Strength Training for Runners

There are still a lot of misconceptions about running and how to best train runners to minimize injuries and enhance performance.

Part of the problem is that there is a low barrier to entry to running.  All you need to do is start running, right? No gym membership, no equipment, heck most people don’t even do anything to prepare themselves for running.  They just decide to start running.

For recreational runners, running also tends to be a fitness choice.  Many people pick a way to get in shape and start exercising, and feel like they need to choose.  Do I want to do strength training or do I want to do cardio work?

Competitive runners also have some misconceptions when it comes to training to enhance their performance.  In the past, many have believed that strength training will bulk you up too much, make you less flexible, and may even slow you down.

There is no doubt that running requires cardiovascular conditioning.  But we can’t ignore how the rest of the body is biomechanically involved.  

Let’s simplify running a little more.

Running is a series of little jumps.  The rear leg has to propel the body forward.  The stride leg has to absorb force.

To minimize your chance of running related injuries and enhance your running performance, you need to understand both of these concepts.  

The key to both of these is strength training.  We can build tissue capacity to handle these forces much more efficiently, especially if we build a specific strength training program for runners with these two concepts in mind.

 

Strength Training for Runners

When it comes to runners, my go-to resource for injury rehab and performance enhancement is Chris Johnson.  Chris has an excellent website and clinic that specializes in runners.  He’s helped me a ton over the years.

Chris has an amazingly comprehensive book right now, Running on Resistance: A Guide to Strength Training for Runners.

We had been talking online recently, and I thought that my readers needed to benefit from Chris’ amazing knowledge on runners.  So we sat down and talked about the book, as well as a bunch of other topics related to strength training in runners:

 

Running on Resistance: A Guide to Strength Training for Runners

If you’re interested in learning more, Chris’s book is an amazing resource for both runners, as well as rehab and fitness professionals that want to work with runners.  It is a detailed guide and program to building capacity, becoming more resilient to injuries, and enhancing running performance.

Chris was nice enough to extend a special 15% off discount just for my readers.  Check out the book below:

 

 

Is Icing an Injury Really Bad for You? What the Science Says

Today’s article is an excellent review of the effects of cryotherapy, or ice, from my good friend Phil Page, PhD, PT, ATC, CSCS, FACSM.  Man, icing an injury sure has taken some heat (see what I did there…) lately on the internet.  There is a HUGE anti-ice movement.  I’m always amazed at how polarizing social media can be, with people screaming their black or white opinion, when in reality much of what we do is in the grey.  I get questions all the time about wether or not icing is good or bad for you, with many people quick to jump to the conclusion that we should not be icing.  Well, let’s find out what the research actually says.  Phil’s the Director of Research & Education with Performance Health, and one of the best at analyzing the research.

 

Is Icing an Injury Really Bad for You?

You’ve probably heard the debate on whether icing is helpful or harmful. You might be strongly on one side or the other, or maybe you aren’t sure which side you’re on because you’ve heard so many different things.

Despite what you might hear from anti-ice gurus that tend to be sensationalized on the Internet, let’s look at the facts and how we got here.

Ice isn’t the bad guy. Yes, we tend to apply ice in some situations that probably doesn’t help and claim we do so for the wrong reasons.  But the bottom line is that there are several benefits to ice, and ice has not been proven to impede the healing process as many claim.

About 30 years ago as a student athletic trainer at LSU, we frequently used ice, following the research of Dr. Ken Knight, who literally wrote the book on cryotherapy. I, as most other athletic trainers, was keenly aware of the mechanism of ice after an acute injury. As a graduate assistant athletic trainer for baseball at Mississippi State, I continued to advocate ice for my pitchers after they threw. Ice was my best friend.

Suddenly, stories came out that icing was bad for pitchers. As a matter of fact, one story back then was that it actually caused bursitis! Knowing a little about pathophysiology, I quickly dismissed that hogwash…  but the gears were in motion against using ice after pitching.

Fast forward to a few years ago. All of a sudden, ice is again demonized, but this time, it’s a vicious attack:

“Icing is wrong.”

“Ice impedes healing.”

“Icing is harmful.”

Say it ain’t so! Wha are we supposed to do?  Those are some bold claims!

