Monday, December 9, 2019

The Evolving Knowledge of Movement - Part IV - What We Know Now

Last week we began our discussion about what we are learning about movement and things that we can implement that will impact these.  Sometimes we learn things that make total sense to us and yet we never thought of it before.  Speed, for me, is one of those.

Speed Matters! 

For the longest time, I always associated excessive valgus or frontal plane motion of the knee during single leg activities to be the thing that put people at greatest risk for non-contact knee injury.  I never really even considered speed at which that motion occurs as a factor.  So, play along with me for a moment.  Standing on one leg, you can slowly move your knee into 10, 15 and 20 degrees of valgus without it hurting or injuring anything.  Now imagine (and I don't encourage you to try) if you moved your knee into 20 degrees of valgus at 220 degrees/sec.  That might not only hurt but may cause some damage.  We know that ground reaction forces range anywhere from 4-8 times body weight in jumping and bounding activities (Nordan and Frankel Basic Biomechanics of the Musculoskeletal System - 4th Edition).  Considering this, can you imagine your knee falling into 20 degrees of valgus at those high rates of speed under those kinds of loads?

What we know now, is that we can impact those speeds with the proper training.  We know that when speeds are high, that including some strength and endurance training for the core (planks and side planks specifically) as well as gluteus medius and maximus training that we see an associated decrease in speeds of valgus.  In addition, simple training in single leg activities where the athlete is controlling not only the frontal plane motion of the knee but also the pelvic motion, that these athletes have better control of their speeds of valgus in single limb performance and perform better on our 3D assessment.

Obviously, exercises that can address this are limited only by our imagination.  There are 100s of different ways to approach.  A couple of my favorites include:

Lumbar Hip Disassociation with Spiral Technique 


Side Stepping with Resistance


Side Planks with CLX


Plank Clock Walks 



These are most effective if done in a fatigued state.  Typically, we will do these at the end of practice or at the end of performance training.  This way, you don't have to do as many sets and reps and there is much better carry over from performance on the exercises to how the athlete moves when they are tired.

Stay tuned next week as we continue our discussion looking at how direction of movement impacts speed.   If you enjoy this blog, please share with your colleagues, athletes and training partners and please be sure to follow us on instagrm @ bjjpt_acl_guy and twitter @acl_prevention.  Train hard and stay well.  #ViPerformAMI #ACLPlayItSafe


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 and ACL injury prevention.  He is the founder | developer of the ViPerform AMI,  ViPerform AMI RTPlay, the ACL Play It Safe Program, Run Safe Program and author of a college textbook on this subject.  Trent has performed >5000 athletic movement assessments in the US and abroad.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Vice Chairman of Medical Services for USA Obstacle Racing and movement consultant for numerous colleges and professional teams.  Trent has also been training in Brazilian Jiu Jitsu for 5 years and complete BJJ junkie. 

Monday, December 2, 2019

The Evolving Knowledge of Movement - Part III - What We Know Now

Over the course of the last couple of weeks, we have been discussing some of the things we are learning when we collect mass data related to movement in athletics.  When you read through the last couple of blogs, you may have asked yourself, where is the research on that?  Frankly, we don't have it yet.  However, we are working on getting some of this published.  Is that bad or make it less valid?  I don't think so.  In my opinion, this is the next generation of evidence based practice.  A generation where technology allows us to capture such large amounts of data that we have never had access to before and that we can now vet and easily identify what trends exist.  Sometimes this can be done years ahead of the research. 

As you may or may not know, many insurance companies are doing a very similar approach.  They capture data sets on an entire populations (10s of thousands) and/or communities and blend that with claim data information (disease states, family history, etc).  They have identified trends with lifestyle, where you live, insurance claims and disease states this makes you susceptible to.  Many are now making recommendations based on this information.  Offering different insurance products and benefits knowing the top 5 diseases you are most likely going to be susceptible to considering all your unique data points.  Insurance companies are doing this to be proactive in preventative medicine to help reduce the human cost and overall health care costs.

