- Movement is very complex and very hard for the majority of people to see and assess
- The standard of practice is often 5-10 years behind the literature and clinical advancements
- There is a strong correlation to improvements in movement efficiency and to mitigating risk of injury and improving athletic performance
- 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
- Sometimes movement is just movement and we try to over complicate it
This is not rocket science, this is movement. We don't have to apply theoretical models, we can simply look at the science and apply what we know. If we had to limit it to one or two things that we know have a direct correlation to movement and injury risk mitigation and performance enhancement, what would it be?
Depending on who you ask, the answer will vary. In my opinion, it would be control of frontal plane motion of the lower kinetic chain. Whether you are looking at this picture of this young high school athlete or this professional football player, we can all see how this motion will result in:
- Loss of kinetic energy transfer across the system - this means a decrease in power output which will impact vertical jump, sprint speed and agility.
- Altered length tension relationships - this means taking a muscle, group of muscles or the entire kinetic chain out of it's optimal position to generate force. This equates to a decrease in the maximal force that muscle or group of muscles can generate which has a direct impact on athletic performance.
- Altered force attenuation along the lower kinetic chain - this means a increase shear stress departed to the articular cartilage and ligaments and abnormal forces departed to the joints. This means that tissues break down faster and are more susceptible to injury.
As we have talked about in the previous blogs, this frontal plane motion "risk factor" can be measured by two components:
- The magnitude of motion that occurs. Frontal plane motion >10 degrees is bad. The larger the magnitude the worse it is.
- The speed at which this motion occurs. The faster this motion occurs, the more potential energy that is present and hence the greater force imparted to the structures.
- Single Leg Squat - <10 degrees frontal plane motion and valgus @ <20 degrees per second
- Single Leg Hop - <10 degrees of frontal plane motion and valgus @ <100 degrees per second
- Single Leg Hop Plant - <10 degrees of frontal plane motion and valgus @ <135 degrees per second
- Use the concept of repetitions to substitution - do as many reps and sets as they can with proper form. Once start losing ability to control frontal plane motion, then either step the exercise back to an easier form or stop. This is the point at which they have reached either muscular, neuromuscular or proprioceptive fatigue. Training beyond with bad movement will simply reinforce bad movement patterns.
- Focus on single limb performance- control frontal plane motion and the speed at which that motion occurs. This can be accomplished with a plethora of exercises.
Dynamic Lunge: Key in this exercise is to make sure they are able to get through the motion while controlling the frontal plane motion of the knee. This is especially important on the step through phase of this exercise.
High Knee Toe Up: Key in this exercise is to bring the leg up into straight flexion and to control the frontal plane motion of the stance leg during.
Standing Gluteus Medius - this is an endurance exercise for the G.Med but has a single limb performance component. Make sure to control the frontal plane motion of the knee during the performance of this exercise.
Single leg lumbar hip disassociation - this exercises utilizes the CLX to pull the knee into a valgus and internally rotated position thus requiring greater activation to prevent this motion. Keep a close eye on the stance limb position during.
Single leg squat - there is no video with this one but the contralateral leg is held in a slight extended position and the athlete squats to 30-45 degrees while maintaining frontal plane control at the knee.
These are some simple exercises we can implement that have a direct impact on the measures we know put athletes at risk. If we carry this same methodology over to our lunges, step up, squats and other forms of training, then we should see a direct impact on frontal plane motion control. Keeping it simple and direct to the measures we are measuring is the most direct route to mitigate risk and improve athletic performance.
If you would like more exercises focusing in this area, you can download our free app on IOS and Android by searching "PhysioSports". The #ACLPlayItSafe app provides four levels of progression to the ACL Play It Safe Program which can be implemented as a part of your team's performance enhancement & injury prevention protocol.
Thank you for following our blog in 2016 and hope you will continue to find this a worthwhile read in 2017. We will be taking the next 2 weeks off and resuming our blogs on Jan 9, 2017. To kick off the new year, we will share some technology advancements we have seen that can be leveraged to drive better, faster outcomes with improving movement.
From my family to yours, we wish you and yours a bless, happy and safe holiday season.
God Bless ~ Trent Nessler, PT, MPT, DPT