At GP, we get plenty of questions from our young athletes about training simply because they are exposed to more training information and conflicting ideas than ever before. Recently, we had one of our athletes ask us, “A lot of my teammates are training at _______ and the trainers there have them stand on BOSU balls and do different movements, telling them it’s what they need as athletes. I’ve watched them and it seems ridiculous to me. They can’t even do simple movements correctly. Why are they doing that?”

We love educating our clients and athletes, especially when it comes to any number of gimmicks that exist in the sports performance industry.

Whether you wish to refer to it as balance training or unstable surface training, plenty of images can come to mind of people standing on wobble boards, BOSU balls, and even stability balls. These items are often marketed as “functional training”, being capable of not only improving your balance, but also increasing core muscle activation and strength. Athletes are often told that balance training is essential to improving as an athlete and reducing their risk of injury.

This school of thought grew out of the physical therapy and rehabilitation setting. In the rehabilitation setting, there is some efficacy regarding the use of balance training in chronic low back pain and reducing the risk of recurrent injury, particularly when it comes to ankle sprains. Unfortunately, there seems to be a sect of the personal training and sports performance industry that has concluded that information gathered on injured patients is somehow applicable to the non-injured individual and high-performance athlete.

The reality is all exercise is functional, if applied correctly to address the needs of the individual. This takes into account their goals, primary sport form, strengthens/weakness, and imbalances that need attention. If your exercise has no direct transfer into any of these areas, the exercise is not “functional”. Functional exercise should never be determined by how it looks, but rather what it produces.

When it comes to balance/unstable surface training, the above paragraph is incredibly relevant.

Why?

Take a moment and ask yourself this question, “When am I ever on an unstable surface during my daily life? When do I compete on an unstable surface?”

If you answered honestly, chances are very little, if ever. So why are we training people on an unstable surface when they are almost never on unstable surfaces?

The fact of the matter is, the floor works just fine.  Unstable surface training probably does more for decreasing athleticism, strength, balance, and movement quality than it helps.

Here is a quote from an article written by the man known as Kiefer:

“You instantly tense up, you almost literally can’t perform certain movements because the nervous system senses the instability of the environment and fires in resistant ways to keep you balanced. In this process, it also shuts down the ability to produce maximum force….Think about it, if you start to slip in one direction and your reflexes caused your muscles to fire with maximum force against that motion—a motion that may be inevitable at that point, like falling—then you risk tearing muscle or connective tissue. The body is trying to protect you by making you weaker.”

1. Several researchers have demonstrated that there is significant increases in stabilizer activity during movements that require increased force (either greater resistance or higher speed) compared to activity seen in unstable environments [1-4].
2. Performing squats on unstable surfaces will increase core activation, but not necessarily core strength [5] and definitely decreases muscle force production [6].
3. Doing pushups on a physioball does less to activate stabilizing muscles than placing your feet on an elevated, stable bench[7].
4. Unstable surface training contributes nothing that cannot be achieved when performing stable surface exercises [8,9].
5. Stable surfaces are superior for some scenarios involving scapular rehabilitation [10].

1. Freeman S, Karpowicz A, Gray J, McGill S. Quantifying muscle patterns and spine load during various forms of the push-up. Med Sci Sports Exerc. 2006 Mar;38(3):570-7.
2. Hamlyn N, Behm DG, Young WB. Trunk muscle activation during dynamic weight-training exercises and isometric instability activities. J Strength Cond Res. 2007 Nov;21(4):1108-12.
3. Nuzzo JL, McCaulley GO, Cormie P, Cavill MJ, McBride JM. Trunk muscle activity during stability ball and free weight exercises. J Strength Cond Res. 2008 Jan;22(1):95-102.
4. Willardson JM, Fontana FE, Bressel E. Effect of surface stability on core muscle activity for dynamic resistance exercises. Int J Sports Physiol Perform. 2009 Mar;4(1):97-109.
5. Anderson K, Behm DG. Trunk muscle activity increases with unstable squat movements. Can J Appl Physiol. 2005 Feb;30(1):33-45.
6. Saeterbakken AH, Fimland MS. Muscle force output and electromyographic activity in squats with various unstable surfaces. J Strength Cond Res. 2012 Mar 24. Epub ahead of print.
7. Lehman GJ, Gilas D, Patel U. An unstable support surface does not increase scapulothoracic stabilizing muscle activity during push up and push up plus exercises. Man Ther. 2008 Dec;13(6):500-6.
8. Lehman GJ, MacMillan B, MacIntyre I, Chivers M, Fluter M. Shoulder muscle EMG activity during push up variations on and off a Swiss ball. Dyn Med. 2006 Jun 9;5:7.
9. de Oliveira AS, de Morais Carvalho M, de Brum DP. Activation of the shoulder and arm muscles during axial load exercises on a stable base of support and on a medicine ball. J Electromyogr Kinesiol. 2008 Jun;18(3):472-9.
10. Martins J, Tucci HT, Andrade R, Araújo RC, Bevilaqua-Grossi D, Oliveira AS. Electromyographic amplitude ratio of serratus anterior and upper trapezius muscles during modified push-ups and bench press exercises. J Strength Cond Res. 2008 Mar;22(2):477-84. 

In order to meet the demands of working with athletes of all levels of preparation, the services at GP are constantly evolving and adapting on many levels. When it comes to the physical preparation of our athletes, there is no single program or method we use with every athlete. We are constantly assessing each athlete from day to day, learning what he or she is capable of performing during any given training session. Constantly assessing our athletes during their dynamic movements also allows us to identify weakness and address them accordingly from both an injury prevention and performance enhancement perspective.

Our approach can often times be a source of both intrigue and confusion for parents and their young athletes, since the majority of them are all too familiar with a ‘one-size fits all’ approach. Many of these athletes even come with ‘cookie-cutter’ strength and conditioning programs given to them by their coach or previous trainer. It becomes our job to explain our approach to training and athletic development and why these ‘cookie-cutter’ programs fail to address individual needs of each athlete. After explaining why each individual athlete requires their own individualized approach and why no two athletes will respond similarly to the same program, it makes sense to them. They often find this very refreshing. What doesn’t make sense to them is how so many coaches and trainers are ignorant of this fact.

In an interview with Buddy Morris, Joel Jamison addressed the heart of the matter by saying,

“Coaches and trainers maybe don’t do the best job of understanding the needs of the sport and they tend to let their athletes over train because of the….push of this country is more intensity, the quick buck, the fast results. The other thing I think that’s influenced our industry probably negatively more than anything else is the marketing aspect. That there’s products, and there’s training methods, and there’s everything being pushed to athletes and coaches from a marketing perspective. We’ve all seen the cross fits, the P90 Xs, all the functional training stuff. It’s the marketing driving the training rather than the training driving the results or the results being based on something scientific.”

”We're trying to create circus acts in this country so, like you said, people can generate revenue. So if you actually read and you understand training methodics and you understand the athlete and training the athlete, you won’t buy into all this stuff out there.”

