By Art Horne

With recent season ending ACL injuries to New York Knicks Iman Shumpert, and Chicago Bull’s point guard Derrick Rose coming on the same day, (not to mention Eric Maynor from the Thunder and Spanish Star Ricky Rubio earlier this season) discussion has arisen as to how these terrible injuries could have been avoided.  Although the possible contributing factors are endless, ranging from previous injury to simply fatigue, one area worth shedding more light on, especially in the case of young Rose, is the implication of the kinetic chain as a whole.

Let’s start at the ground and work our way up.

I think we’d all agree that the big toe is a big deal.   But how closely are we looking at this “pivotal” body-ground juncture?

In a study by Munuera et al, researchers found that “Hallux interphalangeal joint dorsiflexion was greater in feet with hallux limitus than in normal feet.  There was a strong inverse correlation between first metatarsophalangeal joint dorsiflexion and hallux interphalangeal joint dorsiflexion.” (Munuera et al, 2012). 

TRANSLATION: People with abnormally stiff or limited motion at the great toe had excessive motion at the joint just distal.

If you don’t have mobility where you need it, you’ll surely get it somewhere else.

Let’s move up the chain shall we?

In a study by Van Gheluwe and his group,  researchers looked at how a stiff or limited great toe joint changes the way we walk.  In their study, “two populations of 19 subjects each, one with hallux limitus and the other free of functional abnormalities, were asked to walk at their preferred speed while plantar foot pressures were recorded along with three-dimensional foot kinematics.  The presence of hallux limitus, structural or functional, caused peak plantar pressure under the hallux to build up significantly more and at a faster rate than under the first metatarsal head.  Additional discriminators for hallux limitus were peak dorsiflexion of the first metatarsophalangeal joint, time to this peak value, peak pressure ratios of the first metatarsal head and the more lateral metatarsal heads, and time to maximal pressure under the fourth and fifth metatarsal heads.  Finally, in approximately 20% of the subjects, with and without hallux limitus, midtarsal pronation occurred after heel lift, validating the claim that retrograde midtarsal pronation does occur.”

TRANSLATION: if you have a limited motion in your great toe, pressure changes will occur – increase pressure changes will cause pain over time (think blister on your foot).

And pain changes the way we move – period.

Let’s take a look at the ankle.

In an article  by Denegar et al, the authors outline the importance of regaining normal talocrural joint arthrokinematics following an ankle injury.   The authors note,

 “All of the athletes we studied had completed a rehabilitation program as directed by their physician under the supervision of a certified athletic trainer, and had returned to sports participation.  Furthermore, all had performed some form of heel-cord stretching. None, however, had received joint mobilization of the talocrural complex.  Despite the return to sports and evidence of restoration in dorsiflexion range of motion, there was restriction of posterior talar mobility in most of the injured ankles.  Posterior talar mobilization shortens the time required to restore dorsiflexion range and a normal gait.  Without proper talar mobilization, dorsiflexion range of motion may be restored through excessive stretching of the plantar flexors, excessive motion at surrounding joints, or forced to occur through an abnormal axis of rotation at the talocrural joint.” (pg. 172)

TRANSLATION: I repeat, Without proper talar mobilization, dorsiflexion range of motion may be restored through excessive stretching of the plantar flexors, excessive motion at surrounding joints, or forced to occur through an abnormal axis of rotation at the talocrural joint.” (pg. 172)

If you don’t have normal ankle motion, and specifically at the talus, your ankle motion (although appearing normal) is probably coming from other joints and/or in a combination with foot pronation.

Foot Pronation = Tibial Internal Rotation

Tibial Internal Rotation = Femoral Internal Rotation

Tibia and Femur Internal Rotation  =  Knee Valgus (or knee collapse)

Knee Valgus = BAD

But just because you have some extra motion doesn’t mean you’re doomed right?

No.

But, excessive motion without the ability to control that motion certainly does.  So where does knee control come from? The Hip!

