Monday, February 13, 2017

Exercises to Eliminate Pathokinematics - Part II

Last week we started introducing the philosophy behind the exercises to reduce pathokinematics.  This week we will continue on this path with layout on the specifics of what will come in the coming weeks. 

The following series will provide you with instruction in:

  1. Warm Up.  In order to prevent injury, the athlete needs to first warm up the body, raising the core temperature.  Then he or she is able to do some dynamic (movement based) stretching to further loosen the muscles and prepare him or herself for more demanding work on each muscle group.  In some cases, it is also appropriate for the athlete to work on more intensive sprinting and plyometric activities to address speed and endurance. These also serve to further increase body temperature.  The Warm Up consists of:

·       Cardiovascular Warm Up.  Due to the endurance demands of sports, cardiovascular training is an essential component and should be built in to the training plan as a part of the overall performance program.  Our cardiovascular warm up routine will provide you with the most efficient warm up to allow the athlete to achieve optimal gains in the shortest period of time.

·       Dynamic Stretches.  Dynamic stretches provide athletes with a unique stretching routine that focuses on flexibility, balance, strength and endurance.  Dynamic stretches are NOT ballistic stretches.  These use contract- relax techniques which facilitate optimal gains in the shortest period of time.  These stretches include:

§ Dynamic Lunge

§ Sumo Squat

§ High Knee Toe Up

·       Sprint Training.  For those athletes needing to incorporate anaerobic speed or sprint training into their routine, this section will provide a detailed program to allow the athlete optimal gains in speed and anaerobic power, using the 40 yard dash.

·       Proprioceptive Neuromuscular Facilitation and Plyometrics:  Once we have ensured that the athlete’s core body temperature is raised and the muscles are loose, we can incorporate more intensive and targeted pre-stretch, proprioceptive neuromuscular facilitation and plyometric exercises in preparation for the Corrective Exercise Progression.  These exercises are:

      • Bilateral Hops
      • Single Leg Hops
      • Box Jumps
      • Lateral Box Jumps
      • Single Leg Lunge Hops
      • Jump Squats               
  1. The Corrective Exercise Progression (CEP). The exercises in this program will be categorized by the muscle and/or system being trained.  These exercises have been carefully chosen after a through literature review to ensure maximal outcomes.  Each exercise will have 3-7 levels of increasing difficulty within each progression in order to ensure they properly facilitate maximal gains in strength and performance.  Because of the size and scope of the CEP, will consume multiple blogs and devoted a section to each which follows:

The King and Queen of Exercise—The Squat and Lumbar Hip Disassociation


Squat Neuromuscular Retraining (SNMR)

Lumbar Hip Disassociation Exercise Series

Digging Deeper—Targeted Isolation Exercises

Gluteus Maximus Progression

                                               i.     Glut Max Press

                                             ii.     Leg Press

                                           iii.     Step Ups

Gluteus Medius Progression

                                               i.     Side Lying Gluteus Medius

                                             ii.     Side Step with Resistance Band

                                           iii.     Retro Monster Walk

                                            iv.     Standing Gluteus Medius

                                             v.     PNF Step Ups

Adductor Group Progression

i.      Standing Hip Adduction

ii.    Supine Adductors from Pike Position

iii.   Side Lying Adductors

Quad Progression

i.      Leg Extension

ii.    Standing Lunge—Alternating

iii.   Standing Lunge--Back

iv.   Walking Lunge

v.     Prone Place Running

Hip Flexor Group Progression

                                               i.     Single Leg Raises

                                             ii.     Head to Knee Pull-Throughs

Hamstrings Progression

                                               i.     Hamstring Pulls

                                             ii.     Modified Dead Lift

                                           iii.     Single Leg Dead Lift

Lower Leg Progression

                                               i.     Standing Calf Raises

                                             ii.     Seated Calf Raises

                                           iii.     Dorsi Flex Toe Ups

                                            iv.     Rebound Hops

Foot/Ankle Progression

                                               i.     Inversion/Eversion

                                             ii.     Standing Medicine Ball

                                           iii.     Bosu Ball Balance

Addressing “The Core” 

Abdominal Progression (Core Series)

                                               i.     Upper Abs on stability ball

                                             ii.     Obliques on stability ball

                                           iii.     Pike Position Lower Abs

                                            iv.     Side Bridge

                                             v.     Prone Bridge on Elbows

Lower Back Progression

                                               i.     6 Pack on stability ball

                                             ii.     Prone stability ball Leg Raises

                                           iii.     Good Mornings

Warm Up

Warm up exercises are an integral part of any exercise program.  With our program, we use cardiovascular exercise as an appropriate initial warm up step for athletes.  Warm up will consist of both aerobic exercises and anaerobic exercises.  The aerobic exercises will be used for general conditioning and the anaerobic for more sport specific conditioning.  The amount of aerobic and anaerobic conditioning for each individual is going to be determined by the demands of the sport.  For example, for soccer players and long distance runners, the aerobic component should be increased dramatically, while sprinters need more anaerobic conditioning.  At the end of the warm up period, we include a plyometric exercise component which further serves to warm up the muscles, joints and ligaments, as well as providing additional interval and power base training, which is proven highly beneficial in sport.

Cardiovascular Warm Up:  Cardiovascular training should include light aerobic exercise, which can consist of work on a treadmill, elliptical machine or stationary bike and should be at least 10-30 minutes in duration, depending on the aerobic demands of the sport for which the athlete is training.  This should not be a scheduled part of the program, but rather done on the athlete’s own time directly before the program begins.  This is accomplished by having them come in 10-30 minutes early to perform the cardiovascular warm up.  The exercise intensity should be gauged by the athlete’s heart rate (HR), which is determined using the Karvonen formula.

Training HR = [(HR max – HR rest) * .6 to .8] + HR rest

This formula gives you the targeted training HR in beats per minute, at 60-80 degree of the maximum target heart rate.  The final number can then be divided by 6.  This will give you the HR the athlete will measure during a 10 second count. 

Example:  If an athlete wishes to perform with a training HR of 120 to 138 beats/minute, dividing by 6 gives you 20 to 23 beats per 10 seconds.  So when exercising, the athlete takes their HR for 10 seconds to determine if they are within this range.  If the measured heart rate is too low, increase intensity (e.g., speed/pace, difficulty), or conversely, if it is too high, decrease the intensity of the exercise.

HR max  =  220 – age
HR rest  =  resting HR for 1 minute
.6 to .8 determines the relative intensity of the exercise and the number chosen should be based on the general conditioning level of the athlete.

Using this formula will create a much higher intensity than that at which many younger athletes are accustomed.  Therefore it is important that they are taught how to use this formula and how to take their own resting and exercising heart rates so that they can learn to monitor their own heart rate throughout the warm up.

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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