Archive for March, 2014

Shoulder and elbow injuries are far too common in throwing athletes.  Approximately 1/3 of pitchers between the ages of 9 and 18 suffer a pitching related injury.  With injury rates that high we are all failing the athletes that play America’s favorite past time.  I played baseball competitively up until I was 18 years old and I cannot remember one time a coach teaching me how to properly throw a baseball.  From a mechanics standpoint, throwing a baseball is an extremely complex task.  In order to understand it we need to understand a few basic movement principles.

Our shoulder joint is a complex structure made up of 3 bones: the humerus, scapula, and clavicle.  The head of the humerus sits in a socket-like structure on the scapula called the glenoid cavity.  This is known as our gleno-humeral joint (GH).  Surrounding muscles and connective tissue are responsible for keeping the head of the humerus in the glenoid cavity.  Any miscommunication or imbalances between these muscles can lead the humeral head to move improperly in the glenoid cavity.  

The rest of the scapula sits on our thorax and this is known as the scapulo-thoracic joint (ST).  During GH movements the scapula should move smoothly along the thorax.  According to Sahrmann, clinical observations suggest that most syndromes of the shoulder arise from impairments in the timing and control of the scapula (Sahrmann, 2002).  The scapula’s normal alignment should be 3 inches away from the spine between t2-t7 with the medial border (border closest to the spine) parallel with the spine. 

During 180 degrees of shoulder flexion we need 60 degrees of upward rotation of the scapula.  If we have inadequate upward rotation of the scapula and weakness in the two rotator cuff muscles, the infraspinatus and teres minor, that are responsible for pulling the humeral head down into the GH joint when the arm is flexing overhead, we will experience impingement.  Neer described in 1972 a continuum of shoulder issues that begins with impingement and ends in rotator cuff tears.  Also, if our scapula is not aligned appropriately from the start then it will alter actions of the shoulder.  For example, an athlete has tight rhomboid muscles that cause the scapula to start in a downwardly rotated position then it will require greater then 60 degrees of upward rotation to counteract that faulty alignment.  This too can lead to shoulder injuries down the road.

In order for our scapula to function properly we need adequate thoracic mobility.  Postural malalignment such as forward head and excessive kyphotic curve of the thoracic spine lead to malalignment of the scapula, which leads to dysfunction.  A literature review of 150,000 articles concluded by stating that we need to understand the kinetic chain in order to fix dysfunction of the shoulder (http://www.logan.edu/mm/files/LRC/Senior-Research/2011-Aug-12.pdf).

In a nutshell the kinetic chain is how all of the muscles in our body are integrated.  Muscles communicate with one another and the brain through fascial attachments.  Fascia are sheaths of connective tissue that actually contain contractile units, neurons, and blood vessels.  They are the electrical component of the human movement system.  When muscles become weak or injured the fascia, through two-way communication with the brain, will have other muscles take over and do extra work.  This is how movement impairment occurs.  However, the dysfunction does not end there.

We need proper ankle mobility, knee stability, hip mobility and stability, lumbar stability, thoracic mobility, scapula stability, GH mobility, and cervical stability.  Let us look at a common scenario.  We sit down all day long which leads to shortened hamstrings and weak glutes.  Our glutes are our strongest hip extensors, but in this scenario our body will begin to use the hamstrings as the primary hip extensors due to their shortened state and the weakness of the glutes.  This causes our pelvis to be pulled down and away from the lumbar spine causing back pain.  Then we decide to go for a run after work.  From sitting all day glute medius becomes weak.  Our fascia and brain communicate this and this leads to another muscle, our TFL, becoming overactive.  Our TFL inserts into our IT band, which then inserts into our knee.  When overactive our TFL can cause anterior shear forces on the knee and we suffer from anterior (front) knee pain.

Let us look at our youth baseball players.  They sit down hunched over a desk all day at school and then come home and assume a similar posture to watch TV and play video games.  This leads to infraspinatus and teres minor becoming elongated and weak, internally rotated humeral head, increased kyphotic curvature of the thoracic spine, shortened hamstrings, and weak glutes.  This prolonged posture alone is going to lead to both shoulder and hip dysfunction.  From there they go to baseball practice and repeatedly practice this dysfunction without ever being coached.

