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

Last week, we looked at the lack of frontal plane control and the impact on both performance and injury risk.  We also spoke about the control of frontal plane motion means controlling how much the knee moves and how fast it moves in that direction.

Unfortunately, this movement pattern is all too common in our athletes.  We may think we may only see this in the untrained or lower level high school athlete.  The reality is that we see this across the entire spectrum from high school athlete, to college, to Olympic to professional athlete.  Part of the reason we often don't see it is that we are not assessing for it or recognizing it during training.

The severity of the of the frontal plane motion (both amount and speed) can dictate how much this will impact an athlete's risk and the impact that this will have on performance.  So as the increase in magnitude or speed of valgus increases, so does the risk and the impact on performance.  The impact of frontal plane control is not only determined by how much and how fast the athlete moves into valgus but at which point during your assessment.

For example, compare the following athletes.

• Athlete A starts to fall into valgus on rep one
• Athlete B starts to fall into valgus on rep one at a high rate of speed
• Athlete C starts to fall into valgus at rep 8

In this scenario they are all at risk however, I think we would all agree that athlete B is at the highest risk followed by A and then by C.  This can help us not only from an assessment perspective but can also guide the intervention or the starting point for the intervention.  In this scenario, with no further information, I am going to start Athlete B in a single leg squat in a staggered stance (provides increased base of support and stability) and work on controlling frontal plane motion throughout the range of the exercise.  Athlete A, I might start in a single leg squat with contralateral leg in the athletic position and work on them controlling frontal plane motion.  Athlete C, I might start in some hops until they can't control frontal plane motion and regress to single leg squat while controlling frontal plane motion.  

So, although it is the same motion, it is the severity of the motion (magnitude vs. speed and magnitude vs. control till some fatigue sets in) that dictates the exercise or level of exercise we would do with the athlete.  End of the day, any exercise that is performed where the athlete is "allowed" to train without controlling these motions will simply reinforce the default motor pathway that led to the faulty movement pattern in the first place.  Training in this pattern will result in this being the default they move to when demands are highest and they are fatigued.

For control of frontal plane motion, we traditionally think of this as just a gluteus medius weakness.  However, what we now know is this is a little more complex than that.  We often see those who have immediate inability to control motion and speed to have components of gluteus medius and gluteus maximus weakness and poor core control.  These individuals often have inability to sustain and controlled plank position for one minute and often perform poorly on side planks.  With side planks, these individuals are not only challenged with maintaining the position but also have an inability to control trunk rotation during.  

Obviously, there are over a 1000 ways to address frontal plane control and is something we are all capable of doing.  Biggest thing for us all to keep in mind:

1. Training needs to include single limb training - ensuring to put the athlete in positions that allow them to successfully control frontal plane motion.  If this is a single leg squat in a stride stance or single leg squat with contralateral leg in the athletic position or single leg plyos doesn't matter.  As long as the athlete is controlling frontal plane motion.  When they can no longer control that frontal plane motion, then should move to a lower level of the exercise to allow them to keep training while controlling that motion.
2. If there is high amounts of valgus and at high speeds, then there is the need to make sure to include core training and focusing on maintaining control at the hips.  Control of the hips means we want to prevention the athlete from falling into a trendelenburg, retro-trendelenburg or cork screw.
   
   
   
3. We need to train for some level of fatigue in single limb training.  We know that fatigue impacts lower extremity mechanics and force attenuation in runners (Weist et al Am J Sport Med 04) and there is an increase in frontal plane motion with fatigue (Brazen et al Clin J Sport Med 10).  Therefore bringing fatigue into the equation is needed and to keep them training in this fatigued state with good mechanics.  This ensures that when they are fatigue in competition or practice that they are moving better and at decreased risk for injury.
4. Train in the athletic position.  There is a trend to train folks in a pistol squat position or with the leg in the forward position (Position A).  Studies show that this is an effective position for strengthening the quads.  However, this is not the position that athletes injure themselves in competition.  The core, the limb and center of mass are positioned in a different position.  Therefore, from a specificity, it makes sense to train in more of an athletic position (Position C).  This position has a lot more core, pelvic and glut activation. 

Next week, we will continue that discussion with looking at some specific exercises that we find aid in controlling frontal plane motion.  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 also a Brazilian Jiu Jitsu purple belt and complete BJJ/MMA junkie.