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Broken Bones, Broken Hearts And The Ottawa Ankle Rules by Art Horne

Posted by Boston Sports Medicine and Performance Group on Sep 27, 2010 6:11:00 PM

by Art Horne

A review of:
Jenkin M Sitler MR, Kelly JD. Clinical Usefulness of the Ottawa Ankle Rules for Detecting Fractures of the Ankle and Midfoot. J Ath Train. 2010;45(5):480-482.

Basketball season is back and with it comes a new season of early morning conditioning runs, late night pick-up games, and of course, a few ankle sprains along the way.  Like clockwork, gasps by teammates and spectators can be heard followed by the uncertain question after such injury, “is it broken?” 

First introduced in 1992 by Stiell et al, the Ottawa Ankle Rules were a guideline for caregivers after ankle trauma to determine whether or not an ankle/foot x-ray was warranted in the evaluation and care of the athlete.  Having been designed to have a high sensitivity for detecting significant fractures, its other goals include decreasing unwarranted radiation and avoiding long waits in the emergency rooms for x-ray evaluation.

Based on the Ottawa Ankle Rules, Stiell et al recommended x-ray evaluation after an ankle sprain for the following:

1. Patients 55 years and older (not the typical NCAA college basketball athlete)
2. Those that were unable to bear weight for 4 steps both at the time of injury and during evaluation.
3. bone tenderness at the inferior tip or posterior edge of the lateral malleolus or
4. bone tenderness at the inferior tip or posterior edge of the medial malleolus.

For those athletes with a suspected mid-foot fracture, x-ray evaluation were recommended for those that:

1. had pain at the base of the 5th metatarsal, cuboid or navicular.

Exclusion criteria include:

1. injury past 10 days
2. pregnancy
3. patients under the age of 18
4. presence of isolated injuries to the skin.

What does this all mean?

If a college athlete sustains an ankle sprain and is able to walk off the court and does not have bony pain either the medial or lateral malleolus and is void of bony pain at the base of the 5th (or other midfoot bone) then it is highly likely that he/she does not have a fracture.  Conversely, if an athlete sprains their ankle and is unable to bear weight at both the time of injury and at the time of evaluation (once the emotional piece has settled), an x-ray evaluation is warranted due to the very high likelihood of a fracture.

The Ottawa Ankle Rules Modified – Buffalo Rule

“The Buffalo Rule was derived to increase the diagnostic accuracy of the Ottawa Ankle Rules, with the point tenderness criterion directed to the crest or midportion of the malleoli (distal 6 cm of the fibula and tibia), reducing the likelihood of palpating over injured ligament structures.”

Big Cost Savings

“The Ottawa Ankle Rules are reported to result in a 19% to 38 % reduction in radiography costs associated with excluding ankle fractures after sprain injury.”

“The Buffalo Rule is reported to result in a 54% reduction in radiography costs."

“National cost savings estimates with implementation of the Ottawa Ankle Rules range from $18 to $90 million annually (depending on the payor mix involved).”

Conclusion

“Based on the current research, it is recommended that the Ottawa Ankle Rules and, by extension, the Buffalo Rule be included in both athletic training clinical practice and educational programs.  In the present era of cost containment, increased awareness of unnecessary tests and procedures will only become meaningful.  Accordingly, clinicians will need to use the information presented in the systematic review, combined with their own practical experience and the patient’s values, to determine how best to apply the data in an evidence-based manner.”

References

Jenkin M Sitler MR, Kelly JD. Clinical Usefulness of the Ottawa Ankle Rules for Detecting Fractures of the Ankle and Midfoot. J Ath Train. 2010;45(5):480-482.

Leddy JJ, Smolinksi RJ, Lawrence J, Snyder JL, Priore RL. Prospective evaluation of the Ottawa Ankle Rules in a university sports medicine center: with a modification to increase specificity for identifying malleolar fractures. Am J Sports Med. 1998;26(2):158-165.

Leddy JJ, Kesari A, Smolinski RJ. Implementation of the Ottawa Ankle Rules in a university sports medicine center. Med Sci Sports Exerc. 2002;34(1):57-62.

Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Worthington JR. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med. 1992;21(4):384-390.

Topics: Art Horne, Health & Wellness

Recovery for Basketball by Devan McConnell

Posted by Boston Sports Medicine and Performance Group on Sep 27, 2010 6:08:00 PM

by Devan McConnell


Recovery and regeneration are hot topics in the field of Sports Performance. In my experience, much of the information about regeneration is anecdotal, and that which is not is often highly debated. At Stanford, I try to implement a multitude of different recovery strategies. Some may work better than others, and I am always learning and honing my protocols, however in my mind it’s better to be doing something directed at recovery and regeneration than doing nothing at all. Here are a few of the tools and protocols I will use with my athletes throughout the year.

1. Hydrotherapy- This can take several different forms, and as I said before, much of the research and recommendations on hydrotherapy is conflicting, but what seems to be constant is that some sort of hydrotherapy is beneficial, and the faster you get your athletes in the water, the greater the benefit. We will implement cold tub baths, hot tubs, contrast baths, contrast showers, and hydro-massage, where we can use pressurized water within a tub to apply direct massage. From time to time we will also perform pool workouts. It is important to note if the athlete is finished training or competing for the day, as this will influence which protocol we will use, and whether we finish hot or cold.

2. Stretching- Maybe one of the simplest and most often used protocol is just good old-fashioned post practice/workout static stretching. Not only  can we restore some length to overworked tissues, but we can also trigger the parasympathetic nervous system to begin bringing down heightened physiological markers and start relaxation. We will also employ other stretching techniques, such as Active Isolated Stretching, Partner Stretches, Fascial Meridian Stretches, etc.

3. Self Myofascial Release- This would consist of the use of foam rollers, massage sticks, various balls of different size and density, as well as other soft tissue tools. The purpose post exercise is to decrease the tone of soft tissue, release trigger points, activate the parasympathetic nervous system, and begin the process of returning the body back to baseline.

4. Lower Body Elevation and Breath Work- These are two very simple ways to begin the recovery process, which we will usually pair together. We simply have the athletes lay out on the turf along with their feet elevated up against a wall. At the same time, they are instructed to put one hand on their stomach, and the other on their chest. For about 5 minutes we will just focus on deep belly breathing, attempting not to let the chest rise and fall with each breath. This diaphragmatic breathing pattern facilitates relaxation, quickly brings heart rates down, and helps with venous return.

5. Cobblestone Mat Walks- We set up several cobblestone mats and the players walk back and forth barefoot for a few minutes. Eastern Medicine has long preached about the benefits of cobblestone walking, as the bottom of the feet are said to have a sort of “road map” to the rest of the body, where specific acupressure points can influence heart rate, blood pressure, relaxation, etc. Even if you do not believe this, after a tough training session, practice or game, it just feels good on the feet. Happy feet make a happy player!

6. Post Workout Nutrition- Nothing fancy here, just a carb/protein drink immediately post exercise to facilitate recovery via muscle protein synthesis, glycogen repletion, and hydration.

7. Yoga- We have a yoga instructor on staff that we can set up sessions with. From time to time we will utilize yoga for its relaxation and regenerative properties.

8. Flush Rides- Flush rides on the bikes post game can help bring down heart rates and work out some of the “tightness” the players often report feeling. 10-15 minutes of low level riding also allows players to “debrief” and relax with each other.

9. Mobility/Dynamic Cooldown- Mobility of the ankle, hip, and thoracic spine is always important, and by having a brief mobility circuit set up where the players perform one or two drills for each area serves the double purpose of adding in mobility work and slowly bringing athletes back down from a heightened sensory level after a strenuous session or game. Similar to the secondary effect of flush rides, the psychological benefit of “debriefing” together post game is an added bonus.

All in all, we have many tools available to help aid in recovery and regeneration of our student athletes. Some are well documented, while others are a bit outside the box. I believe what is most important when it comes to recovery practices are to make sure you are always doing something. Consistency in my mind is perhaps the biggest factor of whether or not a benefit will be seen in performance from utilizing recovery methods. Another important factor is to not get stuck using just 1 or 2 modalities. Like the exercises we prescribe, the body will adapt to recovery methods used over and over, eventually decreasing the effectiveness. Therefore, it is important to use a multitude of different tools in order to continue to see a positive response.