This is no different and the only difference is this is related to movement and demographic information in athletics.  The key is, we are collecting this in mass numbers so we become privy to this information often ahead of the research.  However, when collecting information like this, one of the things that is always important (besides blinding the data and maintaining HIPAA compliance) is whether or not the data you look at is "actionable data".  What I mean by that, is this data that we can learn from and implement some kind of strategy that will positively influence the outcome of the data.

All too often we get research or use technology which provides us some great data.  But this data is less meaningful if is is something I can't do anything about.  For example, if I collect mass MRI and athletic data on female athletes and find out that female athletes with narrow femoral notches rupture their ACL more in soccer, how am I supposed to change that?  Training can't change that.  On the other hand, if I find that athlete's who can't maintain core stability within 8 degrees of flexion/extension and rotation rupture their ACLs more, then this gives me something I can train with my athlete and change.  So, let't talk about some of this "actionable data" that we have and how this may influence how we train our athletes.   

Variance by Level of Play, Gender and Sport - Although this data is not quite clear yet, we are shooting to identify baselines for what puts a Division I female soccer player at risk versus a Division I male linebacker.  This will be extremely valuable for pre-season testing.  Just like performance testing done at the beginning of a season, we should eventually be able to use this data to provide us with a baseline from which we measure against to see the effectiveness of our interventions.  Further, we can have a training minimal goal to achieve for new recruits or those hoping to be recruited that once achieved, reduces their risk of injury during participation at this level. 

Variance in Multiple Sport vs. Single Sport - this should be simple, get your kids involved in multiple sports.  Rugg et al Am J Sport Med 18 showed NBA players who played multiple sports in high school not only played better in the NBA, but got injured less and had longer professional careers.   McGuine et al Am J Sport Med 17 showed that high school athletes that played multiple sports sustained less lower extremity injuries and the severity of those injuries suffered were less.  Why is that?  When an athlete trains in multiple sports, they are getting variations in the way that they train.  With that variation in training comes an increase in athleticism and agility.  What we see, is those athletes that are multiple sport have better frontal plane control of the knee and lower speeds of valgus.  What does that mean?  This means that when there is less frontal plane motion and better control of speed of frontal plane motion that kinetic energy transfer is better.  So when the player cuts to their left they are not only able to generate more power but that power is transferred much better to explosive power.   In addition, with this increased control of motion, there is less strain or force placed on the muscles, ligaments and joints in compromising positions.  This means less injuries.  So, take home actionable item here: Let your kids play multiple sports.  They will be better athletes and get injured less. 

Next week, we will talk about Speed Matters.  High speeds of valgus in single limb performance puts athletes at greater risk for lower limb injuries.  Knowing that, if we see that in an athlete, how do we train to control that speed?  Stay tuned as I am super excited to share with you.  If you enjoy this blog, please share with your colleagues, athletes and training partners and please be sure to follow us on instagrm @ bjjpt_acl_guy and twitter @acl_prevention.  Train hard and stay well.  #ViPerformAMI #ACLPlayItSafe


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 and ACL injury prevention.  He is the founder | developer of the ViPerform AMI,  ViPerform AMI RTPlay, the ACL Play It Safe Program, Run Safe Program and author of a college textbook on this subject.  Trent has performed >5000 athletic movement assessments in the US and abroad.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Vice Chairman of Medical Services for USA Obstacle Racing and movement consultant for numerous colleges and professional teams.  Trent has also been training in Brazilian Jiu Jitsu for 5 years and complete BJJ junkie. 