The argument against ice tends to center around ice impeding the healing process as an ‘anti-inflammatory.’ Throughout the healing process (injury, inflammation, repair, remodeling), we need each of those stages to occur in order.  As an anti-inflammatory, the question was if ice actually creates an environment that does not allow the tissue to repair itself?  Interestingly, this same argument came out around the same time as people started questioning NSAIDS for the same reason!

Well, one study did get published (Tseng et al. 2013) titled, “Topical Cooling (Icing) Delays Recovery from Eccentric Exercise-Induced Muscle Damage.” The authors found increased signs of muscle damage after applying ice following eccentric exercise compared to a ‘sham’ application (although I’m not sure how you actually can apply ‘sham’ ice).

Bingo. Proof that ice impedes healing!  Right?  Hold on cowboy. That’s not the whole story.

What you didn’t hear about unless you actually read the study was that the authors concluded:

This study does not provide evidence on whether recovery from pitching-induced muscle damage would be slowed down by topical cooling.”

And while the authors found increased biomarkers in the group receiving cold therapy, there was no difference in strength or pain between the groups.  And I won’t even get into the question of adequate power with an n of 11.  You could argue that the study did not have enough subjects to have much clinical relevance.

Yet, ice was under attack again.

In addition, a few review studies of ice after ankle injuries raised more doubt on the practice of “RICE” (Rest, Ice, Compression, Elevation). The conclusion was that the quality of the research was generally poor quality, and the outcomes were inconclusive.

Note the word, “inconclusive” is not the same as “ineffective.”

And many times, effectiveness of icing was measured by the amount of swelling, rather than the actual healing process and return to activity. And while we know that ice doesn’t do much for swelling after the first 48 hours (Cote et al. 1988), modest cooling has been shown to reduce edema in animal studies (Collins 2008, Deal et al. 2002).

Yet, there we were, left to question if icing for recovery or after acute injuries was actually helping or hurting our athletes.  How did we get to this point?

 

The Claims Against Ice are Largely Based on Pseudoscience

The claim that ice is harmful by delaying the healing process is not supported by science. You may have seen bits and pieces of “science” in the false claim, but it’s a play on science that doesn’t give you the full picture or ability to make such a bold statement.  It’s called pseudoscience….statements that appear to be based on the scientific method, but are not.

Icing is not harmful or wrong to use.

You have witnessed a sham. Like the cup-and-ball game. It happens so fast and seems logical, but it’s a mind-trick.  Here are several things to consider.

Confirmation Bias

This is the tendency for us to accept evidence to confirm our own beliefs or theories. If you think ice is bad, you will tend to accept the information that supports your belief.  This makes us feel good because it confirms our prejudice.

False Logic

If inflammation (A) is necessary to get to healing (C), and ice (B) reduces inflammation (A), then ice (B) must reduce healing (C). FALSE. There is no direct evidence that icing reduces the healing process. In contrast, research supports the fact that ice does not impede healing (Vieira Ramos et al. 2016).  Granted, this was a study from an animal model, but who wants to be a human subject to test that theory?

Circumstantial Evidence

Evidence that attempts to prove a fact by connecting a related event or condition to a conclusion, as opposed to direct observation, is considered ‘circumstantial.’ This could be one of the most common ways science is used to incorrectly support claims. The presence of biomarkers in the blood may be an indirect measure of muscle damage, but it does not prove ‘cause-and-effect’. (Remember the DOMS study I referenced above?) Guilt by association is not the same as ‘causation.’ Using surrogate measures to make a definitive conclusion is a slippery slope.

Inconclusive Conclusions

Poor research (or no research) cannot serve as a basis for a conclusion on efficacy, let alone harm. The evidence on applying ice after an acute ankle injury is ‘inconclusive’ based on only a few studies of poor quality (Bleakley et al. 2004; van den Bekerom et al. 2012). There are no studies that applying ice after an ankle injury reduces recovery time (Hubbard et al. 2004). In fact, one study showed that early application of ice (< 36 hours) resulted in significantly faster return to play compared to delayed cryotherapy (Hocutt et al. 1982).

Comparing Apples to Oranges

Equating 2 things that appear similar, but are actually different, is not a fair comparison. Comparing DOMS to the healing process is not an accurate comparison. We know more about soft tissue healing after an injury than we do about the mechanism of DOMS, which is not a true model of an acute injury. Don’t forget, inflammation is not the same thing as swelling and edema!

