Monday, September 18, 2017

A Dynamic Approach to ACL Rehabilitation and Prevention: Part III - A Guest Blog

Last week, we discussed the use of dynamic taping to assist with quad control during the ACL rehabilitation process.  This week, we will look how Dynamic Tape can assist in controling hip internal rotation.

DYNAMIC TAPING #2: HIP EXTERNAL ROTATION TAPING

There are two major strategies for balance: Ankle and Hip. For those with an ACL injury we spend a

lot of time with single and dynamic balance / jumping exercises, while watching how the foot lands. Reality is much of the control comes from the hip. Weakness at the core and hip external rotators drives an already adducted and internally rotated femur inwards. Through any screening observing the risk factors but what can you do to control it on the field?

A few clinicians in Brazil piloted a study seeing if they could change knee control with a single leg jump in volleyball players. Makes sense with a high-risk population for jumping and landing. They used this dynamic tape hip rotation technique to place the femur in a more externally rotated position. The results were amazing, but not shocking once you see this stuff in action (Bittencourt et al, Brit J Sport Med 2017).

With the hip started in full external rotation and extension, the corrective measure was designed to maximally control rotation when the hip was flexed and internally rotated.  

Watch this Spark Motion video to see all this in action.


*Note with this taping, you do not necessarily need to rotate all the way around for SI control if you don’t feel that is an issue*

“Why” This Dynamic Approach
Through proximal control of the femur, changes distally are affected. Correct the angle and direction of landing and reduction in rotation and adduction is achievable.  But a research study is not good enough for me as I wanted to see this in action. So, I met up with Doug Adams, PT and creator of Trace 3D, a motion sensing system that is essentially a “running lab in a box.” His system is validated against the best of the best so I taped him up.

First, we got a baseline for his running and then followed up with taping. After his second run of it, we looked at the data.
A 50% change in reduced IR at the hip with running, throughout the entire cycle.

Could have been a fluke, right? So that same day I did the same taping at Philadelphia Shriners Pediatric gait lab. How would Dynamic Tape fair with this system? The data was even better. We could see that with the hip external rotation approach, Dynamic Tape was able to take someone pathological with hip ER with walking and restore it to within norms.

Now look at the curve. It changed the rotation evenly throughout the entire motion both closed and open chained! And even more fun at its peak it was about a 46% change in motion, almost the exact same amount that it was just 5 hours earlier with a different person and a different system.
To go even further, we took that same person’s opposite hip and tape it from normal into a pathological hip position and as expected, took someone from normal to abnormal with the taping.




DT TAKE HOME MESSAGE
Changes in lower body mechanics take time so why not provide your athlete with a strategy that works now. For those of you worried about tape then “weakening muscles” or movement patterns rest assured, once someone can perform a battery of tests without the tape and passes, you don’t need it anymore! Therapeutic taping is not an “every day” thing, it is designed with a purpose that stems from a biomechanical need. Once the need is gone, so goes the tape.


Want to learn more about Dynamic Tape or the Trace 3D Running System? Please contact Keith J. Cronin, DPT, OCS, CSCS at keithjcroninpt@gmail.com or visit the website at www.dynamictape.com


Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of an athletic biomechanical analysis, is an author of a college textbook on this subject  and has performed >5000 athletic movement assessments.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training.   He is also a competitive athlete in Jiu Jitsu. 

Monday, September 11, 2017

A Dynamic Approach to ACL Rehabilitation and Prevention: Part II - A Guest Blog


DYNAMIC TAPING: #1 QUAD EXTENSOR MECHANISM
Every, and I mean EVERY, rehabilitating ACL injury has quad weakness. The swelling, soft tissue damage, and duration of inactivity is going to shrink that muscle up. When the quad does not work effectively to eccentrically control movement, combinations of adduction and IR at the hip are accentuated, putting at risk an ACL that restrains anterior translation and rotation. There are other things to consider such as:  
  • Landing technique 
  • Core activation 
  • Glute strength and stamina 
  • Force absorption (gradual / spread out vs. sharp / high peak forces) 
  • Hip external rotator activation 
  • Gastroc power / strength 
  • Foot Pronation / supination

But that quad is the big stand out every day in therapy.

