting one arm laterally and reaching towards the ceiling. Dynamic stretching involving the hips can work wonders for hip mobility and range of motion prior to training. Personally, I am a big fan of Rob Shaul's "mountain athlete" hip mobility - you can check it out here and here.

           In summary, spending just a few minutes a day incorporating mobility drills and preventative methods into warmups and preparation goes a long way to decrease chronic injury. If we come across chronic and nagging injuries, it is important to not give ALL of our attention to the one problem area. We need to assess other factors that may be contributing to the onset of these conditions, and mobility of the primary movers are a great place to start. There are a number of available programs that are good coaching tools for helping to recognize areas that need improvement. I briefly discuss two systems that are pertinent to identification and restoration of muscular imbalances and the kinetic chain below.

          Gray Cook helped in the release of the the Functional Movement Screen (FMS) back around 1995. The FMS is a battery of tests designed to help coaches identify important deficiencies in their athletes. Using movements such as the overhead squat and in-line lunge to name a couple, athletes attempt to demonstrate mobility and stability. I am currently spending some time experimenting with these assessments, and will post more on our results.

For more on Functional Movement Screening, click here

           Within the last ten years or so, the Postural Restoration Institute has shed light on the fact that the body is asymmetrical, and in doing so has developed a revolutionary set of rehab modalities that can help to reduce detrimental effects that result from the natural left-right discrepancies in the human body. I will post more on this as I gain familiarity with their techniques and methods.

For more on the Postural Restoration Institute, click here

-Alex

Post 7: Functional vs. Sport Specific Training

           Two words or phrases that are too commonly interchanged in the S&C world are "Functional" and "Sport Specific." These are not the same thing. They are similar in the fact that they prepare any given athlete for their events or season. However, they are not similar in purpose. Functional Training creates athletes, Sport Specific Training creates basketball players, runners, hockey players etc.

          Functional training uses exercises that confuse athletes and typically provoke questions like "what does this have to do with (insert your sport here)?" A good answer for these questions is simple: "Exactly." It is functional training. It has very little to do with YOUR - specific sport - (notice how that was just "sport specific" backwards?) Cool. I said in my opening paragraph that functional training creates athletes. Athletes require strength in scenarios different than powerlifters or olympic lifters. Rarely during competition do athletes need strength while they are standing still. They are almost always on one leg, unsupported by something else, off balance, leaning, or otherwise. Starting to sound like the words used in the exercises you do isn't it? Athletes need strength in these unusual scenarios, and that's why we train them that way. Yes you can develop strength through squats, bench presses, and things like that, but the speed of the movement, and the nature of the movement (how many points of support you have etc.) are NOT the same as they would be while competing.

          The brain controls the body, the body controls the movement. If you were to do a heavy squat, you would become stronger in the legs, the brain is trained to recruit powerful muscular contractions to produce force while both legs are securely on the ground and there are no other external factors. Is this newly gained strength useful in sport? Yes, but only to a certain extent. The conditions under which you compete don't typically require this type of bilateral standing strength. Don't get me wrong, I love the squat for developing stength. BUT, as the training season progresses, It's more sensible to train the same muscles by doing things like lunges or bulgarian squats where you can manipulate the range of motion and stance because the mind and body will remember how to produce forces in these positions that are more similar to athletic movement.

          Having said that, being athletic is a universal benefit no matter what your specific sport is, there's those words again, "sport specific." Basically, you can train any athletes using the same quad, hamstring, and glute exercises, but their core exercises will vary depending on what they compete in. For example, track and field athletes will typically use olympic lifts because of the powerful hip, knee, and ankle extension that is used in thrower's "wind ups" and in running. Volleyball and basketball athletes will use the same types of lifts, but with lighter loads and not from the floor because they are required to jump a lot for blocks, rebounds, layups, and spikes. This is what is known as sport specific. Doing these extra exercises ON TOP of building a strong athletic strength foundation is what makes training programs different, and why certain athletes use different exercises based on their sport.

          To tie it all together, functional training is the basis for building strong athletes. Familiarizing the brain and neromuscular pathways with movements that require strength in less than favorable positions creates more athletic bodies. Sport specific training is simply the variance in exercises that relate more to one sport than the other, making you more efficient and competitive at your individual event.

