Tag Archives: Functional Movement Screen

ACL Injuries and Prevention – Jump Training Part II

Last week I talked about some of the main causes of ACL injuries and why they occur at a rate of 3-4x more often in female athletes.  You can find that article along with our first jump training video here:

This week I’m posting the second video in a series of three showing how we begin jump training to a box.  This type of training can be used for ACL injury prevention and to enhance sports performance.  It’s also what we do post-surgically to get the athlete used to jumping again and landing safely.

The great thing about box jumps is that the forces on the knee are quite low because you are not coming all the way back down to the floor.  It’s also much easier because of this for the athlete to work on proper landing technique.

Before I get to the video though I thought I’d post a picture of what you don’t want your athletes knees to look like.

ACL Injuries

a.k.a. valgus collapse of the knee

Check out the video below for more:

Looks fairly simple but let me assure you it can be quite challenging for many athletes – boys included.  Learning to jump and land correctly has been proven to help prevent ACL injuries and it must also be a huge focus of any post-surgical ACL rehabilitation program.

If you have any questions feel free to contact me Joe@elitepttc.com or 231 421-5805.  We also do injury prevention and return to sport testing which does include a number of jump/hop tests.  If you’d like to know where you stand in relationship to other athletes in your sport we can definitely set that up for you.

ACL Injuries and Prevention

ACL injuries (anterior cruciate ligament) have been an epidemic in sports but even more so in women’s athletics.  Females are 3-4x more likely to tear their ACL than men.  There are several proposed theories on why this is so but for the purposes of this article and what we address here at Elite Physical Therapy we will discuss the following:

  • Poor movement quality
  • Strength deficits
  • Landing mechanics

I’ll go more in depth in subsequent articles but for now here are the basics:

Poor movement quality

There are just certain joints in our bodies that need to be very mobile in order to get us through our daily activities and especially sporting activities like running, jumping, and cutting.  Don’t get me wrong – all of our joints need to move through their full range of motion for us to be efficient movers.  Some just need to be emphasized a bit more because of their tendency to become stiff while other areas of our body need a bit more stability/motor control.  Check out the picture below to get an idea of how this works – it’s called the Joint – by – Joint theory.

Alternating sequence of mobility - stability through the entire body

Alternating sequence of mobility – stability through the entire body

It’s a very simplified way of looking at things but it does often work out this way.  The knee joint needs to have a great deal of stability in all directions to prevent injury.  If the ankle and hip joints above and below are moving well then the knee joint will more likely stay within it’s accepted range of motion during athletic movements.  If the ankle and/or hip are stiff then the knee may just have to go outside of it’s normal boundries to land from a jump or decelerate while cutting.  This is where things can go south in a hurry!

Strength deficits

There is plenty of research out there in the medical and physical therapy journals showing that strength deficits can lead to knee injuries, and in particular ACL tears. Years ago the main concern was the ration of strength between the quadriceps and hamstrings, which if it was below a certain level it could inhibit an athletes ability to decelerate correctly leading to injury.

Lately the focus has been more on the hips and muscles of the ‘core’ and how weakness or lack of control in those areas can contribute to injury.  I’ll get more into the ‘how’ and ‘why’ in another article but it is a reality that needs to be addressed.

At Elite Physical Therapy, we know that a comprehensive strength program must be implemented to assist in the prevention of ACL injuries.  Quality movement is critical for effective strength training as well.  Being able to combine these qualities is what we do best, and definitely one of my favorite things to talk about so more to come for sure!

Landing mechanics

It is also well documented that female athletes land and cut differently than the male athletes.  Women tend to land stiffer and higher than the men who typically land in deeper hip and knee flexion angles.  Stiffer and higher landings are more dangerous as far as the knee joint is concerned.

Strength and movement quality again play a large role in this.  Some athletes can’t even get into a good position to perform complex athletic movements.  Big problem!

Many don’t have the strength to get into the proper positions.  Another big problem.