First glance your response may be, “Wow, that is a lot of tape.” Yes, it is, but let’s talk about why. By having a 2” powerband (two pieces together) and a 3” on top it creates significant resistance to knee flexion, thus, turning potential energy of tape in kinetic active extension.

To see this in action, watch this video:




“Why” This Approach to Quad Control
For those who are skeptical about taping, I understand as so was I. The first time I came across Dynamic Tape it sat on my shelf for 6 months. Wasn’t till I met the creator that I realized he had truly designed a new product and approach to therapeutic taping.

Recently I started playing around with BodiTrak, a portable light-weight force and pressure mat, that is beginning its journey from golf to rehabilitation. This 11-pound stellar tech break through that operates wirelessly from your iPhone (how awesome is that!) showed some interesting information when used with Dynamic Tape. I started examining simple case examples of old ACL injuries using BodiTrak, measuring force production during a single leg jump. In the past couple months, I have done this 5x with the same success every time. The most interesting case was with a female therapist at a course I was teaching. She had a 5-year-old L ACL repair (torn twice) and a chronic history of knee pain. We had her jump up and down on the BodiTrak mat and found that her R leg produced 2.1x body weight, while the L was at 1.4x with awful motor control and high peak forces landing. 8 seconds to figure out how to jump on one leg!

I applied the power band quad taping and the next jump on the R was 2.1x BW, no changes. On the L, it was 2.1x BW!!! And this time it only took her a couple seconds to figure out how to jump. We then took the tape off and she never got above 1.7x BW but the carryover was still present.

DT TAKE HOME MESSAGE
Did the tape exert 50% more force production to make up the difference? No, but what it did to is improve eccentric control. The therapist felt more control and the appropriate motor pattern kicked in. She would absolutely need to continue to strengthen but this was a solid motivator to get her back to working harder. As a clinician, you have a new means to improve quad control while still functionally working through rehabilitation. As a bonus if your patient must wear a brace, Dynamic Tape goes right under it. 😊


Want to learn more about Dynamic Tape or BodiTrak? Please contact Keith J. Cronin, DPT, OCS, CSCS at keithjcroninpt@gmail.com or visit the website at www.dynamictape.com



Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of an athletic biomechanical analysis, is an author of a college textbook on this subject  and has performed >5000 athletic movement assessments.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training.   He is also a competitive athlete in Jiu Jitsu. 

Monday, September 4, 2017

A Dynamic Approach to ACL Rehabilitation and Prevention - A Guest Blog

Throughout the history of this blog, I have attempted to share with you the latest research and how this might influence our assessment of athletes or training of athletes.  Having focused the last 20 years on ACL rehabilitation and prevention I have been blessed to come across a lot of people who share this passion (or what I call a higher calling) to help athletes stay safe and perform better.  Many of these folks have applied the latest research to their craft or technology.  I am inspired by some of the amazing products that are out there that have been created to help you and I do what we do better, to allow us to do it more efficiently and provide the athlete with a better outcome.  

Considering, I have felt like this should be shared with our viewership.  So, over the course of the next several blogs series, I have reached out to some of these folks who are on the cutting to see if they would mind contributing to our blog.  To provide our viewership a glimpse of their products, what the science is behind these products and how this can be applied to the athlete.  I have personally vetted each of these to make sure this is science based and NOT a sales pitch.  So, please sit back and enjoy as we venture into some of the latest and greatest in movement science and sports medicine. - Sincerely ~ Trent Nessler, PT, MPT, DPT
________________________________________________________________________________
A Dynamic Approach to ACL Rehabilitation and Prevention - A Guest Blog

Over the course of decades of clinical practice and with my adventures across the country, I get the opportunity to meet some amazing people that are doing some amazing things.  Folks who share my passion for prevention and who are on the forefront of innovation for injury prevention.  Rarely do I come across someone who shares this passion and is doing something innovative that is truly impactful on non-contact injury rates.

