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Corrective Exercise Specialist, Bill Hartman talks training the tall guys and implementing strategies to keep your athletes healthier longer

Posted by Boston Sports Medicine and Performance Group on Jan 23, 2011 9:48:00 AM

by Art Horne

everything basketball


Bill, can you describe some common themes that you’ve observed when it comes to evaluating and treating the basketball athlete?

Absolutely.  Most of our basketball players initially present with very poor lumbopelvic stabilization.  Because of the this you’re going to see compensations associated with an anterior shift of their center of gravity associated with an anterior pelvic tilt.  Think of the classical Janda lower crossed syndrome.  The portion of the oblique that controls the pelvis will tend to be lengthened and weak, the glutes will be rendered ineffective because of the pelvic tilt, hamstrings may test stiff or short, and ankle mobility into dorsiflexion is reduced.

Shifting the center of gravity forward puts these athletes in a constant state of active plantar flexion which will result in relative weakening of the toe extensors and dorsiflexors.  Every squat, cut, or jump becomes knee dominant.  What you end up with is a quadriceps dominant athlete with potential for multiple injuries from lower back/sacroiliac problems, to patellar tendinopathy, to Achilles tendinopathy, or even plantar foot pain diagnoses.

Depending on severity of the pelvic tilt, you’ll see a proportionate loss of hip extension, hip rotation, especially internal rotation, and adduction.  Not only does this affect performance in general, but the resulting deficits can cause premature wear’n’tear on the hip joints themselves as a bony block can be created by the altered acetabular angle associated with the pelvic tilt.  This doesn’t even consider the soft-tissue adaptations that will occur.

Hip external rotators will lengthen and weaken, adductors will become stiff or short, quads will stiffen increasing loads on the SI joint, hip joint, and the knee. 

When it comes to training college teams, I’m always looking for the most bang for your buck.  What “global” or “general” corrective exercises can strength coaches, athletic trainers and physical therapists employ to help alleviate these dysfunctions?

It basically comes down to emphasizing  opposing muscle groups to that get overemphasized during practice and play.  For instance, agility, shooting, and jumping all place huge demands on the quads and knees.  Your corrective elements should try to shift emphasis away from the knee and toward the hips.

First this may be a little more specific but use your warm-up time for corrective purposes.  Active forms of hip extension like glute bridging progressions, active hip internal rotation, and active adduction, which often gets ignored, will go a long way to improving and maintaining hip mobility. Without this mobility, your chances of even accessing the necessary hip musculature is much less.  Make sure to reinforce a stabile spine throughout.

Prioritize restoring and maintaining lumbopelvic stability.  If you don’t, the adaptations up and down the kinetic chain will persist no matter what exercises you throw at them.  Many times we’ll have to start simply with floor exercises in supine, quadruped, and sidelying to teach our athletes how to recruit the core musculature, especially the external oblique, and hold pelvic position/neutral lumbar spine.  Most athletes tend to be rectus abdominis dominant.  You’ll see this in a typical plank exercise with rectus dominant athletes showing a large thoracic kyphosis.  This often gets ignored and the faulty pattern gets reinforced.

Emphasize posterior chain.  Box squats with the athlete pushing the hips back throws the emphasis on the hips versus the knee, so we can still get our athletes strong and emphasize weak points without the concern of adding overload to the knee.   Romanian deadlifts, low cable pullthroughs, and even back extensions can have corrective properties if proper movement patterns such as hip extension are reinforced.

Split stance exercises like split squats, Bulgarian split squats, and reverse lunges allow the athletes to work on hip mobility in hip flexion and extension as well as improving stability.  Again, a vertical tibia is essential to prevent adding to knee stress.  Make sure you’re getting good hip extension of the trailing leg.  Asymmetrical loading is a great way to enhance trunk stiffness/pelvic stability that you’ll need to gain hip extension mobility.

I’d also include a little bit single leg stance activity.  It’s not about getting incredibly strong on a single leg but more about enhancing stability.  I don’t buy the play on a single leg, train on a single leg mantra.  Overemphasize single leg work and you’ll end up with athletes that can’t handle the high force conditions associated with basketball.  Your primary exercises should be double leg.  Single leg work is merely a supplement.

What is the one thing most people miss when dealing with knee pain in the basketball athlete?

The knee pain is a symptom of the problem, not the problem.  Focusing on the knee and not the influences on the knee will only result in ongoing knee pain.  We know that a lack of lumbopelvic stability, hip rotation, hip abduction strength, and hip external rotation strength will all contribute to overload on the knee.

Prospective studies on anterior knee pain show these deficits develop in athletes with anterior knee pain.

During your presentation at the 2010 Basketball Symposium hosted by BSMPG you touched upon the importance of breathing and beside the obvious need for breathing, can you elaborate on the relation to performance?

We’re really emphasizing developing better breathing technique for a couple of reasons.  Our primary concern initially was to restore effective breathing to strengthen the diaphragm and improve lumbopelvic stability.  Because of the arrangement of our internal anatomy with the liver on the right and the heart on the left, the left side of the diagphragm tends to be flatter or less like a canopy than on the right.  Mechanically this reduces effective stabilization on the left compared to right.  The left side of the pelvis will tilt anteriorly with a relative right side posterior pelvic rotation.  This in turn will affect hip mobility or trickle upward affecting shoulder girdle and spine function.  Performing the breathing exercises has allowed a lot of our corrective programming to “stick” a little more effectively

What we didn’t expect was a secondary effect which was an increase in cardiac output which we identified by our athletes experiencing a reduction in resting heart rate by as much as 4-5 beats per minute.  After talking with Larry Cahalin and then reading the resisted breathing study that you guys did with the hockey team at Northeastern University, we’ve concluded that our breathing work is improving cardiac output via an increase in venous return.  Typically we will have our athletes perform cardiac output development work for longer durations up to 60 minutes in a heart rate zone of 120-150 bpm.  By adding in the breathing exercises and resisted breathing protocols from the study I mentioned, we’ve been able to cut way back on the long slow duration work which the athletes really appreciate.

I know you have an extensive library – what 5 books would you recommend for those working with basketball athletes primarily in a rehab setting should read?

Keep in mind that I don’t think there is a singular resource that has all the questions answered, but here’s  my short list and in the interest of overdelivering throw in a couple extra:

Ultimate Back Fitness and Performance by McGill
Clinical Application of Neuromuscular Techniques, Volume 1: The Upper Body by Chaitow
Clinical Applications of Neuromuscular Techniques: The Lower Body, Volume 2 by Chaitow
Assessment and Treatment of Muscle Imbalance:The Janda Approach by Page, Frank, and Lardner
Diagnosis and Treatment of Movement Impairment Syndromes by Sahrmann
The Malalignment Syndrome: Implications for Medicine and Sports by Schamberger
I’d also recommend the courses from the Postural Restoration Institute