Monday, February 17, 2020

The Evolving Knowledge of Movement - Part VIIB What We Know Now

Over the last couple of weeks, we have discussed frontal plane motion.  Not only the impact that this motion has on injury risk but also the impact it can have on performance.  We also discussed how to visually assess this and how what we are seeing on this visual assessment can lead to some assumptions about risk. 

This week, we are going to discuss some targeted training to help improve these movements.  Prior to talking about training, I want to be clear that what is discussed here is not the end all be all.  There are multiple exercises we can do that will impact this which we can all do.  However, we have found some common patterns with what we see in the movement assessment with exercises that make specific changes to control of frontal plane motion.  Keeping in mind, the majority of these are tested during single limb motion.

Larger varus motions - although the motion that we are recording is not a "true" varus at the knee, it still creates a varus stress to the lower limb.  As depicted here, these athletes tend to have a lot of frontal and transverse plane motion at their hips.  When the center of mass is moved laterally on a planted foot, this creates this lower limb varus stress.  Considering, this is primarily (not all) driven from the inability of the core to stabilize and control the center of mass during single limb performance as well as the hip musculatures inability to stablize.  With these folks, focusing on core stability (planks and side planks) as well as frontal and rotational stability of the hips and core in single limb performance is critical. 

Larger of valgus motion - for those that fall into a large valgus in the absence of loss of pelvic control, we will typically focus in on the gluteus maximus and gluteus medius.  The gluteus medius and maximus are high endurance muscles and are active with every step that we take.  Research indicates when these muscles fatigue, that there is a corresponding increase in frontal plane motion (Weist et al Am J Sports 04).  Considering, I tend to focus a lot of pushing endurance and fatigue resistance with these muscles.  Combining motions that pull the limb into the dynamic valgus position under resistance (depicted here) can help facilitate the function of these two muscles to resist that motion and aid in increase recruitment of. 

Large valgus motions with high speeds - when there is a combination of a large increase in motion and speed, this is often associated with a weakness of the hip (gluteus medius and maximus) as well as core.  When speeds exceed 200 degrees/sec, we tend to see this as whole kinetic chain (meaning from the foot to the core).  Typically, one of the links in the kinetic chain will prevent the athlete from falling into these motions at such high rates of speed.  As weakness of the entire kinetic chain increases, so do the speeds of valgus because there is less resistance along the chain to slow it.  In these cases, I will do a lot of core, hip and ankle stability exercises in isolation and in single limb performance. 

Before we get into specific exercises, I would like to discuss how BFR (blood flow restriction) can be implemented to address a lot of these issues.  Although most think BFR is a fairly new, it has actually been around since the 60s and was used a lot in bodybuilding.  As a avid weightlifter for 40+ years, I vividly remember doing some form of this as a younger lifter using straps and bands (not recommended but what we did at the time).  BFR has had a resurgence in sports medicine with a variety of new products coming on the market and a lot of new research in the area.  Aside from the impact on growth hormone (GH), insulin-like growth factor 1 (IGF-1) and myostatin, there is also an up-regulation of motor units.  In addition, studies show you can have an impact on VO2Max and stroke volume with BFR.   

Considering these findings, there is a lot of application to control of frontal plane motion.  As such, some of the exercises we will discuss include the application of BFR.  This allows us to maximize the benefit of the exercise in a shorter training session.

Side planks with CLX - this is a great exercise which brings in the entire upper and lower kinetic chain.  In the side plank, the ankle everters must be every active to in an isometric and eccentric fashion in order to prevent the foot from falling into a inverted position.  With the combination of the CLX, this brings a cross link of lower kinetic chain to core to upper kinetic chain.  While the gluteus medius (on the down leg) must actively stabilize at the hip, the contralateral glut is working in a concentric and eccentric fashion.  At the same time, by drawing in the upper shoulder girdle movement and stability, this adds increased complexity to the core and lower kinetic chain. 

Next week, we will continue this discussion with looking at some specific exercises that incorporate some of the concepts we discussed with BFR to continue to push controlling frontal plane motion.  Stay tuned as I am super excited to share with you.  If you enjoy this blog, please share with your colleagues, athletes and training partners and please be sure to follow us on instagrm @ bjjpt_acl_guy and twitter @acl_prevention.  Train hard and stay well.  #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,  ViPerform AMI RTPlay, 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 also a Brazilian Jiu Jitsu purple belt and complete BJJ/MMA junkie. 

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