Articles & Resources

by Art Horne

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

Many strength coaches utilize the exam "break" as an opportunity to fit in extra lifts and training sessions for their basketball teams.  At the same time, many basketball coaches utilize this time for additonal film study, shooting drills and prolonged practices since their athletes are not taking classes. 

Is the additional "stress" of exams, late night studying along with extra training and court work counterproductive?
 
How are you managing the extra time over exam break with your athletes?

______________________________________________________

During the break, you have to pick your poison.  As the saying goes, “you can’t ride two horses with one ass”.  Surprisingly, as a staff (and this is probably unusual for most college basketball programs), we’ll do less on-court activity (forty minute maximum and mostly skill work) and more off-court activity (weight training, non-impact “light/tempo” bike work, corrective exercises, therapeutic work, etc.).  I work mostly with female basketball players and the physical attribute that a collegiate female player needs more than any other it’s strength.  If you can continue to improve their strength level throughout the year then you can continue to enhance their athleticism and reduce the incidence of on-court related injuries. In a nutshell, the break gives us the advantage and opportunity to do more strength/movement work (something that is difficult to do throughout the competitive season in my opinion).  We want our players to be strong and healthy prior to our Big Ten conference schedule which is grueling.  In addition, the break allows our redshirt and freshmen players who play limited minutes (and who are physically underdeveloped) more opportunities to improve their strength level as well.

Ray Eady
University of Wisconsin

Besides changing each year, the only consistent philosophy that I have stuck to over the Christmas break is to not bury our athletes under the bar.  When I was younger, I thought this was a good opportunity to throw in extra training sessions or increase the volume or intensity or sometimes both (yes, I was young) during this time since our athletes were no longer going to classes and “only” taking exams and thus had ample time to recover.  Needless to say, I forgot that our athletes were actually student-athletes and the “stress” of studying and preparing for exams placed a tremendous physiological stress load on them which made additional productive training sessions almost impossible.  For the few guys that had exams finished prior to the actual exam week we will provide opportunities to work on individual skill development and/or additional training sessions to address specific weaknesses and not just to get a “work out” in (for some guys this means also addressing nagging injuries in multiple treatment sessions).  For the last two seasons we have played in a holiday tournament (Hawaii and Mexico) followed by another tournament right after, then directly into league play. The additional commercial travel after exam week followed by 3 games in 3 days, travel some more, then 2 games in 2 nights followed again by 3 league games in 5 days makes recovery our primary focus during this time.  When we travelled with a squad of 15 athletes last year, the individual load in practice was much less than the volume incurred this year with only 11 athletes practicing and at sometimes only 10 which meant no breaks for most of the guys during each and every practice. 

Art Horne, MEd, ATC, CSCS
Northeastern University

 
I am in a unique situation here at one of the most prestigious academic institutions in the world, as a result these kids are under amazing pressure from not only an athletic standpoint but from an academic one too.  When they say they have been up all night studying, they are telling the truth. It is super tough for me as my head coach also demands a ton from them on the court and pushes them pretty hard at all times.  Last year (my first in the college setting) I saw this 2 week break from games, Stanford has a rule that no games finals week and the week before, as a time to really get after it and push them a bit more in the weight room.  It completely backfired b/c our coach had the same mind set and these kids were just getting run into the ground.  We came out of the break and our guys started to breakdown just after the New Year.  Minor injuries mounted and we had a rash of stress fx’s. Now I know these take time to build but I don’t think the added work we did helped the situation This year I completely changed my mindset and approach for this break. I eased up in the weight room focused on more individual corrective work, worked on things that had potentially become issues due to the mounting # of practices and games.  I also brought in a yoga instructor (something I have used in the off-season before) to do a team session. This was more from a relaxation standpoint.  I think that this year backing off made it a bit easier on my guys to not only get thru finals but also our coaches practices over that time.   We’ll see if the strategy will help us start off the Pac-10 season with a little more pep in our step….
 
  
Keith D’Amelio,  MS, ATC, CSCS, PES, CES
Stanford University Men’s Basketball

Last May I looked at our schedule and planned our training year with an increase in volume and intensity during the so called "break".  We had a 10-day period between games and the opponents during the period in most years would be considered lesser opponents. 