Keith J. Cronin, DPT, OCS, CSCS is one of those guys.  I have personally seen the impact of some tapping techniques that he is doing have a direct impact on an athlete's ability to control frontal plane motion and speed of motion at their knee (two major risk factors).  So I have asked Keith to provide a guest blog on what he is doing in order to share this with your audience.

A “Dynamic” Approach to ACL Rehabilitation and Prevention
If you are interested in ACL rehabilitation and looking for: 
  • A treatment that impacts an athlete ON and OFF the field 
  • A methodology that addresses all movement impairments the result of poor activation, weakness, or body mechanics 
  • A system that gives you, the clinician, absolute control in how much force and which direction to push or pull the body to work at its best

This blog series is for you.

Since I first saw the “ACL Play It Safe” program and kit my initial response was, “wow, this just makes sense.” ACL rehabilitation and return to sport is already confounded with many different factors, including, but not limited to: 
  • Extent of injury / movement dysfunction 
  • Quality of Rehabilitation Adherence / compliance of patient 
  • Sport played 
  • Internal healing aptitude (yes, some people are just more Wolverine than the rest of us) 
  • Anatomy 
  • Previous Injuries

If the goal is to maximally train the body using the right series of exercises to inevitably pass a battery of movement tests, what then are we most concerned about? So many things perhaps, but for this article we are going to examine improving movement using a strong recoiling viscoelastic tape is a toll that should be in everyone’s tool belt. And we aren’t talking about rigid tape or kinesiology tape, we are referring to Dynamic Tape, the “Original” Biomechanical Tape, that is changing the way clinicians think about taping.

Dynamic Tape: If Kinesiology Tape and Rigid Tape Had a Baby…….
Before we get into taping techniques, let us start with what we know.
Pretty much everyone is familiar with rigid tape. Whether its leuko (medical duct tape) or white  
athletic tape the product is simple:
  • Place the body in a neutral or corrected position 
  • Use a rigid, no elastic product to restrict movement 
  • Tape across a joint to have a mechanical effect 
  • PURPOSE – reduce stress on damaged tissues through mechanically locking up a joint

These techniques have been around for 40+ years and if you are an athletic trainer, you by trade are a master of the craft. Researchers are at least mostly in agreeance that if you prevent a joint from moving overall the kinematics of human movement will change.

In the late 1970s, a chiropractor named Dr. Kenzo Kase figured out how to push this in an entirely different direction. His approach was to use a stretch cotton product that allowed full ROM while having a neurophysiological effect on the body.

1.       Place a muscle in a lengthened position
2.       Use a stretch cotton that extends to 140 – 170% of length to pull on the skin / soft tissue
3.       Tape in different patterns to have different effects on the body
4.       PURPOSE – to create a neurophysiological interface to afferently affect the nervous system to efferent reduce pain and swelling

Millions of rolls are sold throughout the US each year from pediatrics to post-surgical to geriatrics to sports. But here is where a lot of researches and getting into some arguments. It is true that there has been research to support having a positive effect on chronic pain (more than 3 months) with the low back but when it comes to making mechanical changes, the data just isn’t there.

Ryan Kendrick, physical therapist and creator of Dynamic Tape, felt the same way. He worked with professional tennis players and was always looking for way to extend his treatments onto the court. He liked using rigid tape to make mechanical changes but it locked up motion, meaning his athletes could not move the way they wanted. Kinesiology tape allowed 100% range but did not have the ability to absorb force or alter movement patterns that would improve function. He thought to himself what if a tape could:
  • Absorb force to reduce the workload in the muscles and underlying tissue
  • Change movement patterns immediately through strong recoil 
  • Allow for 100% ROM with no rigid end to the tape  Be soft, breathe easy to prevent skin decay 
  • Stretch in 4 directions to contour to the human body exceptional well   
  • Stack “tape on top of tape” to increase force if necessary

To learn more, watch this 2-minute whiteboard video on the innovation that is Dynamic Tape

From this he created the first even Biomechanical Taping System that sports and rehab have ever seen. Since 2010, this product has made its way into 35 countries on word of mouth alone. You may have seen it and thought it was another kinesiology tape but today you will learn how this advancement in taping technology is going elevate your ability to manage ACL rehab, and everything else for that matter.  

