Monday, March 28, 2016

How to Eliminate Pathokinematics - Part IIX

Last week, we talked about the importance of stretching and flexibility and use of dynamic stretches.  This week we will continue our discussion by looking at the impact of the core.


Another key concept to define here is the “core” or midsection.  This has been defined by many different authors to include various muscles, groups of muscles and body parts.  For our purposes we define the core as anything from the pectoral muscles (chest) to the knee. 

It is critical to examine the role of the core in pathokinematic movement patterns.  In order to do this, let’s further define the core.  It includes the latissimus dorsi, multifidus and other back muscles, the muscles of the abdomen, including, but not limited to the obliques, rectus abdominus and transverse abdominus, the muscles of the hips such as the adductor, abductor and rotator groups, (including the piriformis and gemelli brothers), and the gluteal group.  Also, for our purposes, we will include the pectoralis major and other chest muscles, as well as those in the front of the hip, such as the hip flexor group.  Last, we include the muscles of the upper leg, including the quadriceps and hamstrings groups.  All of these are connected in some form or fashion either by origin/insertion or through fascial connections.

Strengthening the core adds to increased force attenuation which results in reduced potential for injury, as well as increased transfer of energy across the system, i.e., greater power distributed throughout the kinetic chain.  Without sufficient core strength/endurance, there is inefficient transfer of energy across the region.  This adds to altered length tension relationships of the lumbopelvic region as well as muscles attached to this region, including the quadriceps, hamstrings, and gluteals.  It stands to reason, then, that improvement in core strength, endurance and power improves athletic performance, and reduces potential for low back pain and lower extremity injuries. 

The correlation of core strength to performance as well as injury prevention has been well vetted in the research.  In 2011, Chaudhari et al JSCR showed that improvements in core strength added to improved athletic performance in MLB pitchers with less walks and hits per inning in players with good core stability .  Chaudhari et al further showed in 2014 AJSM that improvement in core stability in MLB pitchers also resulted in 44% less time on the DL when compared to MLB players without.  This is just a few of the multiple studies showing the impact on athletic performance.  Other benefits of strengthening the core will be discussed in the next section on the Role of Strength Training. 

When training the core, proper technique is critical.  All too often, success is determined by ones ability to do a more difficult form of the exercise than in performing the easier form of the exercise correctly.  This is often seen in core training and it is important to keep in mind that the movement patterns and compensations that you train in your training sessions will be the ones that the athletes will resort to in a fatigued state.

One example of this is the plank.  All too often, we test teams and players who have been doing planks as a part of their training however fail when we test them.  Unfortunately, they end up training improper form so when testing them in the proper position they are not able to maintain that position.  What is the proper position.  This video produced by Theraband helps to explain proper form.

Role of Strength Training

Why is strength training important in the discussion of pathokinematics?  We know from our research that the core is directly responsible for power output to the lower extremity.  We also know that the upper body sends signals to the lower body through the core on which way to move and when.  An example of this is in running.  When the runner’s arm moves forward, the location of the elbow tells the knee where it needs to be in space relative to the rest of the body in order to maintain balance, and the location of the hand and wrist tell the ankle where to be in position, relative to the rest of the body.  All of these signals are sent through the core via the kinetic or power chain.

We also know that if we have certain core weaknesses, these lead directly to imbalances in the lower extremity.  For example, as discussed previously, we know that weak gluteus medius and maximus muscles are directly related to valgus at the knee (or a turning in of the knee) during movement.  This can lead directly to changes in the striking pattern of the foot and ankle, and eventually the entire system from the gluteus medius muscle (part of the core) down is compromised.  Certainly we can see how power output is reduced as well as efficiency.

Through strength training, we can effectively increase the effectiveness of the core in managing balance/proprioception and in sending power through to the lower extremity.  In the following chapters on the Corrective Exercise Program, you will see exercises designed to directly impact the core.  Additionally, we know that strength training builds bone density, increases endurance and facilitates a higher resting metabolic rate, all of which are directly related to health, fitness and injury prevention.