Recovery and Regeneration are a hot topic in Sports Performance these days for a reason. With so much on our athletes plate every day, and the level of competition so close, the ability to recover faster than your opponent could be the difference between winning and losing. If you aren’t spending a few minutes addressing this crucial part of the training and adaptation process, you might not be getting all you could be from your athletes.

Topics: Health & Wellness, Devan McConnell

Why Athletes Should Avoid The Bars by Guest Author

Posted by Boston Sports Medicine and Performance Group on Sep 27, 2010 6:04:00 PM

(An intemperate look at barbell-centric training)


by Steve Myrland

 

“Get out of the weight-room boys.  I don’t need you weight-room strong . . . I need you farm-strong.”

Irving “Boo” Shexnayder
LSU Track & Field Coach
(to his team)

 

Perhaps the most persistent blunder athletes and coaches make in training to compete is regularly mistaking “strength” for “athleticism,” so let’s clear this up right away:  Athleticism—the ability to express one’s physical self with optimal speed, agility, strength, balance, suppleness, stamina and grace while avoiding injury—is the goal.  Strength, as you will note by re-reading the sentence, above, is a single element of the collective term:  athleticism.  You cannot be athletic without being strong; but you can be strong without being athletic. 

Peek into any high school weight-room and you will see big, slow guys lifting weights under the misguided notion that strength is the holy-grail.  It isn’t.  Big strong guys are a dime-a-dozen. Big strong guys who can move get recruited . . . get scholarships . . . get drafted . . . get rich. Therefore, the strength you create in training must necessarily be strength that augments the whole, rather than constrains it.  It must be athletic strength; that is, it must always promote better movement.

Strength and stamina are among the easiest athletic qualities to improve—provided you disconnect both from all other athletic qualities (speed and agility, for instance).  Absent any connection to those genuine game-breakers, it is not at all difficult to create stronger muscles and bodies that are conditioned to work for longer and longer periods of time.  Creating better athletes, however—athletes that are able to project the qualities most rewarded in competition—requires a more refined approach to training.

In the quest for athletic strength, the lines of the argument are generally drawn between the free-weight advocates and the health-club machine crowd.  I tend to fall in with the free-weight folks in this but such a simplistic line of separation gives a free pass to one particular piece of equipment that is every bit as non-functional as any chrome-plated, stack-loaded, one-plane-wonder health-club machine:  the barbell. 

On a “functional continuum” of training equipment, I would place machines well down towards the non-functional end of things and I would place the venerable Olympic bar right next to them, even though it sails under the free-weight banner.

Here’s why:  When you grab hold of a barbell with both hands, you are virtually locking yourself into the sagittal plane.  Movement in the other two available planes of motion, frontal and transverse, is theoretically possible, but it is unlikely, at best; and if you are doing a traditional barbell exercise (squat, deadlift, snatch, clean, bench press) your body will do all it can to minimize any potential movement in those two unwanted planes.  Effectively, the bar locks you into one plane and out of two.  It restricts—not unlike health-club machinery. 

Unfortunately, the neural patterning that results from this kind of training is decidedly unfriendly to a body that will be regularly required—in competition and life—to move; to react, stop, start, twist, generate speed and withstand impact.  Strength-training programs based primarily on barbell lifts do a poor job of preparing bodies for the competitive environment because they “teach” the body to be stiff and unyielding—brittle—rather than strong and supple.

If you think of the spine as a length of chain, with each link making its individual contribution to movement in three planes, you get a sense of what a wonderfully elegant, supple design the human spine is.  If several links in that chain are (effectively) fused together, all flexion, extension, leaning and rotation that would normally come from those links will necessarily be handed on to the nearest available segment of the chain where the links are still able to move. 