Next week we will begin to discuss how you can use Dynamic Taping to improve quad control in your ACL patient.

About the author Keith J. Cronin DPT, OCS, CSCS

Keith J. Cronin is a physical therapist and owner of Sports and Healthcare Solutions, LLC., a consulting company that works with domestic and international companies to provide quality clinical education and sales training for rehab and athletic products. Keith graduated with his Doctorate in Physical Therapy (DPT) from Belmont University in 2008 and later earned his Orthopedic Certification Specialist (OCS). Keith currently is a reviewer for the International Journal of Sports Physical Therapy (IJSPT) on a variety of topics including throwing athletes, concussions, and ACL rehabilitation. Keith has produced several online CEU courses for PTWebcuation.com on the topics of running injuries, ACL rehabilitation, Patellofemoral Syndrome, and injuries to the Foot and Ankle. In 2012, Keith participated in a concussion education program in Newcastle, OK that resulted in the documentary “The Smartest Team: Making High School Football Safer” which had several runs on PBS worldwide.

Keith has also been published in a variety of media, publishing almost 100 articles through venues including MomsTEAM.com, Advanced Magazine, the 9s Magazine, the American Coaching Academy, and Suite101. Keith was also featured on Fox2News several times on topics of concussions and ACL injuries. In 2008, Keith was a winner of the Olin Business Cup at Washington University for his product innovation “Medibite” a jaw rehabilitation system designed to improve the outcomes for individuals suffering TMJ dysfunction. Prior to graduate school Keith was a collegiate baseball player and top-level high school cross country runner. Keith also had the opportunity to work as a personal trainer (CSCS) prior to his career in physical therapy, providing a very balanced approached to educating fitness and rehabilitation. Keith has focused his career on the evaluation, treatment, injury prevention, and sports conditioning strategies for athletes, with particular attention to youth sports.


Keith lives in the Denver, CO with his wife and two daughters, Ella and Shelby. 

Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of an athletic biomechanical analysis, is an author of a college textbook on this subject  and has performed >5000 athletic movement assessments.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training.   He is also a competitive athlete in Jiu Jitsu. 

Monday, August 28, 2017

The Evolution in Movement Assessment - Using Wearable Sensor Technology To Reduce Athletic Injuries

HS VB Player Demonstrating Poor Movement
As a parent, there is a certain thrill of seeing our kids participate in sport.  Nothing more exciting than seeing your child be successful or victorious in competition.  Yet, when an injury occurs, there is a deep ache we get seeing our child suffer and wonder if there is something we could have done.  Now, there is the ability to help reduce injury risk while helping them improve athletic performance!
Annually, there are over 300,000 Anterior Cruciate Ligament (ACL) injuries in youth athletics in the US (AAOSM Annual Conference 2016).  This devastating sports injury has an annual health care cost of over $5B plus long term impact to the children who suffer them.  One in four youths who tear their ACL will suffer another during their athletic career (Wiggin et al – Am J Sport Med 2016) and 20% will reinjure their ACL in 2 years (Holm et al Am J Sport Med 2012).  In addition to being at risk for re-injury, once an injury has occurred, their future performance is negatively impacted (Read et al Am J Sports Med 2017, Harris et al Sport Health 2013).

But what if you could identify those at risk?  Research indicates alterations in the way the athlete moves (biomechanics) puts them at higher risk for these injuries.  According to sports medicine experts (Wilk J Orth Sport Phy Ther 2015), we:

·       Need a better way to screen risk for ACL injuries
·       Need a better way to objectively measure progress
·       Need a better way to objectify return to play 
Testing Division I Athletes Using ViPerform AMI
Identifying and correcting altered biomechanics has been shown to have a direct impact on ACL injuries and athletic performance.  The current standard of practice in assessing movement is a paper pencil test that relies on the visual interpretation of the assessor.  These assessments are not well supported in the literature for injury prediction or objectively measuring an athlete’s ability to return to play (Bardenett et al Int J Sport Phy Ther 2015, Bushman et al Am J Sport Med 16).  So, how do we objectively and reliably measure the altered biomechanics that put athletes at risk of injury or decreased performance?  The team at Select Medical uses the latest in wearable 3D sensor technology to identify these risk factors and have developed an exclusive program to address deficits noted.  ViPerform AMI™ is an assessment offered by Select Medical that integrates the latest movement science with 3D wearable sensor technology.

