Optimal Shoulder Performance From Rehabilittaion to High Performance
Eric Cressey, MA, CSCS is the president of Cressey Performance in Hudson, MA. Cressey is a highly sought-after coach for healthy and injured athletes alike from youth sports to the Olympic and professional ranks, with baseball development as his greatest focus. Behind Erics expertise, Cressey Performance has rapidly established itself as a go-to high-performance facility among Boston
athletes and those that come from abroad to experience CPs cutting-edge methods.
Eric has lectured in four countries and more than one dozen U.S. states; written over 200 articles and four books; contributed on scientific journal articles and book chapters; and co-created four DVD sets. He publishes a free weekly newsletter and daily blog at http://www.EricCressey.com. A record-setting competitive powerlifter, Cressey has deadlifted 650 pounds at a body weight of 174 and is recognized as an athlete who can jump, sprint, and lift alongside his best athletes to push them to higher levels.
Michael M. Reinold, PT, DPT, SCS, ATC, CSCS is considered a leader in orthopedic and sports rehabilitation as a clinician, educator, and researcher, with specific emphasis on the shoulder and the treatment of overhead athletes. Mike is currently the Head Athletic Trainer of the Boston Red Sox and Coordinator of Rehabilitation Research & Education for the Sports Medicine Division of Massachusetts General Hospital.
Mike has lectured extensively throughout the nation, published over 50 scientific journal articles and book chapters, and is the
author of the textbook, The Athletes Shoulder, 2nd Edition. Mikes contributions to sports medicine have earned recognition by groups such as the APTA, ESPN, Sports Illustrated, The Sporting News, Mens Health, The Boston Globe, and The Boston Herald. For more information, visit Mikes free educational website at http://www.MikeReinold.com.
This DVD and the following guidelines have been provided as general information for exercise and
rehabilitation and are intended for educational purposes. Any individual beginning exercises contained in this video, or beginning any other exercise program, should first consult with a qualified health professional. Discontinue any exercise that causes discomfort and/or dysfunction and consult with a qualified medical professional. Please consult with a physician prior to implementing any rehabilitation or exercise protocol. This DVD does not contain medical advice. The instructions and advice presented are in no way a substitute for professional testing, instruction, or training. The creator, producer, and distributor of this DVD and program disclaim any liabilities or loss, personal or
otherwise, in connection with the exercises and advice herein.
Inefficiency vs. Pathology
Eric Cresseywww EricCressey comwww.EricCressey.com
What would you think if a coach/trainer had
82% of his athletes with disc bulges or herniations at one level, and 38% at more than one level?
27% of his athletes with vertebral fractures?27% of his athletes with vertebral fractures? 34% of his athletes with rotator cuff tears? 79% of his overhead throwing athletes with labral
tears? 26% of his jumpers with patellar tendinopathy?
Miniaci A. et al. Magnetic resonance imaging of the shoulder in asymptomatic professional baseball pitchers. Am J Sports Med. 2002 Jan-Feb;30(1):66-73.
79% of professional pitchers (28/40) had abnormal labrum features magnetic resonance imagingg g gof the shoulder in asymptomatic high performance throwing athletes reveals abnormalities thatmay encompass a spectrum of nonclinical findings
*There are people out there myself included that think that you may very well need a SLAP lesion to throw hard in the first place!
Jost B et al. MRI findings in throwing shoulders: abnormalities in professional handball players. Clin Orthop Relat Res. 2005 May;(434):130-7.
Researchers looked at throwing and non-throwing shoulders of 30 handball players and non-athletes w/MRI
More abnormalities seen in throwing shoulders Although 93% of the throwing shoulders had abnormal magnetic
resonance imaging findings, only 37% were symptomatic. Symptoms correlated poorly with abnormalities seen on magnetic
resonance imaging scans and findings from clinical tests. This suggests that the evaluation of an athlete's throwing shoulder should be done very thoroughly and should not be based mainly on abnormalities seen on magnetic resonance imaging scans.
Not just about throwers, though! Has been demonstrated with swimmers, volleyball players, AND non-athlete controls
Rotator Cuff Fun
Sher et al. (1995): MRIs of 96 asymptomatic subjects, RTC tearsin 34% of cases, and 54% of thoseolder than 60.
