The Four Myths of Youth Baseball Injury Prevention

I recently spent a weekend with many high school baseball players as part of a summer academy here in Southern California. The experience was great—the teaching, instruction on technique and performance, as well as lessons on leadership were memorable—and wow, these kids are great players, too.

I had a chance to speak with a lot of the players, not only on some of their minor varied injuries, but to address injury prevention as a whole with the players. As I reflected on my time speaking with the coaches and players, it was apparent to me that there is a lot of myths regarding injury prevention and overall arm care. These myths seem to be perpetuated by travel ball coaches and the media.

I wanted to briefly address some of the main myths that I have seen or encountered that may be prevalent in other communities or teams. These myths don’t represent any certain team, organization, or specific area, but include a collection of thoughts that I think can be very helpful for parents, coaches and players alike.

 

Myth 1 – “Rest is Rehab After an Injury”

One of the most interesting conversations I had with an athlete this past weekend was regarding a previous injury that he sustained to his shoulder.

He told me that he was instructed to “shut it down,” and rest from baseball activities. He said he did just that, for two months. I asked the athlete what type of stuff he did during that period of inactivity from baseball.

He quickly told me, “nothing, I rested and felt better afterwards.”

While a period of rest is important, particularly to curb the cumulative “microtrauma” that is taking place over the course of a season or summer, rehab should always be an active process.

As an athlete, especially during a “resting” phase after injury or even between starts or tournaments, there should always be a varying level of rehab that does not include throwing the baseball. Throwing a baseball should be reserved for certain activities that may include bullpen sessions or mechanics-driven instruction.

However, I would stress to all the youth players a few things. It’s incredibly important to not focus on just the “reactive” side of injury. This includes the “my shoulder hurts” or “my elbow is really tight and bothersome.”

Instead, focusing on a “preventative” approach is often more beneficial. In this way, we can work on keeping arms healthy and prevent future injury, as opposed to just addressing an athlete who is in pain.

To reiterate, “resting” during a baseball season or during a period of injury, should not be completely passive. This should not be complete rest. This should be relative rest.

Relative rest includes soft tissue mobility to restore range of motion or resistance band work to increase muscle activation. Baseball players should continue to improve the resiliency of their bodies and arms to tolerate the stresses of playing baseball during the times in which they are not actually playing.

 

Myth 2 – “Playing Year Round Builds Strength and Ability”

In my opinion, one of the greatest threats to the health of a youth baseball player, is simply playing baseball year-round.

By playing baseball during the entire course of a year, the athlete never has the opportunity to halt the cumulative microtrauma of throwing a baseball over the course of a season. Year-round play also prevents the ability for a true off-season to rest and address deficits in strength and coordination that can actually help baseball performance.

Dr. Glenn Fleisig of the American Sports Medicine Institute in Birmingham, AL, best describes this level of sports participation in a 2012 article stating that pitching competitively more than 8 months per year increased the odds of surgery by 5 times. That’s truly startling, and represents one of the easiest ways to avoid injury – don’t play as much.

While I do advocate for having a period of no baseball throwing, I think it is still important to perform active exercise, especially for the core and the lower half. Proper training of the core and lower half can reduce the athlete’s risk for injury. This is similar to the first myth. Rest does not mean do nothing.

Lastly, throwing all year can obviously bring upon concerns of arm fatigue. Dr. Fleisig continued in the same article above by reporting that a pitcher who regularly pitches fatigued was 36 times as likely to require surgery.

While these numbers are staggering, they both represent modifiable ways that we can avoid injury. In other words, playing year-round and playing fatigued are both factors that can be avoided through proper communication.

 

Myth 3 – “Throwing Faster is Due to Just Weighted Baseballs”

Velocity is the name of the game, especially in youth baseball. Athletes are infatuated with how fast they can throw, as they believe that it is the sole determinant of success and college opportunities.

We are truly in the “velocity era,” in baseball now. Injuries occur more and more, not only in terms of frequency, but as well in a variation of the type of injury.

This article is not necessarily to address the benefits or disadvantages of weighted baseballs, I want to briefly touch upon the misconception that arm strength via the use of weighted baseballs are the ultimate solution.

I believe that aside from improving mechanics, which can easily stress the shoulder and elbow in ways that are potentially harmful, lower body rotational strength, improving muscle mass, and increasing generalized body weight in an effective manner are the most critical factors towards improving velocity.

While arm strength, a resilient rotator cuff, good shoulder range of motion, and adequate thoracic spine mobility are all important to tolerate the demands of throwing a baseball, developing a powerful lower half rotational component can greatly impact the force that is even able to be dissipated through the arm.

Lastly, I spent a lot of time with skinny baseball players this past weekend. Granted some of these kids are only 15 or 16 years old, but a few of them can throw in the upper 80’s. While this is fairly impressive, I can only imagine the improvements in velocity that will simply take place from not being 140 pounds.

Young athletes can easily get caught up in the newest training tools such as weighted baseballs, but the easiest way to develop velocity without actually throwing is to improve lower half strength and rotational power in addition to simply becoming bigger and stronger by gaining effective muscle-dominant weight.

Everything else is just gravy.

 

Myth 4 – “Innings Pitched in Different Settings Don’t Aggregate”

One of the most troubling conversations I had with a youth athlete this weekend was with one who had shoulder discomfort. He told me he made over 20 outings this past season as a starting pitcher during his high school season and that he recently participated in a weekend college showcase by throwing 95 pitches.

Admittedly, the athlete told me that he was fatigued and sore, but he felt that the pitches thrown recently in the showcase should be considered differently than the ones he threw recently as his high school season ended.

It’s important to note that all pitches count towards the cumulative stress on your throwing arm, whether it be during a live session or simply to the catcher as part of a bullpen setting.

Dr. Fleisig reported in the same 2012 article that averaging more than 80 pitchers per game at the youth level almost quadrupled the chance of surgery.

I often tell young players that they need to be their greatest advocate. Understanding and communicating their pitch counts, conveying feelings of fatigue, and being able to say “no.”

 

Final Thoughts

While these myths represent a brief snapshot of conversations I had this past weekend, other players, coaches, and health care providers can probably relate to these myths in some way.

Ultimately, from an injury rehab profession perspective, I think a lot of our attention is towards injury reaction and rehab, when it should shift to injury prevention with a good grasp of the modifiable injury risk factors for optimal baseball performance moving forward.

Is Heavy Lifting Good For Pitchers?

