Articles & Resources

In this interview, Art discusses his new book, "Barefoot in Boston: A Practical Guide to Achieving Injury Resolution and Enhancing Performance", as well as discussing some research on barefoot walking and training versus wearing shoes, what to look for in minimalist shoes, how he has incorporated barefoot training with his basketball team, and much more..(including how to take a hack saw to a basketball shoe!)

** This interview is under the members section and can only be viewed with a membership to this site but with fresh information being posted weekly along with interviews from Gray Cook, Dr. Stu McGill and others, membership clearly has it's privileges!

Click HERE to read this great article by Mike Reinhold.

Check out what Indiana Pacer's Strength & Conditioning Coach has to say about life in the NBA.

Click HERE to read this article.

Shawn Windle - Indiana Pacers

by Art Horne

Over the past several years I have made the integration of Sports Medicine care and Strength Training a core principle within our department.  This is relatively a new concept as strength coaches and sports medicine professionals have often been pitted against each other by sport coaches, athletes and often themselves.  Although this new path to better health and performance is clearly thwart with challenges, there are some simple steps that both departments can make that immediately impacts BOTH the health and performance of the student-athlete and leaves both professionals looking better in the eyes of all those around them.  Below is a question from a colleague that I wanted to share publicly.  In order to answer his question, as well as many others, it is my intention over the next few months to describe and share with you the many small steps that any college or university can implement in order to provide an improved care and performance model.

Question:

I would like to start out by saying that I really enjoy watching the videos and articles that you have released in reference to the approach you use at Northeastern University to bridge the gap between strength and conditioning and sports medicine. I am a strength and conditioning coach for a small Div. I college and also have a background in athletic training. I wanted to see if you could provide more insight as to how you take the results from the screening and testing that you do and then implement them into your programming. We screen our athletes, which consist of the FMS and a couple more orthopedic screens that we feel are applicable to the particular sport (Modified Thomas Test, Bridge w/ Leg Extension, Reach/Roll/Lift, etc….). How would you then use the results in the development of your program? Do you give each athlete individual work or do you use a systematic team approach addressing common faults or dysfunctions? I am torn as to what to do because as I am sure you are familiar with, time I have to spend with athletes is limited and getting them to comply with performing certain exercises on their own time can be very difficult at times. Any advice or examples that you could provide would be very beneficial. Thanks in advance for your time.

The Language Barrier:

The first step in any “relationship” is being able to understand what the other person is saying, and there is no greater communication gap in existence than the one that currently exists between Sport Medicine and Strength Training professionals.  In order to discuss dysfunctional movement patterns, corrective exercises, rehabilitation goals or substitutions/alternatives for strength exercises both parties must share a common language and then demand continuity with these terms.

I remember many years ago speaking to one of our staff members about a particular athlete and suggesting that she speak to the strength staff about an alternative exercise for an athlete who was suffering from some low back pain.  When asked what I recommended I immediately suggested a more spine sparing approach to her current “core strengthening” exercises and that we recommend McGill’s “Birddog” exercise which has been proven to be safer on the spine than the flexion based crunches the athlete was accustomed to in the weight room.  Not knowing what a “Birddog” exercise was, I quickly demonstrated the exercise to my co-worker at which time she smiled and said that she was familiar with the exercise but learned it as a kneeling opposite arm-leg reach.   Confused, (since McGill made the exercise famous as part of his “Big Three”) I asked another staff member what the exercise was that I was performing to which he replied, “a quadruped contralateral reach.”  Now slightly irritated (but happy that the name at least described the movement), I bolted over to the strength room to inquire about their knowledge of Stuart McGill, his research and what they called this particular exercise.  To my surprise McGill’s work had never been heard of and that this particular exercise was programmed as a “Flying Superman” within the student-athletes performance training.  It became painfully clear that the first order of business was getting both staffs to speak the same language, both within each department and across them. 