But hip strength, control, and neuromuscular timing is seldom appreciated, and in the case of the basketball athlete it is certainly poorly measured, especially after ankle injury.

In a study by Bullock-Saxton, researchers investigated muscle activation during hip extension after ankle sprain and showed a changes in timing of muscle activation in the ankle sprain grouped compared to the non-injured group.

 “the results highlight the importance of the clinician’s paying attention to function of muscles around the joints separated from the site of injury.  Significant delay of entry of the gluteus maximus muscle into the hip extension pattern is of special concern, as it has been proposed by Janda that the early activation of this muscle provides appropriate stability to the pelvis in such functional activities as gait.” (pg. 333)

In another study examining ipsilateral hip strength/weakness after the classic ankle sprain, researchers demonstrated that subjects with unilateral chronic ankle sprains had weaker hip abduction strength and less plantar flexion range of motion on the involved sides (Friel et al., 2006)

“Our findings of weaker hip abductors in the involved limb of people with chronic ankle sprains supports this view of a potential chronic loss of stability throughout the kinetic chain or compensations by the involved limb, thus contributing to repeat injury at the ankle.” (pg. 76)

“If the firing, recruitment, and strength of the hip abductor muscles in people with ankle sprains have been altered because of the distal injury, the frontal-plane stability normally supplied by this muscle is lacking, and the risk for repeat injury increases.  Weak hip abductors are unable to counteract the lateral sway, and an injury to the ankle may ensue.”

TRANSLATION: Ankle sprains cause neuromuscular changes up the chain and specifically in the hip.  If this weakness is not addressed after an ankle injury,” frontal-plane stability normally supplied by this muscle is lacking.” 

Lack of frontal-plane stability + Knee Valgus = Injury

Of course suggesting that the above points are exactly the reason for which Rose suffered his injury is certainly a stretch and not the intention of this post, nor is it to question the treatment that he or any other NBA player received prior to their devastating injury (for the record, the Chicago Bulls Sports Medicine and Strength Staff are regarded as one of the very best in the league).  What I am suggesting however is that examining athletes and patients with the use of advanced technology to determine a state of readiness to participate, and/or examine more closely changes in gait and neuromuscular firing is certainly worth pursuing, especially in light of the ever-rising salaries within professional sports.  A quick look is certainly worth the small investment.

One thing is for sure, ACL injury is not limited to teenage females or only seen on the soccer pitch.

Previous Posts:

The NBA Should Have Learned From The NFL - Injuries On The Rise

Did The NBA Lock-out Ultimately End Chauncey Billups' Career?

See lectures directly related to gait, injury prevention, and performance at the 2012 BSMPG Summer Seminar:

1. Dr. Bruce Williams: Hit the ground running: Appreciating the importance of foot strike in NBA injuries

2. Dr. Bruce Williams: Breakout Session: Restoring Gait with evidence based medicine

3. Art Horne and Dr. Pete Viteritti: Improving Health & Performance - Restoring ankle dorsiflexion utilizing a manual therapy approach

4. Dr. Tim Morgan: Biomechanics and Theories of Human Gait: Therpeutic and Training Considerations

5. Jose Fernandez: Advanced Player Monitoring for Injury Reduction

See the most advanced player monitoring equipment currently available at the 2012 BSMPG Summer Seminar:

References:

Munuera PV, Trujillo P, Guiza L, Guiza I. Hallux Interphalangeal Joint Range of Motion in Feet with and Without Limited First Metatarsophalangeal Joint Dorsiflexion. J Am Podiatr Med Assoc. 102(1): 47-53, 2012.

Denegar, C., Hertel, J., Fonesca, J.  The Effect of Lateral Ankle Sprain on Dorsiflexion Range of Motion, Posterior Talar Glide, and Joint Laxity.  J Orthop Sports Phys Ther. 2002; 32(4):166-173.

Van Gheluwe B, Dananberg HJ, Hagman F, Vanstaen K. Effects of Hallux Limitus on Plantar Foot Pressure and Foot Kinematics During Walking. J Am Podiatr Med Assoc. 96(5): 428-436, 2006.