Moreover, with the exception of back-squats, a barbell puts the resistance on the front of the body, contributing to the development of shoulders that round forward.  This front-emphasis affects all bodies differently because of individual differences in lever-lengths (arms, legs and torsos). Big-chested, short-armed power-lifters always have the advantage when it comes to bench-pressing.  Short-legged, short torso, long-armed lifters make the best squatters and deadlifters. 

Barbells are an insult to the inherent “uniqueness” of human beings. A bar treats all bodies as if they were the same by limiting things to the sagittal plane and by requiring loads to be carried either in front or behind, not where an individual’s own center-of-gravity is optimized. This requires all manner of nasty postural compensations that are directly or indirectly related to many athletic deficiencies and (even) injuries.  After all: a barbell is designed to accommodate the load rather than the lifter; while dumbbells and other similar resistance tools both require and allow bodies to be wholly integrated, connected and self-organizing. 

I have trained two high level hockey players in the past few years (one male and one female) who are both strong, but who suffer from significant movement impairments and all the recurring pain that generally attends dysfunctional athletic bodies.  I realize that two athletes hardly constitute a reliable research cohort; but even so, both of these athletes share one significant training detail: both relied (heavily!) on the barbell as their primary off-ice training tool.  I believe this to be a major mistake.

The female hockey player competed in the 2006 Olympic Games in Turin, and was desirous of competing in the 2010 Games as well, but she was struggling with chronic back pain and feared it would end her playing career prematurely.  Her strength-training and strength-testing were predominantly barbell based.

In watching this athlete move, it was evident that a large segment of her spine didn’t (move, that is).  Her thoracic spine appeared to be a single undifferentiated mass, never contributing its share of rotational or lateral movement.  There didn’t (even) appear to be much flexion and extension in that part of her back; so even in the sagittal plane, she struggled.  Her lower back-pain was a constant constraint on her ability to perform—in training and on the ice.  She worked with a chiropractor/active-release therapist, a physiatrist and me, and we all combined efforts to try to re-mobilize her thoracic spine and provide her with training strategies that would permit her to maintain and enhance that mobility, herself.  Prominently included in that sackful of strategies was the admonition to “STAY AWAY FROM THE BAR!”

The male hockey player left college early, a high draft-choice; but he spent three years in the up-and-down (minor-league – NHL) holding pattern that is often a frustrating feature of the professional experience.  When I first worked with him, he weighed 205 lbs, and he moved pretty well.  Two years later when we trained together again, he weighed 215 lbs and he did not move as well as he once did.  His additional ten pounds wasn’t fat; but neither was it muscle that enhanced his movement capability.  In fact, it detracted from it.

In both these cases, I believe the problem was far too much emphasis on barbell generated strength.  I know the female player agrees;  I hope the male player does too—but male athletes (and male coaches) are far more easily seduced by the charms of the bar than females.

For both athlete and coach, the bar offers the ripest, low-hanging, easily quantifiable fruit.  It is so simple to measure barbell progress.  You can do absolute one-rep max-testing and force your athletes to be power-lifters and Olympic lifters for one day each month (a risky idea!); or you can project 1RM’s using any of a number of mathematical models.  I learned this one from Jerry Martin (U-Conn) when he was the head Strength & Conditioning coach at Yale:
 
(.03 x reps [failure]) x weight + weight

so:  (.03 x 7) x 200 + 200 = .21 x 200 + 200 = 42 + 200 = 242.

An athlete who “fails” at seven reps using a weight of 200 lbs has a projected 1 RM of 242 lbs.  I found this formula to be acceptably accurate—for barbell lifts.  (Still do; I just don’t have much cause to use it, these days.)

It is probably the ease with which strength can be quantified that makes the bar so irresistible to athletes and coaches.  Walk into any weight-room and ask any male in the place: “Who benches the most?  Who squats the most?  What’s your max in the deadlift?”  You will get quick answers to all your questions.  Or:  you can simply consult the inevitable “record board” listing the top bench-pressers, squatters, deadlifters etc., etc., etc..

The bar is an easy way to measure strength and (I believe) easily measured strength is the first refuge of a poor coach.  We can happily report strength-gains to convince sport-coaches that we are doing our jobs in the weight-room and that the coach’s athletes are benefiting from the time they spend with us.

