Jan 29, 2015Ready for Prime Time
When a minor league pitcher sought treatment for some back and shoulder pain, this rehab team helped propel him into the big leagues–and a pennant race.
By Dr. Micheal Clark and Marty Miller Micheal Clark, DPT, MS, PT, CES, PES, CPT, is President and CEO of the National Academy of Sports Medicine and Team Physical Therapist to the NBA Phoenix Suns. Marty Miller, MS, ATC, PES, CES, CSCS, is a former athletic trainer for the Montreal Expos and currently Director of Fitness at the BallenIsles Country Club, where he continues to work with professional baseball players during the offseason. Clark and Miller can be reached at: www.nasm.org.
In professional baseball, every minor league player is waiting for one phone call: “Are you ready to play in the Big Leagues?” For Zach Miner of the Detroit Tigers, that call came on June 4, 2006, after starter Mike Maroth was sidelined with an elbow injury. A 24-year-old right-handed pitcher, Miner had played in the minors for five years with limited success, but was pitching better than ever at the start of 2006, with a 6-0 record in Triple A ball.
Although Miner’s call-up was originally for a fill-in stint, he ended up staying–sometimes starting, sometimes relieving–and ultimately helping the Tigers win their first American League pennant in 22 years. On the season, he went 7-6 with a 4.84 ERA, and made the Tigers’ reduced playoff roster in September.
There are many steps in making it to the major leagues, but one that some players neglect is staying healthy. Understanding this dynamic, Miner came to us after his 2005 minor league season, complaining of mild pain in both his right posterior shoulder and lower back. He had never been sidelined with a major injury, but he wondered if his symptoms were slowing him down, and if any underlying problem had the potential to end his career before it ever truly got started.
Overuse and repetitive trauma injuries occur frequently in baseball. A major league season is 162 games long, and there’s also a month of spring training and possible postseason play. Players will perform the same repetitive tasks thousands of times over the season, leaving them at risk for breakdown and injury. However, with a specialized, integrated conditioning program, injuries can be prevented and performance can be improved.
Miner began his integrated program with us at the end of the 2005 minor league baseball season. Previously, he had only used traditional strengthening programs that did not take into account any of his movement impairments. He had gone straight from high school into pro baseball.
Before initiating a program for Miner, we performed a comprehensive evaluation. When it comes to assessment, we feel an integrated approach is critical. The combined efforts of the nervous, muscular, and skeletal systems are responsible for even the simplest movements in the human body, and collectively they make up the kinetic chain. If a small dysfunction occurs in any of these systems, the others’ ability to perform their functions will be substantially reduced.
Therefore, we perform goniometric measurements, manual muscle testing, and most importantly, an Integrated Movement Assessment. The movement evaluation includes an overhead squat and single-leg squat. Using our understanding of functional anatomy and biomechanics, we assess structural alignment and the neuromuscular efficiency (coordination) of the kinetic chain. If a breakdown or movement compensation occurs at any of the joints that make up the kinetic chain, the structural integrity of the muscles that control those joints will be evaluated. (See “Assessment Chart” for check points.)
The purpose of this testing was to discover any pre-existing muscle imbalances, joint dysfunctions, or neuromuscular inefficiencies that could be leading to the discomfort in Miner’s shoulder and lower back. The tests were also chosen to discover any movement dysfunctions that could cause problems in the future.
Whenever there is excessive motion during the assessment, which can be caused by either overactive (short/tight) or underactive (long/weak) muscles, the nervous systems will constantly elicit less then ideal firing patterns. A strategic plan can then be created based on these findings. Once the corrective exercise training plan is implemented, the imbalances will be corrected and optimal movement of the kinetic chain will be restored.
Restoring optimal movement is key, because if any segment of the body functions in a less than ideal manner, the altered movement patterns that develop will place increased stress on the tissue around those particular joints. As we condition our athletes, we purposely place stress on their bodies. If there is optimal alignment of the kinetic chain, loads will be handled by the body efficiently and will elicit positive responses. But if the structural integrity of the athlete’s kinetic chain is compromised, the stress we place on them may actually leave them more susceptible to injury.
So how did Miner do on his assessment? During his overhead squat, his feet everted, indicating probable over-activity in his lateral gastrocnemius, peroneal complex, and the short head of his bicep femoris. Underactive muscles that likely contributed to this movement compensation included his medial gastroc, popliteus, and medial hamstring complex.
When Miner squatted, he ran out of available dorsiflexion in his foot and ankle complex in the sagittal plane. To continue descending further into the squat, his body found the path of least resistance. Miner moved his foot and ankle into the frontal and transverse plane (eversion and external rotation) to create the dorsiflexion he was lacking. An everted position of the foot and ankle moves the posterior tibialis, medial gastrocnemius, and medial hamstring into a lengthened position. To correct this movement compensation, those muscles would need to be strengthened.
