With off-season fundamental work and passing leagues becoming a much more normal part of a quarterback’s development, we have begun to see an increase in overuse injuries. Generally, if the throwing motion is done correctly, the quarterback won’t feel any pain, but so few quarterbacks throw the ball with great mechanics that injuries do occur. Adding to this issue are some issues in training – so many quarterbacks do the same workouts as their teammates, which is potentially a problem for two reasons: who’s to say their teammates have a good workout written by their coach in the first place? And a quarterback needs a different workout because of the extreme specificity of their position.
Quarterbacks overuse a relatively unstable joint with a lot of force, which can lead to many overuse injuries. Quarterbacks are also dissimilar to pitchers in that a football is much heavier than a baseball and forces the arm to externally rotate, putting a lot more stress on the arm. The task of coaching a quarterback to be both effective and healthy is a difficult one, and not one that should be undertaken by an under-qualified coach. So many head coaches want to be the ones to coach their quarterbacks, which makes sense, however, if their knowledge on biomechanics and fundamentals is lacking in any way, they put their quarterback at a much higher risk of overuse and chronic injuries.
Let’s start by taking a look at kinetic sequencing, which is how the body transfers power into the throw. All of our power starts from the ground; as we push and twist into our feet we use the force the ground returns to us to power our throw (as you Isaac Newton followers will remember, for every force, there is an equal and opposite force, so when we push and twist into the ground, the ground returns that same force). From there, we twist our hips out in front of our shoulders, then shoulders out in front of our arm, then eventually the arm catches up, the elbow extends, the arm pronates down and we release the ball. Each segment of the body goes a bit behind the one before it, which creates power and torque. This is the same effect as a whip or a trebuchet (see: ancient but brilliant catapult system). This kinetic chain is extremely effective for creative power, but if one part of this chain doesn’t work right, all the successive parts of the chain are forced to compensate, which can lead to poor throws and injuries, particularly when done for hundreds and thousands of repetitions.
The first thing we must do to prevent throwing injuries is check biomechanical integrity. For those of you who have been with us for a while or regularly read our blogs, you know that biomechanical integrity is essentially the body’s ability to move correctly. A quarterback must have good thoracic spine mobility (which allows the hips to go in front of the shoulders in the chain), good external rotation in the shoulder (which allows the shoulders to lead before the ball), and a stable scapula (to stop the shoulder from leaving the back too soon, helping to support the smaller muscles inside the shoulder complex). While biomechanical is by far the most important part of preventing throwing injuries, it has been discussed in other posts and this entry will focus on some other items. Just keep in mind that all I’m about to write is a moot point without biomechanical integrity.
The common injuries we’re going to examine today are rotator cuff/labrum issues, biceps tendinitis, and UCL strains. These are what I feel are the three most common and easily preventable injuries in quarterbacks. Often times, these are brought on more from bad training habits and throwing mechanic issues.
The rotator cuff and labrum are fairly small items in the shoulder that require the support of the scapula in order really maintain any stability. When a quarterbacks tells me he has pain or injuries in the rotator cuff or labrum (which would really have to be a doctor’s diagnosis), the first thing to look at is the scapula. If the scapula doesn’t stabilize to the back well, it will put extra pressure into the cuff and labrum. This is what some physical therapists refer to as winging – as the hands move up, the scapula comes quickly away from the spine. To fix this, do exercises such as Y, T, W’s, pillow presses, wall sits with scapula mobility, or anything that creates scapula retraction. This should help train the scapula to hold onto the back better, and begin to save the shoulder.
Biceps tendinitis is a very painful injury, and is particularly damaging to a quarterback as the rotator cuff and biceps are two links of the same chain. A quarterback with biceps tendinitis often times causes the injury through his training regimen. By doing straight-bar bench presses and curls, we tighten the complex of muscles and tissue around the connection of the shoulder, chest, and arm. In doing so, we inwardly rotate the shoulders, creating a slightly hunched look, and put extra pressure into the rotator cuff and biceps. Because of this, I highly suggest all quarterbacks remove curls and bench press from their training regimens. Instead of curls and barbell bench press, increase pulling exercises such as chins up and inverted rows, and use dumbbells instead of a barbell (this allows a free movement of the shoulder because dumbbells can rotate, as opposed to being locked into position by a barbell which stops the shoulder from being able to rotate). Chin ups and inverted rows will help the quarterback open up their posture and still strengthen the smaller muscles in the arm without tightening the front of the shoulder, biceps, and chest.