As the athletic activities get faster, more complex, impose higher forces, etc it becomes more and more challenging to perform them using good technique.  Fortunately all of these qualities can be addressed through physical therapy and proper training techniques.

Check out the video below showing how we start teaching athletes to jump correctly using box jumps.  The nice thing about landing on a box is that you don’t really have to come all the way back down.  Much less strain on the knees and an easy way to work on jumping and landing technique.

I’ll be posted a new video every few days showing more of the progressions we use.  We will also be hosting some ACL prevention clinics in the near future so if you’d like to learn more and get some hands on assistance than please contact us.

Here is what we have coming up:

December 28th from 2 pm – 6 pm at Kingsley High School with the Northern Pride Sports Academy.  6th – 8th grade girls basketball skills camp.  We will be teaching a session on jumping progressions to improve athletic performance and reduce injury risk.

In February (date to be determined) we will be hosting an ACL Injury Prevention clinic here at Elite Physical Therapy and Sports Performance.  Topics will include mobility training, strength training, and jump training progressions. More on that to come as we continue to line up speakers and instructors.

For more information you can contact us at 231 421-5805.

Joe Heiler PT

Ankle Mobility Drills for Runners

This is the last in our series of dynamic warm-up drills for runners that we use here at Elite Physical Therapy and Sports Performance.  In this video Scott McKeel demonstrates some of our favorite ankle mobility drills to get those ankles moving which will help with a number of common injuries like plantarfascitis, Achilles tendinopathy, IT band syndrome, knee pain, and low back pain.

 

We do small group, and even individual, training sessions for runners which includes the Functional Movement Screen plus other critical tests to find the weak links in mobility and flexibility, strength, and running technique.  If you’re interested contact us:  joe@elitepttc.com

Dynamic Warm-Up for Runners Part III

In this episode Scott McKeel continues with the dynamic warm-up series including drills for lower body warm up and running technique.  These drills are great for those who have been battling common running injuries like plantarfascitis, hip bursitis, IT band syndrome or low back pain.

 

We do small group, and even individual, training sessions for runners which includes the Functional Movement Screen plus other critical tests to find the weak links in mobility and flexibility, strength, and running technique.  If you’re interested contact us:  joe@elitepttc.com

Dynamic Warm-Up for Runners Part II

Part II of Scott McKeel’s series on dynamic warm-up drills for runners.  In this episode Scott takes you through some of our favorite lower body warm up and run technique drills here at Elite Physical Therapy and Sports Performance. These drills are great for those who have been battling common running injuries like plantarfascitis, hip bursitis, IT band syndrome or low back pain.

 

We do small group, and even individual, training sessions for runners which includes the Functional Movement Screen plus other critical tests to find the weak links in mobility and flexibility, strength, and running technique.  If you’re interested contact us:  joe@elitepttc.com

Running Performance and Injury Prevention Clinic

Are you a runner? Are you interested in preventing annoying injuries that may sideline you from training? Are you interested in improving your performance? If you answered yes to any of the above questions, the Running Performance and Injury Prevention clinic sponsored by Elite Physical Therapy and Sports Performance, Crystal Lake Clinic, and Running Fit is where you need to be on June, 6th from 9:00am to 12:00 pm!

This clinic will give attendees information on common running injuries, ways to prevent them from happening, and ways to manage injuries while training. This clinic will also give insight on race day performance, proper warm-up techniques, and foot typing to make sure you as an athlete are in the right shoes on and off the course.

This clinic will be split into two sessions. The first half will be a lecture and discussion format while the second half will be divided into break-out sessions to learn by performing.

Everyone is welcome whether you’re a weekend warrior, an avid runner, a coach, or someone looking to begin running. This clinic is for everyone!

Where: Traverse City West High School Practice Gymnasium

When: June 6th, 2015 9:00 am-12:00 pm

Cost: Prepaid: Adult=$10, Students= $5
Door Price: Adult= $15, Students =$10

What to bring: Clothes to exercise in, water bottle, energy, notebook and pen for notes, and your energy!