Because most of the members on your staff (both Sports Medicine and Strength) have come from a variety of educational backgrounds, continuing education courses and levels of expertise, it is important to begin formulating a shared exercise and assessment language in order for civil conversations to first take place.  By investing only a small amount of time and addressing this often overlooked, yet integral first step your staff will begin to enjoy the following benefits:

1. Provide improved services to your student-athletes.  Imagine the previous example taking place and a student-athlete approaching you for help with their kneeling opposite arm-leg reaches.  Now, the name basically tells you exactly what is needed, but imagine you knowing the exercise as a different name and perhaps emphasizing a different teaching point altogether.  Would you teach the athlete how to do the exercise “your” way? Find the athletic trainer who wrote the rehabilitation program to help them out? Or tell them that you’re sorry but you don’t know what they should be doing?  In any case precious time is wasted and as a fellow athletic trainer, this is something none of us has enough of.  In addition, you can imagine the frustration of the student-athlete witnessing your staff stumble through the most basic exercise descriptions!

2. A shared language allows staff members to be interchangeable because now each staff member is calling the same exercise the same name and teaching it while emphasising the same teaching points.  This allows athletic trainers to jump in and help with all rehabilitation programs, and not just “their own teams” as well as provide continued care during an athletic trainer’s absence (sick day, vacation or travel with another team).

3. Continued care and coaching along the performance continuum.   Here’s where the magic happens: whether the athlete your provide care for is one week into their ACL rehabilitation or the starting point guard for the basketball team pushing 300 pounds in the squat rack, the exercises if named the same, taught the same and progressed the same all fall along the same care-performance continuum.    Let’s examine the above example to really understand the power of the shared language.  Imagine on the far left hand side the student-athlete one week post-op ACL reconstruction and on the far right side the starting point guard pushing serious weight and performing at the highest level.  Moving along the continuum from left to right the athlete will experience and undergo exercises such as: Quad Sets, Straight leg Raises, Clams, Glute-Bridges, Mini-Band walks, Wall Squats, Body weight squats, Lunges, Box Jumps, and the list goes on.  At some time this athlete will be in the weight room and not be able to perform the Olympic lift for example programmed for the team that day but can certainly do pull-ups, side bridges and a number of other exercises that the strength coach has put in place during any particular phase or block of training.  If a shared language exists, the athletic trainer and the strength coach can have a civil and meaningful conversation about where the athlete is and discuss and implement substitutions for exercises that are not appropriate for them all while progressing the athlete safely along this care-performance line.  Not to mention, many of the rehabilitation exercises can be implemented safely within strength training program as substitutions for advanced exercises thus minimizing the athlete’s daily rehabilitation time and allowing the athletic trainer who is providing care for this athlete more time to focus on other athletes or say for example address soft tissue restrictions with the same athlete during “rehab” time which often requires a one-on-one time period, thus making their strength training time much more effective.

Now, some people may say that a couple of exercise names or switching names from time to time is really not a big deal.  Perhaps not.  If you only care for one team, perform all the rehabilitation by yourself and no other staff member helps you, then you can certainly come up with your own language.  But imagine for a moment a car factory where all the parts are all called different names, put on in different orders and actually assembled with various degrees of precision.  Would you ever buy a car from a factory like this?  The answer is a resounding no - so how can we expect our student-athletes to buy in to what we are saying if each staff member is saying something different?  By having an Exercise Pool to draw consistent language from, the number of benefits far outweigh any possible downside while also reducing the amount of confusion among your own staff and encouraging an atmosphere of shared help and patient responsibility. 

Next week: How a shared language during initial assessment can limit overall injury rate and increase performance immediately.

Desmond Santiago

Puerto Rico

Desmond Santiago began his career as a trainer in 1997 in one of the best gyms of that time: The Caparra Fitness Club. Later in 1999, Desmond ventured to Power House Gym where he worked independently and quickly became one of the most sought out trainers in the gym. In the year 2001 he founded Optimum Body Performance. The aim was to create a team of professional trainers all certified and well prepared to provide top-notch service to clients, designing and providing exercise and fitness programs, geared toward the goal of the clients.

Desmond‘s passion and continual pursuit for quality, brought him to establish his own training facility in the year 2005. There he created and implemented innovative and successful performance enhancement training programs for his athletes and members. Desmond soon developed a reputation and established himself as the best in Puerto Rico, allowing Optimum Body Performance to open its second facility in the year 2008 at the Natatorium in Central Park, Puerto Rico.

Desmond is a National Academy of Sports Medicine (NASM) Performance Enhancement Specialist (PES) and a National Strength and Conditioning Assoc. (NSCA) certified Personal trainer (CPT). Trained and mentored by some of the best performance enhancement Coaches in the US.

