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Brian Schiff’s Blog

Injury Prevention, Sports Rehab & Performance Training Expert

Archive for 'injury prevention'

It is that time of the year again. Everyone wants to lose weight and trim their waistlines. Abs, abs and more abs, right? I am all about some core training, but I am always concerned with some of the ab variations that I see commonly used at the gym and in group fitness environments.

Many exercise enthusiasts have tight hip flexors and poor abdominal control. Sprinkle in a history of low back pain or a prior disc injury along with straight leg abdominal exercises and now you have the perfect recipe for a possible back injury. Why is that? Well, the psoas originates from the lumbar spine and attaches to the lesser trochanter on the hip.


In the picture above, you can see how the muscle impacts the spine and hips. As you lower your legs toward the ground during an ab exercise, there is a reverse muscle action that takes place and resultant anterior shear force exerted on the lumbar spine. When the abdominal muscles cannot resist this motion, the lumbar spine hyperextends.

Many people will even report feeling a pop in the front of the hip while doing scissor kicks, leg lowering or throw downs. In many cases, this may be the tendon running/rubbing on the pectineal eminence. Unfortunately, long lever and/or ballistic abdominal exercises with inherently poor core stability/strength, fatigue and gravity working against you will create significant load and strain on the lumber spine. Ever wonder why you wanted to put your hands under your back while doing 6 inches? Your brain is trying to flatten the spine using your hands as it knows the hyperlordotic position is uncomfortable and threatening.

In light of this, I put together a little video for PFP Magazine revealing a safer way to work your abs and prevent undue stress and strain on your back. Check it out below.

Keep these modifications and progressions in mind the next time you hit the gym or a boot camp class focusing on core/ab training.

In my previous post, I outlined the history and findings related to my son’s medial elbow pain. Since publication of that blog post, I have since been given the results of his MR arthrogram and have further updates. If you did not read the prior post, you can click here to read it.

Initially, my concern was tendinitis or more of a flexor/pronator strain given his mild yet persistent soreness and response to rest. The imaging revealed that his UCL was pristine, the radiocapitellar joint liked good, no osteophyte formation or really any inflammation in the soft tissue. The surge told me he had to look closely, but there was evidence of mild fluid around the apophysis. So, in essence, there was some overload/strain being placed on the growth plate.

Given that my son’s growth plates are still open at age 15, he was experiencing some overload (apophysitis) rather than strain on the UCL itself. Had he been skeletally mature, there likely would have been more stress being placed directly on the ligament itself. So, this was good news for all of us.

We received the results on Tuesday October 31. With clearance to pitch last weekend as tolerated by the MD, I elected to have my son throw a bullpen last week. He threw 25 pitches on Wednesday night (one week ago) and was at 100% and pain free. As such, I let him throw 40 pitches in our showcase game last Saturday. He again threw pain free. Now that Fall baseball has ended, we will shut him down for some extended rest and focus on arm care and overall strength and conditioning as he continues his HS workouts.

Some key takeaway points for players, parents and coaches:

  • Never dismiss pain that occurs with throwing
  • Educate players about throwing related soreness/tightness (such as lactic acid build up that would be typical after a start on the mound) so they can differentiate that from true pain
  • If velocity, mechanics or performance in a player suddenly drops, be suspicious of a potential injury knowing that most players will try to throw through it (look for shaking/rubbing of the arm, grimacing or other body language that is outside the player’s normal routine)
  • If you suspect an injury, seek out an immediate assessment from a knowledgeable physical therapist and/or MD who treats baseball players as they will do a more comprehensive evaluation and uncover the root cause of dysfunction faster
  • Getting imaging in a higher level player will provide peace of mind for the athlete, parent and coach allowing for proper care and progression back to pitching as evidenced in this situation
  • Managing pitch counts, innings pitched and recovery between appearances will be instrumental in preventing or reducing injuries

In the end, we must rely on the athletes to communicate what they re feeling. Often, pitcher push through fatigue and pain in the spirit of competition. It is imperative that we advise against this in order to promote long term health and prevent more serious injuries. I know I feel fortunate that my son’s injury was not serious at all.