One factor to consider when training to impact pathokinematics in sports is fatigue.  More precisely is training in a fatigued state.  Training the core, gluts, single limb performance and proprioception in a fatigued state is critical to carry over to sport.  Doing so, aids in assisting to maintain better posturing and movement during the later phases of competition.  For an exercise to do post practice, try this exercise.

Role of Cardiovascular Training

Cardiovascular training has application in the discussion of pathokinematics as well.  It is critical that athletes employ some sort of cardiovascular training, combined with stretching, prior to beginning an exercise session in order to warm the body and loosen muscles, ligaments and tendons so they will be prepared to work.  When the body is cold, it is more difficult to reach full extension during exercises or movements that require it, because the muscles and connective tissue are simply not elastic enough to allow a full range of motion.  As a result, the athlete must compensate for the inability of the body to get into certain positions early in the exercise routine, which can lead to injury and decreased performance---and over the long term, poor motor programming.  Body tissues that are cold and consequently less elastic are also significantly more prone to injury.  Of course cardiovascular training in combination with other kinds of training is part of an overall program of fitness for athletes and non-athletes alike.  It facilitates heart and lung health, blood flow to the brain and extremities and an increased metabolic rate, even at rest.  Weight-bearing cardiovascular training also contributes to bone health, which becomes increasingly important as we age.

 Rest and Recovery

Many injuries occur because of illness, burnout, or overtraining.  In fact, two of the biggest enemies to sport are break-down and staleness, which is sometimes called burn out.  Consistency, moderation and time to recover are all essential to avoid injury and maximize athletic performance.  Because consistency in training is the single biggest predictor of fitness in athletes, care must be taken to avoid long breaks in training that can be caused by illness or injury, and which can lead to de-compensation or de-conditioning.  Consistency leads to continuous improvement, but for many athletes, the perception is that working harder, faster or more often is the key to higher performance.  Consequently, for these athletes, it is hard to listen to the body and take time off when needed.  The result can be long periods of missed training due to breakdown of the body over time and chronic fatigue. 

Rest is essential to recovery and to getting stronger.  In other words, without rest the body’s systems do not have time to regenerate and then during the next workouts, form and endurance suffer.  Sleep is the most important recovery strategy since during sleep the body secretes growth hormone that repairs damaged muscles and repairs other physiological systems that are taxed during training.  The key to effective training is to tax the body JUST enough so that it is able to recover and regenerate, and get stronger, before the next work out.  If we don’t allow enough rest, then breakdown leads to more breakdown, until finally the body becomes injured or ill. 

The idea in any training or rehabilitation program is to increase the quantity of quality training and eliminate training that is of poor quality altogether.  Most amateur athletes, in particular, train too often and often too much.  They are notorious for not training hard enough on hard days or training easy enough on easy days.  In other words, many athletes train at a moderate level all the time.  This leads to chronic fatigue and eventually overtraining and injury.  At the very least, it prevents real performance gains in endurance, speed, strength, power, or efficiency.  So, in other words, we want our athletes to train as little as possible to achieve the desired adaptation response.

Be sure to include at least one day of complete rest in the athlete’s routine each week while training, and include regular active recovery days as well.  Active recovery can include days of shorter training duration, lower intensity or cross training in another sport or activity that uses different muscle groups.  Also, as noted before, during intense periods of training, it is important for the athlete to get enough sleep and many trainers recommend including an extra hour every night, in addition to regularly scheduled naps during the day if possible.  On days where there is even the slightest hint that the athlete is tired, or unmotivated to complete his or her training, there could be an underlying reason that should be paid attention to:  The bottom line is, even with extra rest built in to the athlete’s schedule, when approaching a work out:  “when in doubt, leave it out.”[ii]

Dr. Nessler is a practicing physical therapist with over 17 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 and author of a college textbook on this subject.  He serves as the National Director of Sports Medicine for Physiotherapy Associates, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training. 

[i]McGee, Bobby, Running Mechanics, Art and Science of Triathlon Lecture Series, Endurance Films, USA Triathlon Training Series, 2009.
[ii] Friel Joe and Byrn, Gordon, Going Long:  Training for Ironman Distance Triathlons, The Ultrafit Training Series, Velo Press, Boulder, CO 2003, page 10.

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