UCL injuries (the ligament that runs along the inside of the elbow and associated with Tommy John surgery) generally arise from throwing mechanic issues (which generally arise from physical limitations or poor coaching). To prevent these elbow injuries, first make sure the shoulder and scapula are functioning properly. As we discussed before, when one part of the kinetic chain doesn’t work, the successive ones are forced to compensate. So, if the shoulder isn’t working right, the elbow compensates. Next, look at the mechanics involved. During the time in which the arm is moving forward into the throw, does the elbow ever move below the level of the shoulder? Or, does the angle between the forearm and upper arm ever go below 90? If either of these things are true, it is probably contributing to the pain in the elbow. To put in a few bench marks, the elbow should have approximately a 90 degree angle when it is cocked back, ready to begin moving forwards. At release, the elbow shoulder be at about ear height, still with a slight bend.
When designing a training program, make sure to include plenty of work on scapula stability and mobility, helping consistently prep the shoulder to be properly functional during activity. Also work on thoracic rotation, as that will help the parts of the chain coming before the shoulder and elbow to work properly. This would include stretches that help separate the hips and shoulders, like a half kneeling twist. Avoid pressing exercises with the exception of push-ups and dumbbell presses (nothing that locks the hand and shoulders, preventing them from rotating), and increase the amount of pulling exercises like chin ups, inverted rows, and dumbbell rows, etc. Also avoid overhead pressing, as this puts the shoulder in a fairly compromising position and generally isn’t done properly (most athletes over-extend their spine to save the shoulder, which ends up just hurting the back).
A couple red flags in the throwing motion that can lead to injuries:
-A low elbow through the release: make sure the elbow is about ear height at the release.
-A straight elbow at release: this tends to lead to AC joint pain in the shoulder. Full extension in the arm shoulder only be reached after the release, not before.
-An elbow that rises above the height of the ball: the elbow should never be higher than the ball at any point in the throwing motion, even while we are just cocking the arm back to throw. This creates wing, which in both quarterbacks and pitchers is a huge red flag. This will lead to both rotator cuff and UCL issues, as well as potentially erratic accuracy.
-A long strider: quarterbacks who over-stride lock their hips into place early, instead of allowing rotation. This decreases hip to shoulder separation, which causes the release point to be further in front of the body, which causes the rotator cuff to be overstressed AND the elbow to drop at release, which sends the ball high (see: Mark Sanchez). The proper stride length is approximately the athlete’s tibial tuberosity X 1.5, or about 26-30 inches in most quarterbacks.
Finally, even if a quarterback does all over the throwing mechanic and training items correctly, they still need to take care of their shoulder. Ice properly, warm-up properly, and tell your coach if your arm is feeling overly fatigued. Repetitions are not a problem; bad repetitions with an uncared-for shoulder are a problem.
If you have any questions, please feel free to write me at adrayson@SportPerformanceU.com.
One of the fastest growing movements in sport performance today is players training through CrossFit. Everyone wants to get an edge – to be faster, stronger, bigger, more skilled, more explosive, and all those other buzzwords too. And, logic would dictate that if one place makes you work until you drop then that place is getting the most out of you. However, this is not true, and for football players (or any athlete who is training for a particular sport) CrossFit is one of the worst things you can do.
Let’s just examine the name of the company – CrossFit, playing on the term of “cross
training” which was at one point very popular. This idea is built off of people doing a wide variety of workouts, including different levels of endurance, strength, power and speed during every workout, to force the body to adapt to a great diversity of stimuli. However, in football, we know exactly what we are training for – we know the rest intervals, the strength-endurance and power-endurance requirements, the exact movements that translate to our sport. This begs the question: why in the world would we cross train? Why would we spend hours and sweat preparing out bodies for things we already know we won’t encounter?
(I should mention that there is a portion of the population that cross training works for. Some folks who are already extremely athletic and well versed in exercise and technique, and are exercising for the sake of exercise rather than to train for a specific sport, could find that a cross training program is quite good. Additionally, people who don’t know the demands on their daily life and need to be in shape for a wide variety of demands needs cross training as well. When talking to a Navy Seal friend of mine, his workouts very much resemble cross training workouts. If he were still playing football, however, his workouts would be considerably different. So, while this post is somewhat an indictment of CrossFit, it is not meant to be an indictment of cross training itself).
