Articles & Resources

Treating Anterior Knee Pain In The Basketball Athlete by Art Horne

Posted by Boston Sports Medicine and Performance Group on Sep 21, 2010 7:47:00 AM

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Topics: Art Horne, Health & Wellness

Anterior Knee Pain In The Basketball Athlete by Professor Paul Canavan

Posted by Boston Sports Medicine and Performance Group on Sep 21, 2010 7:46:00 AM

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Topics: Health & Wellness, Paul Canavan

An Interview With Stu McGill

Posted by Boston Sports Medicine and Performance Group on Sep 21, 2010 7:45:00 AM

Dr. Stuart McGill talks basketball backs, capacity and the importance of the hip hinge in his most recent interview.

Interview by Art Horne

Stu, in both your books and dvd’s you emphasize this concept of “capacity” and it’s importance, yet when discussing with sports medicine and strength colleagues this concept is still either misunderstood or not truly appreciated.  Can you discuss this concept briefly and also touch upon how a collegiate basketball athlete can protect their “capacity” during the course of a day while attending classes, etc during a normal school day so that they are either able to be productive during a therapeutic exercise program later in the day or able to train at a high level without getting hurt?

Answer: Athletes have a capacity for work. On one hand it is important for most players to dedicate the majority of the training capacity for basketball. This is well understood. But consider the player who has an injury history, and the injury must be managed. Lets use the example of a flexion intolerant back. The BB player sits on the bench then, when standing up, takes a while to gain full extension of the spine and hips because of stiffness, discomfort, or even pain. Sitting (spine flexion) stole some capacity. Now consider off-court activities such as computer work (and more sitting) or driving to practice (more sitting with spine flexion). This used some of the spine capacity to train so that they will break into pain sooner during the BB training session. I would have to say that most flexion intolerant BB players I have consulted with did the damage in the weight room. They did not have the discipline of perfect form during squats and cleans, and ended up damaging the spine discs with flexion motion. The load associated with the squat and clean on long body levers really exacerbates this situation. So the original injury mechanism was repeated flexion bending of the spine under load. Subsequently, they are limited in the number of bending cycles their spine can undergo – this is their capacity. It is compromised. Now consider the player who brushes their teeth or ties their shoes with spine flexion. They just used up some of the tolerable bending cycles performing a non-BB activity. Discipline of movement form off court allows more of the capacity to be available for BB training. This is a concept that can be extremely important in getting nagging injuries better, and in enhancing on-court performance. Coaching this goes beyond BB specific training! 

I often find most freshmen college athletes are not able to disassociate their backs and hips when arriving on campus to start a training program.  Can you discuss the importance of the “Hip Hinge” in the basketball athlete and how you would teach it to an incoming athlete or someone rehabilitating from injury?

Answer: Athleticism comes from having great athletic hips – jumping, running acceleration, and cutting are all enhanced. However, for the hips to fully express their athleticism, the spine or core must be stiffened. Consider the vertical jump off a single leg takeoff. Here the power comes from explosive contraction of the hip extensor. But the core must be stiffened at this instant to prevent an “energy leak”, and a loss of power that should have been projected into the floor.  So, the ability of the athlete to train hip motion with a stiffened core is paramount for enhancing on-court performance. This is also essential for off-court strength and speed training, where emphasis on hip power generation with a stiffened core enables a higher training load with more safety. Thus, the fundamental movement pattern we call the “hip hinge” is needed.
Here we start standing, the palms are rested on the front of the thighs. Stiffening the core to prevent spine motion the athlete begins the squat motion with the hands sliding down the front of the thighs, and the hips travel back. As the hands reach the knees, carry the upper body weight down the arms resting on the knees. Now the knees should be over the mid foot. If they are not, pull them back by moving the hips back.
Now when standing up, simply slide the hands up the thighs and pull the hips forward. But ensure the  knees remain over the mid foot. This ensures a perfect hip hinge. It enhances performance and safety!

In your video, The Ultimate Back: Enhancing Performance you discuss the importance of an Anchor Point or in Latin a “punctum fixum” – can you discuss exercises in which basketball athletes must be clearly proficient in prior to engaging in rotational medicine ball exercises?

Answer: This also goes back to the previous question. Explosive hip motion requires the core to be stiffened or locked. Try a lateral stepping drill with a soft core and the hips are slow. But then stiffen the core and the hips are able to snap and explode. This is because the core is now the “fixed point” for the hip muscles to pull from.
For me the rotational med ball exercise is a slightly different issue. I have been brought in as a consultant to Pro teams after the players started with back pain. A previous consultant had them throwing med balls sideways explosively, into a wall. They damaged their discs with repeated twisting. They did not understand that the discs will damage doing this. The only way to protect against this is to rotate about the hips and not the spine. The core muscles are designed to stop motion, not create twisting motion. The hip joints and muscles are designed to be the power generators.  So here, a fixed core prevented injury and allowed a higher tolerable training capacity. But it also increases athleticism too.
 