Unfortunately, easily measured strength is rarely competitively useful strength. That is something far more difficult to quantify in the simplistic terms of pounds lifted.  Better measures of the efficacy of any strength program would be such things as acceleration speed; multi-directional speed and agility; vertical / horizontal jump and lateral bound; balance; speed-stamina; and the real holy-grail of all evaluative criteria by which any training program ought to be judged:  injury rates.

It is my contention that if more athletes were as devoted to gaining true athleticism as they are to enhancing their numbers in the weight-room, we would have more good athletes and fewer injuries. 

The strength-training required to build bodies that are adaptable rather than simply adapted—bodies able to survive and thrive in the wholly unpredictable (and therefore dangerous) competitive arena—cannot be done using a steady diet of restrictive barbell lifts.  Rehearsing single-plane movements with an awkward, restrictive tool does not provide performance benefits or insurance against injury when the ball is snapped, the pitch is delivered, the puck is dropped, the serve is struck or the gun goes off and chaos reigns. A barbell tells a body what it can do rather than asks a body what it can do, and that is the real line of functional differentiation.
“Simplicity yields complexity.”  I heard Vern Gambetta say that in the first seminar I ever attended as a young coach and the statement hits the bullseye.  Equipment that poses genuine physical puzzles for bodies to solve has a far greater chance of being useful in creating truly athletic athletes than equipment that “dumbs ‘em down” as the saying goes.

We work, after all, with people who are generations removed from naturally physically challenging childhoods.  Movement for all young people is now entirely optional throughout the childhood years.  Indeed, movement is now the least likely choice for children and adults, which partially explains our current health crises of obesity and diabetes.  We must coach physically inarticulate people to be able to perform physical tasks that were once taken for granted in all young people (like the ability to skip!) but which are often maddeningly beyond reach for many these days.

Our job, as coaches charged with improving the performance capabilities of athletes, requires that we be prepared to continually evaluate and re-evaluate our tools and methods and jettison all those that fail to achieve our desired objectives, even if the tools we must jettison include a few sacred-cows like the much revered—and still ubiquitous—barbell.

We have so many excellent ways to impose athletically appropriate resistance challenges.  Dumbbells, medicine-balls, kettlebells, stretch-cords, water, sand and hills all share performance enhancing advantages that barbells lack.  All are (relatively) inexpensive and most are also portable, as well, adding a huge measure of program versatility into the bargain.  Why not choose and use them?

Topics: Strength Training, Guest Author

Squat - How To Build A Bigger Squat : Part II by Jay DeMayo

Posted by Boston Sports Medicine and Performance Group on Sep 21, 2010 8:33:00 PM

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Topics: Strength Training, Jay DeMayo

Diversifying Your Repetoire by Brijesh Patel

Posted by Boston Sports Medicine and Performance Group on Sep 21, 2010 8:27:00 PM

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Topics: Strength Training, Brijesh Patel

Squat - How To Build A Bigger Squat by Jay DeMayo

Posted by Boston Sports Medicine and Performance Group on Sep 21, 2010 8:24:00 PM

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Topics: Strength Training, Jay DeMayo

Core Stability and Basketball Training by Brian McCormick

Posted by Boston Sports Medicine and Performance Group on Sep 21, 2010 8:23:00 PM

by Brian McCormick

During a high school all-star training camp last weekend in Los Angeles, Draft Express’ Jonathan Givony tweeted about the players’ inability to hold basic yoga positions. He further blamed these athletes’ weak core strength and commented about his disbelief.

Givony used one of the buzzwords of the training industry: core strength or core stability. There are some basketball trainers who appear to train players strictly for improved core strength (though with no real measure of improved core strength or what it means).

When I spent time at the IMG Academy, I never saw a basketball player perform a power-related lift. Instead, every instruction involved imagining the core or tightening the core or doing something to the core. Givony spends a lot of time watching professional trainers, so I imagine he has picked up on this idea, and its apparent importance to basketball success.