Selective Science

Unbalanced reporting. Cherry-picking the literature. All signs of pseudoscience. The anti-ice movement has neglected years of research on the mechanism of ice after injury, focusing only on a select few studies that support (but in reality DON’T support) their argument. Dr. Knight explained that ice is not an ‘anti-inflammatory’ per-say (Knight, 1976); rather, it prevents the secondary injury to tissues by dampening the negative physiological effects of widespread inflammation. His position has been supported by other researchers as well (Ho et al. 1994, Merrick et al. 1999). And to top it off, one study quoted against icing (Bleakley et al. 2004) even concluded, “The sooner after injury cryotherapy is initiated, the more beneficial this reduction in metabolism will be.” Hmmm…the anti-ice crowd must have missed that statement.

 

The Benefits of Ice

Ice is not wrong or harmful.  The theory that ice impedes the normal healing response by limiting inflammation is not well documented in the literature. If you have been swayed by this on the internet, I would urge you to try to research this more and scrutinize the literature.  Be careful of what you see on the internet and ALWAYS seek to validate anything yourself.

Ice has plenty of benefits and clinical validation.

Proper application of cryotherapy can reduce secondary injury and reduce edema formation if applied within the first 36 to 48 hours (remember, ice doesn’t reduce swelling after the acute injury phase, and may not play a huge role in inflammation or recovery).  We do know that ice helps reduce pain, spasm, and guarding, allowing more mobility (Barber et al. 1998, Raynor et al. 2005).   More than anything, ice is a convenient and potent pain reliever, so it’s ok to apply ice to ‘chronic’ conditions as a safer pain reliever at any time. In fact, cryotherapy has been shown to decrease the amount of prescription pain medications needed after surgery (Barber et al. 1998, Raynor et al. 2005).

Sure, there are some times that ice is overused or erroneously used fort the wrong reasons, like reducing swelling after 48 hours.  The clinical research may not be conclusive, but there is no direct evidence that ice impedes healing. The argument that ice is ineffective or harmful is based on pseudoscience, and we need to be aware of this tactic.

Just be careful what you read, everyone has a bias.  #StandUp4Ice.

 

Understanding Tommy John Surgery and How to Avoid It

Note from Mike: Today’s post is an excellent article from New York Yankees team physician, Dr. Chris Ahmad, and Frank Alexander, ATC.  We know that Tommy John injuries continue to rise. Chris and Frank have written a new book to help educate your baseball players, parents, and coaches about Tommy John injuries, and more importantly, how to avoid them.

We have an epidemic on our hands in youth baseball.  With nearly half a million participants, baseball is one of the most popular high school sports in the United States.1 Injuries to the throwing arm continue to grow every year and there is no slowing down in sight.

While there are a number of injuries that a baseball player can succumb to, the most well-known are Tommy John injuries, also known as ulnar collateral ligament (UCL) tears. Once considered a career ending injury, Dr. Frank Jobe revolutionized baseball and all of sports medicine in 1974. That summer, he performed the first UCL reconstruction on the most famous recipient – and namesake – of the surgery, Tommy John.  

UCL injuries are the most studied condition in all of orthopedic surgery and its popularity in the media has made it a preeminent sports injury.

It is estimated that 1 in 4 Major League pitchers will need Tommy John Surgery in their career. In 2000, 13 MLB pitchers had UCL reconstructions. Over a decade later, in 2012, that number had increased nearly three-fold to 32 pitchers requiring the season ending surgery.2

Unfortunately, the increasing numbers of players falling victim to UCL injuries translate to the younger levels of baseball as well.

Evidence suggests the trend has impacted adolescent athletes with a 50% increase in UCL reconstructions in high school baseball players aged 15 to 19 years old.3 In New York State alone, the volume of UCL reconstructions increased by 193% over a 10-year period.3  These younger players may feel pressures within the competitive culture in youth baseball. This may lead players to play through pain and more talented players may be told they have to throw more frequently and with greater intensity.

While there are several reasons why there are so many Tommy John injuries, research has described overuse to be the main cause of player injury.

There is a 500% increase in risk for surgery for those players that pitch more than 8 months per year and a 400% increase in risk is observed for those that throw more than 80 pitches per game.3

Not only are younger athletes enduring this big-league problem, their understanding of the injury leads many of them to want the surgery even in the absence of injury.  There are still many myths about Tommy John Surgery.

