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by Art Horne

In the vast majority of well planned programs in both Strength and Conditioning and Sports Medicine, athletes and patients must “qualify” for a particular exercise prior to being introduced to it as a formal part of their training or rehabilitation program.  For example, it would be ill advised to simply ask an athlete to perform depth jumps without knowing they had a sufficient strength base first (1.25 x BW for females and 1.5 x BW for males seems to be standard).  Hang Cleans are rarely taught until an athlete or patient shows proficiency in a box jump, good front squat technique and a reasonable strength base.  Even in Sports Medicine, one must “qualify” to drop the crutches after injury in favor of full weigh-bearing so long as they are abel to demonstrate normal, pain-free gait.  Yet, when it comes to addressing “core” exercises many are often prescribed without thought or prior planning.  This is especially true when evaluating rotational exercises.

McGill has demonstrated time and again that people with troubled backs simply use their backs more during activities.

“But you need a strong back don’t you?”

Well yes, but there’s more to it than that.  In fact, the guys that have these troubled backs most often have much stronger backs but are less endurable than matched asymptomatic controls (McGill et al, 2003).  In addition, those that have back pain (and a stronger back mind you) tend to have more motion in their backs and less motion and load in their hips.  And we all know what poor hip mobility means don’t we – you got it, back pain.  (McGill SM et al. Previous history of LBP with work loss is related to lingering effects in biomechanical physiological, personal, psychosocial and motor control characteristics. Ergonomics 2003;46:731-46.)

"So what does all this hip, back and stability stuff have to do with rotational core and power training? I just want to throw some heavy medicine balls against the wall and wake up the neighbors!”

Not so fast, as I mentioned, mobile hips and a stable and strong mid-section are paramount and a MUST prior to any type of rotational medicine ball or rotational power training.  The Mobility-Stability/Joint by Joint Approach to Training made famous by Boyle and Cook is of course a must, yet very few actually test to see if their athletes have “stability” where stability should lie – the lumbar spine. This is especially important for post players who require a decisive and strong drop step to establish position in the post. Any leakage in energy or disconnect between their shoulders and lower body will surely afford them a less than desirable position on the low post.

Isn't being on a poster great?

Prone Touch - A Rotary Qualifier

The simple “Prone Shoulder Touch” or “Prone Touch” is a simple test to ensure your athletes are able to lock in their lumbar spine while undergoing and controlling a very basic rotational force.  In this test the athlete is resisting rotary forces by picking one hand off the ground, touching the opposite shoulder and replacing.  If your athlete cannot hold their pelvis and shoulders level to the ground they are simply not ready to “produce” rotary forces due to the fact that they just demonstrated that they could not even “resist” a simple rotary force.  You wouldn’t depth jump an athlete unless they could produce the required force first right? 

Remember, the core, more often than not functions as a preventer of motion and not as an initiator.  Good technique in both daily living tasks and sports demand that force be generated at the hips and transmitted through a stiffened core. (McGill, Ultimate Back Fitness and Performance)

Not sure if your athlete is holding their spine in place?  I often ask athletes to touch each shoulder 20 times total after lifting up their shirt and exposing their low back.  (Baggy basketball shirts and shorts won’t allow you to view and make an appropriate decision.) Being able to hold this position, and ultimately resist the 280 lb power forward trying to dislodge you from the block requires not only strength but strength that endures.  Twenty touches may seem like a lot, but dysfunction rarely presents itself at first, and requires a bit of fatigue before it jumps out at you. 

Note: many tall athletes will automatically find this exercise to be difficult. Starting them on their knees or bringing them up to a box serves as a nice starting position.

Athletes that struggle to hold the Prone Touch position should start with simplier exercises such as McGill's Bird-Dog and Stir the Pot prior to beginning more advanced exercises.

Anti-Rotation Press Progression

Key Points: maintain a capital "T" posture with shoulders level and spine perpendicular to the ground.  Don't let the resistance or cable rotate your torso.  Encourage athlete to breathe normally.

Chopping Patterns

Mastering the Chop prior to the Lift or other more advanced core lifts in important as it provides for a good understanding of body position, awareness and handling outside forces while maintaining a stable spine.

Key Points: place your hand on your athlete's head and ask them to push into your hand to ensure they have good posture and a tall spine.  Progression much like the Anti-rotational press starts in a tall kneeling position, to a half kneeling position, and finally to a standing positon.

Lift progression

Most athletes have trouble understanding body position and thus mastering the Chop prior to the Lift is key in developing appropriate rotary resistance strength. 

Key Point: Lift should be broken down into two distinct components during the teaching phase. 1. pull towards mid-line, and 2. press away (I like to remind our basketball athletes to finish strong as if they were powering up with the ball towards the hoop).  Maintain tall posture and capital "T" position throughout.

Looks a lot like Dwight's about to do a dynamic lift pattern doesn't?

Landmine

Besides a variety of medicine ball throws which incorporates producing force, the landmine is the last in the progression to resisting rotary forces. Posture, technique and breathing are key here as well.