Monday, November 25, 2019

The Evolving Knowledge of Movement - Part II - What We Know Now


Last week, we began our discussion talking about what we are learning from collecting over 1000 data points associated with movement on over 14,000 athletes across the US.  This week, we continue this discuss on what we are learning regarding movement.  It is this "actionable" data that we can then improve our interventions to provide our athletes with better injury prevention programs, rehabilitation programs and performance enhancement programs. 
  • Variance in Multisport vs. Single Sport - when comparing athletes who play or specialize in one sport vs. athletes who play multiple sports, we see that multisport athletes have less frontal plane motion, speeds are lower and there is less frequent loss of balance.  Considering this and the fact that the less frontal plane control you have the greater risk of injury, it is one more reason that we should push our athletes to be multisport athletes.  In a recent study using the ViPerform AMI on single sport athletes and multisport athletes, the authors found there was much greater control of frontal plane motion in multisport athletes.  These findings will be presented in Science Meets Practice at the 2020 APTA's Combined Sections Meeting in Denver, Colorado.
  • Variance by position - when comparing athletes at the same level of sport (Division I) and in the same sport (football), we find that control in single limb performance changes based on position.  For example, we see that running backs have much better control than lineman.  
  • Speed Matters - when comparing comparing those that can control frontal plane motion to those who can not, we see some trends associated with speeds and injury risk.  We also see a speed barrier (once this speed is exceeded) that is associated with chronic lower extremity injuries.  Athletes that exceed this barrier are those that have chronic whole kinetic chain issues (ankle, knee, hamstring, etc).  
  • Direction of Movement Impacts Speed - the movement we see associated with the highest magnitude of valgus and speed of valgus is the medial hop.  This is a very challenging movement for most athletes to stabilize but is also a critical movement to control.  
  • Concussion Impacts Frontal Plane Stability - when comparing like athletes (same gender, level of sport and sport) we see that those that have had a previous concussion have a slight decrease in frontal plane stability (amount of motion and speed of motion) but a significant increase in recorded losses of balance during testing and less control at the pelvis during testing.
  • Frontal Plane Stability Impacts Performance - when comparing the magnitude of motion and the speed at which valgus occurs to flight time, what we see is that as frontal plane stability decreases there is a decrease in flight time (amount of time in the air with single leg hop).  Flight time is an indication of power output in single limb performance.  These results would suggest that there is a significant loss of kinetic energy which translates to a decrease in power output and hence decrease in flight time. 
  • Time to Stability - time to stability is the time that it takes for an athlete to stabilize once they perform a hop.  Typically this is seen once they land and they have multiple smaller hops to gain their balance or stability.  The time for the first contact on the landing to the time where they stop hopping is defined as the time to stability.  We are able to capture the time stamp from the moment they land to the time where they become stable.  One of the things we see is that the longer it takes to become stable, the greater the increased risk for injury.  
  • Pelvic Motion Matters - during single limb testing, all too often we are focused on what is occurring at the knee and forget about the rest of the kinetic chain.  One thing we see is that some athletes may be able to control their knee motion but are not able to control their pelvic motion.  Just like the knee, we see that athletes who have greater degrees and speed of pelvic motion during single limb testing are at greater risk for injury and specifically at greater risk for low back and hip injuries.  
I hope as you read this you can see all of the implications not only to injury but also to performance.  That now that we know about these factors we could look for ways to improve.  That is exactly what we have done.  Next week, we will continue that discussion on how we change these movements through movement guided interventions.  Stay tuned as I am super excited to share with you.  If you enjoy this blog, please share with your colleagues, athletes and training partners and please be sure to follow us on instagrm @ bjjpt_acl_guy and twitter @acl_prevention.  Train hard and stay well.  #ViPerformAMI #ACLPlayItSafe


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 and ACL injury prevention.  He is the founder | developer of the ViPerform AMI,  ViPerform AMI RTPlay, the ACL Play It Safe Program, Run Safe Program and author of a college textbook on this subject.  Trent has performed >5000 athletic movement assessments in the US and abroad.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Vice Chairman of Medical Services for USA Obstacle Racing and movement consultant for numerous colleges and professional teams.  Trent has also been training in Brazilian Jiu Jitsu for 5 years and complete BJJ junkie. 

