Monday, November 14, 2016

Challenging the Status Quo - A Clinical Commentary Part II

Last week, we took a slightly different direction with blog, offering more of a clinical commentary than our typical literature review.   I had mentioned that after spending countless years in reviewing of the literature, clinical research and over a decade assessing movement, it led me to some clear conclusions:
  1. Movement is very complex and very hard for the majority of people to see and assess
  2. The standard of practice is often 5-10 years behind the literature and clinical advancements
  3. There is a strong correlation to improvements in movement efficiency and to mitigating risk of injury and improving athletic performance
  4. We need to recognize where the flaws are in the current ways we assess movement are so that we can become better at what we do
  5. Sometimes movement is just movement and we try to over complicate it
  6. The standard of practice or care, in my opinion, tends to be the standard of the lazy and status quo. 
Last week we discussed the complexity of human movement and how difficult it is for most to reliably assess human movement with a high degree of validity.  We further discussed how the standard of practice is typically 5-10 years behind the most current literature and why that may be the case. 

Today we will continue along this route to discuss the implications that poor movement have on athletic performance.  If we take a pure evidence based practice approach, we know that only 43% of athletes who tear their ACL return to the same level of athletic performance (McCullough et al Am J Sport Med 2012).  Whether you are measuring the impact this has on vertical jump, sprint speed or points/rebounds scored (Harris et al Am J Sports Med 2013), we know if you tear your ACL that this has long term impact on athletic performance measures.  But what if you don't tear your ACL.  Do these same movements put you at risk for performance issues. 

Again, if we wanted to take a pure evidence based approach, we could look to the literature to guide us in this respect.  For example, we know that the same movements that put you at risk for a non-contact ACL injury also impact athletic performance (Myers et al J Strength Con Res 2005).  We also know that lack of core stability not only puts you at risk for an ACL injury but also has a direct impact on pitching performance in MLBs (Chaudhari et al Am J Sport Med 2011).  But do we really need a research paper to tell us that? 

Sometimes those of us in the health professions get to caught up on "Is it proven in the literature".  I don't think there is anyone of us, as a coach, strength coach, physical therapist or athletic trainer, that could not look at the athlete in the above picture and know this would impact her athletic performance.  If she is a basketball player, any of us could see this poor movement pattern demonstrated here would have a direct impact on her vertical jump.  If she does this in a bilateral hop, can you imagine what this would look like in single limb performance?  9 times out of 10, if you see this in bilateral performance, you can be guaranteed that you will see this in single limb performance. 

Ok, so I get it.  We may see that in a female high school athlete but if I work at the collegiate or pro level, the kind of movement patterns I see would not be that clear or easy to see.  Really?  Is it that it is not that easy to see, or that when we should be quantifying it we might not be looking at it?  This is a perfect example of a pro athlete who "passed" his movement assessment but when the rubber met the road (broad jump) this is how his mechanics looked.  In high level exceptional athletes, they may perform at extraordinary levels with poor movement.  So do we let that go for fear of messing up their performance?  Does the risk that this puts them at less of an issue in comparison to the "potential" impact on performance?  This is a valid question and one we must consider.  Although there is NO research on this, what we do see is that when these movements are improved, that there is a direct and positive impact on athletic performance.  When the athlete is given a movement specific program that is supplemented with their traditional training, we see that the positive changes in movement are then carried over to their movement during high level athletic performance.  This then equates to improvements in athletic performance. 

Again, this is not validated in the research but I think anyone who deals with athletes, that sees movements like this, see this as truly a no brainer.  Like we said last week, movement is complex.  But what we do see is if you can make an athlete move more efficiently, then you will mitigate their risk for non-contact musculoskeletal injuries and improve their athletic performance. 

Next week, we will continue this discussion and look at challenging the status quo.  I hope what you take away from this section is:

  1. Previous ACL injury has a big impact on future athletic performance - therefore we must do MORE to prevent
  2. Movement has a direct impact on athletic performance!
  3. We need to talk to athletes and coaches more about the impact that our programs have on PERFORMANCE versus injury risk
Taking this approach will improve compliance with programs and create greater adoption of programs by our coaching staff.

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, is an author of a college textbook on this subject  and has performed >4000 athletic movement assessments.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training. 

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