If you look around social media, you’ll see that more baseball pitchers are lifting “heavy.” This is, in general, a good trend – pitchers were coddled and treated with fragility for years.

But, pitchers are different – different than position players, and they’re different than other athletes in general.

But, how different are they? Is heavy lifting good for pitchers, in the same way that it’s good for other athletes? Let’s discuss.

 

First: Is Lifting Heavy Even A Real Distinction?

Honestly, it’s a stupid, often meaningless term.

As far as I can tell, it simply means that a person tries hard to lift weights. If you lift consistently and try hard, well, then by default you’ll get stronger, weights will get heavier, and there you go – progressive overload eventually leads to heavy weights.

Really, “I lift heavy” just means “I do what I’m told and I try to get stronger in a progressive manner.”

For players who have been in a decent college program, they get this by default. Most large programs with good strength coaches have their baseball players – including pitchers – do the big compound lifts like chin ups, squats, deadlifts, etc.

One who defines himself as “a pitcher who lifts heavy” is really just a pitcher who enjoys lifting and pushing himself more than others. The heaviness of it is partly just a choice to keep progressing.

Remember: if you can only squat 150lbs, you can’t just choose to lift heavy one day and squat 315. It takes time.

What’s actually important, though is this: When a pitcher draws the line.

 

When Lifting Heavier Becomes Riskier than the Reward

We need to look at the big picture.

The problem is, what you’re doing today may not be hurting you precisely today. But, it may be eating away at you. Ask a career distance runner – his knees felt fine at 20, 30, 40, maybe even 50. But by 55, he has no cartilage left and is in chronic pain.

Missing a rep trying to get up a 455lb deadlift today may not hurt anything but pride. But, here’s what it’s doing to an arm that’s extremely valuable to a pitcher:

  • Passing tremendous strain through the forearms, elbows,
  • Passing tremendous strain through the biceps tendon (which attaches to the labrum)
  • Passing tremendous strain through the back, shoulders, spine
  • Building a large, thick upper back that may not be good for shoulder mechanics and flexibility

 

Now, the SAID principle states that the body responds to the demands placed upon it. We know this to be true – do enough push ups, and your chest will grow bigger and stronger to do the job more efficiently and protect the tissues from being damaged by the activity.

Specific

Adaptations to

Imposed

Demands

 

If we want our pitching arm to be stronger and more resilient to injury, we have to impose stress on them, and weightlifting is a great way to do this. Think about rock climbers – they have the strongest forearms and fingers on the planet, because they impose the task of clinging to tiny holds on the face of a sheer rock.

Yet, rock climbers have injuries – though fiercely strong, forearm muscles tear and tendons pop. The body must recover and keep stresses below the failing threshold of the weakest tissues in the chain. The very thing that made them strong also breaks them down.

 

When Is Heavy Too Heavy?

I’ve worked with many, many young baseball and softball players as a full-time strength coach. It frustrates me that countless young kids imitate college players and the clients of very green trainers; they want to work out exactly as they do, because it looks cool on Instagram.

Just because it may work for one player (or appear to be working today) does not mean it’s good for that player long-term, or good for others at all.

Bro! Pitchers should lift heavy, bro!

Before I tell you what I think is too heavy, I’m going to tell you: I’ve seen firsthand how my strength training programs have affected hundreds of young pitchers, unlike many internet-only trainers. I adjust workouts each month in my academy, especially as their throwing volume changes. It’s complex and learning how to optimize an athlete’s workout in person is important.

I’ve seen firsthand how complaints of elbow pain decreased when I lowered the volume of heavy deadlifting, overhead pulling, and farmers carries. All are great exercises to build strength, but can make throwing arms angry.

Yet, getting strong is important. There are three phases that determine if you need to keep pushing, or start backing off to maintain strength and reduce injury risk.

 

Foundation Phase: Large Upfront Gains

Athletes with a low training age (0-3 years) are going to make large performance gains – including throwing harder – by getting stronger and putting on muscle, provided their flexibility doesn’t suffer too much.

This means getting big lifts up to:

  • Squat: 1.0x bodyweight on the bar for 8 reps
  • Romanian Deadlift: 1.0x bodyweight on bar for 12 reps
  • Trap Deadlift: 1.5x bodyweight on bar for 6 reps
  • Front Squat: 1.0x bodyweight on the bar for 8 reps
  • Barbell Hip Thrust: 2.0x bodyweight on bar for 8 reps
  • Chin Ups: 8 reps from full hang with no assistance

 

Johnny Wholstaff, a fictional pitcher who is 16 years old and weighs 160lbs, should hope to be able to:

  • Squat 160 for 8
  • RDL 160 for 12
  • Trap Deadlift 240 for 6
  • Front squat 160 for 8
  • Hip Thrust 320 for 8
  • Do 8 chin ups.

 

These are good benchmarks for a pitcher aged 13-21 with a low training age, and he will see good results from reaching these milestones. Use them as a guide, not as an absolute.

 

Intermediate Phase: Higher Weights, Diminishing Reward

Once a pitcher can check off all the above big lift benchmarks, usually after 3-5 years of training, he’ll enter an intermediate phase where he is:

  • Pretty strong
  • Pretty good at lifting, as far as technique is concerned
  • Still seeing performance increases, but at a lower rate

 

We are all aware of diminishing returns, and they start to show up here – we’re now fighting for smaller incremental gains in performance. That’s okay! – keep going. Now, we’re building to fill our strength and power “bucket.” Go beyond the recommended weights we had before.

But, that bucket is getting full…

 

In the graphic above, courtesy of Mike Reinold, he was explaining that athletes need a routine that establishes balance – they need strength, but not at the expense of other things like arm care, or good mechanics.

Likewise, pitchers need to throw and have good mechanics, but can’t throw so much that they leave other areas underdeveloped or bodies over-stressed.

As the strength bucket fills, injury risk increases, as tissues are getting stressed much higher to squeeze out ever-smaller performance gains.

 

The Maintenance Phase

Okay. Now, you’re a high school senior, college or pro pitcher. You’ve got a moderate training age (3-6 years) and you’re pretty strong. You weigh 175-220 lbs. If you can lift the goal weights we discussed, it’s time to start allocating more of your time to different things.

Why? Because…

  • You’re strong enough
  • Injury risk is high
  • Performance gains through weightlifting are now very low
  • The risk vs reward is no longer worth it

 

You deadlift 445lbs. You want to get to 495.  Okay – why? What will that do for you? Add more velocity? Probably not. Improve your slider, curve or changeup? Nope. Improve your command? Nope.