The emphasis of many athletic development programs is typically rooted in developing the physical qualities needed in the sport of competition. Physical qualities usually emphasized are endurance/work capacity, strength, body awareness, agility, quickness, speed, and explosive power. Improvements made in any of the previously mentioned physical qualities can certainly improve an athlete’s fitness and physical preparedness for competition. But great athletes are rarely defined by their level of fitness and how ‘in-shape’ they are. They are defined by their ability to play the game and perform the skills of the sport. Great coaches and trainers understand this, being able to take an athlete’s newly developed physical qualities and transfer them to into improved skill execution or technical mastery of sport related movements.

This is accomplished by specificity of training.

In order to ensure specificity of training, it is first necessary to determine the exact physical qualities an athlete is in greatest need of. Many coaches and trainers refer to this as ‘identifying the deficiency’. Once the deficiency is identified and an understanding is developed as to how the deficiency is limiting on-field performance, the deficiency can be trained appropriately.

To identify deficiencies, the majority of coaches and trainers utilize tests to determine an athlete’s level of strength, endurance, explosiveness, and even flexibility. While these tests are often necessary and provide quantitative information that will help assess how an athlete stacks up in comparison to others, what these tests fail to indicate is how efficiently an athlete can perform sport-specific skills or maneuvers.

Physical performance tests fail to indicate an athlete’s needs in relation to game performance. To ensure transfer of training into improved sport performance, identifying an athlete’s developmental needs must take into account an analysis of all components involved in successful competition. Often, this involves a complete biomechanical analysis of movements related to sport-skill execution.

For example, the deep squat is often a staple of many strength and conditioning programs. It can be a tremendous exercise for building hip strength and power and for a variety of other reasons. But when you examine the sport-related movements of many athletes, one can come to the determination that the need to deep squat is not a priority for many athletes. Consider hockey and basketball players. These sports require hip external rotation strength and power to execute sport-specific movements (skating, lateral cuts, change of direction, etc.). Rather than placing greater and greater emphasis on improving strength in the deep squat, these athletes will be better served in developing hip external rotation through other exercises which more closely mimic the external rotation demands of the hips in competition.

Again, great athletes are rarely the strongest or the fittest. There are studies that demonstrate Olympic-level athletes and World Record holders are not the strongest athletes (with the exception being in strength sports such as powerlifting and Olympic weightlifting). Athletes on the highest levels of performance do not lift the greatest amount of weight in commonly used exercises, such as the clean, squat, bench, or deadlift.

More commonly, athletes will fall in the midrange of strength numbers. What this is demonstrating is a ‘point of diminishing returns’. Many athletes reach a point at which increases in strength or other physical qualities do not always equate to improved sport performance.

Successful athletes must be able to execute sport skills with technical mastery and precision. Regardless if you are a hockey, football, soccer, lacrosse, baseball, tennis or track athlete, you need great acceleration, speed, agility (ability to change direction quickly), and the ability to jump high (which also requires explosive power). But arguably most important is the ability to perform all sport skills with mastery and precision of movement.

An athlete will never be successful if they do not have the ability to execute sport skills successfully. This is why technique must be closely analyzed and why the training of physical qualities must directly enhance the performance of sport-specific skill execution.

Analyzing an athlete’s sport skill technique and the demands of game play becomes a necessary first step to determine exactly what their training program should consist of. Often to correct and/or enhance technique, special strength exercises are implemented to develop the specific strength an athlete needs to execute movements more efficiently.

We addressed special strength exercises in this article. Special strength exercises are intended to replicate the exact neuromuscular pathways utilized in the execution of specific sport skills.

With proper analysis and identifying the ‘deficiency’ of the athlete, it enables the training program to have greater transfer into sport performance. The training program is continually adjusted as improvements in strength, speed, agility, and explosive power are integrated into technical mastery of skill execution.

Related Articles:

Training for Elite Athletes
Common Mistakes in Developing Young Athletes

Mobility is sexy and it sells.

Get your foam rollers. Get your PVC pipe. Get your stretch bands. Let’s get mobile!

Between mobility screens, mobility workouts, mobility tools, and mobility DVDs, there are plenty of opinions and products available for purchase.  The experts are convincing you of how crucial mobility is for health and performance, while doing their best to convince you to purchase their product.

Enough with it.

While some elements of mobility have merit, many of the approaches to mobility (warm-ups, DVDs, seminars, evaluation systems) are very general and cookie-cutter. A lot of it is unoriginal thought simply repackage and over-priced. Many of these products are not impressive. They are systematic programs that are easy to apply. It’s the classic, “If you see X, then perform Y” approach, providing correctives for movement errors and superficially removing a degree of critical thinking. No wonder the products are so appealing. Someone else has done the thinking for you, so just follow the instructions in the manual and you too can be an expert.

Mobility and movement so easy that seemingly anyone can be an expert?
What troubles me is the trend towards ‘simplifying’ movement, when movement is quite the opposite. Movement is complex. It should be recognized that once you add variables such as load or speed or vector/direction, movement changes. Most screens do not account for these variables and I wish more ‘experts’ understood this clearly.

One individual who has a unique, and truly expert, understanding of the complexity of movement is Stuart McGill. McGill is a spine biomechanics professor from the University of Waterloo. He has authored over 300 scientific publications that address the issues of lumbar spine function, low back injury mechanisms, investigation of the mechanisms involved in rehabilitation programs, injury avoidance strategies, and high-performance training of the back. He serves as a consultant to many medical management groups, elite sports teams and athletes, governments, corporations and legal firms. On top of all those responsibilities, he is often referred the most challenging back pain cases from around the world.

Professor McGill sees two patients per week, spending 3 hours with each patient. His evaluation is of paramount importance in relation to the success he has in treating his clients and athletes. The time he spends on evaluation is often significantly more than many providers spend with a patient on their first visit. As a chiropractor, I know doctors that see 15-40 patients a day and don’t have the time to spend on lengthy assessments. Quick and easy ‘systems’ or ‘assessments’ are exactly what many professionals in the fields of rehabilitation and fitness need.

But does ‘quick and easy’ ensure a thorough exam? Does it ensure all variables have been accounted for? Unfortunately, this is what many have to deal with, so 'quick and easy' is certainly better than no assessment at all. But keep it mind there is a huge limitation to operating in that fashion. This is exactly why my brother and I tailored the operation of GP to allow for the necessary amount of time for our assessments.

At GP, we do not perform general assessments. Every single assessment is personalized to the individual, modified to meet their objectives. What we perform during an assessment “depends” on the presentation in front of us. We understand that movement and the action of musculature is not always obvious. Muscle action will change depending on the movement task, having an effect throughout the entire body. Regarding the ability to recognize the muscular demands of movement, Professor McGill has said, “This is the transition point between a trainer and master trainer.” I’m sure he would say that this also separates a therapist and master therapist.

You will not find our approach in convenient DVD and PDF format, leading you step-by-step through our evaluation and corrective process. Why? The approach we take at GP is very difficult to teach and has taken years to develop through mentorship, experience and self-learning. Whereas, most movement screening systems have the advantage of being easy to teach.

Being ‘easy to teach’ is good for business. But is it the best service for our clients and athletes? Certification courses are designed to churn out new coaches or new trainers at a mind-numbing pace. You would be foolish to assume everyone walking away with a certification functions with ‘expert’ understanding. But that’s what they want you to believe since most attempt to position themselves as experts.