Many players see their idols in Major League Baseball have surgery and return to the field throwing harder. What the younger athletes don’t see is the painstakingly long hours that the pros put into their rehab. Mike Reinold recently had a podcast episode with several Tommy John patients to describe their experiences.

There is a common belief among players, parents, and coaches that the rehab program post-Tommy John was shorter than 1 year and allowed for a quick return to throwing.4 We are now seeing players at the higher levels of competition returning to sport around 14-16 months and the average at the Major League level is 15 months post-operatively.

The popularity of Tommy John Surgery in addition to the perceived glamor players receive upon their return is what leads the younger players to think surgery is necessary. Research from our office has shown that 51% of high school baseball players believe that they need Tommy John surgery in order to enhance their performance.4  This is in the absence of an injury – meaning, players that are healthy think they need surgery just to get better at the game of baseball.

Players should have surgery for UCL insufficiency (i.e. tear), not to improve their performance. While we want to celebrate the return of our favorite athletes to the playing field, we only hear about the successes and not much about the players that are unable to make it back. The success rates of Tommy John Surgery range between 80 – 90% and even though players make it back to the field, pitchers throw fewer innings post-operatively.2,4 Having surgery places an enormous burden on the player mentally, physically and emotionally.

As the numbers of youth athletics participants continues to rise, it may seem that elbow injuries have become a part of America’s pastime.  Leaders in the field have established guidelines for our younger players in hopes that they will remain injury free and continue a long, healthy career.

 

A Guide for Young Baseball Players

Even with the implementation of these guidelines we continue to see a rise in throwing arm injuries leading us to write our book Understanding Tommy John Surgery and How to avoid it: A Guide for Young Baseball Players.

 

Understanding Tommy John Surgery and How to Avoid It

 

Our vision for Understanding Tommy John Surgery is to help younger players better understand elbow injuries and that it is not okay to play through pain. Some warning signs may include decreased velocity, elbow tightness, and difficulty warming up.  We also discuss a number of different ways for youth baseball players to stay healthy such as keeping a log of the number of innings or pitches thrown, proper warm-ups, and sport diversification.

By allowing our players to understand their elbow and know that playing through pain is not a good idea, we may finally see a reverse in the trend of Little Leaguers being diagnosed with Big League problems.

If you’d like to learn more and join in our efforts you can visit Dr. Ahmad’s website and get your own copy of Understanding Tommy John Surgery and How to avoid it. If you or a family member has a baseball related elbow injury, Dr. Ahmad will happily review the images with you as a free service and is available to all baseball players across the nation. You can learn more at his website!

 

References

 

  1. Saper, MG, Pierpoint, LA, Liu, W., et al. (2018). Epidemiology of shoulder and elbow injuries among United States high school players. American Journal of Sports Medicine, 46(1), 37-43.
  2. Erickson, BJ (2015) The epidemic of Tommy John Surgery: the role of the orthopedic surgeon. American Journal of Orthopedics, 44(1), E36-E37.
  3. Hodgins, JL, Vitale, M, Arons, RR, & Ahmad, CS. (2016). Epidemiology of medial ulnar collateral ligament reconstruction A 10-year study in New York State. American Journal of Sports Medicine, 44(3), 729-734.
  4. Ahmad, CS, Grantham, WJ & Griewe, RM (2012) Public perceptions of Tommy John Surgery, The Physician and Sportsmedicine, 40(2), 64-72.

5 Exercises You Should Perform If You Sit All Day

Do you sit all day? Don’t worry you are not alone.

Sitting throughout the day, and a more sedentary lifestyle in general, has dramatically increased over the last several decades as desk jobs have become more popular and our devices have taken over as our form of entertainment.

The media loves to tell you that “sitting is the new smoking.” This is backwards in my mind, and something I’ve discussed in detail in a past article Sitting isn’t bad for you, not moving is.

In the article, I listed 3 things you should do if you sit all day to stay healthy:

  1. Move, Often
  2. Reverse your posture
  3. Exercise

For those looking for some specific exercise, here are 5 great exercises to perform to combat sitting all day.