Between May and December a number of things transpired that changed our "working of the plan"
1) We didn't add 2 more walk-ons in the pre-season so our main guys (12 scholarship+1 walk-on) were getting considerably more repetitions in practice than I predicted.
2) We had some misfortune or poor preparation(my fault) and had some injuries that once again added more overall physiological load to the student-athletes who were healthy and practicing.
3) I forgot how demanding academically this institution is.  If you subscribe to Hans Seyle's work/theory you accept that stress is stress wether it be physical or psychological.  Our athletes were really trying to be STUDENT-athletes. 

So going into the break I scrapped the Accumulation and Intensification microcyles that I originally wrote-in and focused more on reduction in volume in our primary lifts and instituted more targeted corrective exercise for specific athletes.  I cut out most of the assistance exercises and replaced them with the corrective. I didn't compromise the targeted or relative intensity in the training session in the primary lifts, I just cut back on the the total volume.

When they get back from a few days off for Christmas I'll research anecdotally what they felt in regards to recovery during that period with a TQR questionnaire. 

 Mike Curtis, M.Ed., CSCS, USAW, SCCC, NASM-PES, CES
Head Strength & Conditioning Coach, Men's Basketball
University of Virginia Athletics

I don't believe in adding "extra" workouts in just because there is extra time to do it. I try to help my guys recover as much as possible by constantly monitoring volume. I've found that keeping my focus on volume, guys are able to recover and be ready for the next session.

Glenn Harris
Boston University, Strength and Conditioning Coach

by Art Horne

In a recent interview with Sue Falsone from API on Sportsrehabexpert.com (see link below), Sue discusses the concurrent roles that the diaphragm must operate as - both a RESPIRATOR and STABILIZER.  She mentioned that Stu McGill talks about "Breathing Through The Brace" and the importance of breathing while also stabilizing the core.  Clearly, one cannot come at the expense of the other and when the diaphragm does have to choose, breathing will always win.  As Stu has shared with me in the past, it is possible to both evaluate and train the diaphragm to concurrently provide stabilization while also bringing air into the body. 

See the below video for an example of training the diaphragm to act as both a respirator and stabilizer. 

Check out this great interview with Sue Falsone on Sportsrehabexpert.com

By Liz Clarke

Washington Post Staff Writer

It starts with Maryland's basketball players standing on opposite sidelines, crossing one foot over the other and rocking back and forth to stretch their feet and ankles.

Next comes a series of choreographed forays across the width of the court and back, in which the Terps move like dancers in a Thriller video - skipping, high-step jogging, crab-walking sideways. That's followed by a sequence inspired by yoga's Warrior Pose in which players adopt a stance resembling a runner frozen mid-stride, then touch the floor, reach skyward, twist at the waist and repeat.

Maryland's eight-and-a-half minute, pregame stretching routine - conducted while most opponents shoot lay-up after lay-up at the opposite end of the court - is called "Movement Preparation." And it's designed to get the Terps' muscles ready for the full range of explosive movements demanded by the 40 minutes of competition to come.

It's just one aspect of the men's basketball team's strength and conditioning program that's unlike that of most other colleges in that it blends concepts from professional football and baseball regimens, as well as yoga - all with the goal of improving players' mobility, stamina and confidence.

The program was developed by a former Penn State offensive lineman, Paul Ricci, who spent nine seasons training the Baltimore Ravens for the rigors of the NFL before joining the Terps.

Though it's tricky to draw a direct link between gym workouts and on-court results, the Terps have had just one missed game and one missed practice by a starter in two-and-a-half years. And players, to a man, say they're in the best shape of their lives.

"We are stronger," says Coach Gary Williams. "And we are quicker."

Sophomore center Jordan Williams is a case in point.

As a standout at Torrington (Conn.) High School two years ago, the big center was viewed by most recruiting gurus as more of a project than a blue-chip prospect - a late-bloomer wrapped in a bit too much baby fat. "Runs the floor reasonably well," declared ESPN's 2008 Player Evaluation. But "needs to continue to improve his footwork and post moves . . . [and] continue to improve his body."

Since joining the Terps, Williams has shed more than 20 pounds, pared his body fat from 19.5 percent to 12 percent and seen his performance and stamina soar.

In the Terps' last game, the Dec. 12 loss to Boston College, Williams delivered his ninth double-double of what is proving a remarkable statistical season, looking every bit a contender for college basketball's Naismith and Wooden awards. Moreover, he played a career-high 38 minutes - unfathomable as recently as last spring, when Williams got winded banging bodies with the ACC's big men after just 25 minutes.

"He has changed my whole physique," the sophomore center says of Ricci. "It's like night and day from when I came in here. I give him a lot of credit."

