Monday, April 4, 2016

How to Eliminate Pathokinematics - Part IX

Last week we discussed the role of the core, strength training and the importance of rest.  This week, we will build on those discussions to talk about periodization training and psychology of sport. 

Periodization refers to the habit of planning the annual or seasonal workout schedule to allow the body to rest and recover and then be in a period of continual overcompensation followed by more rest and recovery.  This concept was developed and popularized by a Romanian sports scientist by the name of Tudor Bompa in the 1960s and was first published in his work Theory and Methodology of Training.  The concept basically refers to a progression from more general fitness related training to more specific training needed for the sport, so it is related to the concepts of specificity, hypertrophy and adaptation discussed earlier.  Periodization concepts are also used to target the special needs of the individual athlete as determined by previous injuries or other kinds of sports performance limiters, e.g., pathokinematic movement patterns, certain kinds of muscle weaknesses, etc.  Periodization training typically involves the use of macro-cycles, meso-cycles and micro-cycles, the details of which are beyond the scope of this book.  However, if we look at training on an annual or seasonal basis, we can break the training plan into several distinct periods:
  1.  Preparation:  This is the period of training that comes first in which skills, mechanics and techniques are refined, the athlete begins a regular training schedule after having taken time off, and he/she prepares for a more intense period of training.  During this phase, strength/resistance training should be developed, cardiovascular training built, and movement economy practiced.  This period can last anywhere from four to twelve weeks.
  2. Base:  This is the period of training in which endurance, force and speed are built.  This is when the athlete prepares for the next session which is the building session by establishing an overall base of fitness that will carry him/her through the season.
  3. Build:  This period is where the athlete gradually increases intensity, duration and frequency of workouts to more closely approximate the requirements of the sport he or she is competing in later in the season.  The build period includes a lot of endurance and muscular endurance work, plus increased force training.  It is during this period that many athletes push too hard, and are more susceptible to injury.  Because the concept of periodization means a progressively increasing and strategically focused training schedule, it is important to remember to allow more recovery time as the quantity and intensity of training increases.
  4. Peak:  The peak period is the time during which the athlete’s intensity is highest, and therefore recovery needs are also highest.  This is where the athlete attempts to most closely simulate the specific needs of his/her sport prior to the first race or competition, including all the strategies required for racing or other competition.
  5. Race:  Race period, or as it might be known in some sports, “Competition” period, is the time when the athlete should be fully prepared and be at the highest fitness level possible for his or her sport.  If the preparation, base, build, and peak phases were all maximized and used properly to strategically progress the fitness and endurance level of the athlete, then he or she should be ready to compete at the highest levels possible.
  6. Transition:  This period is the “off-season” and usually lasts from 4-8 weeks.  This is a time when rest (both physical and psychological) is substituted for focused sport specific training.  Active rest and cross training are effective ways to maintain overall fitness during the transition time. 
Transition time can also be used during an active season for longer term rest and recovery.  Transition time is applied often after “breakthrough workouts.”   Breakthrough workouts are those that require more than 36 hours to recover[i]  and are used to push the body to overcompensate in order to learn to combat fatigue and increase mental stamina.  They are often focused primarily on increasing muscular endurance.  The number and frequency of breakthrough workouts varies greatly by athlete and sport, and should be planned with full periods of rest and recovery afterward to avoid injury and allow the body to build.  
Remember:  Strength and performance gains actually occur during periods of REST.  Performance gains do not occur during training, as is commonly believed.  It is only during the periods of rest between periods of break-down of the body that it is regenerated and becomes stronger via a process of overcompensation or, as it is also known, adaptation (Appendix I).  Again, to reiterate an earlier statement, the idea in athletic performance improvement is to do as little training as possible to generate an adaptation response that results in the body becoming stronger and more efficient at the given activity.  Anything more results in overtraining and anything less results in sub-maximal performance gains.
Periodization should also be considered during and inside a regular training schedule.  One method that we like involves three or four weeks of increasing training volume and intensity followed by one week of rest and recovery, with a drop in both volume and intensity of training.  This week allows the body to rest and recover, and ultimately become stronger.  Each week during the harder first three or four weeks of the cycle, training volume or intensity are not increased by more than 10 % at a time.  This is what many coaches, trainers and experts in the field refer to as the “golden rule” of training.  Any more can lead directly to injury.
All of that considered, it is vital during all training phases that proper movement is carried through all phases.  So, no matter what phase the athlete is in or what lift is being performed, if poor movement is allowed to continue, this will limit overall performance.  Whether that is measured as maximal poundage lifted or timed sprint speed, strength training that allows for movement compensation is strength training that is reinforcing poor movement. 
Take the following case in point.  This valgus occurring at the right knee was limiting her PR.  Once this was corrected, kinetic energy transfer across the system was much better which allowed for an increase in her PR.
Psychology of Exercise and Sport Psychology      
In order to help athletes and others change their movement patterns during exercise or sport, we have to understand two things:  a.) what motivates them to exercise or train in the first place and b.) what will motivate them to work hard to change their behaviors in order to exercise or train in a different way.  There have been hundreds of studies on the psychology of exercise and more specifically sports psychology in recent years.  Researchers have studied the psychology of exercise in the general population and also taken the interdisciplinary approach to understanding sports psychology for athletes by looking specifically at the fields of kinesiology (the study of human movement) in combination with psychology.  The question remains, what are the drivers of exercise, training and participation in sports? 
It is beyond the scope of this book to delve too deeply into the underlying motivators in sports performance and exercise across all populations.  However, it is critical that we, as professionals who help athletes (and others) learn to move better in order to avoid injury, maand sensitive to, the psychological and motivational drivers of performance.  Without this sensitivity, we will be ultimately unable to affect any real and lasting change that will result in improvement. 
nage pain, rehabilitate when injury has already occurred, and improve athletic performance, be cognizant of,
That said let’s consider a few of the more commonly accepted “exercise” motivators across the general population such as:
  • Competition
  • Current cultural trends towards health and wellness
  • Love of a chosen sport/fun
  • Release of brain chemicals that reduce stress, anxiety, etc.
  • Mental escape
  • Sense of control
  • General sense of accomplishment
  • Pay,  prizes, awards, scholarships
  • Social aspects
  • Body image
  • Reduce effects of aging
  • Ability to eat more
  • Exercise addiction
  • Relaxation
  • Weight loss or management
  • Rehabilitation from injury or illness
  • Educational requirement
  • Mood elevation, increase feeling of happiness
  • Force of habit