The next point on today’s agenda talks of the basic principle of CrossFit’s programming. They use their “workout of the day,” so that everyone who walks through the door does the same workout. Essentially, a one-size-fits-none model. Every single person who wants to train has different needs – they have different restrictions, different goals, different training experience, play different positions, just to name a few variables. There is never a good excuse to have everyone doing the same workout. The idea of every individual doing the same workout is idiotic, moronic, whatever word you want to use. Different people need different exercises.
Now to address CrossFit’s programming specifically. The number of videos I have seen with folks doing as many snatches as they can in five minutes, or trying to do a hang clean variation blatantly wrong, or fighting to learn a deadlift when their body simply cannot do it, is appalling. The workout of the day does not follow the basic principles of physiology or biomechanical integrity. Snatches are exhausting – it is downright dangerous to have someone hoisting a barbell overhead for five minutes. Hang cleans are complicated – allowing inexperienced lifters to max out their hang clean is simply asking for injury. Deadlifts require proper hip mechanics, which only a certain percentage of the population has - ignoring individual biomechanics will lead to chronic back pain for many CrossFit participants. The fact of the matter is that the way exercises are programmed and taught is important, and CrossFit misses many of the basics that even our interns knew without having to be told.
Take a look at some of the best professionals in the country when it comes to sport performance – think of Eric Cressey and Mike Boyle up in Boston; think of Gray Cook and Lee Burton of FMS; think of some of the great staff members of Athlete’s Performance out West; take a look at the programs here at SportPerformanceU. In all cases, the people who write the programs have years upon years of education and experience. They never stop pursuing great information and research. They are constantly looking for ways to bridge the gap between theory and application. Now take a look at a CrossFit trainer – in many cases, the trainer took a weekend course to get certified, and is then allowed to train others. That is a dangerous situation. Add to that the fact that their workout of the day is based on making people do crazy workouts (CrossFit’s owner recently told a magazine that he basically came up with ways to screw with people when designed his workouts as a personal trainer, and that strategy grew into CrossFit), and what you have is under-qualified people teaching less than intelligent workout programs. Does this really make sense?
In any instance, if you are looking to train properly, make sure you are working with a well-qualified individual, who has done their due diligence on finding training methods that are right for you. Make sure biomechanical integrity is included before any training actually starts. Do NOT join “class” structured workouts. Each and every athlete has individual needs – make sure yours are being met.
There is no doubt that mechanics and fundamentals are crucial to any quarterback (or athlete), and constant dedication to that end is an enormous contributor to individual success. However, in some cases, working on throwing mechanics or fundamentals without first testing for biomechanical integrity can hinder the results an athlete gets out of hours of work on mechanics.
Let’s take, for example, a young man who works hours on end on his throwing mechanics, and pretend his shoulder is somewhat inflexible and won’t move into the correct positions during the throw. Since he can’t get his arm into the right position, all those hours of work are being put towards a compensated throwing motion, one that is not the most efficient or effective, and could quite possibly be causing injury to both his shoulder and whatever joints are bearing the excess pressure created by the incorrect throwing mechanics. In this case, the young man is actually hurting himself, which is unfortunate because he wants to work hard to achieve his goals. But, without the proper analysis done on his body beforehand, no matter how much work he does, he will not reach his goals; as we said, his shoulder lacks mobility, and he cannot yet throw the football properly, and will not be able to, despite his efforts.
What is the lesson to be learned from that scenario (which, by the way, is a real scenario I encountered a few years ago with a young quarterback)? The take-away is that quarterbacks need to do a biomechanical analysis before doing serious throwing mechanic work; in fact, this is true for every position, but we’ll focus on quarterbacks. If, prior to working on his mechanics, a quarterback were to find out how his body functioned, address areas that were of concern, get his body moving with biomechanical integrity, and only then begin throwing mechanic work, he would put himself in a far greater position to succeed. He would have a reduced risk of injury and a greater capacity to learn and execute the skill correctly.
So, whether you are a coach or player, remember – mechanics are not the foundation for success. They are a big part of success, but there is a layer of physical capabilities underneath mechanics that serve as the foundation – biomechanical integrity comes first. Once that foundation is solid, good mechanics and fundamentals can be built.
SPU's Alex Drayson writes the SPU Football Performance Blog.