Bullock-Saxton, J. E., Janda, V., & Bullock, M. I. (1994) The Influence of Ankle Sprain Injury on Muscle
Activation during Hip Extension. Int. J. Sports Med. Vol. 15 No. 6, 330-334.

Friel, K., McLean, N., Myers, C., & Caceres, M. (2006). Ipsilateral Hip Abductor Weakness After Inversion
Ankle Sprain. Journal of Athletic Training. Vol. 41 No.1, 74-78

Smith RW, Reischl SF. Treatment of ankle sprains in young athletes. Am J Sports Med. 1986;14:465-471.

by Carl Valle

I decided to interview Rob Shugg from Kinetic Performance after hearing a few new definitions of what power is, and felt that we needed more sport science tools to help the performance community understand how to develop power in team sports. Track and field is very objective, but the methodologies tend to be cloudy. I wanted to get Rob's opinion on the matters of true development and monitoring of elite sport as he has many years with the Australian Institute of Sport and in the private sector with technology and performance. The BSMPG is the first conference in the US to promote Gymaware and Kinetic Performance as technology and data is becoming more and more important to help teams find the winning edge. 

Most of the US professional and college teams are familiar with linear transducers for measuring power, could you expand on the differences between Gymaware and the Tendo system, specifically with the advanced analytics and cloud benefits. 

First I’d like to give your readers a quick outline of the GymAware components:GymAware Power Tool - A linear transducer that connects via bluetooth to an iPad, iPod Touch or iPhone. 

iOS apps: 

GymAware Lite App - a stand-alone weightlifting analyzer app withextensive training, feedback and plotting functions. 

GymAware App - a cloud-connected weightlifting analyzer app offering online data and athlete management. 

GymAware/Kinetic-Athlete cloud analysis server - a web based account for managing and analysing Power Tool and other athlete performance data.So as you can see, while the Power Tool and the Tendo weightlifting analyser are both linear transducers, only GymAware offers a complete athlete performance stack, from data collection to athlete performance management. You canstill use the Power Tool like you use the Tendo unit to motivate and train athletes, but in addition you can start to look at[other variables] like dip and lift profile to improve technique. 

The GymAware Power Tool has evolved through 5 different models over the last 10 years with each new release improving accuracy and usability. There is a good comparison [here] between the latest Power Tool and the Tendo Power and Speed Analyzer. To talk about the benefits of the cloud server and advanced analytics, you first need to look at system accuracy as this is fundamental to the success of the advanced features.The high accuracy of the Power Tool opens up new opportunities in preparing athletes for competition. With high accuracy you can look for more subtle changes over time that give you real insight into the state of the athlete. 

Power is often pursued by teams, could you look at how power can act as a marker of both performance and fatigue with team sports? Currently Benchmarks and profiling seem to be important for individualization. 

There’s no doubt that power is a key factor in producing game winning performances, and power profiling to optimize power training plays a vital role in any professional team. But recently in Australia, regular (3 to 5 times per week) power and/or velocity monitoring has proved to be a very reliable way of monitoring for fatigue. At last year’s ASCA conference Dr Kristie Taylor suggested that we should 

Other performance managers have reported to us that the Power Tool measurements are so sensitive that they can see slower power recovery after games played at a particular stadium known to have a hard playing surface. Regular monitoring with GymAware adds a completely new dimension to the knowledge available to the sports performance professional. 

Kinetic Athlete is not new to player monitoring, why does Kinetic Performance's experience make you a leader in player management? I think to answer this you need to look at environment that lead to the development ofGymAware. 
 

Click HERE to continue reading...

Learn more about this new technology along with the most advanced health and performance monitoring tools currently available at the 2012 BSMPG Summer Seminar - May 19/20th.

article by Jose Fernandez

After reading last week´s posts from Coach Boyle and Carl Valle I decided to do a little research on Self Myofascial Release and foam rolling. What motivated me is that there is not a clear protocol stablished regarding when, how and for how long athletes should use foam rollers. Some coaches recommend to roll before working out and others after, some coaches prefer to just continuously roll over the muscle surface and others recommend to hold on the trigger point for a few seconds.