They then enter the gym and bench press, perform bicep curls, and tricep extensions to strengthen their shoulder and elbow muscles.  The problem is this is not how these muscles are integrated to work together during a throwing motion.  We first integrate these muscles together during crawling.  They all work together to pull the torso and scapula over the stance arm supplying balance.  Now think of the lead arm while throwing.  They play important roles with the rotator cuff muscles to stabilize the scapula and pull the humeral head into its proper place in the glenoid cavity.  In the throwing arm we need the same support from the surrounding musculature.  The pecs then help stabilize the spine and aid in torso rotation to throw.  If we have tight pecs or an internally rotated humeral head it will limit our ability to externally rotate our shoulder properly, lead to dysfunction and asymmetry in rotation and in time we will develop injuries.

We also need proper timing between the deltoids and rotator cuff.  The rotator cuff muscles need to fire first to pull the humeral head into an optimal spot.  Front raises and lateral raises are popular exercises being done in the gym for the shoulder.  When infraspinatus and teres minor become weak the supraspinatus (another rotator cuff muscle) has to pick up the slack.  This will lead to impingement and down the road a rotator cuff tear.  All this athlete is doing in this scenario in the gym is further engraining their dysfunctional movement.

This does not even begin to scratch the surface of what can go wrong in throwing a baseball.  Breathing, eye position, the anterior and posterior oblique chains, deep longitudinal system, and lateral system all play critical roles in the complex movement of throwing a baseball.  We will dissect all of these as well as throwing mechanics in upcoming articles.

 

 

Here is my latest article on Breaking Muscle  http://breakingmuscle.com/nutrition/your-food-and-your-mood-carbs-depression-and-cognitive-decline.  It discusses how your diet may be negatively altering your mood and the long term risks associated with it.

Want to learn more about brain chemicals that control mood, weight, and appetite?  Check out my guide to your neurotransmitters and interview here, http://www.ameerrosic.com/secrets-to-controlling-your-weight-cravings-and-mood-quick-guide-to-understanding-neurotransmitters/

I am a part of the upcoming Health Warrior Summit.  In my interview with Sarah Olson I discuss why a calorie is not just a calorie and how our modern day environment is leading us to crave for junk foods.  Along with my interview are 21 other interviews with top practitioners in the field.  Sign up today before spaces run out!  http://healthwarriorwellness.com/summit-KevinCann

Everyone enters the gym with hopes of losing weight and getting bigger, faster, and stronger. This is usually attempted with no regards for movement quality. All too often we go to the gym and just go through the motions of doing exercises without ever thinking about it. Not to our own fault, but that is how the entire field of exercise is set up. Magazine articles claiming results in just a few weeks and even the educational system for personal trainers is lacking a true understanding of human movement.

Developing proper movement patterns begins right from birth. During growth and development we go through a progression of movement patterns known as primitive movement patterns. They are supine support, rolling, pushing up, quadruped, and crawling. These fundamental movement patterns lay the foundation for quality movement as an adult. The inability to perform these movements can increase injury risk and decrease performance.
We develop dysfunction from poor sitting posture, sleeping posture, being sedentary, wearing sneakers, etc. Then we go to the gym and further ingrain this dysfunction. Push-ups and planks are two of my favorite exercises to perform, but they are two of the most poorly performed exercises in the gym. Next time you are working out look around at people’s posture during the exercises. There will most likely be flaring of the scapula (the medial border of the shoulder blade moving away from the thorax), winging of the scapula (inferior angle pulls away from the thorax), and/or increased lumbar lordosis
winged-scap-1

