Monday, February 6, 2017

Exercises to Eliminate Pathokinematics - Part I

Throughout the last several months this blog we have discussed pathokinematics and the impact they have on both performance and the potential for injury in athletes.  In one of the previous series, we provided you with several tools to assess movement and interpret the results of those assessments.  We also discussed how technologies could be leveraged to address.

 A movement assessment should be designed to assess movement patterns (pathokinematics) that are commonly associated with increased risk for athletic injury and reduced athletic performance.   The goal of the assessment should be to identify strengths, weaknesses, and tightness in the musculature and other structures of the body that cause or contribute to pathokinematic movement patterns.  Once these are identified, it is possible to “prescribe” corrective exercises that directly influence and improve those weaknesses and tight areas of the athlete’s body, making them stronger, more flexible, and more capable of transmitting power throughout the kinetic chain and lower extremity during sports activities.  It should be mentioned here that in addition to corrective exercise, there are many other techniques and manual interventions that clinicians use to correct deficits we see and identify using a movement assessment.  These are beyond the scope of this blog and will not be covered here but should be considered in a comprehensive treatment plan.

 In the series “How to Eliminate Pathokinematics” we reviewed some General Facts and Terminology associated with exercise and training in preparation for the information contained in this blog series.  Here we introduce the Corrective Exercise Program, or CEP.  The Corrective Exercise Program (CEP) is designed to directly and specifically address the components that contribute to pathokinematic movement patterns.  This is a movement specific program and not a sport specific program.  It is the concepts and methodology from all this body of work from which we developed the ACL Play It Safe Program.  However, each of the exercises included here will be the more clinical exercises and not the group/team interventions that are a part of the ACL Play It Safe Program.  Each of the exercises described here have levels of progression that increase the difficulty and/or endurance requirement of the exercise.  If prescribed and conducted correctly over time, these exercises will not only drastically improve the athlete’s movement patterns but will also improve overall athletic performance and reduce the likelihood of certain types of lower extremity injuries, specifically those involving the lower back, hip, knee, and foot/ankle.

In 2009 unpublished study 40 college athletes were placed on an exercise program to directly address weaknesses observed in a movement assessment.  The results of this targeted exercise program were phenomenal.  It was shown that when the athletes participated in the exercise program for 8-12 weeks, they were able to increase their vertical jump by and average of 4 inches and improved 40 yard dash time by 1.4 seconds.  In our current body of work, we are not only seeing dramatic decreases in overall lower limb injury rates but also huge health care savings for the university.  We are demonstrating an average savings of $30k to $50K per team per season in DI athletics.  In 2016, we continued this work with DI Football.  The results of this work is currently being written up for publication but preliminary analysis shows the lowest recordable injuries in 8 years and the team was nationally ranked for the first time in the colleges history.   

Using what we learned from this and many other similar studies, as well as years of experience working with athletes, we have developed a set of exercises that assist in reducing the potential injuries in the lower extremity and improve performance.  The program details follow, but it is important to remember that before beginning any exercise program, it is a good idea to have a complete physical performed on the athlete. 

This program is designed so that it can be used in many different ways and for many different sports.  For example, the CEP can be used for rehabilitation of an injured athlete when targeted exercises are chosen to address the injury or injuries.  The Physical Therapist or Athletic Trainer can “pick and choose” those exercises most appropriate to address the rehabilitation needs of the individual.  The CEP can also be effectively used to address pain issues associated with overuse, repetitive motion or pathokinematic movement patterns in athletes.  We have found that when the CEP is used to strengthen the athlete, either when used in a targeted fashion or as an overall exercise regime, pain with lower extremity activities is reduced.

Of interest to many in today’s fitness world is the use of this type of exercise program in athletic performance enhancement.  Our results show that athletes who use the Corrective Exercise Program in fact increase athletic performance, specifically in peak vertical jump height and sprinting speed as noted above.  This has also been validated in work by Myers, et al who have showed similar results.  The CEP can be used to improve technical ability specific to a given sport, strength, speed, endurance and power output.  Portions of the CEP can be used to target specific weaknesses or areas of tightness and inflexibility the athlete demonstrates in the movement assessment, or can be used in its entirety as a full and complete exercise program.

Because of the difficulty and intensity of the CEP, when adding it (or parts of it) to an already full training plan, it is easy to over-train the athlete.  Care must be utilized therefore in prescribing exercises in the CEP that involve the same body parts as those already being taxed in the regular training routine or sports activity.  They should instead be used to replace or substitute for those exercises, or enough rest should be allowed between them.

As discussed above, after a thorough assessment of the athlete, we now have an idea of where their individual weaknesses and tightness exist.  As with any exercise program, you and the athlete should be sure that they are physically capable of safely beginning or proceeding with a rigorous exercise program.  The exercises in this progression begin at a fairly difficult exercise level, requiring participants to have a basic level of fitness and flexibility.   Again, please be sure to have your patients/clients check with their physician before beginning this or any exercise program. 

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. 

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