Moving forward, I will adjust his off season and in-season throwing to ensure he actually conditions his arm with more frequent throwing (not pitching) to ensure his endurance is better, as I feel this may have been a factor in his overuse scenario. While he threw a weekly bullpen this summer, he only threw on average 2 days per week on top of that. He threw daily in middle school ball last year and never had any arm related issues on the mound.

Each player is different in terms of their build, pitching capacity, arm talent, etc. With that said, I think it is important to analyze their performance over the year based on innings pitched, pitch counts, rest between outings, strength program, throwing programs and perceived fatigue to evaluate what works bets for the player. Educating players and parents about arm care and health management strategies will reduce injuries and facilitate long term success for pitchers that have a chance to play in college and beyond.

I have a steady flow of baseball players who come to see me for shoulder and elbow rehab. As a former pitcher whose playing career was altered by an arm injury at age 14, I have a particular interest in throwing injuries. My son is a 6′2″ left-handed pitcher that plays showcase baseball. He will be the subject matter of this post moving forward.


Many of the players I see for shoulder and elbow pain suffer from pathological GIRD (glenohumeral internal rotation deficit). While it is common to see throwers with less internal rotation on their dominant side, it is important to assess total shoulder motion to make sure their mobility is within 5 degrees of their non-dominant side. Asymmetry in total shoulder motion and shoulder flexion increase the odds of elbow injuries. Click here to see the correlation in professional pitchers. Additionally, insufficient external rotation gain on the throwing arm increases injury risk. Click here to read an abstract summarizing data within the same group of professional pitchers.

Given this information and my background, I have preached arm care for years to my son. For some background, my son has pitched since he was 9 years old. Since I have been a coach for his team in one capacity or another since he was 10, I have closely monitored and controlled his pitch counts, innings per outing and total innings per year. He has always been able to throw hard, but he had a big growth spurt in middle school and his velocity grew with that.

He now throws between 75-77 mph as a HS freshman. He is projected to be 6′5″ tall and weighs 170 pounds at this time. His showcase coach pitched in MLB, and we have two other organizational pitching instructors with big league experience who supervise his weekly bullpens. His total innings pitched for 2017 = 43. Research indicates anything over 100 significantly increases injury risk. With all that said, he has developed some medial elbow pain over the past 4 months. He has no history of arm trouble to date. My intention is for this post to serve as useful diagnostic and proactive intervention for those who may see and experience similar cases.

Continue reading…

Shoulder impingement is a common problem for many clients. Specifically, some clients will suffer from internal impingement as a result of a significant loss of internal rotation range of motion, also known as GIRD (glenohumeral internal rotation deficit). This has been widely researched in baseball players, and it is a common issue for overhead athletes. Of note, it can also impact those doing repetitive overhead lifts.

It is common to see asymmetry in internal range of motion for the dominant and non-dominant arms. For those clients who have a total shoulder motion asymmetry greater than 5 degrees, it becomes more important to resolve internal range of motion deficits based on the current literature. In my previous post, I revealed how to improve soft tissue mobility. In this post, I will review the sleeper stretch and cross body stretch to improve posterior shoulder mobility while increasing internal rotation.

The video below from my column ‘Functionally Fit’ for PFP Magazine will demonstrate how to do these stretches.

Tightness and trigger points in the infraspinatus are common and create lots of dysfunction in the shoulder. You may also see tightness in the teres minor. Problems may include a rounded shoulder, chest tightness, a rotated scapula causing fatigue in periscapular muscles, trap tightness and even anterior compression of the humerus.

It is essential that any trigger points be resolved prior to stretching to make a lasting impact on the soft tissue mobility. The video below reveals how to use a trigger point ball to reduce soft tissue restriction in the posterior shoulder that may impede proper mobility and mechanics. Tightness may predispose overhead athletes and those doing resistance training to increased risk for rotator cuff and/or labral injuries.