Okay. So why? To be the best at weightlifting? To earn a pride button for being the strongest pitcher in the bullpen?

Personally, I reached this phase at age 21, but didn’t know it. I realized it at age 25 and when I did, I started allocating more time to other things, other than simply lifting heavy weight. I had filled my strength bucket and making it overflow wasn’t going to make me a better pitcher.

Are you a powerlifter, or a pitcher? Once you can do the following, it might be time to move on and start allocating less time to strength work and more time to other types of training:

  • Trap Deadlift or Regular Deadlift: 405lbs x 3 reps
  • Squat: 365 x 5 reps
  • Front Squat 335 x 5 reps
  • Chin Ups: 15 bodyweight reps, which is equal to around 5 reps with 50 pounds added
  • Barbell Hip Thrust: 405lbs for 8 reps
  • Farmers walks: 40 yards with 120lbs per hand
  • Bench Press: simply not an important measure of strength for a pitcher.

 

My Recommendations For Pitchers:

Pushing to ultra-high weights on any given lift will have a negligible effect on pitching prowess. It will almost certainly make your arm irritated if you’re lifting that way while pitching at even a moderate volume. And, the risk versus reward simply is not there.

Lifting consistently and progressively (which ultimately means heavy) is great. Yet, it’s important to know when to say when.

 

Key Takeaways

  • Get a program from a trainer who has played the game him or herself, or has worked with a lot of players in real life.
  • More isn’t always better, and there is a definite point of diminished returns that affects risk and reward.
  • Exercises should fit the athlete, not the other way around.
  • When returns are so diminished that they pale in comparison with the risks, then it’s time to back off, move on, or choose new exercises
  • Realize that the goal is the sport, not being the best at lifting.
  • There are countless ways to build explosiveness without the Olympic Lifts, which are sometimes deemed “essential.” No exercise is essential – exercises are merely tools and multiple tools can do the same job.
  • Be careful of the monkey-see, monkey-do that is all too prevalent on social media.

 

Want More Pitching Help?

Check out two of my best resources, both of which are completely free:

 

How to Throw a Hammer Curveball YouTube Video Course

Go here to check out my free online course hosted as a playlist on YouTube.

 

The Pitchers Development Checklist

Go here to get the free checklist to figure out if the pitcher in your life is doing everything he should be to reach the next level.

 

Thanks for reading. Leave a comment below!

Determining Individual Stability Needs for the Baseball Player

I was having a conversation with one of my players the other day about his body. He’s been having trouble with his front shoulder “popping out” whenever he finishes a swing, and it’s happened multiple times throughout his high school season. He continued to tell me that his school trainer and the orthopedic said that he shouldn’t be stretching at all because that is only going to hurt him. I continued to say, “I couldn’t agree more”.

I then get looked at like I have 2 heads. So, rather than writing the dialogue of this conversation I was having, it gave me the idea to write a post on this concept of mobility and stability needs in the baseball population.

 

The Laxity Test

The Laxity Test is a great tool to use to determine if someone is loose-jointed or not. The only other tool you need is your eyes, making it super simple to administer.

More specifically, it is commonly known as the “Beighton Hypermobility Score”. The only disadvantage of using this test is that the “scores” are not quantifiable. It is either a yes or no.

The tests are used bilaterally (both sides of the body) totaling for a score out of 9. Let’s go over them one by one with pictures of all the tests listed below from physio-pedia.com.

 

Passive hyperextension of the 5th MCP joint beyond 90 degrees

In other words, this is when the pinky can reach vertical when the palm is flat on the ground.

 

Passive opposition of the thumb to the forearm

In other words, this is when the thumb can be pulled towards the inner aspect of the forearm.

 

Passive hyperextension of the elbow beyond 10 degrees

In other words, this is when the elbow extends outward from the body and the hand is slightly below the line of the elbow.

 

Passive hyperextension of the knee beyond 10 degrees

In other words, this is when the knee extends behind the body and is behind the line of the hip.

 

Active Forward Flexion of the Trunk

This is performed with the knees fully extended so that the palms rest flat on the ground

 

Previous researchers have determined that a score between 4-9 shows that the individual has ligamentous laxity within the joints, while other researchers determined a 3/9 to be the case, and other researchers determined a 6/9 to be the case (physiology-pedia.com)

 

Applying the Beighton Score

Basically, no one can agree on anything! Use your own judgment here. Ask a lot of questions with the athlete. When I perform evaluations with my athletes at Infiniti Sports Performance, I assess laxity in their joints. Then I ask these questions:

  1. Do you find that you don’t need to stretch a lot before a game?
  2. Are both of your parents flexible? Mother? Father?
  3. Do you mostly feel “tight” or “loose” before a game?

Believe it or not, general ligamentous laxity (GLL) can be genetic!

In a study investigating the relationship of GLL with acute and chronic shoulder injuries with athletes, the results showed that those with GLL had higher incidences of shoulder pain, chronic shoulder injuries, and shoulder instability in comparison to those who did not have GLL (1).

To keep the individual athlete healthy and on the field, it’s important to determine where they fit on this mobility vs stability spectrum.

For those with GLL, you must be EXTRA strict on keeping your shoulder healthy and stable. Adding more shoulder stability exercises into your arsenal and performing some band work before a game might be the missing piece that keeps you on the field longer!

 

Reference

Saremi, H., Yavarikia, A., and Jafari, N. (2016). Generalized Ligamentous Laxity: An Important Predisposing Factor for Shoulder Injuries in Athletes. Iranian Red Crescent Medical Journal.

SLAP Injuries in the Baseball Player: Classification and Subjective Evaluation

A superior glenoid labrum injury is a common reason for shoulder pain in baseball players.

These injuries were initially explained by Dr. James Andrews in 1985 secondary to a biceps tendon origin pathology. The injury is described in that the biceps tendon exerted a traction-like force to actually “peel” the labrum off the glenoid structure, itself.

These superior labral tears, anterior to posterior (SLAP), have several different types can be stable or unstable that are under the umbrella that was previously described that result in the “peel back” etiology.

One can also back the argument that due to the high loads of eccentric contraction that occur in the late cocking phase of throwing most baseball players (pitchers in particular) have some level of a SLAP tear or superior labrum lesion that is, for the most part, asymptomatic in nature. Some SLAP tears may even be considered necessary adaptations to the throwing shoulder for baseball players.