 

5 Exercises You Should Perform if You Sit All Day

I’ve been talking about the concept of Reverse Posturing for years. The concept is essentially that we need to reverse the posture that we do the most throughout the day to keep our body balanced and prevent overuse.

Sitting involves a predominantly flexed posture, so doing exercises that promote the posterior chain would be helpful. These will depend on each person, but if I had to pick a basic set of exercises these would be the 5 exercises to combat sitting all day.

 

Thoracic Extension

The first exercise is for mobility of your thoracic spine. This is the portion of your back that becomes the most flexed while sitting all day. This is probably the biggest bang for you buck exercises in my mind:

If you are looking for more drills, you should view one of my past articles for several more great thoracic mobility drills.

 

True Hip Flexor Stretch

The second exercises is another mobility drill, this time for the pelvis. We always perform mobility drills first to maximize range of motion. This exercise is called the true hip flexor stretch, something I termed several years ago after seeing so many people do this stretch poorly.

This exercise will help prevent your hips from getting too tight, as well as put your entire spine in a better position.

Chin Nods

Now that we’ve done a couple of mobility drills, let’s try to reinforce a few movement patterns to reverse your sitting posture and activate a few select muscle groups.
The first is the chin nod, which is great for the neck muscles and forward head posture. Many have heard of the chin tuck exercise, but the chin nod exercise is a little different in my mind.

Shoulder W’s

The next exercise builds off the chin nods, and now combines the chin nod posture with retraction of your shoulders. This will help turn on your posterior rotator cuff and scapular muscles all in one drill.

Glute Bridge

Lastly, we want to focus on the glutes and their ability to extend the hips, and taking some pressure off your low back. This glute bridge exercise, in combination with the above true hip flexor stretch, will be a great combo to help with your overall posture and core control.

How to Integrate These Exercises into Your Day

An easy way to start and keep it simple is to perform each of these 10 times. These should take less than 5 minutes to perform and will make a big impact on how you feel throughout the day.
Many people ask, “how many times a day should I perform these?” Or even, “do I need to do these every day?”

You don’t need to do these every day. Just on the days that you sit… :)

But seriously, remember these are 5 exercises you should do if you sit all day, so doing them at the end of each day to reverse your posture is a great idea. Many people who sit for a really long time like to perform them during the day as well.

As you get comfortable with them, you may find that certain ones help you feel better than others. Feel free to add repetitions to those as needed.

 

Want a Comprehensive Online Training Program?

champion strong online training - multiple devicesWe’re super excited to now offer an amazing online training program, Champion Strong. It’s our flagship training program that we use at our gym Champion PT and Performance with many of our clients. It’s designed to give you a comprehensive program to follow at the gym that focuses on helping you look, feel, move, and perform better.

We have video demonstrations of all the exercises, plus a bunch of great educational videos to teach you the major movements. Plus it has an awesome training app to view, schedule, and log your workouts.

We’re really proud if it. Click below to learn more and sign up for less than $1 a day:

 

The True Hip Flexor Stretch

The hip flexor stretch has become a very popular stretch in the fitness and sports performance world, and rightly so considering how many people live their lives in anterior pelvic tilt.  However, this seems to be one of those stretches that I see a lot of people either performing incorrectly or too aggressively.  I talked about this in a recent Inner Circle webinar on 5 common stretches we probably shouldn’t be using, but I wanted to expand on the hip flexor stretch as I feel this is pretty important.

I’ve started teaching what I call the “true hip flexor stretch.”

I call it the true hip flexor stretch as I want you to truly work on stretching the hip flexor and not just torque your body into hip and lumbar extension.  It’s very easy for the body to take the path of least resistance when stretching.  People with tight hip flexors and poor hip extension often just end up compensating and either hyperextend their low back or stress the anterior capsule of the hip joint.

I explain this in more detail in this video:

 

The good thing is, there is a simple and very effective.  Once you adjust and perform the true hip flexor stretch, most people say they never felt a stretch like that before, hence the name “true hip flexor stretch.”

