September 2011: Eric Cressey MA, CSCby John Meadows on September 24, 2011
JOHN: It is my pleasure to introduce this month’s featured interview Eric Cressey. I have come across Eric’s educational videos on YouTube, and read his work on his blog, and am very excited about sharing his knowledge and skill with you!!
Eric, can you give my readers some background on what you do for a living, and what some of the things you are most passionate about in terms of training, nutrition, or whatever?
ERIC: Sure thing.
The majority of my time is spent as president of Cressey Performance, a facility just west of Boston that I co-founded in 2007. While we work with athletes and general fitness clients from all walks of life, we’ve carved out a nice niche for us with baseball players, which constitute about 80-85% of our clientele. We have athletes who travel from all over the country to little ol’ Hudson, MA to spend some snowy winters with us because they view training us as a competitive advantage that can help their careers.
Additionally, I do a lot of writing, consulting, and presenting on a wide variety of topics in the fields of health and human performance. Training baseball guys is undoubtedly my greatest passion, as it’s something I’ve devoted a ton of time and energy to over the past few years – and I feel like we’ve built something very special at CP. At the same time, though, I appreciate variety more than ever – whether it’s training an Olympic bobsledder, working with a pro boxer, or helping a weekend warrior get rid of back pain.
JOHN: I am interested in getting some injury perspective. For example, many weightlifters have chronically sore elbows, rounded shoulders, bad knees, etc.
1. Do you find that baseball players incur the same such injuries?
2. If so, is there any underlying similarity in the root cause of the injuries.
I know this is a very generic question. I’d just like for you to expound on common root causes, such as inflexibility, poor muscle and strength balance, etc. I wonder how much overlap exists?
ERIC: You can really go in either direction on this one. On one hand, throwing a baseball is the single-fastest motion in all of sports – and with that stress comes a unique set of injuries that you simply don’t see in the general population. For instance, the rotator cuff issues we see in baseball players are usually articular-sided (undersurface) tears, whereas “ordinary folks” – whether they are desk jockeys or avid lifters – wind up with bursal sided (on top) tears. It’s the difference between external impingement (ordinary folks) and internal impingement (throwers). Likewise, I can’t say that I’ve ever seen an ulnar collateral ligament tear of the elbow in a non-thrower because most people can’t get to this position sitting at their desk, lifting, gardening, or whatever else it is they do during daily life.
With overhead throwing athletes, we have people who are already asymmetrical (we all are), but participate in activities that can push the asymmetry so far that it becomes a pathology.
On the other hand, there are a lot of issues that we see in all populations. People sit far too much and lose ankle, hip, and thoracic spine mobility – and athletes spend loads of time sitting on buses and planes for travel. Our high school and college guys sit in class all day. And, of course, everyone goes home and sits in a horrendous posture to mess around on Facebook, Twitter, and Instant Messenger nowadays. The gap between high-level athletes and the general population gets smaller and smaller every day. Good training – aimed at attaining adequate strength, power, mobility, and tissue quality – can prevent all of these individuals from reaching symptomatic “threshold.”
Another area in which high-level athletes are much like general fitness folks is that you can assume that they are ALL injured. 83% of asymptomatic Americans have disc bulges and/or herniations that they don’t even know are there. 79% of professional pitchers have some “abnormal” labral feature in their throwing shoulders. You can do diagnostic imaging – MRI, bone scan, x-ray, whatever you want – of literally any joint in the body and find something wrong in just about anybody, whether they sit at a desk all day or throw 95mph in front of 45,000 people. In short, we’ll all a mess structurally, but how we move is what matters.
JOHN: I think many of us struggle with that “sitting too long” thing. I had a weird experience a few weeks ago where when I got up out of my seat, my hip flexors hurt pretty bad. Once I walked around for a few minutes, they loosened up. I have people come to me all the time with tightness and pain similar. Can you give my readers 1-2 tips on loosening up this area, or activating it, whichever you think is more productive in the long run?
ERIC: The advice I give all our clients is that the best posture is the one that is constantly changing. “Creep” starts to kick in at right about 20 minutes, so if you can get up and move around every 15 minutes or so, that’s a great start. And, while at your chair, “fidget” constantly.
When it comes to training to undo this damage, think of the posture in which you spend more of your day: hip flexion and thoracic flexion. Going to the gym and riding the recumbent bike for 45 minutes is only going to further cement this wretched posture. You need to get the hips and thoracic spine extended – so selecting standing exercises such as these will work well:
- posterior chain work – deadlifts, pull-throughs, good mornings, hip thrusts, 1-leg RDLs
- horizontal pulling – cable rows, dumbbell rows
- split-stance lifts is a great start – lunges, split squats, split-stance cable chops/lifts
JOHN: I also would like to get your thoughts on foam rollers. I purchased this big monster with nodules on it called a “rumble roller”, and I swear rolling on that thing has done wonders for my range of motion in squat, reduced any hip pain I was having, and even loosed up my hip flexors when rolling directly on them. Do you find this to be a useful too?
