Monday, March 2, 2020

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

Last week, we ended our discussion talking about BFR (blood flow restriction) training and how this might be implemented into our training for helping athletes control frontal plane motion.  Today we can continue on with this concept of integration of BFR into our movement training.  Before we go any further, I want to be clear, this is NOT a comprehensive review of BFR.  If you want our comprehensive course on BFR, please follow this link to our BFR course with Northeastern Seminars.  For the purposes of this blog, this will be a very cursory review.  For more information on contraindications, protocols for implementation and clinical observations, please refer to our online course.

During our discussion last week, we talked about the impact of BFR on GH, IGF-1 and Myostatin and how this adds to muscle growth, soft tissue repair and bone healing.  In addition, we also talked about the increase or up-regulation of motor units with the application of BFR.  With the up-regulation of motor units of a muscle, what this means is that more of the whole muscle is recruited or activated with low exercise intensities.  Due to the fatigue that the BFR is creating, this "tricks" the system to recruit more of the muscle to perform the task at hand.  This is great for those of us trying to get our athletes to recruit more gluteus medius and maximus to aid in control of frontal plane motion.  Most of the studies out there using BFR, typically do a rep sequence of 30-15-15-15.  This is performing 30 reps, give 30 sec rest and perform 15 reps, 30 sec rest and so on throughout the sequence.  At the conclusion of this set, you release the cuff and allow for full reprofusion of the tissue.  Give a 3-5 minute rest and then repeat that sequence for 3-4 complete sets.

We know from the literature (Brazen et al Clin J Sport Med 2010) that when an athlete is fatigued, that their frontal plane motion increases.  It is this increase in motion that is often associated with risk for lower kinetic chain injuries.  As such, we need to train for this fatigue and create motor patterns in the primary motor cortex (higher centers of the brain) that control this excessive motion in these fatigued states.  In other words, we need the default pattern that the athlete resorts to in a fatigued state to be a movement that controls frontal plane motion.  The only way to create these default movement patterns is to train the athlete in a fatigued state.

Considering all this, the following a sequence is one that I do with a lot of my athletes.  This is obviously a later in the game sequence and is one that I would consider aggressive (expect some muscle soreness from).  What I am attempting to do is fatigue their gluts as much as I can, then require them to perform a task that will require frontal plane stability.

I have them do a sequence of side stepping with a theraband, retro monster walk, and glut bridges with 60% LOP on both legs and using a moderate resistance (green or blue band).

Side Step with Theraband: The band is at the ankles and the athlete is in a squatting position.  Both feet are pointing ahead throughout the exercise and the athlete does not raise up out of the squat position during the movement.  

The athlete steps out, as depicted here, without raising out of the squat position.  It is vital to keep the feet pointing straight ahead.  Most athletes with weakness of the gluteus medius will toe out.  It is important to prevent this from happening.  Perform 15 reps one direction and 15 reps back the opposite direction.

Retro Monster Walk: As soon as the athlete completes the side stepping, they turn around.  remaining in a squatting position and with the band around the ankles, they will step back in a posterior diagonal step.  Once stable, bring the opposite foot to the stance leg and immediately strive in a posterior diagonal direction.  

This will keep you moving backwards.  Repeat this for 15 steps backwards and turn around and repeat in the opposite direction for 15 strides.  The athlete should remain in the squatting position the whole time.

Glut bridges on the physioball: As soon as the athlete is complete with the above, they will lay on their back and put their feet up on the ball.  The feet are close together and digging the heals into the ball.  The knees and hips are at 90 degrees.  

Keeping the knees at 90 degrees, the athlete pushes their hips off the ground until the hips are at a neutral position (not hip flexion or extension).  Pause and repeat.  Perform 30 reps.

At this point, release pressure on the cuffs and allow full reprofusion for a 3 minute rest.  At the conclusion of three minutes, bring them back to 60% LOP and repeat the sequence for 3-4 sets total.

At the conclusion of the 3-4 sets, we remove the cuffs.  Immediately, I will move into working single limb stability.  This may consist of 2-3 sets of single leg hops followed immediately by 2-3 sets of single leg squats.

During single leg hops and single leg squats, it is essential to ensure that the athlete is controlling frontal plane motion.  This will be EXTREMELY difficult for them to do.  Considering, it is important to follow the repetitions to substitution mind set.  If they can't do the exercise with the proper form then we need to regress the exercise.  Don't stop.  Regressing the exercise to a simpler form still works motor patterns we want and prevents them from falling into the negative default program.

 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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