An everted foot and ankle may also cause the knee to adduct and internally rotate during movement. This indicates weakness in the gluteus medius, which is a key muscle for providing stability to the entire lumbo-pelvic-hip complex in the frontal plane. Along with the gluteus medius, the gluteus maximus is also placed in a lengthened position if the knee adducts and internally rotates.
At Miner’s lumbo-pelvic-hip complex, we noted an excessive arch, along with the movement compensation of arms falling forward, which indicated probable overactivity in the latissimus dorsi, hip flexor complex, and erector spinae. The anterior-tilted position of his lumbo-pelvic-hip complex placed his latissimus dorsi in a shortened position, which can affect both the origin (thoracolumbar fascia) and insertion (anterior portion of the humerus). This decrease in length and extensibility prevented Miner from fully extending his arms above his head without creating compensation in his glenohumeral joint.
Miner’s normal posture of protraction through the thoracic spine would also mimic the above described movement compensations. These altered positions placed the rhomboids and middle and lower trapezius in a constant state of stretch. As a result, Miner was unable to maintain the proper glenohumeral rhythm necessary during his pitching motion.
When we evaluated Miner’s compensations, we were able to correlate them to his shoulder and lower-back discomfort. His most prominent compensations were the arch in his lower back and the fact that his arms fell forward upon the descent of his squat.
We then explained to Miner that his shoulder and lower back pain were being caused by the movement compensations identified in his assessment, and he took a particular interest in correcting them. Besides obviously wanting to decrease his current pain, he hoped to increase his overall performance and prevent injuries in the future.
AN INTEGRATED PROGRAM
The program we designed for Miner focused on correcting his overactive and underactive muscles, increasing his body’s stability, improving coordination, and furthering strength and stamina to prepare him for the upcoming season. Each phase of his training was broken into three or four weeks, so the whole process fit into his five-month off-season.
Phase One: Our first priority was to address Miner’s movement compensations with an approach we call Corrective Exercise Training (CET). This phase lasted three weeks. The goals were to inhibit the overactive muscles that were causing movement compensations, lengthen the overactive/short muscles, activate the underactive/weak muscles, and integrate optimal movement into functional movement patterns.
To inhibit the overactive muscles, Miner performed self-myofacial release on the following muscles, doing one set for 30-60 seconds, and following with static stretching on these muscles for 30 seconds:
• TFL/IT band • Adductor magnus • Lateral gastroc • Latissimus dorsi.
He activated the following weak muscles for 15 reps and two sets, with a tempo of 4/2/2:
• Gluteus medius • Gluteus maximus • Popliteus/posterior tib combo • Medial gastroc.
To integrate these movements into functional movement patterns, he did the following:
• Prone iso abs with hip extension, with a five-second hold, 3x each leg, for 10 reps and two sets. • Standing one-leg reach in the frontal plane, with a five-second hold, for 10 reps and two sets. • Wall ball squat to scaption, with a tempo of 4/2/2, for 15 reps and two sets.
Phase Two: Upon completion of the CET protocol, Miner moved into a four-week Integrated Stabilization Training (IST) program. The goals were to increase total body stability, endurance strength, and neuromuscular efficiency while improving inter- and intra-muscular coordination. We also started cardio training three times a week.
For Warmup/Flexibility: • Hold tender spots for 20 to 30 seconds of the: SMR lateral gastroc, IT band, TFL, adductor magnus, latissimus dorsi, and pecs. • Conduct static stretching, with 30-second holds of the: lateral gastroc, TFL, adductor magnus, latissimus dorsi, and pecs.
For Core and Balance: • Ball bridges, 3×15, 4/2/2 tempo, no rest • Prone iso abs, 3×1, 30-second hold, no rest • Cable PNF, 3×12, 4/2/2, maintain neutral spine, arm movement only • Single-leg balance and reach, 3×5, three-second hold, movement in all planes.
For Reactive Work: Jump up to hold, 3×12, three-second hold, rest 15 seconds. Do one set in each plane of motion.
For Strength Training: The following exercises were done at a 4/2/2 tempo for 15 reps and three sets, with no rest in between except for the step-up, which allows 60 seconds of rest. We added work for the biceps and triceps some days.
• Ball squat w/scaption • Standing band chest press, one leg (press until shoulders are fully protracted) • Standing cable row, one leg • Ball combo one (lying prone over a stability ball, the athlete engages the core and lower body while making three distinct movement with his arms) • Step-up sagittal plane to curl.