In general, what logical progression that you would follow when dealing with a freshmen basketball athlete based on the above? (example: front bridge then front bridge with 4-point lifts, to prone touches, etc).

Answer: This really depends on the athlete and as you know I can only decide this after I have performed an assessment to determine the balance between their various fitness attributes. I need to see if any movement flaws exist which need correction. Then work on hip mobility and power generation and stability in the core. Then move on to endurance, strength and full power and speed production. This process is detailed in my “Ultimate back fitness and performance” book.

You mention the importance of the latissimus dorsi as a stabilizer throughout the video, yet many strength coaches and basketball athletes train them primarily as a pulling muscle through chin-ups and not as the massive lumbar stabilizer that you make them to be. Can you expand on their importance in preserving the spine during strength training?

Answer: This is an interesting question and one of culture. In Russia you would not be even asking this question because emphasis on the lats is ingrained in their training culture. For example, when performing a bench press, “bending the bar” through the sticking point with latissumus dorsi is common in Russia yet I have to coach this in North America. The same can be stated when squatting with a bar across the shoulders. At the bottom of the squat the athlete focuses on hip abduction together with lat contraction. This stiffens the spine, adds back extensor torque, and facilitates the hip extensors. It results in a higher lift with less risk of injury. Again, this is not well practiced in North American training but is a staple in Russia. This is just one technique where performance is enhanced together with a reduced injury risk – a real win-win.

Obviously with basketball athletes there is a concern with long levers and subsequently tall spines, what exercises should strength coaches either avoid or be very strict when prescribing and coaching?

Answer: Again, I have to state that I could only answer this after assessing the athlete. But as a general approach I would probably avoid deep squatting a 7 foot tall center and focus on creating hip power off one leg over the short range to mimic a foot plant with a single leg takeoff. Again – this is short range hip extensor explosion with a stiffened core. That’s how the great ones take off from the top of the key and dunk a BB!


Thanks for your questions Art – keep up your great work. Remember I learn from you with your “on the court experience” as much as you learn from me with our mechanistic investigations.


For more information, or to order McGill’s dvd’s and books, visit backfitpro.com.

Topics: Art Horne, Health & Wellness

Seeing The World Through The Hole In A 45 Pound Plate

Posted by Boston Sports Medicine and Performance Group on Sep 21, 2010 7:40:00 AM

By Art Horne 

 

It was first described to me during the summer of 2005 when I visited my good friend Mike Potenza, who was working at the time as the S&C coach at the University of Wisconsin for both the men's and women's ice hockey teams (by the way, both teams won national championships that year).  He introduced me to Steve Myrland, a former strength and conditioning coach at both the professional and collegiate level and a guy that I now describe to others as simply "the strength Zen master."  While having coffee one morning, Steve was describing to Mike and I the frustration he was having with a college strength coach who only "saw the world through the hole in a 45 pound plate," and the coach's inability to see and embrace the importance of movement, function and anatomy.  Now, all of us have taken a 45 pound plate from the rack, lifted it to squat bar height, peered through the tiny 2 inch hole and loaded it up onto the bar.  The view just prior to loading is exactly what Steve was talking to me about.  The world, (or weight room or even more simply your athlete's performance continuum) has a very limited offering if only viewed through this hole, compared to the massive area that the plate encompasses, which basically equates to the entire rest of his or her development.

Up until that point in my very young career, I considered myself a "strength" guy.  If it wasn't heavy, it wasn't training. If it didn't have chains hanging off of it, or if your training partner didn't have to pull the bar off your throat, then you simply weren't working hard enough.  About two minutes into our conversation I realized that I was one of the strength coaches that Steve was talking about.  I guess the hole in the plate which I was coaching through at the time never allowed me to see the epidural injections that some of our athletes were getting due to their back pain, or the multiple ACL injuries our female athletes were incurring on a yearly basis.  Steve challenged me to remove the dense piece of iron that obscured my vision and allowed me to evaluate and prescribe a training program that reflected the whole athlete (with respect to his/her sport, previous injury, movement impairments, volume at practice or games, current and future goals and yes, even strength development) and not just the athlete I once saw through the hole in the 45 pound plate.