Moving beyond the initial assessment, continual re-assessment is a staple of the process at GP. Our approach focuses on continually assessing and fine-tuning the program as necessary. This is why mobility, like any ‘movement fix’, must be applied appropriately with a solid understanding as to why it's being applied.

Just because someone has a tight hip, doesn’t mean you should blindly advocate foam rolling and performing goblet squats.

Can’t maintain your arms overhead during an overhead squat?

Oh, that is totally caused by tight lats. You need some foam rolling on the lats and then band stretch the daylight out of those bad boys.

Heels come off the ground during the squat? Tight calves and limited dorsiflexion, right?

Let’s foam roll those calves and mobilize those ankles.

This thinking is widespread and too simplistic. In my opinion, it’s no different in application than simply telling someone to stretch because they are tight. Do you think it's superior or different because you applied a foam roller? Sure it may get results a percentage of the time, but often there are deeper underlying issues being missed. Let’s consider the following quotes:

“Soft tissue injuries result from excessive tension, so excessive tension in the rehabilitation setting is counterproductive…stretching of…chronically tight tissue is counterproductive. It may give an initial sensation of relief because the muscle spindles have been deadened, but this practice…weakens the tissue further because of the weakened proprioceptive response.” – Boo Schexnayder

“Stop trying to stretch and mobilize, let tissues settle and regain their proprioceptive abilities so they tell the truth.” – Stuart McGill

During my time in the fields of Chiropractic, Sports Rehabilitation and Sports Performance Training, I have had the unique opportunity to be mentored by some great minds. I know I can say the same thing for my brother and that is why he holds the title as Head Performance Coach at GP. Ryan and I are consistently working to get better in order to better serve our clients and patients. Whether that is through conversation with mentors, attending continuing education seminars, or simply reading. When it comes to rehabilitation or training of an athlete, one question we continually seek to improve our understanding of is, “How much strength is enough?”

One concern the ultimately comes to mind is whether the reward of high-intensity strength training is worth the risk? Certainly extremely high-intensity loads are necessary for the development of the strength athlete, or those who participate in the sports of Olympic weightlifting, strongman, and powerlifting. But when it comes to athletes who are not competitive strength athletes and are simply utilizing strength training as a means to enhance athleticism, how much strength is needed for optimal performance?

How Strength Relates to Sports Performance
Common sense would allow us to derive that if an athlete possesses greater levels of maximal strength and power compared to an opponent (all other factors being equal), the stronger athlete would have a distinct advantage. Suitable levels of maximal strength should include, but are not limited to the following considerations:

1. Sport of Participation. Requirements of maximal strength levels will differ depending upon the specific sport of participation. The physical requirements of a particular sport will assist to determine the various strength levels that are necessary for the participating athlete. As an example, does the cross-country runner need the same maximal strength requirements as a hockey player?
2. Position of Sport Participation. For athletes who participate in the same sport, the physical requirements based on their specific position will have an influence on their strength requirements. Consider the defensive lineman and defensive back positions in football. These two positions differ greatly in their physical requirements. Is the required maximal strength level going to be the same for both of these athletes to have optimal sports performance?
3. Competitive Level of Sports Participation. Participation at specific levels of competition may require advanced levels of maximal strength. Maximal strength requirements may change considerably when evaluating the demands of a high school, collegiate, and professional level athlete. The same can be said of the differences seen in competitive levels of competition. To illustrate this, consider that NCAA athletics are divided into three divisions (levels) of competition (DI, DII, DIII). One could derive that higher strength levels would be required for athletic success at the higher levels competition and differences in maximal strength and power output levels between DI, DII, and DIII athletes have been documented.
4. Competitive Standards. There are levels of strength that are necessary, not for guaranteed success, but necessary for an athlete to compete. This is common in the strength sports of weightlifting, powerlifting, and strongman. But adequate levels of strength are highly important in other sports as well. This is part of the reason various professional leagues (NFL, NHL to name a couple) hold annual combines. Athletes are tested on various physical and strength qualities and are then evaluated against their peers to predict athletic success. There is a physical “standard” that athletes must meet or exceed for consideration as a draft selection.

Working with athletes to develop their performance brings on a host of unique challenges. Arguably the greatest challenge is associated with the intrinsic motivation level of young athletes. The varying levels of self-driven motivation among the young athletes at GP is interesting to observe, especially as the character of the athlete begins to emerge. Motivation level becomes even more apparent as we progress through the training program, taking notice of what the young athlete is willing to do on their own to improve their performance. Ultimately the question becomes, can they sustain the motivation year after year if they begin a structured training program early in their career? There are several factors which can influence an athlete's dedication, below are just a few that come to mind:

•  “My son/daughter is the best athlete on their team.”
• “ My son/daughter was just voted the best player in their age group at a recent camp.”
•  “My son/daughter is a natural athlete and they always get placed on the highest level teams in the area."

• Enthusiasm and Desire - Top athletes have a hunger, a fire inside which fuels their passion to achieve an important goal, regardless of their level of talent or ability.
• Courage to Succeed -  It takes courage to sacrifice, to work out when you’re tired, to seek out tough competition, to stick to your program, to test your limits, and to overcome obstacles.
•  Internal motivation and self-direction - Direction and drive need to come from within.  The goals must be ones that you have chosen because that’s exactly what you want to be doing.
• Commitment to Excellence - Elite athletes know that to excel at their sport, they must decide to make it a priority in their life.  They make an honest effort each day to be the best at what they do.  At some point you must say, I want to be really good at this; I want this to work.
• Discipline, Consistency, Organization - Elite athletes love what they do and it is easier for them to maintain consistency in training and in competing. Regardless of personal problems, fatigue, or difficult circumstances, they can generate the optimal amount of excitement and energy to do their best.
• Being focused and yet relaxed - Champions have the ability to maintain concentration for long periods of time. They can easily let go of distractions and take control of their attention. They don't let emotions get the best of them and cause poor performance.
• Ability to handle adversity - Top athletes know how to deal with difficult situations. Adversity builds character, but adversity also reveals character. When elite athletes know the odds are against them they embrace the chance to explore the outer limits of their potential.  Rather than avoiding pressure they feel challenged by it. They are calm and relaxed under fire. Setbacks become an opportunity for learning.

In our previous article, Structural Adaptations – Not Just An Athlete’s Problem, we discussed structural adaptations and why they must be accounted for in both training and treatment plans. Clearly, structural adaptations have impacts from a sports performance and clinical perspective.  With that in mind, prior to treatment, our goal is to not simply assess from a structural standpoint, but to also assess functional capacity to determine if there is a functional capacity deficit (i.e. endurance, strength, balance, reactivity, dynamic posture control). It is my job as a clinician to choose the most appropriate evaluations to identify functional deficits. I choose not to limit my evaluations to x-rays or imaging and finding structural abnormalities. It should be evident that treatment based on the findings of imaging alone is flawed when you consider the enormous amount of false positive rates in asymptomatic people. This is why I couple structural evaluation with a functional evaluation that looks at motor patterns or movement, not just isolated joint range of motion or strength.