The DorsaVi ViPerform AMI™ combines movement science with accuracy of the DorsaVi system (an FDA approved) wearable sensor device.  After performing this 15 minute assessment, each player will be provided with an assessment using lab quality data which will provided a comprehensive report showing:

·       Overall movement
·       Demographic risk factors
·       Loss of balance
·       Limb symmetry index
·       Magnitude and speed of valgus in single limb performance

ViPerform AMI Report - Providing Lab Quality Data
Using this lab quality data allows the clinician to make much more informed decisions on clinical interventions and season training protocols to reduce injury risk and improve athletic performance.   
Using this information and Select Medical’s ACL Play It Safe Program, they have demonstrated >58% reduction in all lower extremity injuries and significant improvements in athletic performance in Division I athletes.  Science and technology helping to keep athletes safe, in the game and performing at a higher level!  #MoveRightPerformBetterLastLonger.  For a Select Clinic near you offer this program, visit their website at https://www.selectphysicaltherapy.com/  For more information on the ACL Play It Safe Program, download the free app on Android or IOS under "ACL Play It Safe".  




Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of an athletic biomechanical analysis, is an author of a college textbook on this subject  and has performed >5000 athletic movement assessments.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training.   He is also a competitive athlete in Jiu Jitsu. 

Monday, August 21, 2017

Movement Efficiency in Mixed Martial Arts - Part IV

In the last several weeks we have been discussing movement assessment in the mixed martial arts athlete and how this can guide our training.  Single leg activities are also critical to sports and sports performance.  Recent studies in the American Journal of Sports Medicine state that single limb testing is one of the most important movements to test as it has the highest predictive value to performance in sports.  

Single Leg Squat – In this test, the athlete is asked to perform 10 repetitions of a body weight single leg squat on the right and on the left.  During this test, you are assessing the ability of the athlete to stabilize their knee in the front plane AND their pelvis in the transverse plane.  It is normal for an athlete to have slight movement at the knee and hip but excessive movement (greater than 10 degrees) and a large variance right to left results in an increase in injury risk and decreased athletic performance (as result of loss kinetic energy across the system).

Rational:  Single leg squat is one of the best indicators for athletic performance and injury risk in athletics.  This is true in sports which require a significant amount of single limb motion like running.  This is especially true for the MMA where a lot of the sport is kicks, knees and explosive power coming in single limb movements.  Symmetry in control of the knee in the frontal plane and control of the pelvis between the right and left lower limb is critical to optimizing performance, explosive power and keeping injury risk to a minimum. 

Training Impact:  For training purposes, the athlete is asked to perform a single leg squat using a resistance they can control throughout their range of motion while controlling motion at the hip and the knee.  The contralateral limb should be positioned in an athletic position (limb in a slight hip extension – mimicking a running position).  During the course of the exercise, the athlete should prevent the contralateral limb from touching the ground at any time.  Once proficiency is maintained at a given weight, the athlete is then progressed through progressively increased loading and eventually progressing to hopping.  Hopping should be performed in the following progression, anterior/posterior once proficient, medial and lateral once proficient all 4 directions.  If a loss of motion is considered, this could also guide some additional stability and mobility exercises that can be performed. 
 