Now, I'm still a strength guy, but my view on strength development (what really matters - a future blog) vs. numbers improvement (by any means necessary) has changed dramatically.  The next time you load the bar and you peer through that tiny hole, I simply challenge you to think about athletic development in its totality.  If all you have is a hammer then everything looks like a nail; if all you do is load plates, then the window in which you have viewed the world, and the development of your athletes have been limited.  Believe me, the world looks a hole lot different when you begin to look at it with a pair of fresh eyes; or at least a pair not obscured by only iron.

Topics: Art Horne, Health & Wellness

Training Basketball Players

Posted by Boston Sports Medicine and Performance Group on Sep 21, 2010 7:31:00 AM

By Charlie Weingroff, DPT, ATC, CSCS


Matt Sharky in the UK has been given a great opportunity to direct the training of his country's top junior basketball players from U19 down to U13. This is a tremendous opportunity to represent his country and develop young people that regularly populate the D1 teams in the United States.
At his request and my privilege, I will provide some prevailing thoughts that I think are critical in training basketball players.

1. Mobility and Stability
As I warned Matt, my views may not seem as basketball-centric as some would expect. I think athletes are athletes, and from a foundational level, human movement is the same for everyone involved. Obviously the Joint by Joint prevails, but there are singular impacts to the Joint by Joint that I think are more prevalent in basketball players.
One is the height of the players. Bottom line is that a longer lever is harder to control. No matter if it's a long femur, longer humerus or spine, length requires more stability. When the muscular and neuro-muscular systems are challenged as they are in these under- or poorly training individuals, the body will rely on bony approximation and ligamentous strain for stability as well as shifts in tone away stabilizers, creating tension in mobilizers such as the hip flexors, hamstrings, calves, etc., all the places we typically see "tightness."
Coming from the 5 foot nothing walking fire hydrant, having long levers is not the devil's spit. Longer levers typically come with bigger hands (better to grip you with) and bigger frames like shoulder girdle which provide better angles to buttress the spine.
The second point regarding mobility and stability is that most basketball players are what Gray would call Over Powered Athletes. These folks have a Ferrari engine in a ‘72 Beetle frame. The gap between high level basketball players and also-rans is very, very large. The guys that Matt is going to be working with are gifted. They have inordinate fast-twitch fibers and are beyond capable of outrunning their foundational movement dysfunction. Basically, they can still run and jump through the roof at elite levels despite the destruction they are doing to their joints. Now with the adolescents Matt is going to be working with, he can impact their strength and power. But even the U19 guys, he might already be looking at 35-42″ verts. They aren't going to be going any higher. Their durability is going to be where he can help the most. He will have to respect that even when/if strength and power can be enhanced, it must be within the framework of their Functional Performance Pyramid. Whether it's using the FMS or not, I expect training mobility and stability will be the first governor on his player's success.

2. Cervical motion
Buddying off of t-spine limitations that you would expect to see above, one of the most underrated aspects of performance is cervical motion. Taller people, much less players, live much farther away from the world. They have to bend over and look down a lot. That forward weight shift in the upper quarter adds up. The documentation of inter-regional dysfunction with poor cervical motion is clear.
I also think that tall basketball players shield their height from some sort of shame with the upper-crossed posture. I think in some ways they are embarrassed of their "differences." This biomechanical and emotional stress has very underrated effects on mobility/stability and performance.
Check on all of your athletes, clients, and patients if they can EASILY reach their chin to the chest. Get their head almost parallel to the floor looking upwards. Can they turn their head and drop their chin EFFORTLESSLY to touch their clavicle. If they can't, I firmly believe you are leaving inches on the Vertec wheels on the platform, and seconds in the lane. The neck matters for a number of reasons: fascial length tensions that span the entire body, breathing function, spinal stability, peripheral vision, reaction time. If the neck is off, the rest of your body is not optimal. A tight neck is not normal, and it is not efficient. Certainly we will see this more with basketball players.
Get a manual therapist on your team to get the neck on the swivel, and then mobility/stability training and proper breathing training is what you can do to lock it in.

3. Tall Spine
Certainly this principle applies to everyone, but the t-spine is a major offender again from the length and typical in-game postures of a basketball player. I think the T-Spine is as big a part of this ideal stereotype of spinal stability as it can impact the neck as above, the scaps, the low back, and the ribs as they would pertain to breathing techniques. Not only do we need t-spine mobility, but the tall spine posture from the crown of the head all the way down to the buttcrack should be long and stiff during all stability training. Maybe even call it T-spine stability. Longer levers are harder to control, but maybe it means just less or smaller progressions in external load. Long levers are never going to get someone to APF Elite or up on the board for top benches and squats. But that doesn't mean they aren't strong.
This principle holds for anti-spinal movement training and level changes. One of the best teaching tools for this is what I call the Frog Squat, where you take a DB or KB and hold it in goblet position and let the system drop you into a squat. All the while you are packing the neck in and getting tall in the spine. Every push into your spine should get you deeper into your hips. It's a nice teaching tool for the tall spine along with posterior pelvic tilt in all anti-extension positions.
As basketball players are often poorly educated in their training, need it be said that flexion training is complete nonsense even more so when you are taking a larger lever into a bad place. This equals more damage and an even larger struggle to crack out of the neuromuscular nut.
I would also like this principle to govern the limbs. Less load, FULL length through mobile segments of the shoulder (pull-ups, push-ups, bench press), hips (all level changes), and ankles (Deep Squat training). Especially in novice trainees, strength training should be mobility training inherently. Get LONG. Control length by going through length with limited load. Longer limbs have bigger risk/reward. Weak or inefficient athletes have "heavy" enough limbs.

