Jon Herting, PT, DPT, CSCS, ACSM CE-P, USAW is a dynamic clinician who has been involved in rehabilitation and strength and conditioning for 10 years and has built a reputation among athletes as someone who promotes quick results and optimal outcomes. As a Doctor of Physical Therapy and Certified Strength and Conditioning, he has worked with athletes of all levels – from adolescent to Olympic level – and is a part of USA Weightlifting’s medical staff. Jon currently serves as adjunct faculty at Widener University and has developed several continuing education courses for clinicians and certified strength and conditioning professional based around assessment and rehabilitation techniques.
Inside Pitch: I often hear you speak about mobility versus stability. Please explain the difference between the two and why, contrary to popular belief, it is stability that is often a player’s limiting factor, not mobility. What type of exercises can players begin to implement into their program to train stability?
Mobility is the entirety of a range of motion at a joint, and stability would be the ability to control that range of motion. Stability is incredibly important when it comes to keeping an athlete injury-free. Athletes open the door to potential injuries when they are unable to control and stabilize their body at the end (the extremes) of a range of motion.
When an athlete moves into the extreme ranges of a movement, such as full external rotation during a throw, if the athlete does not have the necessary control and stability in those end ranges, they place themselves at a much greater risk of injury. We must keep in mind that because throwing a baseball is such an unnatural motion, baseball players are predisposed to potential injuries that athletes in other sports are not. The first way to address and train a baseball player’s stability is to find an end range of motion (such as a player’s maximal external shoulder rotation) and begin performing isometric holds in that position. This will teach the central nervous system to control that newfound range of motion and specific angle.
IP: What is the biggest misconception you see and hear when it comes to rehabbing baseball players from elbow and shoulder injuries? How might your approach to rehabbing a baseball player’s elbow and shoulder differ from that of another physical trainer?
Most coaches will utilize bands as part of their player’s arm care routines – and bands are great – but I believe there is a critical component of arm care that is being missed by many coaches, strength coaches and even physical therapists across the country.
When I craft all of my programs, I always want to start from the inside out. I like to use the analogy of a house. In order to craft a house, we need to create a good, initial foundation, and only then can we build the walls. The foundation for the human body is the rib cage, pelvis and spine, and this is where we start with all of our throwing athletes. We must address the rib cage, pelvis and spine first, in order to ensure that the shoulders are properly set up and the rotator cuff and shoulder stabilizing muscles are working appropriately during a throw.
The throw is one of the most unnatural movements in which an individual can partake, especially at the highest of levels, so we need to make sure that the foundation is set up appropriately, allowing the shoulder girdle to stabilize and perform the mechanical things we are asking it to do. I believe this can only happen if the rib cage, pelvis and spine are properly aligned.
Further, arm care – even when you are rehabbing an elbow or shoulder injury – has to start at hip mobility. Hip mobility is the foundation from which your torso is going to rotate and your arm will follow as a result. Addressing hip mobility is a huge component of any arm care program I prescribe, because I need to make sure my pitchers – and baseball players in general – can get into their front hip efficiently, which will allow the torso to move freely and prevent the arm from lagging behind. If a player’s hip mobility is limited, their torso will be unable to rotate at its full capacity, forcing the arm to lag behind the body and putting excess stress on the elbow.
The foundation of a good arm-care program is making sure the player has the adequate hip mobility to be able to perform mechanically efficiently. In addition to hip mobility, it is critical to ensure a thrower’s thoracic spine is mobile. We need to make sure our players have that mobility in their midback so their arm can follow their midback. In simple terms: we must gain mobility through the spine, rib cage, hips and shoulders and then make sure we can control and stabilize this newly acquired mobility to perform this very unnatural movement at high velocities. Keep in mind, everybody talks about the kinetic chain, and how one joint position can affect joint positions further up the chain. However, I believe a lot of people forget the importance of the thorax and how the rib cage is moving as it relates to shoulder mobility and the ability to find internal rotation and shoulder flexion.
Players need upper rib mobility in order to achieve full shoulder internal rotation and shoulder flexion. However, far too many physical therapists and coaches neglect to take a look at a player’s upper rib mobility as it relates to the player’s shoulder range of motion. Therefore, being able to specifically address a player’s rib position and how that rib position influences a players internal and external shoulder mobility is a critical component I believe most performance specialists are missing.
IP: How have you evolved as a PT over the years as you have gotten older and wiser? What changes have you made over the years regarding how you treat your patients— in particular baseball players?
JH: Unlike in years past, today I look specifically at rib positions and upper rib mobility in order to increase a player’s external and internal shoulder mobility. In addition, I have come to the conclusion that the scapular thoracic joint is perhaps the most important joint in the body that everybody in the baseball community forgets about. For example, what do throwers typically think about when they do their band programs? What are some of the common “cues” used? Traditionally coaches will say, “shoulder blades back and down.” However, I would argue that instead of thinking about our shoulder blades back and down, we need to get that shoulder blade moving in full motion freely along the rib cage. Anytime we lift our arm over our head or out to the side, our shoulder blade comes up, it does not stay back and down. Therefore, we need to train our athletes’ shoulder mobility and stability as it upwardly rotates, or as it protracts around the torso. If we are throwing to promote shoulder health and shoulder performance, we cannot keep reiterating “down and back.” Coaches, PT’s and strength coaches are missing the boat if they are not cueing their athlete to rotate their shoulder blade upward and reach during an exercise.
IP: Not only do you rehab a majority of baseball players, but you are also part of the USA Weightlifting’s medical staff. In your opinion, should baseball players be performing Olympic lifts? Does the risk outweigh the reward?
I do not believe the reward is worth the risk when it comes to baseball players performing Olympic lifts. The movements put a lot of stress on an individual’s elbow, shoulder and wrists. I believe there are far better ways to train and develop explosive power that are more appropriate and much safer for a baseball player. It is important to note that even with proper and ideal Olympic weightlifting technique, it is still common for these individuals to experience shoulder, elbow and wrist problems. I have been fortunate enough to work with many high caliber Olympic weight-lifters, and even they come to me with shoulder, elbow and wrist problems that need to be corrected.
The heavy load and the repetitive nature of the sport is a lot for anyone to bear, especially a baseball player. I would highly recommend that, instead of using Olympic lifts to train power, performing medicine ball throws, dumbbell jump squats and trap-bar jump squats.
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