Taking a brief look at the pathomechanics of the throwing motion and the underlying structures, one can quickly understand why the anterior portion of the labrum is under immense stress.

During throwing, particularly in late cocking phase at maximal external rotation, the humeral head will shift from a posterior to inferior direction. However, in these types of overhead athletes who likely already have anterior capsule laxity, the shoulder will have exhibit a greater willingness to shift the humeral head in a posterosuperior direction.

This directional-preference the shoulder takes subjects the superior labrum to greater load, particularly in a torsion-manner.

There’s several different types of mechanisms that can be explained by many different types of classification systems. For now, let’s take a look at the different mechanisms as described by Snyder for these types of injuries:

 

Classification of SLAP Tears

The original classification was proposed by Snyder in 1990, where he bunched SLAP tears into four primary mechanisms:

Type 1: These types of lesions are best characterized by degenerative fraying of the superior labrum with not only an intact, but stable biceps tendon. Snyder noted that this type of variant classification was present approximately 11% of the time. These types of lesions are most consistent with a rotator cuff pathology.

Type 2: These types of lesions include a detachment of the biceps anchor from the glenoid that are unstable in nature and are considered the most common variant encountered. Snyder stated that these represent 41% of all SLAP injuries.

Type 3: These types of lesions include a “buckethandle”-like tear of the superior labrum without disruption of the biceps tendon anchor. However, the bucket-handle can become mobile and become entrapped within the glenohumeral (shoulder) joint, creating a very painful clinical picture. This type of lesion is consistent with traumatic instability, in addition to a Type 4 tear.

Type 4: These types of lesions also include the “bucket handle”-like tear of the superior labrum. However, this type of tear also includes an unstable biceps tendon. It should be noted that the level of biceps involvement in this type of lesion can be extremely variable. This type of lesion is the least common variation of a SLAP tear.

 

Subjective Examination Pearls

Examination of an athlete with a SLAP tear that is pathological in nature can be very challenging. It’s likely that a patient who has sustained a SLAP lesion has another present injury. This may include a concomitant rotator cuff injury or even a Bankart lesion of the anterior labrum.

A great subjective examination is key to truly developing a great conclusion of what the patient has going on.

However, a subjective examination can become very difficult as the mechanism is often different in players. It may include a single traumatic event or can be gradual over time as part of an insidious etiology.

Amongst all athletes, the most common clinical symptom that will be apparent is anterior shoulder pain. These can lead to performance issues such as decreased control while throwing or even a decrease in throwing velocity.

The patient may also note an increase in clicking or other types of mechanical symptoms.

While certain types of labral injuries can involve concomitant instability, most SLAP tears in isolation are not unstable in nature.

Altogether, while the subjective examination can be challenging, it’s ultimately imperative to understand that these types of injuries are commonplace in baseball players. In many players, SLAP tears are asymptomatic and not a concern.

5 Ways to Strengthen Your Adductors

When it comes to your adductors, or groin muscles, stretching is one of the most common go-to interventions to keep you from straining or pulling your groin. Stretching is one of the tools we use, but how do we strengthen your groin and adductor muscles?

This article will breakdown additional ways to help you strengthen and keep your adductors healthy.

If you are not a subscriber to Esposito Strength Club, make sure you click here to subscribe so you don’t miss out! You will also get access to all of my Free Online Baseball Courses!

 

What Are Adductors

The adductor muscles (inner leg) are a group of 5 muscles that attach to the pelvis. The adductor muscles play a crucial role when it comes to performance, especially for baseball players. The adductors assist with back leg drive, separation, and hip extension. This includes explosive movements such as jumping, sprinting, and throwing.

For example, pitching requires the adductors of your stance leg to eccentrically stabilize while you drive towards the plate. Then the stride leg adductors have to stabilize as you drive your stride foot into the ground and transfer energy from the ground up to the pelvis, torso, and arm. Once you release the ball, your adductors must eccentrically slow your body down.

Slowing down one of the most violent movements in sports like throwing a baseball is a total body movement. When an area of the body is compromised, other locations will pick up the slack such as tendons and ligaments.

 

How to Stretch Your Adductors

Groin strains often happen with a sudden lengthening of the groin muscles when they are pushed past their limits of range of motion. This can occur in baseball and rotational sports, as well as other sports that involve cutting, reactive and quick stops and starts. Groin injuries are less frequently studied than upper extremity injuries in baseball, but they are still important to consider when training.

 

Here are a few examples of when this occurs in baseball:

  • Pitchers/thrower strides
  • Hitter’s back leg movement
  • Reaction and drop steps that occur in the field
  • Catcher drop and blocks

 

The Split Stance Adductor is a great stretch for the groin and adductors. This allows the athlete, to find their available range of motion and work within that range. This stretch allows athletes to maintain the length needed in their adductors to keep performing at a high level on the field while reducing injury risk.

 

Improve Rotational Power

The adductors play a huge role when it comes to rotating the hips. Transferring kinetic energy from your lower half to upper half will help lead to more potential velocity and power to your swing.

This shuffle is focused on bringing as much speed and momentum as possible into the Med Ball Scoop.  We still want to stay loaded onto your back hip to allow your adductors to lengthen. This will help create more force into your rotation and get good separation from the upper half and lower half.

This “separation” works together to transfer force between the upper and lower body. This is why you see elite athletes, such as baseball hitters or tennis players, rotate explosively through their hips and torso when making contact with a ball.

This med ball rotation exercise specifically targets your ability to powerfully rotate, which is needed for several sports skills, including hitting, throwing and changing directions.

 

Lateral Force Production

Adding bands to some of your jumps, like lateral bounds are a great way to increase your force production. The lateral bound is a great measure of pure power output in the frontal plane and developing power from your groin and adductors. The lateral bound is often tested inside gyms, combines, and athlete intakes.

If you have cranky knees, the band resisted lateral bound also helps decelerate your body at landing.

Coaching Cues:

  1. Secure a light or thin band to a post, rig, or sturdy surface around waist height.
  2. Toss the band around your waist, step out to the point where there is some tension on the band and set up in an athletic position.
  3. Perform a lateral bound
  4. Walk back to your starting point and repeat.

If you are a beginner, work on your jump mechanics first, and progress into these.

 

Eccentric Strength Development

Baseball players can experience high amounts of eccentric stress in their adductors. This is more than likely due to the amounts of high intent throws, swings and the quick reactions that occur in games and practices.