-Alex

Post 6: Foam Rolling & The Kinetic Chain

          Foam rolling is essentially a method of massage therapy that enables the user to control the motion as well as pressure applied. The goal here is to reduce tension in "tight" areas of the muscle by passing it over the foam roller using body weight. Myofascial release is a more technical term to describe this. The entire body, from head to toe is covered in connective tissues called fascia, and this definitely applies to muscular fibers and tissues. As I just mentioned, the fascia is important for maintaining structure and shape of the muscles, and in order to do so the fascia adjusts to the muscle fiber lengths and shapes by becoming shorter and tighter and creating Trigger Points in the muscle.

Fascia at the Glute/Abductors

         
            Trigger points are areas of especially tight muscle due to long term use typical of practice, lifting, and conditioning in athletes. They are also related to the tightness of the fascia within the muscle bellies that surround individual fibers as they adjust to shortened muscles following strenuous exercise. Trigger points are often called "knots" and are sensitive to the touch and in bad cases are even visible as protrusions beneath the skin. This is why it is important for athletes to foam roll before and even after they finish their daily routines. 

           It is important to be proactive when dealing with trigger points because if they are left alone too long, they can have serious negative effects. When tight muscles and fascia are allowed to stay tight, they can begin to have negative effects on adjacent muscles, antagonists, and even joints far from the initial site of pain and inflammation. The body is an amazing machine and will adapt in it's own ways to overcome the stressors placed upon it, even if the way it does this can cause chronic conditions in other areas. 

          The kinetic chain is the relationship of the body's "balance" from head to toe with the hips and pelvic girdle being the central unit. Let's look at an extreme case to illustrate. Say for instance a right handed baseball pitcher stubs his left toe one morning on the bathroom door. He may show a noticeable change in gait (the way he walks) to keep from putting too much weight on that foot. The right leg is now doing more work to let him get to class. The new increase in right hamstring contraction will have an offsetting effect on the hips/pelvis (the central unit) and will likely fall into external rotation on the right side and internal rotation on the left side. From here, he will likely experience tightness in the right lower back due to tightening from the insertion of the erector spinae. Now at the end of his classes he heads to practice and has a bullpen that afternoon, when he throws, he overcompensates with arm velocity through the range of motion to make pitches. After a few sessions the toe is healing, but his body is becoming used to the pattern he has used during these training sessions and he continues to overcompensate with velocity in the arm slot. A few weeks later, he has pain in the rotator cuff, labrum, or even the elbow. All as a result of a painful toe stubbing. 

          Now I'm not saying that unless you foam roll and stretch you will experience a career ending injury, but it is important to listen to your body and heed what it's telling you. This extreme case should provide a good enough reason to address muscle tightness and pain even before it occurs. Foam rolling is a great way to keep the fascia and muscles at optimal resting lengths and decrease the associated pain and discomfort that may hinder performance as a result. 

-Alex

         

Post 5: Week 1 Conjugate Style Program

           Today was the end of week 1 for a program I wrote over the Christmas break. The goal here was to create a westside barbell style conjugate program and this was week 1 of my first stab at it. I realize the volume is pretty low but I dialed up the intensity as best I could to make up for it, and made sure the rest periods were on the clock, allowing for about a minute between sets on dynamic days, and assistance exercises. During my max effort 1RM attempts, I gave myself about 4 minutes between reps once I got up to doubles and singles.

          That being said, I may add a 5th day strictly for purposes of upping the volume for the week. If that doesn't seem to work, I might just add an extra exercise for rep method movements (tricep, delt, upper back, hamstrings, low back, core.) Generally, I felt pretty satisfied with my workouts each day, about 45-60 minutes per workout, but if I'm not feeling totally wrecked tomorrow I might add the extra volume I just mentioned. I started on Day 2, but only because I hadn't maxed out on a squat in over 6 months. You'll also notice that for the core exercises there is no 1RM value for deadlifts, and I plan on knocking those out early next week. I originally wrote this program for only 4 days/week for 4 weeks, but as we noticed when I brought it into the office last week, I could probably use it from anywhere between 8 and 16 weeks if i used each workout for 2 weeks or cycled back to the first week 4 times.

          Anyways, there it is for now. I will follow up this weekend or next week when I make a decision on whether or not to add the extra volume.

-Alex