Monday, November 18, 2019

The Evolving Knowledge of Movement - Part I - What We Know Now

As you may know, I have been involved in movement assessment for the last 20+ years.  This all started back in the late 90s where I was filming people with video cameras with Beta tapes as they performed a series of movements.  Overtime, that progressed to the use of slow motion video technology and from there to the use of the MS Kinect based technology.  After being frustrated with the lack of accuracy, inefficiency and inability to adapt to mass athletic physicals, I began seeking out other technologies to accomplish this task.  That is when I found an innovative wearable sensor technology, DorsaVi and was able to partner then to try to accomplish our vision.

In late 2016, we launched a commercial product to the market called the DorsaVi ViPerform AMI (Athletic Movement Index).  This system leverages DorsaVi's wearable sensor technology to capture athletic movement during a series of core, bilateral and single limb tasks (squatting to multi-directional hops).  Since its launch, we have been using this system in clinical settings, strength and conditioning settings, mass physicals (professional and collegiate) and for objectifying movement and risk for return to play.

This blog series is not about the ViPerform AMI system but more about what we are learning from collecting over 1000 data points/assessment on over 14,000+ athletes across the US.  That is 14,000,000 data points or broken down that is movement data on over 1,000,000 reps, 39,000 minutes of core testing, and demographic variables on >14,000 athletes.  The beauty of capturing data at this level is that you begin to see correlations and trends that we did not previously know existed or maybe that you suspected existed.  Knowing this can further guide what we can do to address those trends in our training or rehabilitation. The intent of this series is to share what we are learning and to provide the reader with some actionable training techniques we have seen that impact these trends.

One of the things that we assess is how stable is the athlete in a single leg squat, single leg hop and a single leg hop plant (an explosive hop forward, back, lateral and medial).  During these motions, we measure how much tibial inclination do you have (this is an indirect measure of your dorsiflexion), how much frontal plane motion do you have (varus to valgus), if your knee falls into valgus, what speed does it occur at and how many times do you loose balance.  From this information alone, we have learned a lot.  Some of the things we have learned are:

  • Variance by level of play - when collecting mass movement data on Division I athletes versus Division II and III, we see some significant differences in stability in single limb testing.  Comparing same sport, DI athletes had much better control than Division II who had better control than Division III.  Specifically, Division I athletes had better control of the amount of frontal plane motion (varus to valgus), speed of motion and loss of balance.  In retrospect this makes a lot of sense as this would have a direct impact on the athlete's overall performance and may be an indication of why they are a Division I athlete vs. Division III.
  • Variance by gender - when comparing male athletes to female athletes of the same sport and level of play, we see that female athletes have slightly more frontal plane motion and slightly higher speeds of valgus.  No significant difference was noted with loss of balance.  This could be one more reason that female athletes are more susceptible to injury.
  • Variance by sport - when comparing athletes at the same level of play (Division I or II) that play different sports (soccer vs. volleyball), you see a big difference in the amount of frontal plane control based on the sport you play.  Soccer players, by far, had much better control in single limb performance than most sports we assess.  

Is that it?  Not even close.  Next week, we will continue this discussion about what we are learning about movement with mass data capture THEN start to dive in on how we improve based on our correctives.  Stay tuned as I am super excited to share with you.  If you enjoy this blog, please share with your colleagues, athletes and training partners and please be sure to follow us on instagrm @ bjjpt_acl_guy and twitter @acl_prevention.  Train hard and stay well.  #ViPerformAMI #ACLPlayItSafe


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 and ACL injury prevention.  He is the founder | developer of the ViPerform AMI,  ViPerform AMI RTPlay, the ACL Play It Safe Program, Run Safe Program and author of a college textbook on this subject.  Trent has performed >5000 athletic movement assessments in the US and abroad.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Vice Chairman of Medical Services for USA Obstacle Racing and movement consultant for numerous colleges and professional teams.  Trent has also been training in Brazilian Jiu Jitsu for 5 years and complete BJJ junkie. 