The pregame stretching is a small part of the Terps' strength conditioning program that also includes weight training after home games, even if it's 10 p.m. or later. The 15-minute sessions are voluntary, Ricci notes, but well-attended, designed to help players get a jump on the recovery process and mentally unwind after games.

And it entailed a grueling regimen this summer in College Park, in which the Terps pushed heavy sleds back and forth across the Comcast Center loading dock, ran sprints in August's sweltering heat and lifted in the gym.

There's a philosophy behind each of these exercises. And it's a radical departure from the prevailing wisdom about how basketball players should prepare in Gary Williams's playing days as a Terp in the mid-1960s.

"You weren't allowed to lift weights," the coach recalls. "The theory then was that if you lifted weights, it would restrict you as a shooter and you'd get too tight, too muscular. Also back then, you weren't allowed to drink water during practice."

Water, many old-line coaches believed, caused cramps. Worse, they viewed thirst as a sign of weakness in players. So they gave them salt tablets instead, exacerbating their dehydration.

Williams concedes he's no expert in exercise physiology. But he liked what he heard about Ricci after the Ravens' coaching staff disbanded following Brian Billick's ouster and invited him in for an interview.

"Part of coaching is you have to know your weaknesses," Williams says. "I knew we needed a good strength program for our basketball players."

After hiring Ricci as Maryland's first director of basketball performance, Williams asked him to get the squad in the best possible shape for the start of practice, to develop each player to his potential, and to build a more explosive team capable of sustaining the press defense he favors.

Ricci consulted basketball trainers in the pro and college ranks to develop a program to accomplish just that. He borrowed the idea of postgame weight-training from his work with the San Diego Padres, where he learned that pitchers routinely lift weights after they've thrown. Many NBA teams also lift weights after games, though it's a rarity in college ball.

It has both physiological and psychological benefits, Ricci says. It jump-starts the recovery process by stretching players' muscles. It calms their nervous systems, which are invariably ramped up after games. And because few, if any, college teams lift weights after games, it gives the Terps confidence that they've outworked their opponents and can withstand a rigorous second half or overtime if need be.

But Ricci's first task was a sales job.

"The main thing about getting them in peak shape is shaping their attitude toward doing it," Ricci says. "A lot of these guys have not had somebody dedicated to them and dedicated to taking care of their bodies like a professional athlete. If they want to take it to the next level - whatever that might be - they have to put in the time right away."

Ricci found that his most powerful ally was any televised NBA game in which LeBron James participated: King James was Exhibit A of the merits of a sculpted basketball physique. Maryland's Greivis Vasquez also drove the point home, transforming himself from a lithe freshman to a muscular ACC player of the year and first-round NBA draft pick.

But initially, some of the exercises Ricci prescribed seemed foolish to Jordan Williams.

"A lot of the stuff! It was like, 'What are you doing?!' " the center recalls. "But when we feel the results, and see the outcome of what he has done for us, it's just remarkable. . . . Last year I probably averaged 24, 25 minutes a game, and throughout the game I found myself kind of tired. Now I think I can play at a good pace the whole game, with a break here and there."

For a more scientific way of gauging the Terps' fitness, Ricci uses a so-called "Bod Pod" - a $45,000 machine, acquired last year through a private donation, that measures body composition through the displacement of air when an athlete sits in one of the two cocoon-like chambers.

That way, players can compare their body fat to the NBA's guidelines (6 to 10 percent for guards; 11 to 14 percent for post players). And Ricci can monitor their progress. Any backsliding suggests an athlete has slacked off on his workouts or strayed from his diet.

Ideally, the Bod Pod will soon be housed in a new weight-room outfitted for the specific needs of Maryland's men's and women's basketball teams, to be located in 2,000 square feet of former storage space in the Comcast Center basement. The floor plan has been mapped out, and private fund-raising is under way.

Meantime, Ricci can tell the Terps are progressing by plain-old body language: the way they carry themselves and flaunt their chiseled physiques.

"You'd think these guys would be confident all the time, but you can really see it change their self-esteem," Ricci says. "Hopefully it builds some confidence when they're playing against the best players. They know they've paid the price."

clarkel@washpost.com
 

by Brian McCormick

Last week, I wrote about learning as a skill. However, what is learning?

Our most colloquial term referring to motor performance is “muscle memory.” However, while this term is accepted generally and practically, learning occurs in the brain. When we talk about “muscle memory,” we are referring to motor programs stored in our procedural long-term memory. Since learning occurs in the brain, we cannot see learning. Instead, we infer learning based on performance.

