Something to Ponder...

In my last post I mentioned that strength training has changed a lot in the past 15 years.  I should say, what we know about it.  Because if you look around, especially in football strength and conditioning, it's the same ole same ole with some tire and rope flipping tossed in.  Bosch's definition of strength training is, "Coordination training with resistance".

THAT is where we should be headed.

Reducing ground contact time in runners

Coach Martin brought up a good topic; both for A.T.'s and coaches alike.  The longer the foot remains on the ground, the more things can go wrong.  I believe there are 2 components to getting off the ground faster.  The first is strength, the second is neuromuscular coordination.  Whenever I talk about strength training for runners, I always go back to an old NSCA article from August of '95 (can't seem to locate it through the NSCA article search, sorry):


The coach put his girl's cross country team through a dumbbell weight training routine. Nothing fancy,  Some of the exercises were specific to running, others were not.  They had maintanance workouts two days per week in season.  The results:  The times of every athlete on the team improved.  Of course a lot has changed in the past 15 years, but the point remains the same.  That is, the right kind of strength training helps bone density and resists gravity from smashing the body like an accordion with every step.  Every (high school) athlete should be able to do a single leg squat to at least 90 degrees without the torso leaning forward and hold it for at least 30 seconds without motion.  Every athlete should be able to give you at least 15 good pushups (girls included) without technique breaking down.  Every athlete should be able to jump out at least a meter and stick their landing without any wiggling.  Every athlete should be able to lunge 3/4 their height for 30s with the knee remaining over the ankle.

Frans Bosch turned me on the neuromuscular component of running.  At ground contact, the knee of the trail leg should be passing the weightbearing leg.  This is important in locking up the front side and propelling it off the ground; minimizing ground contact.  At GAIN this year we had the opportunity to have him put us though many of the drills in his book/DVD.  Running with a jump rope is one of the best drills you can do to help clear out mechanical issues that contribute to a long ground contact.  If you paw the ground, if your trail leg is lollygagging behind you; the rope will stop you.

Joe's Training Room, 2 years out

...and I'm still struggling with the same issues from last year.  Mainly trying to get more high school A.T's involved here.  The blog is not growing, still staying steady at about 65 hits a day.  Hey, I know part of it is my own fault, like not having a Youtube channel.  I was even considering dropping the blog and moving over to the NATA Think Tanks.  However, I followed it for a while and found the participation was even worse.  It has not been a good year for me; an '11 NATA presentation on function is not going to happen.  I don't really understand whats not to like about the approach- it's inexpensive, it adapts and changes to the latest research, and it works.  In addition, after hundreds of hours of work on the ankle book, it is probably not going to happen.

But hey, for those willing to listen there's still plenty of stuff to get to here.  Loads of great ideas and research to digest and apply.  Hope you enjoyed the last year, and as Jay-Z says, on to the next one!

Lateral Epichondylitis (Tennis Elbow)- Less is More, Redux

Thanks fellow GAINer Randy Ballard to this link on an exercise for tennis elbow rehab:
http://well.blogs.nytimes.com/2009/08/25/phys-ed-an-easy-fix-for-tennis-elbow/

I think it complements my post from about a year and a half ago on the topic:

http://well.blogs.nytimes.com/2009/08/25/phys-ed-an-easy-fix-for-tennis-elbow/

Mi Muchacha's Birthday!

Great seats behind home plate at Yankee stadium; then onto the best soul food in the U.S. at Sylvias on Lenox Street in Harlem.

Great Overveiw

Femoralacetabular Impingement in Athletes, Part 1: Cause and Assessment- Byrd, Sports Health 7-10.

If an athlete complains of chronic iliopsoas soreness and/or low back pain that doesn't seem to clear up; be sure to screen for FAI.  I'll post myself doing some tests at a later date.

Occlusion Training in ACL Rehab

I've commented on this issue in the past:

http://joestrainingroom.blogspot.com/2009/06/blog-post.html

I didn't realize it had crept into ACL reconstruction rehab.  I'm going on record here as saying don't do it.

I understand arthrogenic muscle inhibition (AMI) is an issue in knee injury; it's well documented in vitro and vivo.  However, neuromuscular facilitation is a lot more complex and time consuming than increasing the size of a sarcomere.  Unless I'm wrong, all of the research on the topic has been at the myofibril level.