What is foam rolling? (by wikipedia):

“Foam rolling is a self-myofascial release (SMR) technique that is used by athletes and physical therapists to inhibit overactive muscles. This form of stretching utilizes the concept of autogenic inhibition to improve soft tissue extensibility, thus relaxing the muscle and allowing the activation of the antagonist muscle.

It is accomplished by rolling the foam roller under each muscle group until a tender area is found, and maintaining pressure on the tender area for 30–60 seconds.”

Looking at the scientific evidence, I could not find a lot of published material either. See below some of papers I found:

A comparison of the pressure exerted on soft tissue by 2 myofascial rollers

Foam Rollers Show No Increase in the Flexibility of the Hamstring Muscle Group

The Acute Effect Of Self-Myofascial Release On Lower Extremity Plyometric Performance

In this case study we used Tensiomyography (TMG) to assess the change in contractile muscle properties (contraction time and muscle tone) after applying 2 different protocols with foam rollers. Click here to see one of my previous post with a detailed explanation about TMG and the information that it provides.

Foam Rolling & TMG Case Study:

The purpose of this case study was to analyse the change in contractile muscle properties assessed with TMG before and after applying two different SMR protocols using a foam roller. Characteristics of the roller that we used can be found here.

A professional basketball player (Age:22, H: 6.2ft, W: 198.4lbs, no injuries) with more than 6 months experience using foam rollers volunteered for the test, which was performed after a day off and consisted of assessing the Left Vastus Lateralis (dominant leg) with TMG before and after applying two different rolling interventions.

Protocol 1: Holding on the trigger point

- TMG Initial assessment on resting conditions

- Roll until the area of maximum pain is found. Hold the roll on that point for 30 seconds. Immediately after the 30 seconds continue rolling 5-6 times over the whole muscle surface

- TMG Post treatment Assessment 

Protocol 2: Cotinuous Rolling

- TMG Initial assessment

- Continuously roll over the whole muscle surface for 60 seconds

- TMG Post treatment Assessment

Restults:

Protocol 1:

Click HERE to continue reading this article...

There are people that talk the talk, and then there are the people that actually walk the walk.  Andrea Hudy is the latter (and she probably does it Farmer Walk Style!)

Coach Hudy has put more kids in pro uniforms and judging on the way her Jayhawks played in the national championship game this past year, they'll be plenty more Kansas alums rocking the NBA hardcourt next season.  See Coach Hudy at the 2012 BSMPG Summer Seminar as she headlines a list of the country's top basketball performance coaches including the NBA's Indiana Pacer's Shawn Windle, University of Texas Logan Schwartz and Keith D'Amelio (formally Stanford and Toronto Raptors Strength Coach - currently with Nike).

Read why KU found the right fit with strength coach Andrea Hudy below.

article by Tom Keegan

New Orleans — Such silly, dangerous things can happen in the weight room, where steel clangs and challenges fly.

And then there is the facility supervised by Andrea Hudy, strength and conditioning coach for the Kansas University men’s and women’s basketball programs.

So much science goes into the planning of the workouts, the study of the progress each individual makes. Decisions are made with intellect, not emotion.

Well, most of the time anyway.

Former Kansas University reserve guard Jeremy Case, now an assistant coach at Southeastern Missouri State, is fuzzy about the details. He just remembers feeling “terrible” about what happened. Still does.

Hudy recalled more details, perhaps because pain has such a long memory.

Hudy said Case complained he couldn’t possibly do four repetitions of the weight she prescribed.

“It was a bet,” Hudy said. “I said ‘If you do that four times, I’ll do a multiple-fatigue set for 30 reps.’ He said, ‘You’re on.’ I took the bar off the rack, lowered it and I heard it (her shoulder popping.) Everybody heard it. I said, ‘I hurt my shoulder.’ He said, ‘You can’t stop now.’ I said, ‘All right, I’ll prove it to you.’ Twenty-nine reps later, I ended up in the training room.”