As you can see in the pic above, the scapulas are coming away from the back. That is a lack of scapula stabilization. The more he does planks and push-ups in that position the more the dysfunction becomes ingrained. The same applies when we see an increased lordotic curve in the lumbar spine. This is loss of spinal stability. We learn spinal and scapula stabilization through those primitive movement patterns.
Primitive patterns reduce the balance and stabilization requirements to allow for proper development. It takes less balance and stability in supine support then in does in crawling. There is also increased proprioception. We learn a lot from our environment from our hands and feet. We can also learn about proper spinal alignment through contact with the floor. Primitive movement patterns also limit available movements.
For example, when crawling one arm needs to stabilize the body. This is not the case while walking. This all allows for proper learning to take place. Due to our environment we lose the ability to perform these simple tasks because we never practice them. You cannot be an elite athlete sprinting, changing directions, and jumping if you lack the ability to crawl. You may develop the necessary speed and strength for a sport, but injury risk will continue to rise as you get older.
Most exercise programs neglect these fundamental movement principles. Instead they focus on contractile strength of an individual muscle groups, or exercises that place too much load or metabolic demand on movement patterns the athlete or client cannot control. This is why an assessment is such a critical piece of developing an exercise program.
If there is pain or an inability to perform fundamental movements without load or metabolic demand we need to regress and retrain these primitive movements. The majority of people have lost the ability to stabilize the spine. Retraining this also requires relearning how to properly breathe.
Most of our organs are on our right side. When we sit down we compress everything and this limits our diaphragm from actually expanding. This leads to secondary muscles taking over respiration. These include pec minor and our sternocleidomastoid (SCM). When these muscles become overactive they can lead to improper shoulder function. Just stretching or doing soft tissue work will not fix the underlying movement dysfunction. The same goes for the hips.
Improper breathing patterns limit our ability to stabilize the spine. Couple this with sitting all day in a posture that leads to tight hip flexors, inactive glutes, tight hamstrings, and elongated lumbar muscles and we have a recipe for back pain and limited performance. Stretching the hamstrings in this case will not work because it does not address the underlying movement dysfunction. Retraining spinal stabilization and getting the glutes to be more active will release tension in the hamstrings. Principles we will get into at a later time.
I like to retrain breathing patterns with a straw in a 90/90 position while performing shoulder flexion. 90/90 simply refers to the knees being bent to 90 degrees and the hips flexed at 90 degrees. With the feet on the wall and squeezing a foam roller between your thighs, fill your belly with air and exhale through the straw as you bring the shoulders into full flexion while maintaining your back and pelvis on the floor. I like 90/90 here because it retrains posterior tilt of the pelvis. From sitting all day a number of us develop anterior tilt (pelvis rotates forward). It also teaches us proper spinal alignment while moving through the proprioception of the floor while retraining proper shoulder movement. Here is our supine support.
Rolling helps us to develop strength and balance. It teaches us how to absorb higher impact such as jumping and also plays a critical role in training our vestibular system. Ever get dizzy from bending down and standing up? Perhaps your vestibular system needs to be retrained. Try rolling and if your head needs to come up off of the floor to power through it, or if the grounded arm or leg needs to assist then we need to work on this movement pattern.
As a baby once you learned how to roll you earned the right to crawl. Crawling helps us further establish stabilization and strength. We raise our center of gravity up and begin a contralateral movement similar to walking but with less stability requirements. Crawling trains our shoulder and hip function to properly stabilize and move during gait. Problem is once we walk we never go back to crawling. We lose this ability and continue to live life and exercise with this dysfunction, making the dysfunction even stronger. Our biceps and triceps have tendon attachments on the scapula and during crawling they are responsible for pulling the scapula over the stance arm. Too often we neglect their importance in proper shoulder function and train them to only flex and extend the elbow.
Once we have mastered crawling we can begin to learn the adult movement patterns. In my next blog post we will cover the transition from crawling to standing using half kneeling position. Until then, play more like a kid and roll and crawl around!

Red meat has been demonized once again in the media.  Is this warranted?  Find out here. http://breakingmuscle.com/nutrition/is-red-meat-really-dangerous-or-do-we-actually-need-it

I have been a little sporadic as of late on blog posts, but do not worry I will be getting back after it.  My articles the last few years have focused solely on nutrition.  Those articles will continue, but I am going to add another critical piece and begin writing more frequently about the science of human movement.

Many of you probably do not know that my Master’s degree is actually in human movement and I have roughly 10 years experience as a strength coach.  Orthopedic surgeries cost the United States roughly $215 billion annually.  The majority of this is completely avoidable.  Low back pain, knee pain, hip pain, shoulder pain, and the replacements and surgeries that come from these are caused from prolonged moving around with bad mechanics.

My articles will focus on the role of primitive movement patterns in developing adult patterns.  Every movement we make as a baby serves a purpose in the neurological development of more complex movements.  We can use these primitive patterns to help redevelop proper movement function.  Once we develop proper function we can begin to train to become elite in these patterns.

Too often exercise enthusiasts and personal trainers disregard the importance of proper movement and just train to become elite.  They may get bigger, stronger, and faster, but they are getting bigger, faster, stronger in compensatory movement patterns.  This will catch up to them with increased pain and increased risk of injury.  We even see this at the collegiate and professional levels.

Derek rose was an NBA MVP a couple of years ago.  He has barely played any games in the last two years due to a torn ACL and subsequent set backs post-surgery.  Derek Rose has suffered from anterior knee pain is whole life.  A good strength coach could have spared him a lot of pain and major injuries.  Non-contact injuries are on the rise in sports, and this includes youth sports.  These injuries are preventable and with proper movement training we can spare the future generations a lot of costly pain and suffering.  this includes athletes and non-athletes.

In my next post we will begin to gain an understanding of primitive patterns and how important diaphragmatic breathing is to movement skills.