 

True Hip Flexor Stretch

To perform the true hip flexor stretch, you want to de-emphasize hip extension and focus more on posterior pelvic tilt.  Watch this video for a more detailed explanation:

 

Key Points

  • There is a difference between a quadriceps stretch and a hip flexor stretch.  When your rationale for performing the stretch is to work on stretching your hip flexor, focus on the psoas and not the rectus femoris.
  • Keep it a one joint stretch.  Many people want to jump right to performing a hip flexor stretch while flexing the knee.  This incorporates the rectus and the psoas, but I find far too many people can not appropriately perform this stretch.  They will compensate, usually by stretching their anterior capsule too much or hyperextending their lumbar spine.
  • Stay tall.  Resist the urge to lean into the stretch and really extend your hip.  Most people are too tight for this, trust me.  You’ll end up stretch out the anterior hip joint and abdominals more than the hip flexor.
  • Make sure you incorporate a posterior pelvic tilt.  Contract your abdominals and your glutes to perform a posterior pelvic tilt.  This will give your the “true” stretch we are looking for when choosing this stretch.  Many people wont even need to lean in a little, they’ll feel it immediately in the front of their hip.
  • If you don’t feel it, squeeze your glutes harder.  Many people have a hard time turing on their glutes while performing this stretch, but it is key.
  • If you still don’t feel it, lean in just a touch.  If you are sure your glutes and abs are squeezed and you are in posterior pelvic tilt and still don’t feel it much, lean in just a few inches.  Our first progression of this is simple to lean forward in 1-3 inches, but keep your pelvis in posterior tilt.
  • Guide your hips with your hands.  I usually start this stretch with your hands on your hips so I can teach you to feel posterior pelvic tilt.  Place your fingers in the front and thumbs in the back and cue them to posterior tilt and make their thumbs move down.
  • Progress to add core engagement.  Once they can master the posterior pelvic tilt, I usually progress to assist by curing core engagement.  You can do this by pacing both hands together on top of your front knee and push straight down, or by holding a massage stick or dowel in front of you and pushing down into the ground.  Key here is to have arms straight and to push down with you core, not your triceps.

 

 

I use this for people that really present in an anterior pelvic tilt, or with people that appear to have too loose of an anterior hip capsule.  In fact, this has completely replaced the common variations of hip flexor stretches in all of our programs at Champion.  This works great for people with low back pain, hip pain, and postural and biomechanical issues related to too much of an anterior pelvic tilt.

Give the true hip flexor stretch a try and let me know what you think.

 

 

The Kettlebell March Drill for Functional Core Stability

We’re big fans of farmer carries and suitcase carries at Champion.

Carries do a great job of developing functional core stability by adding an offset weight to the center of rotation of the body. But carries also offer so many other benefits – from grip strength, to upper body development, to overall athleticism.

Often times, clients with poor core strength or control will compensate during the carry.

If the core can not stabilize the trunk with the added load of the carry, it will compensate by relying on the static stabilizers of the body and rocking back into hyperextension of the back or leaning to the side.

In the below video, Kiefer Lammi, our Director of Fitness at Champion, shows how we have started to modify the carry in these individuals by adding a march. Not only does this promote better core control, it also facilitates training the trunk to remain stable while the distal extremities move functionally. This is one of the fundamental principles to enhance how well people move and perform.

Follow Champion For More

If you enjoyed this video, the team at Champion and I have been producing a ton of great content on Champion’s social media profiles, including regular content for #MovementMonday and #TechniquesTuesday, plus a ton more:

 

5 Reasons Why I Don’t Use the Sleeper Stretch and Why You Shouldn’t Either

Ah, the sleeper stretch.  Pretty popular right now, huh, especially in baseball players?  Seems like a ton of people are preaching the use of the sleeper stretch and why everyone needs to use it.  It’s so popular now that physicians are asking for it specifically.

I don’t like the sleeper stretch and I rarely use it, in fact I haven’t used it in years.  I don’t think you should use it either.

There, I said it, I felt like I really had the get that off my chest!

Every meeting I go to, I see more and more people talking like the sleeper stretch is the next great king of all exercises.  Then I get up there and say I don’t use it and everyone looks at me like I have two heads!  Call me crazy, but I think we probably shouldn’t be using it as much as we do.

In fact, I actually think it causes more harm than good.

 

5 Reasons Why Shouldn’t Use the Sleeper Stretch

I haven’t used the sleeper stretch in over a decade and have no issues restoring and maintaining shoulder internal rotation in my athletes with safer and more effective techniques.