It’s a painful memory for more than just Hudy.

“Next day her arm’s in a sling,” Case said. “Damn, I feel so bad. Just goes to show how tough coach Hudy is. She’s no ordinary lady. Really tough lady.”

Hudy suffered a torn rotator cuff and torn labrum.

“I lost the battle, but I won the war,” Hudy said. “He didn’t think he could do four reps, and he did six.”

Click HERE to continue reading this article....

Hey BSMPG Friends and Family!

Ever wanted to see Craig Liebenson and Chris Powers speak? Want to enhance your industry knowledge and performance at work? Ready for some serious networking? You are in luck!

The BSMPG Summer Seminar is on May 19-20 in Boston, MA, and…..

Early Bird Registration has been extended for one more week! This discounted price will end at midnight on Sunday April 22nd – don’t miss out!

Be sure to Register for May 19-20, 2012 for the 2012 Summer Seminar in Boston, offering a multi-disciplinary approach to health and human performance. Keynote speakers this year include researchers, therapists, and strength coaches, including Dr. Craig Liebenson and Chris Powers, who have revolutionized our industry and the way we now approach patient care and performance programming. These five keynote presentations will be interspersed alongside breakout sessions with Giants from the fields of Sports Medicine/Rehabilitation, Basketball and Hockey Performance training throughout the weekend. Check out www.bsmpg.com for complete details!

Also, the Dynamic Neuromuscular Stabilization (DNS) Course “B” has been scheduled for April 27-30, 2013 in Boston, MA! Course “A” this past March was SOLD OUT, and this course is sure to do the same! This is the first time course “B” has been offered on the east coast and BSMPG is proud to be part of this educational effort. Details coming soon - check our website for announcements for future DNS events!

SEE YOU SOON!

-BSMPG

Christopher McDougall Talks Barefoot and Why Humans Were Born to Run

Learn how you too can enjoy the benefits of being barefoot by reading BAREFOOT IN BOSTON, available now in both paperwork and kindle.

Recently, there has been a sudden shift from the once poplular and often prescribed high intensity interval training to at least a greater appreciation and understanding of the aerobic system and its contribution to elite physical conditioning and game preparation.  At the heart of this subject matter is none other than Joel Jamieson - BSMPG 2012 Summer Seminar Speaker.

Learn more from Joel along with a number of the country's top performance coaches at the 2012 BSMPG Summer Seminar.  But don't wait - seats are limited and this event is sure to sell out again this year!

Excerpt from:

ULTIMATE MMA CONDITIONING-Joel Jamieson

Method #5 Threshold Training

At the beginning of this chapter, I told you that it was important to increase how much power you could generate aerobically so that you had to rely less on fatiguing anaerobic processes to generate the necessary ATP. The threshold training method is very effective at helping you increase your aerobic power and achieve this goal. The basic premise of the method is very simple, by working your aerobic system to the maximum limits of its energy production abilities, the body adapts by increasing the total number of aerobic enzymes and improving overall contractile properties. As a result, the maximum rate of aerobic energy production increases.

If you’ll recall from earlier, the point where your body begins to shift the majority of its ATP generation from aerobic to anaerobic is known as the anaerobic threshold. This is a very important point because it reflects the maximum sustainable output that your aerobic system is capable of. If we can raise your anaerobic threshold and/or increase your power output at the threshold, then you’ll have to rely less on the anaerobic systems and you’ll have better endurance.

Although there is definitely some genetic influence that determines where your anaerobic threshold is, it’s also a very trainable quality because we can dramatically increase how much power you’re able to produce aerobically through the proper training methods. Threshold training is one of the methods and consists of training at heart rates at or near your anaerobic threshold for different periods of time. Because you are essentially asking your body to produce ATP as fast as it possibly can while predominantly using the aerobic system, this method places a great deal of stress on the entire system and provides a strong stimulus for it to improve. This is one of the reasons it is so effective, but it also means you have to be fairly precise in determining your threshold.