Desmond Santiago currently serves as the strength and conditioning coach for the Puerto Rico National Basketball Team, as a writer for ESPN Deportes “La revista”, as a speaker and educator in the fitness and performance enhancement industry, as a performance enhancement coach to athletes of all levels , but above all as the president of Optimum Body Performance, where he ensures OBP lives up to his Vision and Mission.

Click HERE to read Charlie's Article.

by Art Horne

Below is an excerpt from Barefoot in Boston examining why some shoes may be good while others are just plain bad.

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So what do “fancy” shoes have that ordinary shoes do not?

The answer may be found in a 2001 study by McKay.  Although McKay’s group did not set out to determine the manufacturing differences between lower end and high end shoes, their findings did point to one feature within many athletic shoes that may very well be to blame. In this study researchers sat courtside and watched over 10,000 recreational basketball participants as they played to determine the rate of ankle injury and examine risk factors of ankle injuries in recreational basketball players. Each participant completed a questionnaire which included questions related to: age, sex, height, weight, protective equipment (ankle brace, mouth guard, etc), shoe type (cut low, med, high), age of shoes, whether the participant performed a warm-up prior to playing, and of course questions identifying their injury history.

After analyzing the data, three risk factors emerged:

1. Previous ankle sprain – those athletes with a previous sprain were almost 5 times more likely to sprain again.

2. Players who did not stretch prior to games were 2.6 times more likely to injure their ankles then those that did.  

3. Players wearing air cells in the heels were 4.3 times more likely to injure an ankle compared to those with no air cells in their heels. (It may be hypothesized that air cells located in the heels of basketball shoes decrease rear foot stability, which may in turn increase the risk of ankle injury.)

“So let me get this straight; shoes with air cells, which were placed within the shoe to help the athlete absorb shock or jump higher actually increased their risk of injury?” 

I think it is also interesting to note that there appears to be a protective mechanism to stretching prior to playing and in fact the authors note, “a relation has been shown between tightness of the calf muscles and ankle injuries suggesting that tightness of the calf muscles may be responsible for ground contact of the feet in the supinated position, with a high risk of ankle sprain.” Now I’m not the smartest guy in this metaphorical room, but anyone walking around in traditional basketball shoes all day is sure going to experience gastroc/soleus tightness via the exceptionally built up heel height compared to forefoot sole height.

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I remember reading this study when I first took over the care and performance training for our basketball team and realized that prevention of basketball injuries and resultant time lost due to injury meant so much more than standing on a buso ball three times a week with their eyes closed.  If I was going to have a true impact on preventing lower extremity injuries and pain I was going to have to get into our athlete’s lives – literally.  The following are recommendations and actions which we have taken in an effort to curb ankle trauma ( the leading cause of injury according to Randall Dick’s 2007 study, Descriptive Epidemiology of Collegiate Men’s Basketball Injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 Through 2003-2004).

1. STOP BUYING SHOES WITH AIR FILLED CELLS! There is really two pieces in play here. One - the fact that you’re much higher off the ground inherently makes “tipping over” much easier (ever walk behind a girl wearing stilettos on a Saturday night and witness her ankle flop about? Makes me cringe just thinking about it) and two – add an unstable surface(a pocket full of air – may as well just duck tape a dynadisc to the bottom of your shoe)  to those stilettos and you have the perfect design for the inversion ankle sprain.  

2. STRETCH: getting athletes to do this for the 10 minutes prior to practice is easy since either the athletic trainer or strength coach usually is barking orders, but getting athletes to understand the importance of ankle mobility and dorsiflexion and then addressing it throughout the day is a challenge all by itself.  Providing slant boards or other assistive devices in their locker area or lounge provides additional opportunities for athletes to stretch during the day.  If you want to address this problem you must first address the environment and buy placing a few slant boards in the athletic training room, weight room and locker/lounge areas will surely remind them that this is an important concept.

3. ADDRESS PREVIOUS INJURY:  Previous injury always predicts future injury. This should be addressed on day one or during your annual pre-participation screening times.  Any athlete with prior injury, at least in my opinion, should be further evaluated that day or within the first week and have their limiting factor addressed.  These athletes are going to get hurt again – if you don’t have time to address their problem now, how are you going to have time when they are injured and out for weeks?