Don't be a reductionist; think global, think functionally.  Think about what is taking place here.  You are applying a tourniquet to a limb.  You have have no doppler studies.  The risk here is deep vein thrombosis.  If you think I'm being reactionary here, that DVT following ACL surgery is a rare occurance, take a look at this study-

http://www.orthosupersite.com/view.aspx?rid=22838

If your goal is to hypertrophy the quads, there are safer, more tried and true ways to do it.  We did it in the past with our old NK tables, leg extension machines, orthotrons, KinComs etc.  Those quads came back fast!  Obviously it wasn't the answer.  I know it's frustrating when an orthopedist judges return to play by plopping your kid on the table and putting a tape measure across their thighs.  Stay focused.

E-Stim to the quads & ACL Rehab

"Effects of NMES after ACL Reconstruction on Quad Strength, Function, & Patient Oriented Outcomes:  A systematic review"- Kim et al, JOSPT 7-10.

"There is no evidence to conclude that NMES has an effect on functional performance when measured by anterior reach, lateral step up, and unilateral squat tests..."

"The best evidence suggests that 4 weeks of NMES using a clinical stimulator in conjunction with exercise therapy can result in a moderate effect in self reported patient outcomes at 12 and 16 weeks post operatively..."

"The effect of NMES upon functional performance is unconvincing, and the imprecision in the limited reported results suggest that a clinically meaningful benefit may or may not exist..."

From what I understand from the research, the clinical grade NMES units seemed to improve isometric knee extension strength better than exercise alone.  But...is isometric strength really "NEURO-muscular", and isn't our goal squelching NEUROmuscular arthrogenic inhibition?

Post pitching arm icing?

http://www.boston.com/sports/baseball/articles/2010/07/11/arroyo_has_dealt_well_with_life_in_cincinnati/

Thanks for fellow GAINer Mark Day for the heads up on this article on Cincinnati Reds pitcher Bronson Arroyo.  Scroll down a bit and read his comments concerning post game arm icing.  It's a bad habit to get your players into.

Bookmark this website

http://strengthplusmagazine.com/

Thanks to Tracy Fober, P.T. for the heads up on this.  I've long been a fan of weightlifting derivatives for athletic development.  I think this website could help bridge the gap.  They have a free online PDF magazine, at least for this month.  Worth a look.

Physical Literacy...Do your athletes have it?

I describe a lot of different exercises in this blog that are all appropriate in the right place and time.  However, they are no substitute for physical competancy.  You can pass someone's movement screen and not be physically literate, that's why I don't care for movement screens.  I doesn't make a difference what sport you do, it's universal to all.  I have always admired the Australians.  I always thought they do the best with the small population they have.  Yes, I know it is the size of the U.S., but the central part of the country is mainly uninhabitable.

Coach Kelvin Giles is the CEO of Movement Dynamics (http://www.movementdynamics.com/).  He has quite an international resume.  Educated in the U.S.; then on to the U.K. to coach track and field; back to Australia to become Performance Director for the Brisbane Broncos; and a lot in between.  His broad background led to to develop a set of tests that are universal to all sports.  Pushing, pulling, squatting, rotating, the ability to hop and stick a landing.  Then the ability to measure it and use it to put together a picture a that athlete's level of physical literacy- independant of their skill in a particular sport.

It's the lack of physical litercy that will ultimately limit the athlete's ability to reach their potential.  It's not designed to be an injury predictor, but from the experience I've had with it, it does indeed.  It involves a series of tests and specialized instruments which all gets plugged into a software program that Coach Giles developed.  The PCA (Physical Competancy Assessment) is all ready to be rolled out in the U.S. If you are interested, you may contact him at his website.

Hip to Shoulder Lats

What do you think?  If you were developing a performance/prevention program for a thrower, might these be more appropriate exercises for the lats than a lat pull down or a pull up?

1. Reverse pyramid pushup

2. Windmill lunge

3. Drop step lunge with R/L hand 120 reaches @ overhead.

  Notice I've got the pelvis moving in synchronization with the shoulder, with the hands moving a bit faster by way of the momentum in the 2nd and 3rd pics .  Neither the pelvis or shoulder are fixed.

Great Overview

" Extensor Coxae Brevis: Treatment Strategies for the Deep Lateral Rotators in Pelvic Tilt"- Thomas Myers (of Anatomy Trains fame), Journal of Bodywork and Movement Therapies- July '10.

If we look at the inominate (ilia) bones as the pelvis as the lower extremity scapulae, and the femur as the LE humerus, these muscles would make up the LE rotator cuff. Like the scapulae, the ilia are only dumb bones, and do what the muscles tell them to do. If they are given erroneous information the deep hip rotators, like the rotator cuff of the shoulder they will become stiff and painful.  It's nearly impossible to treat them by traditional methods like ultrasound, electrical stimulation, and therapeutic heat and cold.  They are too deep.