Your groin and adductor muscles help you absorb force when changing direction laterally. Seeing as baseball is played mostly in the frontal and transverse planes, you are asking a lot from your groin and adductors!

So how do we gain eccentric strength for your adductors and groin?

 

The Copenhagen Plank

For those unfamiliar with the Copenhagen Plank, this plank is no joke! For starters, you are getting a great core exercise but on top of that, your adductors are engaged to hold you in that plank position. There is also research supporting the eccentric strength increase while performing the Copenhagen plank.

See the video below for a great demo and breakdown on how to perform and progress the Copenhagen Plank: [H3]

 

Strengthen Your Adductors

For baseball and rotational athletes, we need to make sure we also have plenty of strength to be able to support the force absorption and production that occur every day in the sport.

The Bottom Hold Lateral Lunge

The bottom hold lateral lunge is a great frontal plane strength exercise you can add into your workouts. I personally like the bottom hold as I feel it allows you to find a good lateral position without trying to wrestle the weight into a goblet. Your arms are allowed to stay long like a deadlift letting you get into a similar hinge position. The bottom hold allows you to load this position more so than a goblet, so the strength aspect is slightly higher in this variation

 

The Set Up:

  • Start by holding the kettlebell or dumbbell underneath you.
  • Step laterally and hinge into your landing leg.
  • Bring the weight toward the inside of your shoe/foot
  • Return back to your starting point and repeat on both sides for the desired reps.

 

Final Thoughts

The adductors play a crucial role in athletic performance and development. Yes, we can stretch them, but that is just one piece of the puzzle.

I hope this post helped you learn additional ways to strengthen and support your adductor muscles to help reduce the chance of a groin strain.

A New Injury Epidemic in Baseball Pitchers: Blisters

Injuries to baseball pitchers. You’re probably thinking of an assortment of shoulder and elbow pathologies. The most common ones include labral injuries of the shoulder or ulnar collateral ligament tears of the elbow requiring a Tommy John procedure.

One growing injury trend impacting pitchers at all levels, particularly in collegiate and professional baseball, is blisters. You heard that right. Blisters are causing well over several months per season of cumulative days missed at the Major League Baseball (MLB) level.

These injuries can be particularly debilitating to the throwing hand of pitchers. They can decrease performance through improper ball handling and command, and may result in an inability to throw a baseball without pain or discomfort.

Due to blisters becoming such an issue in baseball, let’s step back and quickly look at the data. Let’s review how these injuries are occurring, as well as discuss ways in which medical professionals can not only treat these injuries but work to prevent them in the first place.

 

Are Blisters in Baseball Pitchers an Epidemic?

During the 2016 and 2017 season each, approximately 190 days were missed in the MLB by pitchers due to blisters. For comparison, between 2012-2015, less than 190 days combined were missed.

So, what happened at the start of 2016?

In a recent article from “The Ringer,” former Dodgers head athletic trainer Stan Conte stated that there’s “no question that there is an increase from previous years.” He continues by stating “the million-dollar question is why. I think we all the talk about the perceived changes in the ball, that has to be on the top of the list.”

The Ringer indicated amongst their incidence data provided below, that “seam-height data” of the baseball testing they had provided from the MLB, that the seams on baseballs itself are lower now than they were before 2016. Can seam height truly dictate the incidence of blisters?

 

Why Do Blisters Occur?

Aside from the growing issue that blisters potentially pose to baseball pitchers, it’s critical for training room medical professionals to understand how to address these issues.

Blisters can form on any finger of the throwing hand of a pitcher. However, typically speaking, most blisters form on the middle finger. This is most likely due to the middle finger being the last point of contact during a fastball pitch.

In addition, these blisters can also occur more frequently on the thumb or index finger, as well. I’ve had pitchers tell me in the past that during a circle change-up pitch, they can even get contact between the nail of their index finger and the inside part of their thumb upon ball release.

Overall, blisters form due to the friction that occurs between the ball (or seam of the ball) and the end of a finger.

This repetitive load and friction that occurs with the hundreds and thousands of pitches thrown, can lead to a focal irritation and breakdown of skin.

 

How to Prevent Blisters

There are several ways in which baseball pitchers have attempted to address blisters. Mark Vinson of the Tampa Bay Rays states that “some pitchers use spray-on antiperspirant, which has been shown to help prevent sweat and reduce added moisture from sweat.”

He also recommends that pitchers place their “throwing hand into a bag of rice in between innings to help reduce moisture on their fingers” as well.

The goal of these preventative measures is to maintain integrity of the skin on the fingertip, and ultimately reduce the likelihood of “pruning” from developing from prolonged moisture that can take place from sweat.

However, once a blister has formed, it’s imperative that treatment begins quickly to avoid any potential of prolonged missed time from competition.

 

Treating Blisters in the Baseball Pitcher

The blister, whether filled with clear serous fluid or blood, can often best be addressed by having a sterile drain be applied with a needle to the affected area.

Most importantly, while the drainage should provide instantaneous relief, it’s critical that the blister be monitored to ensure that it does not open up, creating a secondary skin avulsion.

In the cases in which a “chunk” of the skin has been removed through a skin avulsion, it can cause a significant amount of missed time. This is due to basically having an “open wound” on a finger that is constantly becoming further irritated by throwing.

Outside of having a needle drain the blister, other more conservative measures include Dermabond, which is essentially like a “skin super glue” that can perform as another barrier of friction over the injured finger.

If the skin on the finger begins to open up , pitchers may have to address any potential infections that occur. Vinson states that Betadine mixed with water can be useful as “Betadine helps to clean the area, prevent infection and toughen the skin around the affected area over the long-term.”

 

Summary

It’s clear that the incidence of blisters among baseball pitchers at the Major League level is rising dramatically. The reason for this new epidemic is less clear. Is it due to the type of pitches thrown, the seams of the baseball, or other factors? We don’t have an answer.

In the meantime, it’s important for training room professionals and coaches to try to prevent blisters from occurring at all. When they inevitably do occur over the course of a season, training room staff should be educated on how to address these injuries so that the pitcher can return to the field in a pain-free manner.

Regaining Shoulder Range of Motion in Baseball Players

Regaining motion following heavy doses of high intensity throwing cannot be overlooked.

Throwing causes significant range of motion changes from eccentric stress. Any movement activity causing significant muscle damage can alter movement in the days following.

Pitchers throwing a large amount of pitches suffer significant eccentric stress, not only in the arm/shoulder but throughout the entire body. Joint distraction forces at the shoulder and elbow rapidly increase to 1–1.5 times the body mass to decelerate the arm.