As a chiropractor, I tend to go against traditional approaches in how much attention I give to static body alignment compared to most of my peers. Reason being is that often times a patient can look a certain way (i.e. “dysfunctional”) in a static stance, but when asked to perform a skill, they nail it. This can be especially true of athletes. What I was able to learn over and over again during the course of my residency is that if someone can’t perform a certain movement (i.e. squat), it may be more practical to coach or educate them on better movement (i.e. motor learning) prior to isolating and treating joint or mobility “dysfunctions”. The reality is, if a patient or athlete is performing a new or unfamiliar movement, sometimes they simply lack the skill to execute it in an ideal fashion. This is the prime reason why I find functional evaluations invaluable in determining the best course of treatment.

When it comes to functional capacity, the assessment is intended to identify the relevant functional deficit of that patient. What is relevant to that patient will depend on their history. What areas are bothering them? What does their injury history tell you? What activities have they been involved in that have provided accumulated stress or strain to their body? This can provide insight into the adaptations or compensations patients may exhibit. As for athletes, it is important to remember: the higher level the athlete, the better they are at compensating. Despite being asymptomatic, those compensations will eventually catch up to them and become symptomatic. This will not only impact performance, but injury risk and longevity as well.

Once a functional capacity deficit is identified, the process of treatment can begin. For example, poor stabilization patterns during movement are a common functional deficit. Whether it is lack of stability during everyday tasks such as walking, carrying, lifting, etc., or sport-related skills such as kicking, throwing, sprinting or jumping, it’s important to understand that the functional capacity of each of these activities has different demands as it relates to stability. Our approach must be tailored to match the stabilization demands in order to normalize movement patterns and improve the load-bearing capacity of tissues involved. This is the goal of treatment. Perfection of movement is not the goal. Arguably, perfect movement does not exist. Consider elite athletes who practice their skills all day, consistently, year after year. Are they perfect with their movement 100% of the time? No. Movement has far too many variables to achieve perfection. The goal is better movement coupled with increased tissue capacity to better withstand overloads when movement goes awry.

As a chiropractor, I possess a license to manipulate and improve the function of the neuromusculoskeletal (NMS) system. I prescribe what I feel is necessary for treatment, whether it is joint manipulation, soft tissue/massage therapy, or exercise prescription. When it comes to the management of the clients and athletes here at GP, we perform functional evaluations prior to all training programs and chiropractic treatment. But the evaluation process does not end on day one. Evaluation is a continual process, from session to session. This is vital to monitor for improvement and knowing when to adapt the current training or treatment plan. Continual functional evaluation enables us to handle physical ailments appropriately when they occur. This is just part of the process of our Integrated Approach. It’s important to understand the rationale for a prescribed course of action. Thus giving both chiropractic and training services a better understanding of what to do for each individual to maximize results. So from a treatment perspective, it really isn’t just about knowing how to manipulate or perform ‘active release’ on muscles. Far too often people may know what they do; they may know why they do what they do; but do they actually understand the effects of what they just did? As a clinician, it’s important to understand the effects of the treatment you just provided and the reasons why they were provided.

Summing it All Up
Functional assessments provided at GP help to identify the most necessary intervention or treatment. It helps to identify the root cause of your symptoms and enables you to function better. Structural evaluations can be valuable, but functional evaluations should not be overlooked. There is important information to be gained from both. If you are experiencing unresolved issues such as joint pain, muscle tightness, or limitation in performing specific sport-related or daily activities, consider seeking out a clinician in your area who is credible and offers functional evaluations as part of their services.

 

Similar to a growing number of athletic facilities across the US, Gallagher Performance places a significant amount of emphasis on assessing our athletes in order to address structural adaptations and movement dysfunctions appropriately during the course of the athlete’s training program. This trend is seen throughout collegiate and professional athletics as organizations are recognizing the importance of keeping their athletes healthy by promoting optimal training environments.

However, this service is rarely available to young athletes prior to sport participation or a training program. This is truly unfortunate since proper screening of athletes is not available when it arguably matters most, during the early stages of athletic development. Dr. Mike O’Donnell DC, CCSP, CSCS touched on this concept in a recent interview. He states,

“In North America, athletes start playing a sport as unprepared youth with no background in general conditioning. This isn’t always true, but we have no system to condition young athletes besides just playing the sport. In an Eastern model, camps are held without a sport focus to condition young athletes, and the specialization comes later. In general, early specialization is a mistake. This has been proven to limit progress, lead to early burnout, and increase injury rate.”

• 79% of asymptomatic professional baseball pitchers have evidence of shoulder labrum abnormalities on MRI.
• 40% of dominant shoulders in asymptomatic tennis and baseball players had evidence of partial or full-thickness rotator cuff tears on MRI.
• 34% of asymptomatic individuals in the general population had evidence of rotator cuff tears. 54% of those 60 years of age and older had evidence of rotator cuff tears - so if you’re dealing with older adults, you could safely assume they are present in almost half of this population.
• Recent research has demonstrated that high school baseball pitchers from southern, warm weather climates have decreased shoulder internal rotation range of motion and external rotation strength compared to northern, cold weather climate players. This is likely attributed to adaptation from the number of months spent participating in pitching activities during the calendar year.
• 64% of asymptomatic people that underwent an MRI of their lumbar region had abnormal findings. Keep in mind these are individuals with evidence of lumbar disc pathology (i.e. bulge or herniation) who have NO symptoms and NO pain.
• 93% of youth hockey players age 16-19 have evidence of femoroacetabular impingement (FAI) and hip labral tears. FAI is the result of bony overgrowth found at the femoral head and/or acetabulum of the pelvis. FAI has been linked to increased risk of injury for osteitis pubis and sports hernias.
• 77% NCAA D1 and professional hockey players evaluated in one study had abnormal hip/groin MRI despite being asymptomatic. Hockey players are also more likely to have a structural change known in the hip known as hip retroversion, which allows for greater hip external rotation and reduces the degree of hip internal rotation.
• 87% of 125 NFL prospects had findings consistent with FAI on MRI. The only independent predictor of groin pain was the degree of bony overgrowth.
• Evidence suggests that roughly 25% of men in the general population have some degree of FAI despite being asymptomatic.

1. Miniaci et al. Magnetic resonance imaging of the shoulder in asymptomatic professional baseball pitchers. Am J Sports Med. 2002 Jan-Feb;30(1):66-73.
2. Connor et al. Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes: a 5-year follow-up study. Am J Sports Med. 2003 Sep-Oct;31(5):724-7. 
3. Sher et al. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995 Jan;77(1):10-15.
4. Jensen et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994 Jul 14;331(2):69-73.
5. Kaplan et al. Comparison of shoulder range of motion, strength, and playing time in uninjured high school baseball pitchers who reside in warm- and cold-weather climates. Am J Sports Med. 2011 Feb;39(2):320-328. 
6. Birmingham et al. The effect of dynamic femoroacetabular impingement on pubic symphysis motion: a cadaveric study. Am J Sports Med. 2012, 40(5), 1113-1118.
7. Philippon et al. Prevalence of increased alpha angles as a measure of cam-type femoroacetabular impingement in youth ice hockey players. Am J Sports Med. 2013, 41(6), 1357-1362.
8. Silvis et al. High Prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players. Am J Sports Med. 2011, 39(4), 715-721.
9. Larson et al. Increasing alpha angle is predictive of athletic-related “hip” and “groin” pain in collegiate national football league prospects. Arthroscopy. 2013, 29(3), 405-410. 
10. Hack et al. Prevalence of cam-type femoracetabular impingement morphology in asymptomatic volunteers. J Bone Joint Surg Am. 2010, 92(14), 2436-2444.