For maximum effectiveness, you want to train in a heart range that is within +/- 5 bpm of your anaerobic threshold. Unfortunately, there is no simple and easy way for most people to determine where their anaerobic thresholds are exactly. The most accurate way is through a gas exchange test done at an exercise performance lab, but this is obviously impractical for most people. If you have access to a metabolic testing center in your area, this can offer an effective way to determine your threshold and it typically runs between $75 and $125 for the test.

Aside from using a laboratory testing procedure, it can be difficult to get an accurate gauge of where exactly your anaerobic threshold is. The next best alternative is to use a simple test I came up with and perform 3x5 minute sparring rounds at a relatively high pace with a heart rate monitor on. If you don’t spar, then you can do 3x5 minute pad rounds or something comparable such as the modified coopers test as described in  a later chapter.

For the test, you will need to use a heart rate monitor with a lap function and I specifically recommend the Polar RS100 for this purpose. If you don’t have one of these yet you can order one directly from my website at www.8weeksout.com. All you have to do is record your average heart rate for each of the three rounds, excluding the 60s break between rounds, and take your average heart rate over the entire 3 rounds. While there is no research on this approach to show it accurately reflects your anaerobic threshold, I’ve found it to be reasonably close for most people and it is much better than just guessing.

Once you have found your average heart rate over the three rounds, this is the heart rate number you should use for the threshold training method. To use the threshold method, all you have to do is keep your heart rate at +/- 5 bpm for repetitions of 3-10 minutes at a time using different types of exercises. Many athletes use this method in the form of circuit style training, although they rarely pay attention to where their heart rate is during the circuit. You can use running, MMA drills and sparring, cycling, etc. But keep in mind you’ll need to lower your heart rate range by 5-10 bpm in activities where you are sitting or lying down.

by Jeff Cubos

It’s been over a year since I first began the Dynamic Neuromuscular Stabilization program. Since that initial “A” course, my clinical thought process has expanded exponentially through following up with the “B” and “C” courses, my privileged opportunity to visit Motol in Prague, and the day to day reflections of my current practice.

Well recently, I had the privilege of taking part in another DNS A course that was put forth by Michael Maxwell of Somatic Senses and taught by Alena Kobesova and Brett Winchester. This particular experience was quite special for me because not only was it local (hence no flight costs), but it provided me with the opportunity to share my experiences to date with many of my friends and colleagues who attended the course…including my wife.

I would say however, that the most beneficial aspect of being present was that it afforded me the opportunity to “fill in the gaps”.

Continue to read this article by Jeff Cubos by clicking HERE

Meet Jeff Cubos and other top therapists and strength coaches as attendees at the 2012 BSMPG Summer Seminar.

Register today before seats are filled!!

BSMPG has begun plans to host DNS Course "B" in Boston in the spring of 2013.  Due to the overwhelming response of our Course "A" offering, we have begun plans to host course "B" next spring.

Stay tuned to bsmpg.com for complete details.

Click video below to watch interview with Boston Course "A" instructor, Clare Frank who would also be teaching Course "B" upcoming.

Click below to watch an interview with Craig Liebenson as he talks about the DNS approach.

See Craig Liebenson at the 2012 BSMPG Summer Seminar - May 19th and 20th in Boston MA.

Hurry - this program has a limited number of seats!

University of Kansas Strength & Conditioning Coach

Andrea Hudy

When the 7-foot center Jeff Withey showed up on the Kansas campus in 2009, he was a gawky San Diego kid who weighed a shrimp taco or two above 200 pounds. So how did he develop into the bruiser who has helped put the Jayhawks into the NCAA tournament's Final Four?

Withey describes her as "one of our secret weapons."

Click HERE to continue reading.

See Andrea and other top basketball coaches from across the country speak at the BSMPG Summer Seminar - May 19/20 in Boston.