Researchers have found that the number one motive for exercise across all populations is to improve health.  For younger athletes however, ages 16-25, the number one motivator is competition.  Support of family and friends was paramount to success with exercise programs, and it was found that those persons who participate in shorter workouts at higher intensities feel more confident that they can continue exercising in the future.  It has also been found that people who exercise at a moderate intensity, more often, are more successful sticking with their exercise program than those who exercise at higher intensities, less often.[iv]

Ultimately, before undertaking what amounts to a behavioral and physiological change program in a given athlete, the professional should work with the athlete to understand his or her personal motivations to change.  Is it for injury prevention?  It is for injury rehabilitation or pain management?  Or is the change required or desired primarily for performance improvement?  Ultimately, without this knowledge, it is unlikely that the professional will be able to design and prescribe a program that will strengthen where there are weaknesses, loosen where there is tightness, re-program long-established neuromuscular patterns, influence habits and ultimately improve movement.

In addition to the above, we also must understand how to motivate an athlete to "train differently".  If they are use to using massive weights and performing multiple reps with pathokinematics, how do we change their mind set.  Two things we have found to be very beneficial and which is supported by the current research.  In 2015, Agresta et al published a paper in the JOSPT that showed the importance and impact that visual feedback has on helping runners change their gait patterns.  When an athlete sees how they move and understands how that correlated to impact on performance and injury rates, they are much more likely to focus on corrective techniques.   In 2013, Ardern et al in the AJSM showed that one of the major factors determining an athletes ability to return to sport post ACLR is what is called Sport Locus Control.  Simply stated, this is the athletes perception that they are in control of their destiny versus something external.  This is important in assisting athletes in changing their movement patterns so they feel like they have some control over that.

Sport Locus Control can easily be provided to the athlete by:
  1. Filming them during movement assessment and review the video with them
  2. Educate them on why the movements are occurring and the impact has on performance and injury rates
  3. Educate them on the exercises that will assist in reducing these pathokinematics
  4. Education them on things to watch out for with their traditional strength and conditioning exercises
  5. Empower them to know they can make a difference
Taking these simple steps will go a long way in helping the athlete overcome and correct pathokinematics not just for a season but for their entire athletic future.

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] Friel, Joe and Byrn Gordon, Going Long:  Training for Ironman Distance Triathlons, , The Ultrafit Training Series, Velo Press, 2003, page 32. 
[ii] Friel, Joe, The Triathlete’s Training Bible, Second Edition, Velo Press, Boulder Colorado, 2004., pp 222-223.
[iii] Friel Joe and Byrn, Gordon, Going Long:  Training for Ironman Distance Triathlons, The Ultrafit Training Series, Velo Press, Boulder, CO  2003, pages 193.
[iv] Waehner, Paige.  The Psychology of Exercise Quiz:  What really motivates us to exercise?, Exercise, 2011.

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