Athletic performance is a developmental process, one that ideally involves the integrated efforts of coaches/trainers and therapists in order to maximize results. This is often a complete paradigm shift for many of our athletes and their parents. Unfortunately being focused on short-term results over long-term development is hurting athletes more than it will ever benefit them.

After some recent conversations with our athletes and their parents about the importance of understanding the integrated approach taken to athletic development at GP, we thought we'd provide our readers with a few recommendations. Our hope is that these recommendations help guide the decision making process for young aspiring athletes when it comes to selecting who oversees their training and why an integrated approach may just be what they need.

1. The ‘watchful’ eye of a coach/trainer and therapist is an invaluable asset to athletic development. This is a skill set that many athletes are unfortunately never exposed to. The ability to identify mechanical faults and implement collaborative strategies between coach and therapist to correct these faults sets the stage for reaching athletic mastery while minimizing injury risk. The ‘eye’ for mechanical faults is one thing, knowing how to manage and correct them is an entirely different story. Athletes require an individual(s) competent in both.
2. Physical limitations due to anatomical/structural changes and motor control/technical deficiencies require different management strategies in an athlete’s programming. It is the job of the coach/trainer and therapist to recognize this difference. This should be a prerequisite when considering the services you are about to invest in. If they don't understand these concepts, that should be a red flag. Developing movement efficiency is arguably the best way to simultaneously enhance sport performance and reduce injury risk. Understanding how to manage physical limitations will directly impact movement efficiency and athleticism.
3. When injury occurs, integrated models for “rehab” are better than medically driven models. This of course is dependent on the level and experience of both the coach/trainer and therapist involved. Ideally the athlete’s recovery process utilizes exercises and drills within a modified training program. This serves to minimize time away from the field or weight room and maximize technical improvement of sport-related skills. Dysfunctions of the musculoskeletal system can also be addressed through performance therapy. For more reading on performance therapy, check out this article.

GP recently interviewed Mike O'Donnell DC, CCSP, CSCS. Dr. Mike and his wife, Jessica, run Back in Action Chiropractic located in Fort Wayne, IN. Not only do they provide expert understanding of chiropractic and rehabilitative care, they also bring to the table the unique insight as highly accomplished strength athletes. Simply put, their accomplishments would take up an entire blog post. It's rare to find a clinician and staff not only capable of identifying with athletes and addressing their needs appropriately, but also able to apply these same concepts to improve outcomes for patients. I had the privilege of being classmates with Mike during our chiropractic education at Palmer College in Davenport, IA. Once I got the understanding of Mike's background as both a strength athlete and coach, I knew he would be an invaluable resource not only in my training as an aspiring strength athlete, but in my clinical development as well. My brother and I are truly fortunate to have him and Jess as friends and mentors.

Now on with the interview.

GP: Provide our readers with some information about your background as an athlete, competitive powerlifter and strength coach.
MO: The day after 7th grade football ended I began lifting in my basement. I competed in my first powerlifting meet when I was 15 and won the ADFPA teen nationals that same year. Through high school I played football and was team captain. To train for football I simply did more speed and plyometric work. As a high school and junior lifter, I won six national titles and went to the IPF Junior Worlds, taking the bronze in my last year, 1999. I competed against many lifters who are regarded as the best in the sport today. I have lifted in the USAPL Open Nationals several times. As an undergrad at Western Michigan I studied Exercise Science. This did not include enough sport science to make me happy, so I did tons of research on my own. After my bachelor degree I worked under Buddy Morris at Pitt for a short time. That was a great learning experience. Eventually I decided to go get my DC degree and learn much more about chiropractic and rehabilitation.

GP: You are well educated on the training methodologies utilized in the former Soviet Union and Eastern Bloc countries. Could you explain briefly how those methodologies differ from North American approaches and the impact it has on athletic development here in the United States?
MO: In North America, athletes start playing a sport as unprepared youth with no background in general conditioning. This isn't always true, but we have no system to condition young athletes besides just playing the sport. In an Eastern model, camps are held without a sport focus to condition young athletes, and the specialization comes later. In general, early specialization is a mistake. This has been proven to limit progress, lead to early burnout, and increase injury rate.

GP: You have worked with athletes of all ages and abilities. In your opinion, where are we still falling short in the development of athletes in America?
MO: We fall short in several ways. Early level coaches (high school and below) often have poor qualifications. Also athletes are eager to maximize their results as early as possible. This leads to poor skill development. It is extremely difficult for athletes to unlearn poor habits or a poor work ethic. All too often young athletes look to non-training means (i.e. drugs) for improvement as well.

GP: What would you identify as the fundamental components of effective and efficient programming for athletes?
MO: Once good general preparation is established, the programming should be as specific as possible. Factors like frequency, work load and intensity vary from athlete to athlete and at different phases of training. Weaknesses should be assessed constantly and addressed, but focus should never be taken off the sport form. Overall, one should train as often as possibly but remain as fresh as possible. The programming should never compromise technique.

GP: One common theme you’ll see among trainers/coaches is very little thought that is given to the order of exercise selection/variation during a training plan. It’s almost as if many trainers just ‘make-up’ workouts. Give us your thoughts on the importance of organization of training for athletes?
MO: Organization of training and exercise selection expertise are prerequisites to training anyone. Entire teams should not all be performing the same training. This would assume the entire team has the same deficiencies. There are way too many under qualified "strength coaches" and trainers out there. Even some of the highly regarded strength coaches or online trainers are a joke. This is why I personally have no tolerance for movements and training styles that are fad- based. Put some thought into what you, or your athletes, really need and address it in your training. Further, organizing training should be an ongoing process. There are no perfect programs. Just phases or training blocks. On the other hand, there are some coaches that over coach their lifters/athletes. They are so worried about their own role in the athlete's development that the athlete cannot focus on their performance, or maybe the training isn't being attacked with the mentality that it should be.

GP: What do you see as the most common mistakes coaches and trainers are making in the preparation of athletes?
MO: The most common mistakes - the coach who tries to be the athlete's friend (not hard on them); poor analysis of training needs and the current state of the athlete; and the most important aspect in my opinion (this goes for anyone seeking a great PT, DC, manual therapist or strength coach) is that the coach cannot identify with the athlete because they weren't an athlete themselves. I know several above average coaches that are held back my the mere fact that their athletes cannot identify with them. Either they weren't athletes at all, or they are an unimpressive presence altogether!

GP: What are the qualities and attributes that athletes and parents should look for in a trainer/strength coach before investing in their services?
MO: Sporting background and accomplishments, educational background and accomplishments, and clinical competence, methods, and track record. Period. Anything less, and I am skeptical about what I am getting. I don't care who has the best DVD!