ERIC: I’m glad you asked, as a lot of people like to knock foam rolling. I’m a huge advocate of soft tissue work – and foam rolling is a gentle “gateway” soft tissue experience.
I don’t care whether it’s a focal modality like Active Release, a mid-range modality like Graston Technique, or a more diffuse approach like general massage; just make sure that you get some sort of soft tissue work! A foam roller is a good start and something that you can use between more targeted treatments with a qualified professional. A lot of people really think that they are “breaking up scar tissue” with these modalities, and they certainly might be, but the truth is that I think more of the benefits come from altering fluid balance in the tissues, stimulating the autonomic nervous system, and “turning on” the sensory receptors in the fascia. As Anatomy Trains author Thomas Myers noted in a presentation last June, we have nine times as many sensory receptors in fascia than we do in muscle. You just can’t overlook that.
To read my entire recap of Myers’ presentation, check out The Fascial Knock on Distance Running for Pitchers.
Also, I really like the Rumble Roller. We’ve got one at CP, and we jokingly call it “The Violator.”
JOHN: Very interesting! I was thinking while doing the rumble roller I was just breaking up adhesions, and allowing muscles to glide better, kind of like ART, which I am a huge fan of. Generally speaking, what happens when you “turn on” sensory receptors in fascia?
*Note, a rumble roller can be purchased at http://www.flexcart.com/members/elitefts/default.asp?m=PD&cid=114&pid=3407
ERIC: It may be doing that, to some degree; I’m not sure we really know. One valuable take-home point that I got from the Z-Health school of thought was that mechanoreceptors (respond to pressure) and nocioceptors (respond to damage) seem to always work at odds with one another.
When nocioceptors are firing like crazy, you’re in pain and guarding – which is why foam rolling shouldn’t be crazy painful. It sounds counterintuitive, but a lot of times, the ones who need to be “babied” the most with these diffuse soft tissue modalities are the one who have the greatest need for quality tissue work. If they can just get the ball rolling with some mechanoreceptive input (pressure, not anything that causes serious discomfort), I think it allows them to let their guard down a bit – which, in turn, allows you to make the most of the subsequent mobility and strength training you do.
I like how Charlie Weingroff phrased it: “get long, get strong, train hard.” Soft tissue work is just a component of getting long before you start to truly ingrain more ideal movement patterns under load.
JOHN: Can you also talk about altering fluid balance in the tissues? Do you mean that more blood is getting to the area to deliver nutrients and take away waste etc.? Or do you mean something else?
ERIC: This is far from my realm of expertise, but I take it to mean improved lymphatic drainage as well as a means of improving peripheral circulation – which is why it seems to be a good transition from rest to exercise.
JOHN: Eric can you recommend a particular soft tissue type technique to my readers, or is it more dependent on the nature of the issue? I always found that ART worked well for many injuries that I had.
ERIC: I don’t think one option is necessarily better than all the others, as you have different tools in your toolbox for different tasks. ART is a great approach that is more focal in nature, so it works quite well for zones of convergence like the medial and lateral elbow, rotator cuff insertions, and plantar fascia. Graston Technique, ASTYM, Gua Sha, the Fibroblaster, and cupping are all options that may be better for treating larger areas (e.g., adductors, biceps, hamstrings) that may still need more aggressive work. General massage can be a great “diffuse” modality that isn’t as aggressive. There’s a time and place for all of them – and the most important thing is that the practitioner is comfortable with whatever modality he/she chooses.
JOHN: Too funny, my elbows and rotator cuff are exactly what I used ART for. Switching gears, I know that you are no nutrition slouch either. What are the most common nutritional mistakes you see with your elite level athletes? Is it the same issues that the average Joe faces, or more complex in nature, generally speaking?
ERIC: You’d be amazed to hear how pathetic many elite athletes are when it comes to nutrition, so much of the same advice that we give to general fitness clients and young athletes applies to elite athletes as well. The main difference is going to be increased caloric demands, a greater focus on peri-training nutrition, and more attention to getting many of the valuable nutrients that get overlooked when guys slam sports drinks and convenience food all day. Let’s just say that the typical clubhouse food in the minor leagues is less than stellar – and the off-season becomes a time when guys need to undo some damage in this regard.
JOHN: Doesn’t surprise me at all. There is a lot of controversial methods of eating as well (eating patterns), and probably some validity to them all, but I think one of the hotter debates today is eating less meals per day, but making them larger and more focused around training, i.e. intermittent fasting, and then the traditional 5-6 meal a day approach. Generally speaking, is there a pattern that you like to see your clients use?
ERIC: Most of our clients tend to adhere to the 5-6 meals per day option, simply because we get a lot of skinny athletes who need to gain weight, and this approach allows them to get sufficient calories in. That said, we’ve had a few clients who have utilized some intermittent fasting and really enjoyed not only the convenience it affords, but also the results they’ve attained. As with anything, nutritional strategies need to be individualized to the person, and that’s what we would do.