Monday, November 11, 2019

Neuroplasticity and ACLR - Part II

Last week, we began our discussion on neuroplasticity following an ACL injury and/or ACL reconstruction.  What we found out, was there are changed in the higher centers of the brain and if these are not properly trained that this could be an additional factor that could lead to a reinjury or a decrease in performance once the athlete RTPlay. 

So this is great information, but what do we do with it?  I hope, as a follower of this blog, that you see that any product I ever talk about are ones that I believe in.  I don't do it often but the one's that I do are legit.  I don't push them because I have financial incentive to do so, I do it because I believe in the product.  That said and knowing the pethora of research out there on neuroplasticity following ACL injuries, I started to look for ways to incorporate training that would drive neuroplastic changes, help to reduce risk of reinjury with RTPlay and would improve athletic performance.  That is when I came across Quick Board

Background on Quick Board

There are some visual motor training systems out there that are very expensive and cumbersome to use in a PT facility or sports performance center.  I have found Quick Board to be a reasonably priced system that does not require a lot of space and effectively helps train the implicit strategies we spoke about in the last blog. 

Quick Board is lower extremity training and rehabilitation technology that targets the visual motor system. The first generation Quick Board was developed to objectively test and train athlete quickness, reaction and agility through sequencing and reaction exercises. Before the system was launched, the University of Memphis conducted a research study to investigate whether Quick Board’s methodology transferred to whole body change of direction. The study concluded that Quick Board’s training protocol significantly improved agility after completing 12 training sessions over a four-week time frame.

With the Quick Board, you can objectively quantify an athlete's reaction time, error rates, LSI in speed and agility tasks.  The system also has the ability to print this out in a report which can be logged into an athlete's training log or patient chart.  Due to the system’s objective nature, interest has been quickly growing in the rehabilitation and strength and conditioning markets.  By listening to the market and continually improving the technology, Quick Board has positioned itself as the only scientifically-proven technology that targets lower extremity visual motor training.

How does it work?
Quick Board’s software has a diverse library of exercises that target reaction, neurocognitive reaction, speed, stability, coordination, strength, balance and proprioception. The software also includes protocols based on injury, rehabilitation phase and patient population. It is critical for patients to engage the visual motor system by focusing on the software feedback without looking down at their feet. This enhances proprioception and addresses neuroplastic changes that occur with injuries. During exercises, patients are performing the required movements on the sensor board while focusing on the Quick Board software’s real-time feedback.


For reaction exercises, the Quick Board software lights up a dot area on the iPad screen and the patient reacts to the corresponding sensor on the sensor board. Sequence exercises consist of predetermined movements which the patient must complete as quickly as possible.

The Quick Board software provides exercise results consisting of:

  1. Correct touches completed
  2. Errors incurred by pressing an incorrect sensor location
  3. Average ground contact time
  4. Average reaction time for reaction exercises

Patients perform exercises on Quick Board’s sensor board while focusing on the iPad software’s real-time feedback. The technology’s methodology is based on providing patients with real-time movement feedback during exercises to enhance the neurological impact. Real-time feedback provided during the exercises includes displaying average contact time for each sensor location on the iPad, total number of touches, errors and a progress bar communicating whether the patient is ahead or behind their best result which keeps the patient goal-oriented. 

Automated protocols were developed to reduce the therapist's or strength coach's interaction with the iPad during a patient’s session. Prior to a patient beginning their protocol, the clinician can program the number of sets for each exercise and rest time between exercises. Once those parameters are programmed, the clinician taps the start button and Quick Board’s software takes the patient through the protocol and saves all results to their patient profile.

Before each exercise begins, a patient will see:

  • The exercise name 
  • Exercise settings
  • Demo video
  • Their best result for that exercise 
  • Their most recent result for that exercise 
  • The rest time countdown 
  • How many exercises they have remaining for their session

Quick Board has also developed logical sequences designed to take the athlete from easy task to much more complex tasks (as depicted in the video below).