Considering the importance of single limb testing, it is also an important movement to train and to train correctly. In this example, we see a MMA athlete lunging across the cage during dynamic stretching.  As he does this, you also see (in this still) his right knee adducting toward midline. This valgus motion is the motion that we are assessing in the previous test and a motion which we want to correct.  This motion, in a closed kinetic chain, results increased stress to the ACL, MCL, labrum in the hip and medial structures of the ankle.  If this poor movement pattern is repeated over and over with every repetition and every training session, then this results in an athlete that will do when training, when performing double leg takedowns and when fatigued in a fight.  Allowing this motion to occur in training will result in this motion occurring when this athlete shoots of a one leg or double leg take down.  This means less force (speed of take down) and increased likelihood for this motion to result in a non-contact ACL injury during.  This pattern trained over and over can result in adducting at the hip and possible injury when the athlete is fatigued and when power and stability matter the most. 

Video - in this video we demonstrate the proper form for this exercise which ensures we are training full range of motion and proper movement patterns at the same time.


In addition to this mobility exercise, adding the lumbar hip disassociation exercise will aid in the MMA athlete in improved hip mobility and provide strength and endurance to the hip and core complex.



We hope you enjoyed this series and make sure to come back for more next week.   If you enjoy our blog, please share the passion and follow us on Instagram @BJJPT_acl_guy or on Twitter at @acl_prevention.

Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of an athletic biomechanical analysis, is an author of a college textbook on this subject  and has performed >5000 athletic movement assessments.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training.   He is also a competitive athlete in Jiu Jitsu. 

Monday, August 14, 2017

Movement Efficiency in Mixed Martial Arts - Part III

Last week, we started our discussion about how we assess movement efficiency in the MMA athlete and how that may guide some of our training.  As we described last week, core strength is critical in mixed martial arts for both performance and injury prevention.  The side plank test is an exceptional test for assessing the strength and endurance of the core and is often an exercise that is also used as a part of our training.  This is a great exercise as there is a lot of EMG activity of the gluteus medius, internal obliques, quadratus laborum and transverse abdominus.  During this movement, the EMG activity of the gluteus medius is very high and this is a critical muscle in stabilizing the core/hip/lumbar spine.  The gluteus medius is the muscle that assists in stabilizing the pelvis during single leg activities.  Here we see an athlete demonstrating a retrotrendelenburg, where you can see an arc from his upper body to lower body.  This should be straight and when performed in this fashion this a movement pattern that adds to weakness of the gluteus medius.  If this poor movement pattern is repeated over and over with every repetition and every training session, then this results in the athlete not training the muscles he is setting out to train and the impact on performance will be less than optimal.

This week we will continue this discussion as we look at assessing power generating movements and single limb performance.  Considering this, one of the first movements we want to look at is the squatting motion.

Squat – In this test, the athlete is asked to perform 20 repetitions of a body weight squatting motion.  During this test, you are assessing the ability to perform a squatting motion without a lateral shift (if a plumb line from cervical spine to sacrum is envisioned, the hips should remain equal distance from the plumb line throughout the motion).  If there is deviation to one side or the other, this is referred to as a lateral shift.  



Video – in the following video analysis we see an Olympic athlete demonstrating a right lateral shift during the squatting motion.  This same motion is carried over to training and athletic performance.  




Rational:  The squat is a critical motion for athleticism.  Improvement in the efficiency of the squatting motion has not only been shown to be associated with a reduction in injury risk but also associated with improvement in vertical jump and sprint speed.  Reduction of a lateral shift results in symmetrical force attenuation and improved symmetrical force production.   For the MMA athlete, this means greater force which can be generated with kicks and faster and more explosive takedowns.  In addition, a lateral shift can indicate loss of motion in the ankle, knee or hip on the side they are shifting away from.  This can guide preventative techniques which aid in reducing non-contact injuries during training and fights.  In this picture, we see the athlete from the video shifting to her right side which could indicate a loss of motion in the left hip, knee or ankle.