Mike Reinold, in a 2008 study, showed significant decreases in shoulder internal rotation, total motion, and elbow extension following pitching in the dominant shoulder.  These changes were noted immediately post pitching and continued to exist 24 hours after.  These motion losses begin acutely but can progress into long term alterations.

Many of us in the baseball field have long known about glenohumeral internal rotation deficit (GIRD) when it comes to the throwing shoulder, but several recent studies are linking injuries to other movement loss within the glenohumeral joint.

Over 6 years, Dr. Chris Camp and others studied range of motion on all invited pitchers from one professional organization, totaling 81 pitchers followed and accounting for 132 pitcher seasons.

The authors looked at shoulder flexion, horizontal adduction, external rotation, internal rotation, as well as elbow flexion and extension in both the dominant and non-dominant arm during the pre-season.

Out of the 53 injuries they encountered over the 6-year period, the most significant risk factors for elbow injury were loss of shoulder external rotation and loss of shoulder flexion. Injury risk at the elbow went up 7% for each degree of external rotation loss and 9% for each degree of flexion loss.

None of the range of motion measures correlated with shoulder injuries. The study shows that altered kinematics at the shoulder have a significant effect down the kinetic chain at the elbow.

In the Camp study, the presence of an internal rotation deficit did not correlate to any increased risk of shoulder or elbow injuries.

However, the predominant overall theme remains in that pitching causes significant stresses to the arm and body, and that stress can cause significant motion losses. Motion losses are regularly tied into shoulder and arm injuries.

Regaining full overhead capacity can be much more than simply soft tissue restrictions but an easy place to start is by mobilizing the tissue around the scapula and shoulder. Gaining full overhead motion can be a combination of many factors, and it often starts at form and function when it comes to global movement.

Body and anatomical positions determine form and form dictates function.  The pelvis stuck in a poor position affects the lumbar spine which affects the thoracic spine orientation which 100% affects the scapular position which affects the shoulder.  The following list to regaining overhead motion is a good place to start but is not an exhaustive list by any means.

 

Positions – Form and Function

1. Pelvic control

Pelvic control in my opinion is the foundation of all patterns within the body.  The inability to control the pelvis stems from poor glute and abdominal motor control.

Compensation patterns result from this lack of control in the form of extended spinal positions, especially at the lumbar spine.  An over extended lumbar spine creates the rib-flair up the kinetic chain, and the rib-flair allows for false motion with overhead athletes.

Developing the ability to control the pelvis should be a priority for efficient overhead motion.  Pelvic stability should revolve around the rectus abdominus, obliques, and glute complex.  Teach and train a neutral pelvis along with anti-extension throughout the torso.

 

2. Thoracic Extension

The ability of the t-spine to extend assists in humeral flexion through efficient scapular mechanics.

A poor position places the scapula at a disadvantage.

A forward head posture with excessive rounding of the upper back drives the scapula forward into anterior tilt.

An athlete unable to extend through the t-spine will be unable to effectively upwardly rotate, and posteriorly tilt the scapula resulting in less overhead ability.

A study by Strunce in 2009 showed large increases in shoulder range of motion following thoracic spine and rib manipulations.

Although not on an athletic population, the results demonstrated the immediate benefits of positioning when it comes to the thoracic cage.

Active range of motion at the shoulder improved in flexion by 38° and improved total rotation by 30° after manual manipulation.

Results from another study by Edmonston in 2012 confirmed that extension of the thoracic spine does occur during arm flexion. The ranges of thoracic spine extension with humeral flexion was an average of 12.8 degrees, showing the importance of the kinetic chain in overhead motion.

 

3. Scapular Positioning

For the shoulder to function correctly, it relies on assistance from the scapula to get overhead.  Upward rotation and posterior tilt are significant factors in flexion.

For the arm to get a full 180 degrees of motion, the scapula must contribute 60 degrees while the glenohumeral joint handles the other 120 degrees. Without that 60 degrees, motion is compromised.

Focusing on the lower trap and serratus anterior are a good place to start as both are responsible for upward rotation, while the lower trap is key in posterior tilt.  Both are the most commonly inhibited muscles in overhead athletes due to posture, lifestyle, training methods, etc.

 

4. Soft Tissue Restrictions

Obviously, the muscles attaching to the scapula and humerus play huge roles in not only creating motion but restricting motion as well. Overactive or tight tissues limit motion.

Some muscles that have great influence on scapular positioning and subsequently on motion include the latissimus dorsi, pec major and minor, rhomboids, and levator scapula (to name a few).

Manipulating these common problem areas can go to great lengths in restoring fluid movement and positioning. However, muscles aren’t the only factor.

Capsular restrictions around the glenohumeral joint itself can factor into the equation as well.

 

Soft Tissue for Scapular Upward Rotation

 

T-Spine Extension for Overhead Athletes

 

The “overhead” in overhead athletes tells us all we need to know. The overhead position matters to throwers and being able to get there the right way is key. Don’t let flexion disappear or become a compensation pattern over the course of a long season. Keep moving efficiently for long term health when it comes to the shoulder and elbow.

 

Sources:

Camp, Christopher L., et al. “Decreased Shoulder External Rotation and Flexion Are Greater Predictors of Injury than Internal Rotation Deficits: Analysis of 132 Pitcher-Seasons in Professional Baseball.” Orthopaedic Journal of Sports Medicine, vol. 5, no. 7_suppl6, 2017, doi:10.1177/2325967117s00221.

Edmondston, Stephen, et al. “Clinical and Radiological Investigation of Thoracic Spine Extension Motion During Bilateral Arm Elevation.” Journal of Orthopaedic & Sports Physical Therapy, vol. 42, no. 10, 2012, pp. 861–869., doi:10.2519/jospt.2012.4164.

Reinold, Michael M., et al. “Changes in Shoulder and Elbow Passive Range of Motion after Pitching in Professional Baseball Players.” The American Journal of Sports Medicine, vol. 36, no. 3, 2008, pp. 523–527., doi:10.1177/0363546507308935.

Strunce, Joseph B., et al. “The Immediate Effects of Thoracic Spine and Rib Manipulation on Subjects with Primary Complaints of Shoulder Pain.” Journal of Manual & Manipulative Therapy, vol. 17, no. 4, 2009, pp. 230–236., doi:10.1179/106698109791352102.