Anti-rotation exercises don't have to be exclusionary of eachother and can be programmed either within the same training session or within the same week and do not necessarily have to follow the progression outlined above.  However, strict attention should be given to your athlete's ability to reduce motion/force, not produce it.  Lowering the outside resistance on either a Keiser or weight machine will allow your athletes to maintain proper position and ensure your athletes success while resisting rotary forces and preparing them to do the same on the court.  However, demonstrating clearly that your athletes are first able to begin this progression starts with qualifying your athlete's ability to do so with a simple Prone Touch.

References:

• Aultman,C.D., Scannell,J., and McGill, S.M. (2005) Predicting the direction of nucleus tracking in porcine spine motion segments subjected to repetitive flexion and simultaneous lateral bend. Clinical Biomechanics, 20:126-129.
• Kavcic, N., Grenier, S., and McGill, S. (2004b) Determining the stabilizing role of individual torso muscles during rehabilitation exercises. Spine, 29(11):1254-1265.
• Koumantakis GA, Watson, PJ, Oldham, JA, Trunk muscle stabilization training plus general exercise versus general exercise only: Randomized controlled trial with patients with recurrent low back pain. Physical Therapy, 85(3):209-225.
• Marshall LW and McGill SM. (2010) The role of axial torque in disc herniation. Clinical Biomechanics. 25 (1):6-9.
• McGill SM et al. Previous history of LBP with work loss is related to lingering effects in biomechanical physiological, personal, psychosocial and motor control characteristics. Ergonomics 2003;46:731-46.
• McGill, S.M. (2007) Low back disorders: Evidence based prevention and rehabilitation, Second Edition, Human Kinetics Publishers, Champaign, IL, U.S.A.
• McGill, S.M., (2007) (DVD) The Ultimate Back: Assessment and therapeutic exercise, www.backfitpro.com
• McGill, S.M. (2009) Ultimate back fitness and performance – Fourth Edition, Backfitpro Inc., Waterloo, Canada, (www.backfitpro.com).
• McGill, S.M., Karpowicz, A. (2009) Exercises for spine stabilization: Motion/Motor patterns, stability progressions and clinical technique. Archives of Physical Medicine and Rehabilitation, 90: 118-126.
•  McGill, S.M. (2010) Core Training: Evidence Translating to Better Performance and Injury Prevention. Strength and Conditioning Journal, Vol. 32;3. 33-46.
• McGill, S.M. Presentation at Third Annual Distinguished Lecture Series in Sports Medicine, 2009. Northeastern University.

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by Brian McCormick

Over the last few weeks, a study from U.C. Davis on ACL injury prevention has made its way through the Internet with headlines like “Land on your toes, save your knees.”

However, the actual study’s conclusions differed from the headlines’ implications (“Alterations to movement mechanics can greatly reduce anterior cruciate ligament loading without reducing performance” by Casey A. Myers and David Hawkins in the Journal of Biomechanics). The reports circulating the Internet vary from incomplete to inaccurate, while the study suggests instructions that should be common teaching practice.

The study used 14 female college and high school girls basketball players with at least two years of basketball experience and no prior knee issues. Subjects were instructed to run at “game speed” and make a jump stop at a certain point.

The players executed multiple jump stops without any instructions. After a series of repetitions, the researchers instructed the players to use a specific technique to measure their intervention: “The intervention targeted: increasing the amplitude of the jump prior to landing, increasing the amount of knee flexion at landing, and striking the ground with the toes first, (Myers and Hawkins).”

The study found:
“Subjects increased their knee flexion angle an average of 5.3° and moved the center of pressure at contact an average of 6.6 cm closer to their toes. There was no change in shank angle relative to the vertical during landing...The subjects basically performed the intervention jump stops with greater bend at the knees and landed more on their toes” (Myers and Hawkins).

Here is the big issue with the headlines:
“Jump stops were performed with the toes striking the ground first during the intervention condition versus the majority of jump stops performed with the heels striking the ground first in the baseline condition” (Myers and Hawkins).

Based on my reading of the published study, I have one issue with the study and one issue with its reporting.

The study measured a controlled jump stop in a closed environment. Even if the players were instructed to go game speed, how many players go game speed in drills? Further, in similar drills where players run to a certain spot and jump stops, they slow down before executing the jump stop. Their stride length decreases and speed slows in order to make a more controlled jump stop.

Executing a jump stop in an open environment as a reaction to a stimulus (defender) is a more involved skill. An open-skill jump stop occurs at game speed and without anticipation or preparation. In some occasions, players prepare before executing the jump stop, thinking ahead about their move, but in most cases, the move is a reaction to a defender or situation.

Second, adding the ball and defenders change the skill execution. Executing the jump stop while catching a pass, dribbling or rebounding a ball differs from a planned jump stop.

Therefore, while the specific adaptations suggested by the study may reduce the sheer force on the knee, and may be valuable to incorporate, the findings provide only a starting point, as a coach or trainer would need to incorporate the same findings in open skills to enhance the efficacy of the instruction in a real world setting.

As for the reporting, the study does not advocate a “toe landing.” Instead, the study  found that landing with a deeper knee flexion and initiating the landing with the toes lead to reduced force at the knee.

