Monday, December 31, 2018

Improving Movement When It Matters - Part IIIB

Last week, we discussed why we should consider doing single limb training as a normal part of our performance training but also as a part of our return to sport.  Laying out exactly how one should progress through single limb training is very dependent on the what type of procedure has been done and the physician's protocol.  The information provided here should never be considered in place of advice or recommendations provided by your health care professional.

In health care, there are typically two schools of thought related to progressing an athlete along a continuum.  One which is much more of a medial model/physician based approach is a time based approach.  The athlete will progress to running or plyometrics once the tissues are healed to the point that they can withstand the associated stresses and loads with those activities.  However, many times the tissues may be ready but the neuromuscular and muscular system may not be ready for those kinds of activities. 

The other approach is more of the athletic training/physical therapy based approach which is the criterion or movement based approach.  Once the tissues are healed and ready to withstand the associated stresses, the athlete is not progressed until they are biomechanically sound with the previous lower level or complexity of movements.  The following discussion follows along both of those continuums and however we will only discuss the movement criteria needed for progression. 

In the realm of single limb training, following a criterion based or movement criterion based approach is critical to ensure we are not re-training poor movement patterns but training proper movement patterns.  Although someone's tissues may be healed to the point that they can attempt certain movements does not mean that they are necessarily ready to start said movements.  By following this approach, we are also putting positioning the athlete for a safer return to sport. 

Following is a simple progression for low levels of single limb training to more aggressive levels of single limb training along with some criteria that we can use to make sure one is progressing safely from one level to the next.  This is by no means a comprehensive progression but can provide some ideas on how to progress.

Level I - Partial weight bearing (PWB)  - weight shifts to single leg stance & single leg press
  • Once cleared to start PWB we will typically start weight shifts.
  • Once cleared to start WBAT, we will start full weight shifts to single leg stance
    • Criteria to progress - perform single leg stance without trendelenburg or retrotrendelenburg and without movement of the knee in the frontal plane.
  • Once cleared to WBAT, start single leg press at 20% body weight and progressing up from there
    • Criteria to progress - perform full body weight leg press without movement of the knee in the frontal plane.
Level II - Full weight bearing (FWB)
  • Once cleared to FWB start body weight squats through partial to full ROM.
    • Criteria to progress - perform full ROM body weight squat without lateral shift (shift away from the affected limb) and without movement of the knee in the frontal plane.
  • Standing Gmed (use affected leg as the stance leg) with theraband.
    • Criteria to progress - perform 20+ reps with green theraband without trendlenburg or retrotrendelenburg at the hip and without movement of the knee in the frontal plane.
  • Standing Gmed Isometrics (used affected leg as stance leg) against a wall.  Alternate angles 30 - 45- 90 - 110.
    • Criteria to progress - perform 20+ reps at varying angles without trendelenburg and without movement of the knee in the frontal plane.
Level III - Prior to running
  • Single leg squats - progressing partial squats to 45 degree squats.
    • Criteria to progress - symmetrical knee flexion during squats, no trendelenburg/retrotrendelenburg and without movement of the knee in the frontal plane.
  • Dynamic Lunge - progressing from dynamic lunge stretch to full lunge exercise.
    • Criteria to progress - symmetrical motion bilateral, no movement of the knee in the frontal plane with step through and good hip extension bilateral

  • Side stepping with Theraband
    • Criteria to progress - perform 20+ reps with keeping feet pointed straight


  • Single leg lumbar hip disassociation with Theraband
    • Criteria to progress - perform 20+ reps without trendelenburg, retrotrendelenburg and without movement of the knee in the frontal plane.

  • Single leg hop
    • Criteria to progress - perform 10-15 reps without trendelenburg, retrotrendelenburg and without movement of the knee in the frontal plane.

This is just one example of a progression and some of the criteria used to determine what should be accomplished prior to progressing to the next level.  There is a plethora of exercises that could be used in place of these but the concepts should be the same.  You train the movement you want.  Train trendelenburg or movement of the knee in the frontal plane during single limb exercises this is what you will get when the athlete returns to sport.

Next week we will continue this discussion on single limb training and why that is such a critical part for restoration of proper movement and maximizing carry over to sport.  If you enjoy this blog, please share with your colleagues and follow us on instagram @ bjjpt_acl_guy and twitter at @acl_prevention.  #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, 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 and a competitive athlete in Brazilian Jiu Jitsu for 5 years.