If you have followed me for some time, you know that I rarely talk in definitive terms, as I always strive to continue to learn and grow.  I know my opinions will change and things aren’t black and white.  However, over the years my stance on NOT using the sleeper stretch has only strengthening.  As I learn more and grow, I actually feel more strongly that we shouldn’t be using this common stretch.

So why don’t I use the sleeper stretch?  There are actually several reasons.

 

It’s Often Performed for the Wrong Reason

The sleeper stretch is most often recommended for people with a loss of shoulder internal rotation.  When a person has a loss of internal rotation, it can be from several reasons, including:

  1. Soft tissue / muscular tightness
  2. Joint capsular tightness
  3. Joint and boney alignment of the glenohumeral joint and scapulothoracic joint
  4. Boney adaptations to repetitive tasks, such as throwing a baseball and other overhead sports

You must assess the true cause of loss of shoulder motion and treat accordingly.

Of the above reasons, you could argue that only joint capsular tightness would be an indication to perform the posterior capsule.  But see my next point below…

Performing the sleeper stretch for the other reasons could lead to more issues, especially in the case of boney adaptations.  The whole concept of glenohumeral internal rotation deficit (GIRD), is often flawed due to a lack of understanding of the normal boney adaptations in overhead athletes.

I can’t tell you how many people think they have GIRD that I evaluate and that they in fact do NOT have GIRD.  Click here to learn more about how I define GIRD.

 

It Stretches the Posterior Capsule

If you have heard me speak at any of my live or online courses, you know that I am not a believer in posterior capsule tightness in overhead athletes.  Maybe it happens, but I have to admit I rarely (if ever) see it.  In fact, I see way more issues with posterior instability.  Please keep in mind I am talking about athletes.  Not older individuals and not people postoperative.  They can absolutely have a tight posterior capsule.

But for athletes, the last thing I want to do is make an already loose athlete looser by stretching a structure that is so thin and weak, yet so important in shoulder stability.

Urayama et al in JSES have shown that stretching the shoulder into internal rotation at 90 degrees of abduction in the scapular plane does not strain the posterior capsule.  However, by performing internal rotation at 90 degrees of abduction in the sagittal plane, like the sleeper stretch position, places significantly more strain on the posterior capsule.

Based on the first two points I’ve made so far, if you have a loss of shoulder internal rotation, you should never blindly assume you have a tight posterior capsule.

Assess, don’t assume.

But be sure you know how to accurately assess the posterior capsule.  Many people perform it incorrectly.  Click here to read how to assess for a tight posterior capsule.

 

It is an Impingement Position

This one cracks me, check out the photos below, if you rotate a photo of the Hawkins-Kennedy impingement test 90 degrees it looks just like a sleeper stretch.  I personally try to avoid recreating provocative special tests as exercises.

sleeper stretch impingement reinold

 

This is a provocative test for a reason, by performing internal rotation in this position, you impinge the rotator cuff and biceps tendon along the coracoacromial arch.  If you actually had a tight posterior capsule, you’d get subsequent translation anteriorly during this stretch and further impingement the structures.

So based on this, even if you have a tight posterior capsule, I wouldn’t use the sleeper stretch.  I would just perform joint mobilizations in a neutral plane.

 

People Often Perform with Poor Technique

So far we’ve essentially said that people often perform the sleeper stretch for the wrong reasons and can end up torquing the wrong structure (the posterior capsule) and irritating more structures (the rotator cuff and biceps tendon).

Even if you have the right person with the right indication, the sleeper stretch is also often performed with poor technique, which can be equally as disadvantageous.

People often roll too far over onto their shoulder or start in the wrong position.  If you are going to perform the sleeper stretch, at least follow my recommendations on the correct way to perform the sleeper stretch.

 

People Get WAY too Aggressive

Despite the above reasons, this may actually be the biggest reason that I don’t use the sleeper stretch – people just get way too aggressive with the stretch.  The whole “more is better” thought process.  Being too aggressive is only going to cause more strain on the posterior capsule and more impingement.  You may actually flare up the shoulder instead of make it better.

I always say, if you have a loss of joint mobility, torquing into that loss of mobility aggressively is only going to make it worse.

 

When the Sleeper Stretch is Appropriate

There are times when the sleeper stretch is probably appropriate.  But it’s not as often as you think and it’s most often not in athletes.  The older individual with adhesive capsulitis or a postoperative stiff shoulder may be good candidates for the sleeper stretch.  But I honestly still don’t use it in these populations.  There are better things to do.