Learning requires improvement, consistency, stability, persistence and adaptability. Performance is temporary. Kobe Bryant shoots 7/25 on one night and 14/19 on the next night. Did he learn better shooting technique in between the two games because his shooting performance improved? If he shot 6/21 in the next game, would that indicate forgetting?

No. His performance varies due to performance variables: fatigue, defense, shot selection, time constraints, travel, pressure, etc. His technique - his motor programs - do not change from game to game; his skill is learned. However, his performance of these skills varies due to external and internal factors.

This is an important concept in learning and coaching. How does a coach react to a player’s performance? The coach’s reaction or instruction can become a performance variable and affect performance positively and negatively. Of course, the coach’s instruction is also a learning variable, as the instructions affect the player’s learning of the skill.

One measure of learning is adaptability from situation to situation. I have written previously about this concept in terms of movement away from the ball and used Vern Gambetta’s idea of adapted vs. adaptable. An adapted player learns his offensive set and can execute the set as if following a set of instructions; an adaptable player learns the skills and adapts those skills to different situations. When I played, I adapted to the pattern of the Flex offense in junior high school; however, I did not learn how to use a down screen generally, just within the context of the offense. Therefore, my skill was not adaptable to different situations.

A coach’s approach and instructions affect the player’s adaptability. When coaches limit players, they often affect their adaptability. When coaches use only block drills, they affect their adaptability. For instance, if a player learns a chest pass in a typical two-line drill with no defense, is that skill adaptable to different situations? Will he be able to use the skill in a game situation when pressured by a defender? We assume that skills transfer; we assume that because a player can make an unguarded two-hand chest pass to a stationary target, he will be able to pass off the dribble to a moving target while defended. These assumptions account for many breakdowns in skill execution and coaching. If the player adapts and executes the pass in a game under time stress, then we say he has learned the skill. However, if his skill is useless to him because of the load or time constraints, he has not learned. He is able to perform the skill under certain situations, but he has learned the skill only in those specific situations.

Assuming a high school varsity player has learned his shooting skills, how should a coach react to a mistake? Many coaches and parents immediately yell at a player who misses a free throw to use more legs. However, this type of instruction interrupts the skill execution. A varsity player has learned the shooting technique - he may need to improve, but his technique is consistent, stable, persistent and adaptable: he shoots the same way every time. If his technique changes on one shot because of fatigue or balance or defense, he quickly returns to his technique and does not change his technique permanently; his technique persists over a period of time; and he can shoot in different gyms against different defenders.

When the coach tells the player to bend his legs, the player changes from an automatic processing to a controlled processing. The conscious overtakes the subconscious execution. In a time-stressed task, this usually leads to err because it takes too long to think consciously and make a decision. In a skill like shooting a free throw, the conscious thinking diverts the player’s attention from the rim (external) to the bend of the knees (internal). The player becomes more acutely aware of his body and tries to control the shot, which often leads to sub-optimal performance. When I shoot free throws, and allow my mind to wander, I hit 20, 30 in a row. However, as soon as I realize that I am shooting well, and try to analyze the shot to feel something or to learn something to share with the players who I train, I inevitably miss because my coscious mind controls the action. By thinking about other things, I divert my conscious mind away from the task and allow the subconscious to control the process. Since the skill is well-learned, the subconscious generally leads to make after make.

A bad game is a bad game. A poor performance may illustrate the need for additional learning; for instance, a player may need different practice to adapt the chest pass to game situations, especially in the half court. Therefore, the poor performance illustrates a limitation in the player’s learning, and a coach can use a different type of practice, a more random, varied practice, to enhance the player’s transfer of learning to the game, or the adaptability of his skill.

However, in other instances, a bad game is a bad game. If I am usually a 90% free throw shooter, and I make 5/10 in a game, the worst thing that I can do is change my free throw shooting because of the one poor performance. Performance is temporary. If I have learned the skill well, my skill is stable and that one game is not going to alter my performance moving forward. Instead, as long as my mind does not interfere (affect my confidence and attention), I would expect to shoot 90% in the next game.

Learning is relatively permanent and requires practice (of course, learning can be negative, as one can acquire a skill at a below-optimal level). Observation of skill execution must differentiate between a poor performance (temporary), an unlearned skill (and therefore inconsistent in its execution) and a skill learned with less than optimal technique. Practice should be aimed at establishing the correct technique and making the skill more consistent, more stabile, and adaptable.

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