“While toe strikes that were accompanied by an increase in knee flexion angle at contact produced the largest decreases in peak tibial shear force (PTSF), some subjects were able to reduce PTSF without increasing their knee angle, (Myers and Hawkins).

Therefore, some subjects were able to reduce the force without deepening their knee bend; however, these subjects may have had a deeper knee bend than others at the outset or they may have run at less than full speed.

As for initiating the landing with the toes, what coach teaches players to initiate a landing with their heels? How does a player develop throughout high school and college with a heel-strike landing from a vertical jump?

When teaching jumping mechanics, I have seen two methods:

1. Land like a Ninja: Land softly; initiate the landing on your toes and the balls of your feet and sit back to a flat foot as your knee-bend increases, and you sit down by dropping your hips. 
2. Dorsiflexion: Dorisflex your foot (toes up) and land on the balls of your feet. In this landing, there is less knee flexion. This landing takes advantage of the stretch-shortening cycle for repeat jumps. Even when landing with a dorsiflexed foot, the heel should not hit the ground and certainly should not initiate the contact.

In the article, a reporter interviewed U.C. Davis Women’s Basketball Coach Sandy Simpson:

“It almost always happens coming down from a rebound, catching a pass or on a jump-stop lay-up,” Simpson said. “It doesn’t have to be a big jump.”
His comment suggests one misunderstanding of the mechanics of the injury and points out the flaw with the study that I mentioned above: the ball makes the game jump stop different from the jump stops in the study.

As for the misconception, many coaches who have eliminated the jump stop for fear of ACL injuries have encouraged stops with a smaller vertical component. However, the study’s intervention encouraged the players to jump higher. As Simpson says, and the study suggests, the vertical component does not necessarily influence the incidence rate of injuries, and, in fact, a greater amplitude may decrease injuries (possibly by creating a more straight-down landing, which may help to control the sheer force on the ACL caused by controlling the anterior movement of the tibia).

I have never witnessed an ACL tear on a jump stop. Instead, I have seen injuries on cuts and stops when moving forward. I know two players who tore their ACLs when landing from a rebound, but there was some contact in each case.

It is not the same sport, but I saw some pictures recently of a Division I outside hitter; we assume that OHs land on two feet at the same time, but that never happened. Further, the player did not land with a balanced body, as with a basic, closed-skill jump stop. If we watched slow-motion footage of players landing from rebounds, I imagine that we would find that oftentimes players land one foot at a time and in off-balanced positions. Therefore, to reduce ACL injuries in these instances, we need to practice these landings starting in closed environments and moving to open skill executions.

“Hawkins recommends warm-ups that exercise the knee and focusing on landing on the toes and balls of the feet. The study does not definitively prove that these techniques will reduce ACL injuries, Hawkins said: that would require a full clinical trial and follow-up. But the anecdotal evidence suggests that high tibial shear forces are associated with blown knees,” (from the article, not the actual study).

These exercises should be part of a dynamic warm-up. Jumping, skipping, and running with proper technique should be taught early in the season and emphasized at the beginning of practice to prepare the players for the open skills during practice sessions and games.

“Simpson said that the team had tried implementing some changes during last year's preseason, but had found it difficult to continue the focus once the full regular season began.”

This is the attitude that I do not understand. Coaches have time to run 20 out-of-bounds plays and practice every possible scenario, but not to ensure the safety of their players? I have heard this excuse for years. However, what helps your team more, an extra OB play or having your entire team healthy for a full season?

I have watched college practices; there is plenty of wasted time to incorporate exercises to reduce the potential of injuries. This is like when I worked the Cal Women’s Basketball Camp and sat with the athletic trainer as she pointed to girl after girl who was at-risk for ACL tears; I asked why she did not do a session to teach the girls or at least make them aware. She said that the coaches said that there was not time. We had this conversation while watching the girls play “Land-Sea-Air,” the ultimate camp time-waster.

Even better, the study found that when using the intervention technique, subjects jumped higher after the jump stop than they did with their old technique. Not only would teaching the improved technique potentially lead to fewer injuries, but it could also improve performance! It is a win-win situation, yet one ignored by many coaches and trainers. This is not a matter of adding resistance training sessions or incorporating plyometrics. The intervention effectively suggested that teaching a more effective jump stop - a fundamental basketball skill - would lead to decreased risk of an ACL tear. It isn’t a matter of adding anything, but improving the typical instruction to create a more effective jump stop.

From a skill development perspective, coaches can start with the closed skill used in the drill. Emphasize the higher amplitude on the jump, the toe-to-heel landing and the deeper knee flexion. Next, move to more involved skills. Execute the jump stop with a ball in one’s hands. Then, jump stop while dribbling; then jump stop on the catch; then, land with the ball from a rebound. Finally, move toward the open-skill application by having players jump stop as a reaction to a verbal or visual stimulus (for youth players, Red Light-Green Light works well).

Eliminating ACL injuries is likely impossible. However, incorporating better technique instruction into normal footwork and jump stop drills as well as incorporating proper landing technique into dynamic warm-up drills may reduce injuries and improve performance, which ultimately leads to a better team performance and more wins.