Training Impact:  For training purposes, the athlete is asked to squat using a resistance they can control throughout their range of motion without a lateral shift.  If an athlete has a lateral shift, simply loading that and allowing them to continue with will result in greater variance in asymmetry right to left, bigger impact on athletic performance and increased injury risk.  Once proficiency is maintained at a given weight, the athlete is then progressed through progressively increased loading.  If a loss of motion is considered, this could also guide some additional mobility exercises that can be performed.  If there is a suspected true loss of motion at the ankle, you would most likely see an asymmetry in the ankle motion in the plank test discussed previously.  This will appear as an increase in plantar flexion on the suspected side during this test.  In the training example here, this MMA athlete is doing a weighted squatting motion with kettle bells.  Although this is a great exercise, the problem is that he is shifting to his left side during every rep. Allowing him to do this during his training is just adding to the problem and accentuating his asymmetry.

Next week, we will begin the discussion of single limb testing and look at ways we can assess these athletes and how this can guide our training.  If you enjoy our blog, please share the passion and follow us on Instagram @BJJPT_acl_guy or on Twitter at @acl_prevention.


Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of an athletic biomechanical analysis, is an author of a college textbook on this subject  and has performed >5000 athletic movement assessments.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training.   He is also a competitive athlete in Jiu Jitsu. 

Monday, August 7, 2017

Movement Efficiency in Mixed Martial Arts - Part II

Last week we started the discussion on movement efficiency in MMA and we finished with the question, So, how do we assess that?  So this week, let's begin to take a look at some of the movements that we assess in these athletes and how these equate to injury prevention and performance enhancement. 

Testing the MMA athlete

Plank - In this test, the athlete is placed in neutral spine and neutral hip position, feet all the way together and head neck in neutral position.  They are then asked to maintain this position for one minute period of time. 

Rational:  The plank is a critical position for assessing the stability of the core.  The goal of this test is for the athlete to be able to stabilize while maintaining neutral spine position and neutral hip position.  In this test, the athlete must sustain stability this position within 10⁰ of flexion and extension AND rotation.  Maintaining stability in flexion, extension and rotation is critical to provide stable base for the lower kinetic chain to pull on, to generate force from and allow efficient kinetic energy transfer across the entire kinetic chain.

Training Impact:  For training purposes, the athlete is asked to start training this basic movement correctly.  The key to training is to ensure the athlete is maintaining neutral spine and hip position throughout their training.  Once this achieved, movement and resistance can be added to this movement.  In addition, the push up portion of the dynamic sumo stretch has a big carry over to this test therefore it is critical to ensure this movement is being performed correctly.  Once this is perfected, an exercise like the plank crawl is a great addition to the MMA athlete’s core training routine. 

Plank Crawl

Next we need to look at the core's recruitment in in combination with the pelvic and hip musculature.

Side Plank – In this test, the athlete is place in the neutral spine position ensuring that the athlete is not in a retro-trendelenburg position.  The feet are placed on top of one another and the non-weight bearing arm is placed on the hip.  Head and neck are maintained in a neutral position.  They are then asked to maintain this position for one minute period of time. 

Rational:  The side plank is a critical position for assessing the stability of the core and the endurance of the gluteus medius.  The goal of this test is for the athlete to be able to stabilize while maintaining neutral spine position and neutral hip position (hips not rolling forward or back).  In this test, the athlete must sustain stability this position within 10⁰ of lateral sidebending (moving hips up or down toward the surface) AND rotation.  Maintaining stability is critical to provide stable base for the lower kinetic chain to pull on and to aid in preventing internal rotation of the lower kinetic chain in single leg stance activities.

Training Impact:  For training purposes, the athlete is asked to start training this basic movement correctly.  The key to training is to ensure the athlete is maintaining neutral spine and hip position throughout their training.  Once this achieved, movement and resistance can be added to this movement.  Once this is perfected, an exercise like the side plank with the CLX is a great addition to the MMA athlete’s core training routine. 

Side Plank with CLX


Next week, we will begin the discussion and look at ways we can assess these athletes and how this can guide our training.  If you enjoy our blog, please share the passion and follow us on Instagram @BJJPT_acl_guy or on Twitter at @acl_prevention.

Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of an athletic biomechanical analysis, is an author of a college textbook on this subject  and has performed >5000 athletic movement assessments.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training.   He is also a competitive athlete in Jiu Jitsu.