When Givony tweeted about his disbelief, I questioned him. Why should we assume that someone who has likely never performed a yoga pose should be able to perform a pose correctly within seconds or even minutes? If I brought a group of yoga practitioners on the basketball court and asked them to shoot three-pointers, should I be surprised if they were unable to shoot correctly within a few repetitions?

Further, the average elite high school basketball player is growing rapidly which creates a loss of coordination and strength, as the bones grow faster than the muscles. Most fast-growing teenagers illustrate some awkwardness, which is why players such as LeBron James who grew quickly and never appeared to go through the awkward stage are the outliers. Therefore, the inability to execute yoga poses does not equate with a lack of core strength, regardless of one’s definition of core strength, but instead is testament to the skill involved in learning different poses, especially for long-limbed basketball players.

While core strength is the magic elixir of the training world (and not just basketball trainers), another basketball trainer said that he “pukes in his mouth” when a client tells him that he needs core training. This trainer identifies skill deficiencies and the underlying movements of the skills and creates an exercise program that improves these movements and ultimately the skills. While some of the exercises cross over between his training and the core strength trainers’ training, his focus often differs.

When I worked as a personal trainer this summer, I saw many people do a typical abdominal exercise where you do a sit-up and throw a medicine ball. Most people do a full sit-up and throw the ball to their partner or at the wall at the top of the sit-up using mostly the chest and arms to throw the ball; they wait for the ball to rebound to them and then return to the bottom.

When I do this exercise, the entire purpose is different. This is not a sit-up and throw, but an overhead throw from a supine position (lying on one’s back). My focus is not to contract my abdominals for the entirety of the exercise, as I heard several people explain to each other at the gym, but to contract forcefully at the beginning of the movement to initiate the throw. I do not do a full sit-up because I am not doing sit-ups: I am throwing the ball against the wall as forcefully as possible. In the process of throwing the ball, my abdominals contract and my shoulders come off the ground. However, I do not actively contract my abdominals nor do I actively hold the contraction throughout the movement. I use my entire body to throw the ball, not just my chest and arms, and my arms direct the ball rather than supplying the power.

This is an example of an exercise used for core strength by many that is similar to a movement-related exercise used as a tool to teach rapid contraction and relaxation. The best athletes remain relaxed. When Usain Bolt runs, he does not consciously contract and relax his muscles. He does not actively contract his abdominal wall to maintain his posture. He has an amazing ability to contract and relax at the appropriate time and with the proper order of contractions.

When basketball trainers speak about the lack of core strength, they typically point out a  flawed movement. They do not measure core strength or stability through a core exercise, like one measures upper body strength with a bench press test or lower body power with a vertical jump test.

The traditional test of core strength is the sit-up test, but this is flawed in several ways. First, a sit-up test tests more for strength endurance than strength or stability. Second, there is no specificity, and therefore no certainty of transfer, between an exercise that occurs lying down involving flexion and stability in a standing posture. Finally, Stuart McGill, the godfather of spine research, says that sit-ups place “devastating loads on the disks.” Other studies have suggested that a front squat activates the core musculature more than a sit-up. So, how does one measure core strength? How does one measure improvement? How much strength does one need?

The Journal of Bodywork and Movement Therapies recently published a critical review titled “The Myth of Core Stability” by Eyal Lederman [Journal of Bodywork & Movement Therapies (2010) 14, 84-98]. Lederman addresses the strength question:

To what force level do the trunk muscles need to co-contract in order to stabilize the spine? It seems that the answer is not very much.

During standing and walking the trunk muscles are minimally activated (Andersson et al., 1996). In standing the deep spinal erectors, psoas and quadratus lumborum are virtually silent! In some subjects there is no detectable EMG activity in these muscles.

As for strengthening the core muscles, he writes:

A recent study has demonstrated that as much as 70% MVC [maximal voluntary contraction] is needed to promote strength gains in abdominal muscle (Stevens et al., 2008). It is unlikely that during CS [core strength] exercise abdominal muscle would reach this force level (Stevens et al., 2007).