Speakers/Topics: 

Jake Flynn MD (Crystal Lake Clinic) – Race Day Performance

Scott McKeel SPT (Elite Physical Therapy and Sports Performance) – Common Running Injuries

Joe Heiler MSPT (Elite Physical Therapy and Sports Performance) – Optimizing Movement Quality for Running Performance Enhancement

Victor Sellinger (Running Fit) :  Happy Feet – Foot Wear and Foot Typing

Breakout Sessions:

Dynamic Warm-Up

Self Myofascial Release Techniques

Foot Typing

Adults – use the button below:

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Students – use the button below:

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Annual Musculoskeletal Exam

You go to the dentist for check-ups and cleaning every six months.

I bet he’d rather be seeing his physical therapist!

The doctor sees you for an annual physical.

You see the eye doctor for an annual check up.

So why not see your physical therapist for an annual musculoskeletal health exam?

Here are a few startling statistics:

  • we lose .5%-1% of our muscle mass per year after the age of 30.
  • nerve conduction velocity decreases by 1m/s every 10 years
  • testosterone levels decline about one percent a year after age 30.  Growth hormone levels begin to decrease after the age of 20.

These are just a few examples of normal age related physiological changes.  The direct result is a decrease in strength and power with age.  Over time this can manifest itself as poor balance, poor movement ability, difficulty getting out of a chair or bed, limited endurance, and the list could go on and on.  These declines in performance can also lead to injuries and musculoskeletal problems over time which will lead to a further decline in performance.  The vicious cycle is in full swing now!

There is no way to stop these changes from happening, but we can certainly work to slow them down through smart exercise, nutritional strategies, proper recovery, etc.  The exercise component is where we come in.

Here is what this annual musculoskeletal exam would consist of:

The Functional Movement Screen (FMS) is a battery of 7 screens to determine movement competency – or how well you move.  The FMS has been shown in the research to be highly predictive of injury in athletics and in the military.  We can’t necessarily pin point what the injury will be, but we do know that the wheels are much more likely to come off at some point.

The FMS is being used in all the major sports, in the military, and even at the NFL combine to look at injury risk and prediction in these populations.  The beauty of the screen is twofold:  1)  ability to identify poor movement patterns, and then apply corrective exercises to improve competency within these patterns thereby reducing future injury risk; 2)  ability to identify acceptable movement, and create exercise programs to further strengthen and add capacity to these patterns.

The Y Balance Test looks at single limb balance, strength, and motor control.  Right to left symmetry and poor reach distance are both predictors in injury.  The Y Balance test is a great way to evaluate both, and to compare scores to peers in the same sport or activity level.  There is also an upper body Y Balance test for shoulder stability which is a great way to test overhead athletes.  Depending on your sport, one or both of these tests would be appropriate.

Power Output is a measure of work over time.  In other words, how much work can you get done in the shortest amount of time.  Athletic measures of power include the vertical jump, standing broad jump, and medicine ball throws.  There are other measures that could be used as well depending on your chosen sport(s) or activities, goals, age, etc.  For older adults it may be as simple as how quickly one can get up off the floor and walk a certain distance.

There are certainly other things that could be assessed and measured including strength,  balance, and endurance but those will be specific to each individual case.

When all the testing has been completed, a report is generated using the Move2Perform software providing a movement and injury risk baseline.

This report also helps to generate a program to specifically address the identified needs.  The program would address movement deficiencies through corrective exercises, and also include options for strength training, power production, cardiovascular conditioning, and more.

Follow up appointments are an option to track progress throughout the year and increase the intensity of the program as needed.  Or if you just need a few pointers to get started, we’ll see you again next year.

Give us a call at 231 421-5802312231 590-1364 or shoot me an email:  joe@elitepttc.com for more information including how to get started.

 

 

 

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.