ACL Protocols
Quick Board has been working with industry experts to develop ACL protocols that can be implemented as a part of a comprehensive ACL rehabilitation program. Use of these specific protocols has been shown to have a direct impact and improve performance on the biomechanical factors that put athlete's at risk for injury. We are seeing that when these protocols are implemented as a part of a rehabilitation program, this results in:
  • Improvement in Limb Symmetry Index
  • Decrease in lateral shift during a squatting motion
  • Decreased in magnitude of valgus at the knee during single limb testing
  • Decrease in speed of valgus at the knee during single limb testing
These protocols have been laid out in a phased progressions and designed to emphasize symmetry in bilateral limb testing and symmetry in frontal plane control and speed of frontal plane motion in single limb tasks.  I have personally found the Quick Board to be an invaluable asset I can add to my athlete training that helps improve athletic performance and reduce risk of reinjury.

Next week, we will begin a new series on what we are learning from capturing such large amount of movement data.  Stay tuned as I am super excited to share with you.  If you enjoy this blog, please share with your colleagues, athletes and training partners and please be sure to follow us on instagrm @ bjjpt_acl_guy and twitter @acl_prevention.  Train hard and stay well.  #ViPerformAMI #ACLPlayItSafe


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 and ACL injury prevention.  He is the founder | developer of the ViPerform AMI,  ViPerform AMI RTPlay, the ACL Play It Safe Program, Run Safe Program and author of a college textbook on this subject.  Trent has performed >5000 athletic movement assessments in the US and abroad.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Vice Chairman of Medical Services for USA Obstacle Racing and movement consultant for numerous colleges and professional teams.  Trent has also been training in Brazilian Jiu Jitsu for 5 years and complete BJJ junkie. 

Monday, November 4, 2019

Neuroplasticity & ACLR


Neuroplasticity is not typically a term we think of when we think about knee injuries. However, we now know there are changes that occur in the brain following an ACLR.  Can we change that?  Is there training we could employ that would improve?  Would this training have an impact on performance as well?  Before we get into that, let's look at what we know.
In a study by Kapreli et al Am J Sport Med 2009, the authors showed that there were changes that occurred in the higher centers in the brain following an ACL injury.  In this study, the authors performed functional MRIs on 17 ACL deficient males and compared that to functional MRIs of 18 ACL in-tack males.  What they found was there were distinctive changes in the presupplementary motor area, posterior secondary somatosensory area, and posterior inferior temporal gyrus.  This suggest that such an injury might be regarded as a neurophysiologic dysfunction, not a simple peripheral musculoskeletal injury.  Should this be something we consider as a part of our training and if so, how do we do?
In a study by Monfort et al Am J Sports Med 2019 the authors found that these changes in the brain result in visual spacial deficits.  Meaning the athlete has a challenging time knowing where their knee is in space.  Further, the authors found that if these deficits are not addressed, this could lead to the increase in the valgus angle that occurs with sport specific cutting movements.  It is these neurological adaptations that appear to be associated with clinical deficits that may contribute to poor long-term outcomes and reinjury rates among athletes returning to play. 
As a result of the loss of the ligamentous structure and the associated mechanoreceptors, the system must compensate to regain neuromuscular control. As a result, after an ACLR, the brain begins to rely more on a visual-motor strategy (using visual input to visualize limb placement) as opposed to a sensory motor strategy (mechanoreceptors and proprioceptors) to engage in knee movement. It is believed that these compensatory strategies may put the athlete at greater risk of injury upon return to sport, result in a decrease in athletic performance and lead to poor long-term outcomes. 
The changes in the brain associated with ACL injury and reconstruction are not be sufficiently targeted with current rehabilitation approaches. WE must employ using the principles of motor learning that have the potential to support neuroplastic changes, reduce the risk for a second ACL injury and early onset of osteoarthritis.  If mechanoreceptors at the injury location are affected, it's important to integrate training techniques that target the afferent pathways from the point of injury. Current ACL research has suggested utilizing visual-training technologies and techniques can improve results when combined with already-established neuromuscular training methods.
Motor learning research has shown that externally focusing on the outcome of a movement (implicit strategies) is more likely to transfer to other tasks compared to internally focused movements (explicit strategies). An example of an implicit strategy is seeing a target on a screen in front of you and touching to that target with your foot without looking.  Explicit would be seeing the target and looking at it while you touch it.  Implicit requires more higher center input and is closer to how we must move in athletic situations.
ACL injury prevention programs addressing explicit rules regarding desired landing positions by emphasizing proper alignment of the hip, knee and ankle are reported in the literature.  This may  be a sensible way and effective way, but the use of explicit strategies may be less suitable for the acquisition of the control of the complex motor skills required in sports.  Additionally, this may be one reason re-injury rates remain high. 
These prevention programs may be further enhanced by integration of training which emphasizes implicit strategies. From a practical and scalable standpoint, how can we implement these strategies? This may be one of the most challenging questions providers are left to answer. Establishing new strategies, standardizing the strategies, tracking the outcomes and implementation may lead to paralysis by analysis.  
Next week, we will discuss one method we use to accomplish this.  If you did enjoy, please share with your colleagues, athletes and training partners and please be sure to follow us on instagrm @ bjjpt_acl_guy and twitter @acl_prevention.  Train hard and stay well.  #ViPerformAMI #ACLPlayItSafe