4. Knee Performance
This is maybe what some are expecting when talking about a basketball player. Obviously knees and ankles are common injuries. And through the Joint by Joint, we should believe that ankle mobility, hip mobility, and core stability should beget good knee stability. I think that's true, but it's not the whole story.
The problem is that the basketball jump shot is inherently wrong everywhere. Heels are off the ground. Knees jut forward. Minimal hip hinge. Forward arms and head. If you saw this in the Deep Squat, it would look horrible, and in fact, I would gamble aggressively that most competitive basketball players not exposed to good training would score a 1 if they were pain-free on the FMS Deep Squat. But what is crucial in the jump shot is to maintain a straight up line of verticality to elevate over the defender's outstretched arm. You HAVE to use a bad squat to shoot successfully. And with that in mind, the knee pays the price. Poor surrounding mobility and stability AND knees jutting forward instills tremendous compression retro-patella and posterior meniscus. As the knee continues to flex, there is shearing of the femoral head against the back of the patella. Here is the bony stability that I mentioned above. Try this yourself. Just jut your knees forward without sitting back. Your knees will talk you out of depth. This crash is what an NBA rookie has already done maybe a billion times in the jump shot.
With this in mind, I would ask you to consider the vertical tibia in the box squat, dead lift, rack pull, and split squat as the evidence clearly supports deloading the knee with those techniques. There are both 1- and 2-leg options with the vertical tibia, and as I've mentioned before, loading is barely even necessary. I just came back from dinner with Bill Foran among others here @ Pre-Draft, and he described teaching Shaq to squat when he came to Miami with just all bodyweight.

The beauty of this training strategy is that I believe that the hip-dominant level changes create a posterior glide of the femur away from the retro-side of the patella, and when the real life movements of the real world are attempted, the compression has been attenuated.
While I am sure most would agree this is useful to restore the painful knee to non-painful, I also believe that this technique will improve performance. Clearly the posterior chain is a limiting factor to a quad-dominant squat, so if we can adjunct quad-dominant and hip-dominant choices, skewing power to quad- and strength to hip-, I think there is an accelerated balance and restoration of knee and spinal joint centration. With ideal centration in these "stable" segments, I have every reason to expect performance to improve and stave off pain. I firmly believe that folks that do not have pain simply do not have pain.........................yet.
My recommendations in this topic are box squats (high if necessary and with specialty bars to keep the bar high), deadlifts or more likely rack pulls starting at a height slightly lower than your dowel, split and RFE split squats with a long stride and vertical tibia (90/90 on the bottom). I do not think basketball players should catch the OL. The first and 2nd pulls meet these standards. The catch does not. A 1-leg unsupported squat can be done with a vertical tibia, but I'm not sure many individuals can do it. 1-leg unsupported can also be performed with a box squat technique, but these do not seem to be very challenging. I think most people just plop if not coached well.
Certainly these techniques have little honor for ankle mobility, so this must be maintained elsewhere, as well as integrated the full Deep Squat movement with such options as the Frog Squat or Toe Touch to Squat.
These suggestions are not an excuse to load up 3,4,5 wheels on a side, lock the bar low on your back, and sit back into an above parallel squat. That is trash. That technique is just an excuse to crush your spine and demonstrate that you don't belong in that squat.

5. Strength/Power
Perhaps less rhetoric and theory and more meat and potatoes, these are the exercises I think have most application to fundamental movement and performance for basketball players or any individual.
Flexion-based: Deadlifts, 1-leg Deadlifts, KB Swings
Extension-based: Split Squats, RFE Split Squats
Rotation-based: Chops, Lifts, Turkish Get-ups
1-leg based: 1-leg Unsupported Squat, Step-ups
Squat-based: Squats (tread lightly with load)
Shoulder-based: Push Press, Pull-ups, Push-ups, Inverted Rows, Bent over rows.

Topics: Health & Wellness, Charlie Weingroff