Monday, March 5, 2018

Innovations in Sports Science - Exercise

In our last discussion we talked about innovations in telemedicine and how these technologies aid us in expediting the care of our athletes.  This results in better outcomes, decreased health care costs and decreased episode of care.  This week, we will discuss the advances in resistance band technology.  When we think of innovations, rarely do we think about bands and how advances or innovations here that can have that big of an impact.

In 2015, TheraBand company released it's newest version of the TheraBand resistance band.  The traditional band used in rehabilitation had not been changed in over a decade, so this was a big step.  With the release of the CLX (consecutive loops), this brought a whole new level of training application for training.  The CLX band pictured here has loops throughout the length of the band.  Traditionally, we would tie the band around itself to create a loop which often led to changes in resistance and band breakage.  With the CLX, we can simply use the loop to anchor this to a body part.

For the work we are doing in movement, this was a huge advantage.  One of the things we know is that in order to reduce valgus from occurring at the knee during single limb exercises, we need to aid in recruiting of the gluteus medius.  Traditionally this was done with a TheraBand placed around the knee during a single leg activity.  The clinician would then provide a adduction stress to the band (pictured here) which would increase recruitment of the gluteus medius.  This exercise does increase recruitment of the gluteus medius but research shows this is less than 50% of MVC (maximal volitional contraction) of the gluteus medius (Gmed).  Knowing that contraction of the Gmed is critical to controlling the magnitude and speed of frontal plane motion of the knee, then how can we train the level of MVC that is needed in sport?

This is where the TheraBand CLX comes into play.  One reason that the exercise mentioned above only includes <50% MVC is due to the fact that only one direction of resistance that the muscle provides is incorporated into this exercise.  If you look at the orientation of the Gmed and Gmax, the Gmed has a component of resisting adduction and internal rotation.  The Gmax also has a component of resisting internal rotation.  It is the combination of the adduction and internal rotation that is detrimental to the ACL as well as other structures of the knee.  Therefore, if we can include components of both adduction and internal rotation into the exercise, this will translate to better carry over from training to sport.  With the advent of the CLX, we are now able to pull in both components.

An example of this is the spiral technique we use with the CLX.  In the video below, we use the consecutive loops of the CLX to loop the band around the leg and attach it to the contralateral limb.  Doing this, when the contralateral limb is lifted, the band will then pull the stance leg into adduction and a component of internal rotation.  Doing so, allows us to perform multiple exercises in single leg stance while the Gmed and Gmax have to resist both the adduction and internal rotation components.  Not only does this add to a higher MVC of both muscles but also has a higher carry over to single limb activities in sport.

In addition to the ability to use the CLX for single limb training, this advancement in the TheraBand technology also allows us to use this band in such a way that we can recruit the entire lower kinetic chain.  In the example below, we are performing a side plank exercise.  This is a great closed kinetic chain exercise for the Gmed and studies show there is a high MVC of the Gmed during this exercise.  By incorporating the CLX, we are not only able to increase the MVC of the down leg but also able to pull in more core, upper body and the contralateral GMed.

Stay tuned as next week we will discuss use of some new technologies to aid our athletes in recovery.

Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the founder | developer of the ViPerform AMI, the ACL Play It Safe Program, Run Safe Program and author of a college textbook on this subject.  Trent has performed >5000 athletic movement assessments in the US and abroad.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Vice Chairman of Medical Services for USA Obstacle Racing and movement consultant for numerous colleges and professional teams.  Trent is also a competitive athlete in Brazilian Jiu Jitsu. 

No comments:

Post a Comment