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 and ACL injury prevention.  He is the founder | developer of the ViPerform AMI,  ViPerform AMI RTPlay, the ACL Play It Safe Program, Run Safe Program and author of a college textbook on this subject.  Trent has performed >5000 athletic movement assessments in the US and abroad.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Vice Chairman of Medical Services for USA Obstacle Racing and movement consultant for numerous colleges and professional teams.  Trent has also been training in Brazilian Jiu Jitsu for 5 years and complete BJJ junkie. 

Monday, October 28, 2019

Injury Prevention in Grappling Sports - Part VD

Last week we began our discussion on exercises you can do to prevent lower limb injuries in grappling sports.  In this discussion, we talked about some hip strengthening, hamstring strengthening and core.  This week, we will continue that discussion by looking at some exercises for the core and knee.

Physioball Sit Ups and Obliques:  this is  great exercise for the core and I personally feel this one has a lot of carry over to my sweeps from guard.  Since doing these on a regular basis, I feel definite improvement in my bump sweeps and flower sweeps from guard. 

First thing is making sure your physio ball is the right size and inflation.  The majority of time that I see people do these at the gym, most of them are doing them with the wrong size of ball and/or wrong inflation.  When sitting on your ball, your knees and hips should be at 90 degrees.  With your weight on the ball, the ball should not deform too much.  You want some give to the ball (so not rock hard underneath you) but should not be so deflated that it deforms a lot under you.  One reason we use a ball is that the unstable surface of the ball increases core activation.  This means much more of the core is active to stabilize the ball.  With a properly inflated ball, there is less contact area with the floor which makes this more unstable.  The more deflated the ball is, the more contact area and more stable the ball is.

When performing the exercise, the feet should be close together and you roll your hips and butt back onto the ball.  This further decreases the area of stability and makes the ball more unstable and the exercise harder.  From the start position to the end position, there is not a large amount of trunk flexion that needs to occur (as depicted here).  Sitting up much further than this range kicks in your hip flexors and recruits less of your core.  The arms behind the head are just to ensure proper cervical position and should not be used to pull on the head.  Typically, I encourage folks to super set (do one set and move right into the next exercise) of sit ups followed by obliques (taking right elbow toward left hip and vice versa).  Typically I will have people start with 10 reps each direction for 3-4 sets and progress to 10 sets.

Single Leg Squat - single leg squats are a great exercise to help strengthen the quads and hamstrings and at the same time help us on execution of power and speed with shooting for single leg take downs.  This is also another exercise that I see done incorrectly all the time and when done incorrectly not only decrease the overall impact your training has on performance, it can actually cause you an injury. 