Miniaci et al. (1995): MRIs of 30shoulders under age 50 with no completely normal rotator cuffs.23% had evidence of partial-thickness tears.
Connor et al. (2003): eight of20 (40%) dominant shoulders in asymptomatic tennis/baseball players had evidence of partial or full-thickness cuff tears. Five of 20 had MRI evidence of Bennetts lesions.
Jensen MC, et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med.1994 Jul 14;331(2):69-73.
MRIs of 98 asymptomatic backs
52 percent of the subjects had a bulge at at least one level, 27 percent had a protrusion, and 1 percent had an extrusion [82% of subjects]. Thirty-eight percent had an abnormality of more than one intervertebral disk. The prevalence of bulges, but not of protrusions, increased with age. The most common nonintervertebral disk abnormalities were Schmorl's nodes (herniation of the disk into the vertebral-body end plate), found in 19 percent of the subjects; annular defects (disruption of the outer fibrous ring of the disk), in 14 percent; and facet arthropathy (degenerative disease of the posterior articular processes of the vertebrae), in 8 percent. The findings were similar in men and women.
Soler T, Calderon C. The prevalence of spondylolysis in the Spanish elite athlete. Am J Sports Med. 2000 Jan-Feb;28(1):57-62.
8% of elite Spanish athletes affected 27% of track & field throwers, 17% of rowers, 14% of
gymnasts, and 13% of weightlifters L5 most common (84%), followed by L4 (12%). Bilateral 78% of the time Only 50-60% of those diagnosed actually reported low back
pain Presence of spondylolysis is estimated at 15-63%, with the
highest prevalence among weightlifters. Presence is estimated at 3-7% in the general population
Chou R et al. Imaging strategies for low-back pain: systematic review and meta-analysis. The Lancet, 2009;373 (9662), 463-472.
Review of imaging for low back pain without significant red flags suggesting serious conditions (cancer, fracture, etc)
Lumbar imaging for low back pain without indications of serious underlying conditions does not improve clinical y g poutcomes.
Therefore, clinicians should refrain from routine, immediate lumbar imaging in patients with acute or subacute low back pain and without features suggesting a serious underlying condition.
Some research suggests that MRI leads to poorer outcomes in back pain patients
You Kneed to KnowCook JL et al. Patellar tendinopathy in junior basketball players: a controlled clinical and ultrasonographic study of 268 patellar tendons in players aged 14-18 years. Scand J Med Sci Sports. 2000 Aug;10(4):216-20.
34 elite junior basketball players (268 total patellar tendons)j p y ( p ) Only 19 tendons (7%) presented clinically with symptoms of
tendinopathy. However, under ultrasonographic examination, 26% of all tendons
could be diagnosed with tendinopathy based on degenerative changes. For every one diagnosed, more than three are overlooked This is magnified as one ages!
Just to Scare You a Bit More
Somewhere between 2and 8 percent of the time inAmerican hospitals, a patienthaving a genuine heart g gattack gets sent home because the doctor doingthe examination thinks for some reason that thepatient is healthy.
-Malcom Gladwell, in Blink
Weve misinterpreted the meaning of the word pathology.
any deviation from a healthy, normal, or efficient condition (dictionary.com)I th d i ffi i d In other words, inefficiency and pathology may in fact be the same thing.
My primary goal for today is to show you that if you correct the inefficiency, youll markedly reduce the likelihood that these h l i h h h ldpathologies reach threshold.
Effective screening, and an understanding of population-specific norms is the key.
The site of the pain isnt always the source of the problem
Perhaps the Best Example
The Tendinopathy Debate Tendinosis
osis = degenerative Tissue loading exceeds tissueTissue loading exceeds tissue
itis = inflammatory Inflammation should be easily
controlled with cortisone injections and/or NSAIDs
Maffulli N, Khan KM, Puddu G. Overuse tendon conditions: time to change a confusing terminology. Arthroscopy. 1998 Nov-Dec;14(8):840-3.
In overuse clinical conditions in and around tendons, frank inflammation is infrequent, and is associated mostly with tendon ruptures. Tendinosis implies tendon degeneration without clinical or histological signs of intratendinous inflammation, and is not necessarily symptomatic Patients undergoing anis not necessarily symptomatic. Patients undergoing an operation for Achilles tendinopathy show similar areas of degeneration. When the term tendinitis is used in