GP: How has the background as a competitive strength athlete and strength coach benefited you as a chiropractor and your ability to manage patients from acute stage to reactivation through active care?
MO: This is a great question, because I tell people that ask that I use my training, coaching, and professional background everyday when treating patients. My philosophy in the clinic is the more accurate the assessment, the more accurately I can apply your treatment, whether its passive or active care. As the phases of care progress, it's important to know what type of care or movements to change to. This assessment or "eye for the deficiency" can take years to develop. Today there are systems and seminars to attend and learn these analytical methods, but learning this way can lead to a lot of limitation and misunderstanding. I would advise students, whether they are professional level yet or not, to use the gym as your lab. Lift and learn!!!

That's a Wrap
Mike, thank you for taking the time to answer our questions. Your knowledge and insight is truly appreciated. We always learn something from you and hope our readers learned something as well. For anyone in the Fort Wayne area, be sure to check out Back in Action Chiropractic for the best results when it comes to your health or sport-related goals.

When it comes to athleticism, there is a sad misconception among far too many individuals that athletes are "born not made". People that believe this will often say, “You can’t teach speed” or “That’s just a gifted athlete”. While genetics can play a role in athleticism, arguably the greatest impact on an athlete’s development (or lack thereof) is the training system that is implemented. This would include all elements from its organization to exercise selection and other variables.

While all sports have their own unique considerations, ice hockey demands high levels of athleticism. The transfer of training from off-ice preparation to on-ice performance presents a host of challenges. With the nature of today’s game, proper off-ice training can provide youth and elite level hockey players with the advantage they need to elevate their game.

Here are some tips: 
1. WARM-UP PROPERLY 
In preparation for exercise, the body should be moved through large ranges in all three planes of motion (sagittal, frontal and transverse). Movement prepares the brain and body for exercise by activating the nervous system, warming tissues such as muscles and tendons, and lubricates joints. Movements performed in all planes of motion on a consistent basis will improve stabilization patterns, mobility, coordination, balance, and movement efficiency. Making the time to properly warm-up with allow you to get more out of your training. Simply put, it makes training more productive and will reduce the risk of injury.

2. TRAIN MOVEMENTS, NOT MUSCLES 
The human body operates as an integrated system. Joints and muscles are all coordinated by the central nervous system to produce movement. Muscles never work in isolation, meaning that there is always a pattern of muscle recruitment that occurs with every movement we make. Depending on how we recruit muscles, movement will occur in efficient or inefficient ways. Athletes require mastery of movement. Unlike those who train to for basic fitness or simply to ‘look better’, athletic development and performance-based training programs aim to improve how an athlete moves. Goals focus on strength, stability, mobility, speed, and skill execution with a high degree of movement efficiency.  Sure many athletes look good, but this is often a by-product of their training, not the primary goal.

There can be a mistake in young athletes simply go to the gym and “working out”, either by themselves or with their friends. Especially when they have no plan. If most young athletes are honest, they don’t know what to do during the off-season. Even some trainers have no idea what they are doing with athletes and just “make-up” a training session as they go or select a random workout off the Internet. As the saying goes, “One program on a dry erase board for your group of clients/athletes isn’t training, it’s babysitting.” Higher quality strength and athletic development programs are becoming more available to young athletes; those athletes not involved in those programs will be left behind.

This concept was detailed in our article on Training for Elite Athletes.

3. GET IN TOUCH WITH THE GROUND
This point builds off the previous one. The majority of sport movements and skill execution are initiated by applying force to the ground with the feet/legs. As with land-based sports, the more force a hockey player applies to the ice, the greater acceleration and speed they generate. Strength and power development exercises should be selected based on their ability to enhance ground-force reaction. The same can be said for both speed and conditioning drills.

Utilizing squat and deadlift variations, Olympic lifts, medicine ball throws, jumps, plyometrics, sprints, and hockey-specific agility/change of direction drills would be the most beneficial in developing ground-force reaction. Unilateral movements such as single-leg squats and jumps, lateral bounds, split squats, and lunge variations will also help to develop the movement proficiency need for a powerful skating stride.

4. TRAIN THE CORE FOR FUNCTION, NOT LOOKS
The core is the body’s center of force transfer and movement control. The core is not simply your abs. It includes almost 30 muscles that attach to the spine, shoulders and hips, which function to stabilize the areas during movement. When the function of the core is compromised, inefficient movement results and risk of injury is increased. Hockey and its movement skills require high levels of core stabilization, endurance, strength and power transfer. The demands of athletics on the core will never be met by performing thousands of crunches. Your core training needs a more specific, specialized focus.

Stabilization exercises should focus on things such as maintaining proper lumbo-pelvic posture and the ability to resist or control movement in all planes of motion. Once proper stabilization is achieved, greater attention can be given to rotational power and force generation exercises for increased transfer of training into sport.

5. BE SMART ABOUT YOUR CONDITIONING
The sport of ice hockey places demands on both the anaerobic (alactic and lactic) and aerobic energy systems of the body. For the most part, hockey is an anaerobic game, characterized by intense bursts followed by periods of rest. The anaerobic system is challenged during these intense bursts while the aerobic system is utilized during the recovery period between shifts. This illustrates the need for both systems to be well developed for optimal performance.

Thus conditioning for hockey should focus on an interval-based approach to meet the energy system demand of the sport. Place a priority on developing the capacity and power of the anaerobic-alactic system along with the use of tempo runs/bike sessions to develop the aerobic system. Anaerobic-lactic training is extremely taxing on the body and difficult to recover from. This form of exhaustive conditioning should be used less frequently in the training program.

Remember, conditioning does not mean the same thing as speed training. For more information of developing hockey speed, read this article.

6. RECOVER, RECOVER, RECOVER
Recovery from exercise can be accelerated with proper attention to flexibility, mobility, massage, chiropractic treatment, nutrition and sleep. These approaches facilitate the body’s ability to recover from exercise. Nutritionally, ingesting the proper amounts of whole foods and supplements at the appropriate times during the day can prove to be a huge part of the recovery process. Replenishing energy stores (i.e. muscle glycogen) and providing the building blocks (i.e. protein, fats, vitamins, minerals) for tissue repair and regeneration are just some of the primary goals of proper nutrition. Self-management strategies such as foam rolling and stretching/flexibility work are valuable components in the recovery process. Maintaining proper muscle function and joint range of motion is critically important to minimize injury risk and ensure that you get the most out of your training.

Conclusion
Keep in mind the above tips serve as guidelines. Individual considerations cannot be met in an article of this nature. However, if applied correctly, these guidelines can serve to provide aspiring hockey players with a better understanding of how to go about their off-ice training. For those interested, GP specializes in the training and preparation of hockey players. Contact us for more information.

The concept of sport-specific training has continually gained popularity over the years. It’s a growing market and business-minded individuals are taking notice. Similar to trends in functional exercise, you have a growing number of trainers stating they offer the “latest in sports training”. Frankly, anybody online can say their method or approach is the best. In a competitive market, people enjoy using words to attract your business. There are plenty of gimmicks that exist, namely in the world of speed training. Often times, athletes acknowledge such methods did little or nothing to improve on-field performance. If these gimmicks worked, it's simply because the athlete was a novice or of low qualification. Novices have the unique ability to respond to almost any form of training. But does this mean what was done is most appropriate? Does it mean training was efficient or effective? Not necessarily. When it comes to the training of higher level athletes, previously used methods and/or exercises will eventually fail to produce continual improvements in sport performance. There is a point of diminishing returns and training must adapt accordingly.