I am just going to say it and it is not going to be popular, but I am not a fan of the pistol squat.  For those of you that don't know what it is, good.  For those of you that do, sorry.  Functionally, there is no need for it.  Does it work your quads more, yes.  Does it carry over to sport more, no.  If you look at the position of the core and the contralateral limb (opposite leg) during the execution of the single leg squat shown above and the pistol squat, the position above mimics sport, running and shooting in for a take down much more than the pistol squat. 

The key to this exercise is to make sure you control the motion at your hips and your knee.  Do not allow your knee to go in toward midline (this is called valgus and is bad for your meniscus and ACL).  In addition, watch the position of your hips.  Your hips should not rotate out.  This puts a lot of stress on the hip joint and is commonly associated with core weakness.  When doing this exercise, should shoot for 2-3 sets of 10-15 reps.

Side Stepping with Theraband: This is a great exercise to strengthen your hips, quads and hamstrings.  For this exercise, you want to have a band around your ankles.  This band should be tight enough that when your feet are shoulder width apart, you get a fair amount of resistance from the band. 

While in a semi squatted position and your feet pointing straight ahead, start side stepping to your right.  Make sure you keep your feet pointing straight ahead the entire time and pick your opposite foot off the floor when you step to the advancing leg.  Keep in the semi squat position throughout the exercise.  Step 15 steps in one direction and then repeat in the opposite direction for 15 steps.  Make sure to remain in the squatting position the entire time.

This exercise focuses a lot on glut medius strength which is really important for preventing ACL injuries as well as meniscus injuries in this sport.  In addition, strengthening this position will have a positive impact on your scramble and your take down speed and power. 

Fatigue State Training (FST): FST is a concept that I developed several years ago to prevent injuries in sport.  In sports, if I have a routine that is too long, athletes and coaches are much less likely to include this in their practices and routines if the program takes too long.  Research indicates that if a a program takes more than 15-20 minutes, they are much less likely to do.  So how can I have a program that has the training volume need to create change and yet is efficient enough to be less than 15 minutes? 

What we found is that if we use the fatigue that you create in practice and then do the exercises at the end of your practice, that we get a better training effect with less exercise.  So instead of doing 3-4 sets of an exercise, now I only have to do 1-2 and I still get the same training effect (because you are tired).  At the same time, what we found is that by training in this fatigued state, this actually carries over more to your performance when you are fatigued.  What does that mean?  It means you are not only less likely to get injured, but you are moving better, faster and with more power.  In a match, this can be the difference from getting your hand raised or not.

So how do you incorporate FST into your training?  Considering all the exercises I described, what I recommend is pick your problem area (neck, shoulder, legs or back).  Pick the stretches to do before practice.  Show up 10 minutes early and do them.  At the conclusion of practice, take an additional 10-15 minutes to do 1 set of the key exercises for your problem in a fatigued state.  Do that after every practice and you will start to see some amazing results.

This concludes this series and I hope that you enjoyed it as much as I did.  I hope you found this information valuable and that it helps you keep on the mat.  Most people quit this sport as a result of injury, don't let it be you.   If you did enjoy, please share with your colleagues, training partners and BJJ enthusiast and please be sure to follow us on instagrm @ bjjpt_acl_guy and twitter @acl_prevention.  Train hard and stay well.  #ViPerformAMI #ACLPlayItSafe


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 and ACL injury prevention.  He is the founder | developer of the ViPerform AMI,  ViPerform AMI RTPlay, the ACL Play It Safe Program, Run Safe Program and author of a college textbook on this subject.  Trent has performed >5000 athletic movement assessments in the US and abroad.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Vice Chairman of Medical Services for USA Obstacle Racing and movement consultant for numerous colleges and professional teams.  Trent has also been training in Brazilian Jiu Jitsu for 5 years and complete BJJ junkie.