Post-Workout Flexibility: foam roll and conduct stretching as in the warmup.
Phase Three: With a platform of stability in place from Phase Two, the next phase was designed to build a solid foundation of strength. This program is called Stabilization Equivalent Training (SET) and is a hybrid form of training designed to increase strength endurance.
During this phase of training, the athlete completes one strength-based exercise, then immediately completes a stabilization exercise for the same body part. This helps the body to stabilize itself under heavier loads, handle increased training volume, improve metabolism, and increase motor unit recruitment, frequency of motor unit recruitment, and motor unit synchronization. Phase three lasted four weeks and also included speed, agility, and quickness training, plus cardio work.
For Warmup/Flexibility: • Hold tender spots for 20 to 30 seconds of the: SMR calves, lats, IT band, and adductor magnus. • Conduct active stretching, with three- to five-second holds, for five reps of the: lateral gastroc, hip flexors, adductors, and lats.
For Core and Balance: Two sets of 12 reps with a 2/0/2 tempo doing the following exercises:
• Ball crunch w/rotation • PNF rotations • Ball cobra alt. arm • Single-leg squat
For Reactive Work: squat jump multi planar, 2×10, repeating with no rest.
For Strength Training: The following were conducted for 12 reps and two sets, with no rest except for 30 seconds between the squat-to-row sets. We added work for the biceps and triceps some days.
• Squat to row, two arms, 2/0/2 • Incline DB alt. arm, standing, 2/0/2 • Standing one-leg band chest press, 3/2/1 • Standing cable row, two legs, 2/0/2 • Prone call DB row alt. arm, 3/2/1 • Standing scaption, 2/0/2 • Ball combo one, two-second hold each • Ball squats, 2/0/2 • Single-leg Romanian deadlift, 3/2/1
Post-Workout Flexibility: foam roll and conduct stretching as in the warmup.
Phase Four: Next up was Elastic Equivalent Training (EET). This phase focuses on increasing the body’s ability to produce both force and velocity. A maximum strength exercise is completed, followed immediately by an explosive movement for the same body part using little weight. We also continued to do cardio training and speed, agility, and quickness training.
• Hold tender spots for 20 to 30 seconds of the: SMR lateral gastroc, IT band, adductor magnus, latissimus dorsi. • Dynamic stretching of 12 reps and two sets by doing MP lunges, prisoner squats, and med ball lift series.
For Core and Balance: Two sets of eight reps of:
• Med ball crunch and throw, 15-second rest • Med ball back extension throw, 15-second rest • Single leg hop multi planar, 3-10 second hold, 30-second rest For Strength Training: The following circuit was performed three times, with a two-minute rest in between. Work for the biceps and triceps was added some days.
• Squat curl and press, 2×5 • Arm DB snatch, 10×10 • DB press, 2×5 • Med ball rotational pass, 10×10 • Seated cable row, 2×5 • Med ball throw, 10×10 • Step-ups sagittal plane, 2×5 • Power step-ups sagittal plane, 10×10
Post-Workout Flexibility: foam roll and conduct stretching as in the warmup.
Phase Five: The final phase of Miner’s training was a hybrid model where he would complete one IST (stabilization) workout, one SET (strength) workout, and one EET (power) workout in the same week. This form of training is designed to sustain all of the adaptations of stabilization, strength endurance, and power as an athlete goes through a grueling baseball season. This is key, because if any of these adaptations decreases, his ability to perform at the highest level will suffer and the likelihood of injury will increase.
IN THE BIG LEAGUES NOW
Miner was a high-rated prospect who was learning how to pitch in professional baseball. Selected by the Atlanta Braves in the fourth round of the 2000 draft, he was traded along with Roman Colon to the Detroit Tigers for Kyle Farnsworth in 2005.
Miner’s success in professional baseball was incremental. He did well enough to stay on pace and move up the ranks season after season, but he failed to record a winning season until his 2005 stint with the Tigers’ Triple A club (3-1, 2.36 ERA).
After starting the 2006 season with a perfect 6-0 record (2.82 ERA) at Triple A Toledo, Miner was called up to add support to the Detroit Tigers’ pitching staff. In his first year at the Major League level, Miner finished the season with a winning record (7-6), and helped the team secure the American League pennant and reach the World Series for the first time since 1984.
This off-season he is working with us again, following a very similar program. Some minor movement compensations did return by season’s end, but this is not uncommon after an athlete has played a long season. The good news is that they were much less pronounced than the year before and we were able to clean him up quickly. He won’t be a surprise rookie again this year, but we’re confident he will be strong, with a body ready to endure the challenges of major league baseball.