But of course, there are good ways to perform the sleeper stretch and there are bad ways, technique is important.

For more information on some alternatives to the sleeper stretch, check out my article on sleeper stretch alternatives.

 

How do SLAP Tears Occur: Mechanisms of Injury to the Superior Labrum

**Updated in 2017**

How does a SLAP Tear of the shoulder occur?

That’s a common question I here often.  Now that we have discussed the different types and classification of SLAP tears to the superior labrum, I wanted to now talk about how these shoulder injuries occur. There are several injury mechanisms that are speculated to be responsible for creating a SLAP lesion. These mechanisms range from single traumatic events to repetitive microtraumatic injuries.

This article is part of a 4-part series on SLAP Lesions

 

Traumatic SLAP Injuries

mechanism of slap tearTraumatic events, such as falling on an outstretched arm or bracing oneself during a motor vehicle accident, may result in a SLAP lesion due to compression of the superior joint surfaces superimposed with subluxation of the humeral head. Snyder referred to this as a pinching mechanism of injury. Other traumatic injury mechanisms include direct blows, falling onto the point of the shoulder, and forceful traction injuries of the upper extremity.

To be honest with you, I don’t know if this is actually the underlying cause of the SLAP lesion. I have questioned this theory in the past and don’t know the answer, but part of me at least wonders if these patients already had a certain degree of pathology to their superior labrum and the acute injury led to a MRI and diagnosis of a SLAP tear.

Essentially the MRI may have found an old SLAP tear.

 

Repetitive Overhead Activities

Repetitive overhead activity, such as throwing a baseball and other overhead sports, is another common mechanism of injury frequently responsible for producing SLAP injuries.

This is the type of SLAP lesion that we most often see in our athletes. In 1985, Dr. Andrews first hypothesized that SLAP pathology in overhead throwing athletes was the result of the high eccentric activity of the biceps brachii during the arm deceleration and follow-through phases of the overhead throw. To determine this, they applied electrical stimulation to the biceps during arthroscopic evaluation and noted that the biceps contraction raised the labrum off of the glenoid rim.

Peel Back SLAP Tear

Burkhart and Morgan have since hypothesized a “peel back” mechanism that produces SLAP lesion in the overhead athlete. They suggest that when the shoulder is placed in a position of abduction and maximal external rotation, the rotation produces a twist at the base of the biceps, transmitting torsional force to the anchor.

This mechanism has received a lot of attention and several studies seem to show its accuracy.

Pradham measured superior labral strain in a cadaveric model during each phase of the throwing motion. They noted that increased superior labral strain occurred during the late-cocking phase of throwing.

Another study from ASMI simulated each of these mechanisms using cadaveric models. Nine pairs of cadaveric shoulders were loaded to biceps anchor complex failure in either a position of simulated in-line loading (similar to the deceleration phase of throwing) or simulated peel back mechanism (similar to the cocking phase of overhead throwing). Results showed that 7 of 8 of the in-line loading group failed in the midsubstance of the biceps tendon with 1 of 8 fracturing at the supraglenoid tubercle. However, all 8 of the simulated peel back group failures resulted in a type II SLAP lesion. The ultimate strength of the biceps anchor was significantly different when the 2 loading techniques were compared. The biceps anchor demonstrated significantly higher ultimate strength with the in-line loading (508 N) as opposed to the ultimate strength seen during the peel back loading mechanism (202 N).

You can see photos of the study below.  The first photo is a normal glenoid with the labrum and attaching long head of the biceps.  The second photo is the simulation of the traction and eccentric biceps contraction.  The final photo is simulation of the peel-back lesion.

In theory, SLAP lesions most likely occur in overhead athletes from a combination of these 2 previously described forces. The eccentric biceps activity during deceleration may serve to weaken the biceps-labrum complex, while the torsional peel back force may result in the posterosuperior detachment of the labral anchor.

 

 

shoulder seminarLearn Exactly How I Evaluate and Treat the Shoulder

If you want to learn even more about the shoulder, my online course at ShoulderSeminar.com will teach you exactly how I evaluate and treat the shoulder.  It is packed with tons of educational content that will help you master the shoulder, including detailed information on the clinical examination and treatment of SLAP tears.