Monthly Archives: October 2011

Movement Proficiency and the Ankle

I’ve already had a few questions come up in response to the first blog post:

What are the basic movements that someone should be proficient with to train and compete in athletics?

What are some ways to address these movements in my training?

There are quite a few movements I feel are quite necessary to move well enough to keep injury risk low and to enhance speed, power, jumping ability, etc.  I’ll get into all of them in time, but for now I’m going to spend more time on the ‘Big 3’ from the Functional Movement Screen.

1.  Deep Overhead Squat

2.  Hurdle Step

3.  In-Line Lunge

These are larger patterns with many component parts but what it really comes down to is we need a great deal of mobility from certain joints and stability from others

Mobility – ankles, hips, thoracic spine, and shoulders

Stability – knees, lumbar spine (a.k.a the Core), and scapulae

As you can see from the pictures above, a great deal of mobility is required from each of those areas I listed.

This is simplifying things a bit but if you do not have the requisite mobility then there is no way you will move well in these patterns and the way you run, lift, jump, and throw will be compromised.  We also know that poor mobility leads to poor ability to stabilize the joints listed above as the body searches for compensatory strategies (ways around those stiff joints).

Let’s use ankle mobility as an example.  From a half kneeling position, you should be able to get your knee 4 inches past your toes while keeping the heel down.  See the picture below (the stick in line with the big toe forces you to take the knee outside the stick).  Full ankle mobility will allow the rest of the lower extremity to stay in great alignment while running, lifting, etc. If the ankle is stiff, the foot will pronate (flatten out) and the knee will cave inward all in an attempt to work around the ankle.  All the athlete is thinking is “I have to run fast” so the brain will find a way whether it is right or wrong.  Over time this leads to instability at the foot, knee, possibly even higher up the chain, and ultimately decreased performance and injury.

Ideal = knee 4" past the toesSo if you find yourself struggling to move through the ‘Big 3’ patterns discussed above, ankle mobility should be the first place to look.  So what to do if you’re short of that magic 4″ past the toes?

–  self myofascial release – rolling a lacrosse ball along the bottom of the foot and foam roller/massage stick to the calf

–  stretching for the calf with the knee extended (traditional calf stretch with hands on the wall) and with the knee flexed to get the soleus/Achilles (as in the picture above or standing knee to the wall)

If those just aren’t cutting it, or you experience pain in front of your ankle, then you may have some joint and/or soft tissue issues that will not be solved by just exercise.  Then it’s time to see your physical therapist or chiropractor who has the ability to address these areas.  Here at Elite Physical Therapy and Sports Performance, I use the Graston Technique which has shown tremendous results often in only 2-3 visits.

As with any intervention, be sure to go back and re-check the patterns when you are done.  As ankle mobility improves then your squat, hurdle step, and lunge should all improve as well.  Maybe not to ‘perfect’ yet because there a number of other components involved here, but definitely will have you on the right path.

 

 

“Don’t Put Fitness on Dysfunction”

This is one of my favorite sayings from Gray Cook (physical therapist,). What he’s getting at, is we need a solid movement base – meaning joint mobility and stability, muscle flexibility, and balance – prior to training for strength, power, speed, and so on. Or before just going out and participating in a given sport or taking up something like jogging. Here is the Functional Performance Pyramid he came up with.

What this basically says is we need to move well before we should begin any training program or athletic endeavor. The purpose of this is not only to get better results from our training, but also to prevent the injuries that seem to go hand in hand with training and athletics.

The research is now clearly showing that the movement skills we once possessed as children, are vital to our health and performance as teenagers and adults. Research done in professional and collegiate sports, as well as in the military, is demonstrating that a base level of movement competency is necessary to prevent injuries. Not only that, but training and performance are enhanced in athletics. In the military it has been shown to correlate to drop out rates in basic training.

Do you still move like this?

Here are two factors from the research that relate how well you move to injury risk:

1) Previous injuries
2) Right-Left asymmetries

These are the two biggest predictors of injury in athletics and in those that train, run, bike, ski, etc. Previous injuries we have experienced often create compensatory strategies to allow us to continue to perform our desired activities. Something as simple as an ankle sprain provides a great example. To continue to run, just in this example, the calf muscles tighten down to protect the ankle and you lose ankle joint motion. This requires compensatory motions from the knee, hip, and up the chain into the spine. This is meant to be a short term adaptation but often becomes chronic – a new way of doing things. Over time the accumulating microtrauma can lead to overuse type injuries such as plantarfascitis, achilles tendinopathy, knee pain, or back pain. Occasionally it can lead to bigger, more devastating injuries.

Right to left differences in movement (asymmetries) can create a similar scenario. Often our work, school, and athletic activities create these side to side differences that will have much of the same affect. We move well one direction, but not the other. Repetitively moving in our more mobile direction creates excessive wear and tear on our joints and muscles. When forced to move in our not-so-mobile direction repetitively or with great force (a.k.a sports), serious injury can result.

45 deg on the L and maybe 20 deg. on the R = not good!45 degrees of hip rotation on the Left and 20 degrees on the Right = Not Good!

This is just the tip of the iceberg when it comes to movement quality and injury prevention, but I wanted to give you a little flavor of what’s to come. At Elite Physical Therapy and Sports Performance, we put a premium on enhancing your movement capabilities while rehabbing or training with us. The research is showing that we’re playing with fire by just jumping into training programs or athletics without first assessing how one moves, determining base levels of strength, conditioning, etc. I prefer using the Functional Movement Screen and Y Balance Test with all athletes and those who want to train hard, but it can be any system that takes a good hard look at how you move prior to putting you under the bar or out on the field or court.

I think this quote by world renown physical therapist Diane Lee (who has worked with the Canadian Olympic team) puts in all in perspective: “Don’t run to get in shape, you must get in shape to run”. If you move well, you can train hard. If you have a ‘weak link’ then we must address that to help you meet your goals.