For any athlete, sport-specific training must ensure maximal transfer of the training program to on-field results. If exercise selection or organization has little carry over to making athletes better, you are wasting valuable time and money. Transfer of training can be summed up with the SAID Principle (Specific-Adaptations to Imposed-Demands). The SAID Principle has been proven time and time again in both research and training. This principle implies that training is most effective when resistance exercises prescribed are similar to the target activity or primary sport form/movement. Furthermore, every training method will elicit a specific (and different) adaptation response in the body. There must be compatibility between training and sport. This becomes of increasing importance as an athlete reaches higher and higher levels of athletic competition.

As mentioned before, research has demonstrated how exercises that once worked to improve sport performance for an athlete at a lower qualification level, will eventually lose training effect as the athlete gains mastery. For instance, indicators of maximal strength (squat 1RM) often have a direct correlation in low-level athletes, but lose significant correlation with enhancing sport performance in higher-level athletes. Similarly, movement abilities such as sprinting and change-of-direction (agility) are each separate motor tasks, characterized by specific motor abilities. Improvements in linear sprint speed and change-of-direction ability have limited transfer to each other and the degree of transfer decreases as an athlete progresses.

Thus, in order to enhance the sporting ability of high-level athletes, there comes a time when we must get more detailed than simply chasing increased strength and 'quick feet'. It’s inevitable. There is no way to avoid it. The world’s greatest Sport Scientists understood this and proved the need to go beyond traditional training approaches to see continual improvements in performance as athletes reached higher levels of competition. This is where the concept of Special Strength Training (SST) becomes of importance in the training plan.

Introduction to Special Strength Training
Pioneered by Dr. Anatoli Bondarchuk, SST has been incorporated for decades by coaches in other countries, mostly in the Olympic sports. Dr. Bondarchuk is most noted for his involvement in the throwing sports, particularly the hammer, and his results speak for themselves. It was Bondarchuk’s identification and implementation of special exercises with the highest degree of dynamic correspondence to the sporting movement that became the focus of his athletes' training plan. His organization of training allowed athletes to set world records and win numerous international and Olympic medals despite the fact that they did not possess the greatest strength in movements such as the clean, squat, or bench press.

Exercise Classification System
Bondarchuk classifies exercises into 4 categories:

1. GENERAL PREPARATORY EXERCISES are exercises that do not imitate the competitive event and do not train the specific systems.
2. SPECIAL PREPARATORY EXERCISES are exercises that do not imitate the competitive event, but train the major muscle groups and same physiological energy systems as your sport. However, movement patterns are different.
3. SPECIAL DEVELOPMENTAL EXERCISES are exercise that replicate the competitive event in training but in its separate parts. These exercises are similar to the competitive event, not identical.
4. COMPETITIVE EXERCISES are exercises that are identical or almost identical to the competition event.

“General exercises have little relevance to the sporting action. Specialized preparatory exercises use the same muscles that are involved in a particular sporting action. Specialized developmental exercises include single joint actions that duplicate one portion of the sporting action. They also mirror the velocity and range of motion seen in the competitive movement. Competitive exercises are those that fully mimic the competitive movement in more difficult conditions and easier ones.”

An interesting dynamic has been developing in youth sports. The dynamic has been generated by the current nature of greater focus placed upon competition rather than athlete development. This is evident by the increasing number of games played at the youth level, commonly seen within travel or club organizations. Now, while this trend is not a favorable one and can actually be detrimental to youth athletic development, it has seemed to be the driving force for another trend.

The trend being the greater awareness and proactive nature some parents and young athletes are taking to become more educated on proper nutrition and training. The reality is, at the youth, club, and high school levels of sport, there is a competitive advantage to athletes who not only improve their athletic qualities (strength, speed, power, stamina, etc.), but also become healthier by making better food choices or finding ways to improve recovery.

When it comes to athletic development and preparation, there is no such thing as a “one size fits all” approach. There are far too many individual differences to account for. However, there are some basic principles or guidelines that most any aspiring athlete can implement and see results.

That said, here are five tips that can put you on track to experience better health and more consistent sport performance:

1. STRATEGIC FOOD SHOPPING
 When shopping for food, stay on the perimeter of the store. This is where you’ll find the best in whole food selection such as beef, chicken, fresh produce, and other food that should be the foundation of quality nutrition. The middle aisles mostly consist of processed foods. Sure they may taste awesome, but they do little to support the nutritional demands of young athletes.

2. READ FOOD LABELS
 The importance of reading food or ingredient lists cannot be stated enough. It's important that you know what you are consuming. Food labels can be misleading. For example, items can read “Low Fat” or “Non Fat” in an attempt to appear as a ‘healthier’ choice. However, if you read the label closely, you will find that these foods often have added sugar and/or artificial flavors. As we discussed in this article, fats, such as saturated fat are not the bad guy. Sure, you should avoid foods with trans fat, but the over-consumption of sugar and other processed foods will do more harm to your body than quality, healthy fat ever will.

Focus on selecting foods with a short ingredient list. Food manufactures appear to be taking notice, as they are producing a greater selection of foods with few and familiar ingredients to appeal to the consumer demand for healthier, natural foods.

3. EAT RIGHT, ALL DAY LONG
 When it comes to meals, you can find plenty of people who will advocate breakfast as the most important meal of the day. Others will say dinner. Some may even say lunch. Regardless of opinion, it’s more important to be consistent with your nutritional intake during the ENTIRE day. As a growing and developing athlete, simply focusing on nailing one meal won’t cut it.

It’s important to consume food at adequate levels throughout the day to replenish energy stores and promote an environment within your body that is essential for growth and repair.

4. IN-SEASON MAINTENANCE
 Strength and weight gains occur during the offseason. During the season, athletes need to focus on maintaining what they have built during their offseason.

Why?

With the abundance of practices and games during the season, athletes do not have the energy reserves and time to make strength or weight gains and recover in time for competition. Plus, many athletes can be banged up during the year, thus limiting what you can do with their training. This makes having a trainer or coach who understands how to work around minor injuries of tremendous value.

Establishing an in-season maintenance program can keep athletes healthier and performing at more consistent levels during the season. It also allows them to step into offseason training with greater ease and ahead of the game.

5. TRAIN SMARTER, NOT HARDER
 This is contrary to what almost every athlete hears at some point in their career. Athletes are told to train hard, work hard, etc. While hard work is necessary and valuable, there comes a point when being smart about your training is even more valuable.

Training should produce results. You should be getting something out of it rather than just being exhausted. It’s not difficult to make someone tired. Anyone can make you tired. Those trainers and coaches are a dime-a-dozen. What athletes need is someone that will produce results. There should be measurable gains in strength, speed, and power. If you are not seeing gains and simply becoming more and more tired, you need to start training smarter.

For additional reading on the difference between training smart vs. training hard, check out this article.