It's common for these muscles to become stiff and fibrotic in any lower extremity injury. In the case of the ankle sprain, it can even set you up for another injury, as lack of hip internal rotation has been indicated as a causative factor in inversion ankle sprains.  Myers also makes the comment that when these muscles are hypertonic, the adductor magnus is should also be suspected (he is correct).   Remember any injury is an opportunity for the athlete to do remedial work on things they didn't have time to focus on before.

While well intended, traditional exercises prescribed for lower extremity injuries, such as a stationary bike, may exacerbate this problem.  Many common Yoga exercises address this area.  Non weight bearing hurdle steps are also a good alternative.

Torn Lat- your opinion please

If you are not familiar with Jake Peavy's pitching mechanics, here is the link with commentary:

http://www.chrisoleary.com/projects/Baseball/Pitching/ProfessionalPitcherAnalyses/JakePeavy.html
OK, I know he was a Cy Young award winner. But as I have said in the past, those pitchers who push off the rubber do not have long careers. Jake tore the insertion of his right latissimus dorsi off the intertubercular groove of the humerus. Take a look at the videos and give me your opinion as to what about his mechanics could have caused the injury.

Your hip bone connected to your back bone.

The old "Dem dry bones" song.

"The Association Between Low Back Pain and Osteoarthritis of the Hip and Knee: A Population-Based Cohort Study"- Stupar et al; Journal of Manipulative and Physiological Therapeutics 6-10.

The authors studied the relationship of hip & knee osteoarthritis to low back pain. There was a strong correlation between hip OA & low back pain. The lumbar spine is stuck between two trouble makers- the hips and the T-Spine. If the pain is lower lumbar, always take a look at that those hips. The modified Thomas test is a good, quick screen.

Inner Core? Outer Core? Time to move on

This is one of the ground based exercises from my upcoming ankle book. Look A.T.'s, we've got to move past this inner core/outer core stuff- and all the testing and corrective exercises that go along with it. If you have no idea what I'm talking about, good for you. The model that validates it is 35 years old now, and the newest motor control research does not support it.

The core already knows what to do and when to do it and how strong to do it and in what direction to do it and in what plane to do it and at what velocity to do it; kind of like Beetlejuice from the Howard Stern show. Give the body a movement task. If it zigs when you expected it to zag it is outside the zone of function. Shorten one or more lever arms and try it again.

What's old is new. Unfortunately, what's new is old.

A great Question

As usual, JH asks a great question from my last post that requires further elucidation:

"Since the idaea of function is many muscles, joints, systems, etc, how then does the knee, hip, sacrum, spine have the ability to respond at ground contact when so little time is spent there? Wouldn't the information recieved in the sacrum for example take too long to get there as well as the response to that stimulus?"


The proprioceptors are very much there Jonathon, but according to Lederman act in concert to "fine tune" movement rather than act in a reflex manner, say like when you touch a hot stove. I thought Oschman was nuts when he first proposed the idea of fascia having it's own nervous system; but damn, the research seems to be headed in that direction. Remember when we use the term "functional" it is not the same as biomechanical. Biomechanics are integrated in with function, but it is the neuromuscular system that drives it. I don't see the neuromuscular approach and the functional approach as a one or the other thing; but that's my personal opinion.

Bosch 101

Vern used the analogy of a caterpillar. How does it know which leg to move and when? It has a very primitive nervous system, with no brain to speak of to organize these movements. In my ankle book due out this fall, I mention the fact that in sprinting, ground contact time is too short for proprioceptors to have any input. In sprinting, foot ground impact force takes less than 50ms to reach its peak magnitude and ankle inversion can reach 17 degrees in as little as 40ms. Under these conditions the spinal reflex is too slow to initiate a corrective response.

Frans Bosch believes that, rather than reflexive, this type of neurological input is contained in the muscles themselves. The latest research coming out of last year's fascia congress seem to support this. The "cross talk" that EMG techs see on their monitors might just be a way that muscles communicate with one another. What implications does this have for injury prevention and rehabilitation? For starters, if you are doing proprioceptive training on wobble boards or something similar, you may just be training the athlete to be successful on a wobble board. It may have implications for those who need to perform on unstable surfaces (like surfers), but questionable for others.

The other points I get out of it is time and repetition. The way I see it, it's doubtful this type of motor re-organization can take place in the typical 12 week institutional rehabilitation scenario. The athlete must take an pro-active role in this process (A.T./coach directed; athlete centered). Even in Frans' world, laziness is a hinderance to performance and getting well.