JOHN: When you are helping your clients with their nutrition, do you just focus more on the quality of food they eat, and the timing, OR do you get deep into macronutrient ratios and playing with those numbers?
ERIC: First off, I should be up-front and admit that I refer all our nutrition consulting work to another one of our staff members (Chris), as I’m smart enough to know that he can handle it much better than I can. That said, the general approach is geared heavily toward the quality of food they eat and when they eat it. We very rarely have clients counting calories; once they have the “what” and “when” taken care of, it seems like the “how much” tends to handle itself.
JOHN: Ahh – that’s like a breath of fresh air. Focus on micro nutrition before macro nutrition I always say!
Eric, one thing that is confusing to many, is the balance between staying flexible and growing muscle or getting stronger. Many feel that you can do TOO MUCH flexibility work and compromise joint integrity and muscle growth! Can you share your thoughts on flexibility, and the timing of when it should be done, and anything else our readers would find informative on it?
ERIC: Wow, this is a bit of a loaded topic, so I’ll do my best to relate my thoughts in a way that may or may not make sense when all is said and done.
Flexibility is a garbage term that people have used to cover a bunch of different things, but nobody seems to want to define. I wrote an entire chapter on this for the International Youth Conditioning Association’s High School Strength Coach Certification, in fact. I prefer to use the term mobility, which simply refers to one’s ability to attain a certain position or posture – which is a function of joint stiffness, muscular shortness, muscular stiffness, ligamentous laxity and neuromuscular sequencing/control all lumped together. From that text, here’s a summary on the difference between the two:
- Mobility speaks to one’s ability to reach certain positions. Flexibility speaks to just a few factors that affect that ability.
- Mobility relies heavily on stability – which comes from neuromuscular recruitment. Flexibility relies only on “relaxed” muscles/tendons and joints to go through their isolated range of motion. Effectively, it ignores the nervous system.
- Mobility involves multiple joints simultaneously. Flexibility generally only involves 1-2 joints at a time.
- Mobility takes into consideration the role the fascia plays in governing movement. Flexibility may limit fascia’s inclusion in the assessment because of the isolated nature of its examinations.
- Mobility is easy to assess in a general sense, but always mandates follow-up screening to determine what the source of inhibition is.
Flexibility is a quick assessment, and addressing the inhibition discovered doesn’t promise any improvement in movement quality.
Nobody – except maybe misinformed soccer moms who like to brag to their friends after yoga class – trains flexibility to brag about their “range of motion.” Rather, they incorporate training along these lines because they expect it to allow them to get to positions they otherwise wouldn’t be able to reach and stay healthy in the process.
To that end, there is a time and a place for just about everything. As noted earlier, we use foam rolling and manual therapy to help folks’ mobility efforts along, as they have direct effects on both the nervous system and the tissues in question.
We utilize mobility drills (or dynamic flexibility, if you prefer that term) prior to training as a means of “getting long” while increasing body temperature. Big target areas are ankle, hip, and thoracic spine mobility.
We may also use shorter duration static stretching post-workout to minimize the effects of eccentric stress; this is particularly useful with our arm care program for pitchers, as they encounter the highest eccentric stresses in all of sports when releasing a baseball.
Taking it a step further, we may use longer duration static stretches (up to 15 minutes) or eccentric quasi isometrics (active holds at end-range…rarely for more than 60s) for those with truly short muscles – meaning that they have lost sarcomeres (this is common in post-surgery immobilization cases, as well as meatheads and desk jockeys who don’t get enough amplitude in their daily lives). Here, we are actually working to add sarcomeres back in series – which can actually work to improve muscular strength (and, in turn, size) via optimizing the length-tension relationship.
Of course, stretching an already long muscle can make one weaker, too. It’s why women with congenital laxity who use the wrong yoga exercises often wind up in pain. Lastly, not to be overlooked is the role of increasing stiffness at an adjacent joint in improving mobility. If you’re stiff at your posterior rotator cuff and can’t seem to get internal rotation, improving scapular stability via strength of the lower trapezius and serratus anterior; that added stability “allows” the humeral head to internally rotate on the glenoid. I recently wrote a detailed blog along these lines: Corrective Exercise: Why Stiffness Can Be a Good Thing.
Mike Roberts, Bill Hartman, and I took all these concepts into account when we created Assess and Correct: Breaking Barriers to Unlock Performance. We didn’t care about “flexibility” (whatever that means); we cared about helping people move better so that they could get stronger, gain muscle mass, become more athletic, do the things they want to do – and stay healthy in the process.
JOHN: Eric this is great information and perspective. How can I get my readers more info on this from you (and for myself)?
JOHN: Thank you so much for your time, and gems of information Eric. It is has been a pleasure to have someone with your level of knowledge share with us. Best of luck in the future, and let’s stay in touch!
ERIC: Thank you very much! It was my pleasure – and I appreciate the opportunity.