 

How to Prevent Baseball Muscle Imbalances and Overuse Injuries

BASEBALL is a pattern overload sport, meaning the same movements are replicated thousands of times throughout a season. Since baseball is a one-sided sport, this PATTERN OVERLOAD has the tendency to create muscle imbalances, often times leading to injury and decreasing overall performance.

 

 

Baseball players often throw and swing from the same side of their bodies, because of this, muscle imbalances will inevitably occur over the course of the season if you fail to take preventative measures.

The stresses and loads specific to the game of baseball expose players to a few common biomechanical dysfunctions and muscular imbalances. Here are a few common problems that baseball players encounter, with suggestions on how to correct them.

 

WEAK SHOULDER AND SCAPULAR STABILIZERS

The key to shoulder health and throwing performance is building strong, resilient scapular and posterior shoulder muscles. 17 muscles stabilize the scapula, creating synergistic co‐contraction to stabilize the shoulder complex and guide movement.

 

 

Weakness of the scapular stabilizers and resultant bio-mechanics changes could result in:

  1. Abnormal stresses to the anterior structures of the shoulder
  2. Increased possibility of rotator cuff injuries
  3. Decreased shoulder complex neuromuscular control.

CLICK HERE for a complete J-BANDS™ routine to help build strong scapular and posterior shoulder muscles.

 

POOR THORACIC “UPPER BACK” MOBILITY

All rotational athletes need adequate thoracic spine (upper back) mobility in order to create appropriate separation during throwing motions and changes of direction.

Throwers who lack thoracic mobility, primarily rotation, often have issues with scapulo-thoracic mechanics during the pitching or throwing motion which will inevitably place stress on the anterior shoulder.

Compensatory movement patterns often occur due to lack thoracic mobility including lumbar extension (lower back arching). These poor movement patterns lead to low back pain, abdominal strains, and hip dysfunction.⠀

Here’s a quick and easy drill to maintain thoracic mobility:

 

 

TIGHT “HYPERTONIC” POSTERIOR ROTATOR CUFF

There is no doubt that baseball players and other overhead athletes get tight from throwing. Over the course of a season your muscles tend to tighten and loss of mobility ensues. The deceleration component of the throwing motion exposes the posterior rotator cuff to extreme eccentric workloads.

Simple strategies to maintain tissue and movement quality of the posterior shoulder motion can be effective and can prevent loss of motion and injury, while enhancing throwing performance. In our baseball performance programs, we recommend the use of soft tissue techniques focusing on a few key areas like the posterior rotator cuff, lats, and pecs.

 

 

POOR SCAPULAR UPWARD ROTATION

One of the biggest problems throwers face is scapular and shoulder dysfunction. More specifically, issues related to inadequate protraction and upward rotation of the scapula.

The tendency to lose shoulder and scapular mobility (primarily upward rotation) occurs due to the stress of the throwing motion disrupting the force couple between the upper trap, lower trap, and the serratus anterior. This rotation is essential to maintain proper shoulder joint centration while performing high velocity movements.

 

 

The SCAPULAR LIFT OFF is an effective drill that can be used as part of recovery or a warm-up to maintain the range of motion that we need to throw.⠀

 

 

DECREASED SHOULDER INTERNAL ROTATION

Increased external rotation is correlated with increased throwing velocity. Improving this range of motion is helpful for lighting up the radar gun. However it’s important to note that this added external rotation comes the possibility of anterior shoulder instability and a loss of internal rotation.

In many cases, throwers tend to have decreased internal rotation of the shoulder. This is often a result of excessive external rotation which is necessary for a throwing shoulder to perform at an elite level.

A small decrease in internal rotation in the throwing shoulder is normal in throwers, however if its excessive, it can become a risk factor. Glenohumeral Internal Rotation Deficit (GIRD) refers to a pathological loss of internal rotation in the throwing shoulder compared to the non-throwing shoulder. We can avoid this by preserving as much total shoulder range of motion as possible using the following techniques.

 

Cross Arm Stretch

 

Arm Circles

 

Scare Crows

 

POOR HIP MOBILITY

The hips of a thrower are subject to loss of internal rotation mobility especially in a pitcher’s front stride leg. This decrease in mobility that occurs over the course of the season can cause compensatory movement patterns as well as stress on the front of the shoulder and elbow when throwing.

To improve or maintain hip mobility here are a few of my favorite drills:

 

90/90 Hip Openers

 

Rear-Foot Elevated Hip Flexor Stretch

 

World’s Greatest Stretch

 

OVERALL MOVEMENT IMBALANCE

Because most players either throw and bat from one side exclusively, there is an obvious tendency for some sort of imbalance. You can’t perform 5,000 right-handed throws and zero left-handed throws during a season and not expect your body to compensate in one way or another.

The best way to prevent this from becoming detrimental to your development and performance is to include unilateral training techniques to improve your proprioception and body control.

Here are a few effective unilateral exercises that will help:

 

Non-Dominant Side Med Ball Throws

 

Side to Side Med Ball Slams

 

Non-Dominant Stance Leg RDL

 

Unilateral One Arm Row

 

The Three Hardest Challenges of Tommy John Rehab

My elbow hurts a lot.

My arm feels really tight.

I feel great!

It was really sore the next day.

I had nothing on it – no movement and no velocity.

It started off good, then it started to hurt.

The ball was really coming out well, no pain at all!

It just feels…dead.

If you’re a pitcher who’s gone through Tommy John surgery, you’ve probably uttered all the statements above. If you’re a rehab professional, coach or parent, you’ve probably heard them too as the pitcher(s) in your life finished up their latest throwing session.

As a coach who had two Tommy John surgeries, I know that the hardest part of both of my rehabs – and they were both hard for the same reasons – was the randomness with which the arm recovers and the mental toll it takes on you. Today as a coach, I mentor young pitchers through their own recoveries and hear the same difficulties voiced regularly. Today, we’ll discuss the mental challenges of the surgery in its various forms.

 

First: Why The Last Part of Tommy John Recovery Is The Hardest

After about month eight or nine of the recovery the pitcher is capable of doing a lot of new things that make his arm hurt, get sore, and react in new and confusing ways. The player is also pretty much done with the formal, written throwing protocol, so months 9+ end up being up to interpretation, much like one of those make-your-own-adventure books. This is because pitchers in this last phase are:

  • Throwing nearly at or just near full-speed
  • Throwing off-speed stuff again
  • Increasing frequency of bullpens
  • Beginning simulated games against live hitters
  • Getting physically stronger and doing more demanding lifts in the weight room
  • Feeling the pull that they are almost ready

Because of this, the body is getting huge doses of new things ­­– it’s not just soft-tossing grenades anymore, the pitcher is putting the same forces through his arm that tore it in the first place. He’s mixing all his pitches, and curves, sliders and changeups all make the healing ligament react and get sore.