So, what should a trainer do when there is a noticeable skill deficiency attributed to lack of trunk stability? For instance, some ACL studies have identified lack of core strength as a precursor to ACL injuries, while others simply appear to lack total body coordination which impedes their ability to stop or even execute skilled movements like shooting or jump stops or to hold their proper defensive stance (posture).

Lederman reminds coaches and trainers to remember the specificity principle of motor learning. He cites a study that “assessed the effect of training on a Swiss ball on core stability muscles and the economy of running...The subjects got very good at using their muscles for sitting on a large inflatable rubber ball but it had no effect on their running performance.”

Lederman adds:

“Trunk control will change according to the specific activity the subject is practicing. Throwing a ball would require trunk control, which is different to running. Trunk control in running will be different in climbing and so on. There is no one universal exercise for trunk control that would account for the specific needs of all activities. Is it possible to train the trunk control to specific activity? Yes, and it is simple - just train in that activity and don’t worry about the trunk. The beauty of it all is that no matter what activity is carried out the trunk muscles are always specifically exercised.”

If one sees a trunk control problem while doing yoga poses, the athlete needs more practice doing the yoga poses. However, this does not mean that the athlete lacks trunk control when shooting a basketball or making a jump stop. Similarly, if the athlete struggles to execute a jump stop, yoga will not necessarily improve his trunk control on jump stops. Instead, practicing jump stops is more likely to lead to improved performance of jump stops and improved trunk control on jump stops.

As for attacking the core stability through the activity and asking an athlete to concentrate on his core, as many trainers do, would you ask an athlete to have such an internal focus of control when running or lifting weights or shooting a basketball?

Lederman answers:

Let’s imagine two scenarios where we are teaching a patient to lift a weight from the floor using a squat position. In the first scenario, we can give simple internal-focus advice such as bend your knees, and bring the weight close to your body, etc (van Dieen et al., 1999; Kingma et al., 2004). This type of instruction contains a mixture of external focusing (e.g. keep the object close to your body and between your knees) and internal focus about the body position during lifting. In the second scenario which is akin to CS training approach, the patient is given the following instructions: focus on co-contracting the hamstrings and the quads, gently release the gluteals, let the calf muscles elongate, while simultaneously shortening the tibialis anterior etc. Such complex internal focusing is the essence of CS training, but applied to the trunk muscles. It would be next to impossible for a person to learn simple tasks using such complicated internal-focus approach.

While core strength and core stability are buzzwords and make trainers and scouts sound knowledgable, what does it mean for sports performance? How does one measure the supposed lack of core strength? How does one train a player with poor trunk control? Do exercises on one’s back lead to improved trunk control in an upright position in a dynamic environment?

Stability is important to sports performance. However, stability is not just abdominal exercises. Stability is global: it includes the entire body working together, not a few muscles located around the spine. Isolating these abdominal muscles in training helps one attain a six-pack, but these exercises do not necessarily improve sports performance or trunk control in sports performance.

Instead, if you want to improve trunk control in a jump stop, start at the basics and progress. The basics of a jump stop would eliminate the ball and any pre-jump stop movement. Focus simply on the body stability when landing from a short jump. Next, add the ball, but no prior movement. Then, execute the stationary jump stop while catching the ball. Then, eliminate the ball and add movement before the jump stop. Next, move prior to the jump stop while holding the ball. Finally, return to the full jump stop with prior movement and ball manipulation (dribbling into the jump stop or receiving  a pass). This is a simple progression of motor skill development from the simple to the complex, and provides the specificity required to develop trunk control for an activity.

Topics: Brian McCormick, Strength Training

Periodization for Sport: Part II by Brijesh Patel

Posted by Boston Sports Medicine and Performance Group on Sep 21, 2010 8:21:00 PM

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Topics: Strength Training, Brijesh Patel

Periodization for Sport: Part I by Brijesh Patel

Posted by Boston Sports Medicine and Performance Group on Sep 21, 2010 8:20:00 PM

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Topics: Strength Training, Brijesh Patel

Push Up Progression by Ray Eady

Posted by Boston Sports Medicine and Performance Group on Sep 21, 2010 8:18:00 PM

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Topics: Ray Eady, Strength Training