There is no question that knee injuries are a common occurrence among athletes. The incident of devasting knee injury, such as ACL tears, has been on the rise for years. Once considered an adult injury, ACL tears are occurring more often in children as reported by orthopedic specialists, estimating that thousands of children and teens suffer an ACL injury each year. According to statistics presented at the American Academy of Pediatrics 2011 annual meeting, over the past decade youth ACL injuries have increased 400% and girls are at eight times the risk of an ACL tear as compared to boys. Clearly, there is a problem with knee injuries among youth athletes. But where is the solution?

Mechanism of Injury and Risk Factors
To identify a solution, we must first identify the problem. In this case, the problem is the mechanism(s) of injury most commonly associated with ACL injury. Keep in mind that about 2/3 of all ACL injuries are non-contacted related. Meaning, the athlete didn’t have someone tackle them or have a player roll-up on their leg, resulting in injury. Non-contact injury opens the door to the possibility that a large percentage of ACL injuries can be reduced or prevented. Here are the most common mechanisms of injury associated with ACL injury:

• Jumping/landing improperly
• Planting followed by cutting or pivoting
• Straight-knee landing
• Stopping or landing with the knee hyperextended (too straight)
• Sudden deceleration of movement

• Weak hamstring and gluteal (hip) muscles
• Poor neuromuscular control and balance
• Poor dynamic biomechanics (Jumping, landing, cutting, etc.)
• Fatigue
• Female Gender

1. Improve hamstring strength. The hamstring muscles have a critical role in maintaining healthy knees. Proper hamstring training and strengthening must take into consideration how the hamstrings function during the primary sporting movement(s). For example, land-based sports with an emphasis on jumping and sprinting ability will place a high demand on the hip extension action of the hamstring. The hamstrings must be trained accordingly to be able to meet and accommodate the forces generated during sport.
2. Improve hip and core strength. The musculature of the core and hips have a tremendous amount of control on the pelvis and femur, and thus the knee. Poor hip control puts the knee in compromising positions, increasing the risk of injury. When the core and hips are weak, they needs to be a focus of treatment/exercises. This will serve to improve the stability of the knee.
3. Improve Proprioception (Balance) and Neuromuscular Control. Sufficient proprioception and neuromuscular control is the difference between being able to ride a bike and falling on your butt every time you get on a bike. Understand that altered proprioception and neuromuscular control contribute to abnormal motion during dynamic sporting activities, such as cutting and jumping/landing. One study revealed, “Improved joint mechanics during landing were achieved regardless of the individual’s muscle strength, suggesting that strength may not always be a prerequisite for movement re-education.”  This should demonstrate the importance that mental focus and repetitive use of proper movement has on correcting mechanics.
4. Decrease fatigue. There are 2 types of fatigue, peripheral (muscles) and central (brain).  Peripheral refers to exercise induced processes leading to decreased force production (typical muscle fatigue).  Central fatigue relates to a gradual exercise-induced reduction in voluntary muscle activation. Essentially meaning the brain gets fatigued. It is plausible to say injury comes from both, however from an injury prevention stand point; peripheral fatigue is difficult to manage because your muscles will get fatigued.  But targeted training of central fatigue might be the way to go in preventing injury. How does one train central control. As one study put it, “Exposure to more complex or cognitively demanding movement tasks may facilitate improved perception and decision making within the random sports environment.” This is were mental focus and developing an athlete's awareness of their body during drills becomes important. Mental imagery may prove beneficial in developing central control by utilizing “mental reps” to help engrain proper movement and ideal mechanics.

1. Powers  CM, Souza RB. Differences in Hip Kinematics, Muscle Strength, and Muscle Activation Between Subjects With and Without Patellofemoral Pain. J Ortho Sports Physical Thearpy. 2009;39(1):12-19.
2. Powers CM. The Influence of Abnormal Hip Mechanics on Knee Injury: A Biomechanical Perspective. J Orthop Sports Phys Ther. 2010;40(2):42-51. http://www.jospt.org/issues/articleID.2396,type.2/article_detail.asp.
3. Heiderscheit B. Lower Extremity Injuries: Is It Just About Hip Strength? J Ortho Sports Phys Ther. 2010;40(2):39-41. http://www.jospt.org/issues/articleID.2404,type.2/article_detail.asp.
4. Mizner R, Kawaguchi J, Chmielewski T. Muscle Strength in the Lower Extremity Does Not Predict Postinstruction Improvements in the Landing Patterns of Female Athletes. J Orthop Sports Phys Ther. 2008;38(6):353-361. http://www.jospt.org/issues/articleID.1408,type.2/article_detail.asp.
5. McLean SG, et al. Impact of Fatigue on Gender-Based High-Risk Landing Strategies. Medicine & Science in Sports & Exercise. October 2006.
6. McLean SG. Fatigue-Induced ACL Injury Risk Stems from a Degradation in Central Control. Medicine & Science in Sports & Exercise. January 2009.
7. Hilgefort M, Winchester B. Preventing ACL Injuries in Female Athletes.

What you need to know:

• For athletes, reaction time is highly important to success as many athletic events can be determined by tenths of a second.
• Outside of practice and training, chiropractic adjustments appear to improve reaction time.

"As a professional athlete, I am highly competitive - only accept the best. When it comes to healthcare, chiropractic is an essential service. It keeps on-field performance at its highest level and contributes to the success of the entire team!"

 
"He who treats the site of pain is often lost."

It does not take a professional eye to take notice of the frequency of hamstring injuries in sport. Evaluating the injury list for collegiate and professional teams, you will find that hamstring injuries are at the top of non-contact related sport injuries. Even more staggering is that roughly 1/3 of all hamstring injuries will recur, with the majority recurring within the first 2 weeks. Now these statistics mainly reflect sports which involve sprinting, however hamstring issues can create problems for athletes regardless of sport. It is important to understand that hamstring health becomes more critical as increasing loads and demands are placed on them. Given these statistics, one can logically bring into questions if traditional return to play guidelines and rehabilitation programs are truly ideal.

This article was originally published for MPG New England. It has been republished here with permission.

 "The word ‘athlete/athleticism’ is used too loosely amidst the sporting community. It is one thing to participate in a sport and it is another thing entirely to be an athlete."

-James Smith

1. Sprint exercise resulted in 3 times more fat loss while expending 1/2 the calories compared to those who performed aerobic exercise. (Tremblay)

2. Low intensity aerobic exercise participants lost lean body mass. Over the long term, reduced lean body mass results in a lower resting metabolic rate and thus reduces the ability to burn fat. (Mouglos)

3. One study found that the addition of 4 hours of aerobic exercise per week had no effect on weight loss, while another found performing 45 mins of aerobic exercise 5 days per week for 12 weeks had no effect over dieting alone. (Van Date, Utter)

4. Twenty minutes of interval/sprint training, 3 times per week for 15 weeks led to greater fat loss compared to steady state aerobic exercise. (Trapp and Boutcher)

So is cardio pointless? Even thought it pales in comparison to other modes of exercise in the ability to burn fat, cardio is still effective. However, cardio should not be done alone as one's only form of exercise. Cardio is effective in promoting CNS recovery from intensive exercise and should be a small part of an exercise program that includes proper eating, muscle-building resistance training, and fat-burning intervals.