4. GET INTO THEIR LIVES ON A DAILY BASIS:
a. Encourage your athletes to stop wearing high heels during the day – yes, that’s you big fella. Basketball athletes in general, typically enjoy wearing basketball sneakers during the day in addition to their time on the court.  If you’re ever going to address gastroc/soleus tightness or loss of ankle mobility you have to take away what’s shortening them.  Your ten minute stretch matched up against a day heel elevation doesn’t stand a chance. 
b. Get them out of their shoes altogether.  Obviously this is difficult to and from classes and on the court, but during strength training time be sure to take the opportunity to get the guys moving and grooving without the shoes, ankle tape and braces.  You’ll find that the body has a way to mobilize a stiff ankle all by itself if you just put them in positions that allow for these motions without restrictions.

Learn more about going barefoot, training barefoot and how incorporating a few barefoot strategies into your own training program will help resolve your current injury woes by reading BAREFOOT IN BOSTON.

Click HERE to view Brian McCormick's article.

Click HERE to read this article by Coach Brian McCormick.

by Eric Gahan, MS, ATC, CSCS, RKC

Rehabilitation of the athlete consistently challenges athletic trainers to expand to new and exciting rehabilitation techniques.  It is widely accepted in the athletic training community that an integrated approach to rehabilitation is what gives the modern athlete the strength and coordination to have a safe return to sport, and quite possibly a preventative approach to future injury.
An integrated approach examines the incorporation of core strength with both upper and lower extremity rehabilitation.  Incorporating movements into rehabilitation that challenge the area of pathology with areas that are healthy and strong.

Integration of kettlebells is a dynamic functional rehabilitative way to help to maintain mobility, build stability, and build strength in your patient population.  Mobility is defined as the ability to move freely and easily.  Stability is defined as not likely to change or fail.  In our world of rehabilitation this means the ability to withstand a potential force and finally the definition of strength meaning physical power or energy.  With the integration of ketttlebells we can get all three for the price of one.

Kettlebell Dead-Lift:

Begin with the use of the kettlebell dead-lift.  This movement is the foundation of the kettlbell swing.  It all starts with the hips.  This movement helps to pattern the hip hinge in patients to help protect their back.  Saving patients back from stresses should be on every clinicians mind.  Second is the grip on the handle of the kettlebell.  With a tight grip this activates the inner and outer core and also activates the rotator cuff of the shoulder and finally the latissimus dorsi in the back.  This basic strength movement can help pattern mobility and stability in all basketball athletes.  It can help to build strength and stability while down low in the post while the big men are battling for that last second rebound to win the game.  Can you ask for any more of an integrated exercise?  Why yes you can, please keep reading!

Video of KB Deadlift (front view)

Video of KB Deadlift (side view)

2 Hand Kettlebell Swing:

Now that you have patterned the movement of the kettlebell dead-lift, move on to the kettlebell swing.  The kettlebell swing incorporates several aspect of the rehabilitation for your patient.  First, your patient worked so hard on the glute bridge in the beginning stages of your rehabilitation, activation of the glute complex to decrease activation in the hamstring musculature. The patient then turned prone and worked on building that prone plank.  You had that patient performing prone planks for a minute or even more.  The core was on, the latissimus dorsi engaged.  Little did you know you were already helping to build stability and strength for your patient to perform the kettlebell swing.  The kettlebell swing is your answer to a dynamic functional glute bridge and plank with activation of the latissimus dorsi.  We all know through reading the literature posted here on BSMPG and through Stuart McGill that the latissimus has an active role in core stability.

The Kettlebell swing = Hip hinge and glute bridge + plank + latissimus dorsi activation in a dynamic functional movement pattern.  The kettlebell swing is also a wonderful tool to build on metabolic training.  At times the basketball athletes can raise the heart rate to 70-80% of max heart rate while reaching the final seconds of a minute of continuous 2 Hand swings.  This can help to pattern the ability of the athlete to transition on the court.  It can also help to train them in maintaining perfect form while under the demands of stress.

Video of Kettlebell Swing (front view)

Video of Kettlebell Swing (side view)

Begin to work these kettlebell movement patterns into your training program for all your basketball athletes and begin to see the huge benefits that can be gained from working with this tool.