 

 

Workouts in the weight room are crucial to returning him to game shape and warding off future injury, but as strength returns, heavier weights cause the elbow to react and get sore, sometimes painful as well. How does a pitcher balance all these things?

This question raises many, many more questions:

How much should he lift after a hard bullpen that caused a little pain? Should some exercises be omitted, altered, or used with lesser resistance?

Should bullpen pitch count increase? If so, how much?

Should rest between pens begin to decrease? If so, how much?

How much should a pitcher throw in between bullpens?

Is long-toss okay? If so, when?

Are weighted balls appropriate? If so, when?

When can a pitcher return to a game?

When can he pitch on back-to-back days in relief?

His arm hurts a LOT – is that normal? Is it torn again? How long should I wait to throw?

 

The common answer to all the above is this: it depends. It’s a very unsettling answer.

There are a million variables that can’t be addressed in the written throwing protocol. There’s just too much variation and too much throttling up and down to account for it all. The experience is similar for players but also completely and painfully unique.

If the questions above seemed confusing…imagine you’re a 19 year-old kid going through this for the first time – it’s a lot.

 

Challenge #1: Interpreting and Coping with Types of Discomfort

There are four main feelings a pitcher will experience in his recovery:

  • Pain: that sharp, stabbing feeling.
  • Soreness: that dull, burning feeling.
  • Tightness: When the arm feels constricted and doesn’t move like normal, as if the joint is swollen or needs to “pop.”
  • Deadness: a general dull, achy, fatigued feeling in which the arm just…can’t.

Which of these is worse? Pain gets a pitcher’s attention the fastest, but all are unique. Soreness often turns to pain. Tightness turns to any of them and makes throwing very uncomfortable. Deadness is demoralizing.

Some of the best advice I ever received was from Stan Conte, former head ATC of the Los Angeles Dodgers. He basically just reminded me that my arm had holes drilled in it, and that the muscles and ligaments were sliced open before being stitched back together. He explained that it would never be “normal” again, and that weird pain, sensations and unexplainable things would happen. I just had to learn to accept some of that.

When I thought of it that way, I stopped dwelling on slight pain and the little aches and soreness – those were just from my arm being, well, a lot like an old car. Old cars make lots of weird sounds and are a little bumpier, but they still drive just fine.

Pitchers who have had a surgery – any surgery – are never going to feel fresh off the assembly-line again. When they stop believing they have to feel perfect and brand new to pitch, things mentally get a lot better.

 

Challenge #2: Dealing With The Randomness of Pain 

 

What’s extra frustrating about the recovery is that there is little reason why one day is a good day and why another day is a bad day.

Sure, when a player overdoes it or does something new, the arm usually reacts in a negative – but still normal – way. However, lots of times a player will be adequately rested and has set himself up for success in his routine…just to find lots of pain and discomfort that doesn’t add up.

This – unfortunately – is also normal. It’s especially frustrating and worrisome because a player feels helpless to prevent or predict good and bad days. The follow exchange was had between myself and one of my college pitcher clients, who I have been mentoring through the last stages of his rehab in conjunction with his school coaches. It sums this point up perfectly.

 

 

Challenge #3: Expectations That Are Set Too High

Lastly, there’s this idea that every player should be back on the mound, dominating and throwing 2-5mph harder at the 12-month mark. This just isn’t reality for most pitchers. Most pitchers will feel like their old selves again somewhere between the 14 month and 24-month mark. Even when a pitcher is back in games, he often won’t reach his previous level of statistical performance until the second competitive year back…if he does so at all.

I doggy-paddled through my first season back following each surgery, struggling to keep my head above water and not get released by the team. I posted league-average ERAs in both seasons and could not locate my off-speed stuff to save my life. I got by with good velocity and a fierce will to compete. Had I not had both of those things, my career would have ended; I would not have had enough tools to get by in pro baseball.

But in year two following both surgeries, my command of all three pitches improved dramatically, and my velocity went up another tick or two. Year two was much, much better than year one. Year one was hard.

 

Tommy John Surgery: It’s a Long, Hard Road.

A lot of people take for granted just how hard it is to return from Tommy John Surgery; it’s not a guarantee for any pitcher, and the mental toll is often greater than the physical. The uncertainty, randomness, pain and daily grind will challenge even the toughest of athletes. The big challenge is staying the course and trusting that tomorrow will be better…even when today wasn’t.

 

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4 Arm Care Exercises Baseball Players Should Be Doing

 

I had another request from a subscriber to go over some arm care exercises this week. I put together a video below of 4 exercises I consistently use with our throwers during arm care days, or after a throwing session.

Don’t be the person who doesn’t do any arm care. Take it from me…I never did any, and I had Tommy John in High School, then a SLAP Tear in College.

Take the 10 extra minutes to do some arm care!

 

HERE’S WHAT’S IN THE VIDEO:

  1. Forearm Wall Slides are a great shoulder mobility exercise. This exercise works your scap protractors, and your lower traps, which assist in upward rotation. Kind of important if you throw things overhead!

✅Key Cue: Make sure you are not substituting lumbar extension to get overhead. Engage your core to keep your rib cage down.

  1. Quadruped T-Spine Rotations are a great exercise to mobilize your upper back and thoracic spine. Having a mobile T-spine will prevent you from substituting with your lower back to rotate. Throwing a baseball is a violent rotation. Using your lower back will impact your performance and possibly your injury risk.

✅Key Cue: Keep your hips and lower back as still as possible. Follow your elbow with your eyes as you perform left and right rotation.

  1. 3-Point Contact Y Scap Raises help maintain muscular balance. You can make this exercise more difficult by lifting a dumbbell. Just be sure to maintain proper technique.

✅Key Cue: Make sure you don’t lift your arm too high. You should be able to draw a straight line from your hips through your shoulder and arm at the top of the lift.

  1. Stability Overhead Press is a great strength and endurance exercise for the posterior shoulder muscles. As you press overhead, you must stabilize as the band tries to pull you forward.

✅Key Cue: Use a lighter band. Nobody is handing out world records for stability overhead press in the gym!