Monday, January 7, 2019

Improving Movement When It Matters - Part IIIC

Last week we talked about the importance of single limb training and how, by using a criterion based approach, we not only impact kinesiophobia and strength, but also drive improvements in movement that have much higher carry over to sport.  Before we move off the subject of Single limb training, there are several things we need to talk about.

In a criterion based approach, in order progress from one level to the next, we must be able to perform the prior level with good technique.  What exactly does that mean?  This means one must be able to perform the exercise while demonstrating good control at the:
  • Foot and ankle
  • Knee
  • Hip

Foot/Ankle Range of Motion
Starting at the ground and moving up, let's first look at the foot and ankle.  First in order to have good control of the foot/ankle, you must first have adequate range of motion at the ankle.  When looking at the literature, there is not a lot of literature letting us know how much motion at the ankle does an athlete need to do a single leg squat or single leg hop.  So in one of our recent studies, we looked at ankle dorsiflexion in over 700 injured and non-injured athletes.  Looking at the non-injured athletes (N=300), we found the mean ankle range motion to be following:

The mean range of motion for dorsiflexion for single leg squat was 33 degrees and those that had scored lower (higher risk and/or injured) had a mean range of motion for dorsiflexion <20 degrees. 

For a single leg hop, the mean range of motion for dorsiflexion was 30 degrees and those that had scored lower (higher risk and/or injured) had a mean range of motion for dorsiflexion <15 degrees.  What we can take away from this is that we should shoot for 30 degrees or > dorsiflexion range of motion for someone to perform a single leg squat correctly with good form.  So from a criterion based perspective, 30 degrees or > dorsiflexion could then be a criteria we consider prior to starting of single leg squatting activities in order for someone to do it right with proper technique.

When dorsiflexion range of motion is an issue, aside from the traditional exercises we do, there are also some dynamic stretches we can do that will aid in driving improvement in dorsiflexion range of motion in full weight bearing, in a closed kinetic chain and during motion. 

Dynamic Sumo:

In this dynamic stretch, you will see throughout several portions of this exercise we are pushing DF range of motion that is much greater than 30 degrees of dorsiflexion throughout various ranges of motion of the proximal links. 

Dynamic Lunge:

In this dynamic stretch, we continue to push dorsiflexion ranges of motion exceeding 30 degrees throughout various portions of the movement.  If you have an athlete with limited DF, this will typically result in predictable movements that are easily observed. 

Foot/Ankle Stability
In addition to range of motion at the ankle, having the neuromuscular control at the foot and ankle is critical injury prevention and whole kinetic chain stability.  Yet, this is often a movement that is missed in most movement assessments. 

As you can see from this picture, when just looking at the knee, this looks like a valgus or frontal plane motion at the knee.  Yet in one picture, we see the hip fall first and in the second picture, we see the foot fall first.  Why does that matter?  Same athlete yet the training will be considerably different on the right side versus the left side.  On the athlete's left side, we can see we need to do more ankle, intrinsic and foot/ankle proprioception versus the hip strengthening and proprioception on the athlete's right side. 

Next week we will continue this discussion and talk about the impact at the knee and hip.  If you enjoy this blog, please share with your colleagues and follow us on instagram @ bjjpt_acl_guy and twitter at @acl_prevention.  #ViPerformAMI #ACLPlayItSafe

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 and ACL injury prevention.  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 has also been training and a competitive athlete in Brazilian Jiu Jitsu for 5 years. 

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