Boston Sports Medicine and Performance Group, LLC Blog

Predicting Performance and Injury Resilience in Collegiate Basketball Athletes : Part II

Posted by Boston Sports Medicine and Performance Group on Thu, Aug 30, 2012 @ 07:08 AM


by Art Horne


BSMPG Basketball Seminar


Just recently Dr. Stuart McGill, Jordan Andersen, and I published an article in the Journal of Strength and Conditioning Research examining the link between traditional pre-season strength, fitness, and sports medicine testing to overall on-court basketball performance and injury resilience throughout the course of two collegiate basketball seasons.  Although I would be the first to admit that there are some clear limitations to this study (number of participants for example), key performance predictors (points scored, ability to rebound, block shots, etc) were NOT associated with traditional strength or performance measures so often pursued in collegiate basketball strength programs.

Below is a summary of our most interesting findings followed by my thoughts and experiences from the last decade of both training and caring for the collegiate basketball athlete.  The two should not be confused as one and the same, although many of the findings in this study only strengthen my position when it comes to training and caring for the basketball athlete.  Findings are in bold, with narrative following in normal text.


1. A “stiffer” torso leads to better performance

This goes without saying. 

This is most evident when watching elite vs. novice athletes performing lateral shuffling followed by a change of direction.  In general, elite athletes will be able to “stiffen” their core/spine quickly providing a stable base from which their limbs may generate force against in preparation for the sudden stop and change in direction.  Novice athletes tend to take much more time to slow down and reverse directions.  This is a major contributor to the decreased lane agility times seen in elite athletes (see #4 below).  The ability to stiffen quickly however is not solely responsible for improved change of direction time and increased performance.  The ability to “relax” this same musculature is much more important – yet rarely trained in modern performance programs.   

This phenomenon has been studied at length by Leo Matveyev, one of the leading Russian sports scientist where he found an underlying theme among the top level of sports mastery in the Russian system of classification – those that achieved the highest level also had the highest speed of muscle relaxation.  The speed of relaxation following muscular contraction was nearly 200 percent faster than lower level athletes, and those that were classified just below “master of sport” demonstrated relaxation times of about 50% slower! (Dietz, 2012)

These findings mirror McGill’s work where he examined elite MMA fighters as they struck a punching bag and discovered a “double-peak” in muscle activity where initial muscle contraction was quickly followed by relaxation as the striking limb traveled through the air, followed again but a rapid increase in muscular tension as the limb contacted the bag.

“Muscle activation using electromyography and 3-dimensional spine motion was measured. A variety of strikes were performed. Many of the strikes intend to create fast motion and finish with a very large striking force, demonstrating a "double peak" of muscle activity. An initial peak was timed with the initiation of motion presumably to enhance stiffness and stability through the body before motion. This appeared to create an inertial mass in the large "core" for limb muscles to "pry" against to initiate limb motion. Then, some muscles underwent a relaxation phase as speed of limb motion increased. A second peak was observed upon contact with the opponent (heavy bag). It was postulated that this would increase stiffness through the body linkage, resulting in a higher effective mass behind the strike and likely a higher strike force. Observation of the contract-relax-contract pulsing cycle during forceful and quick strikes suggests that it may be fruitful to consider pulse training that involves not only the rate of muscle contraction but also the rate of muscle relaxation.” (McGill, 2010)

In personal conversations with McGill we both agree that this “double-peak” phenomenon, although not yet measured in basketball athletes, also occurs in elite level point guards during a cross-over maneuver as they blow by the opposition on the way to the basket and is a must at the highest level of basketball competition – think Derrick Rose, Chris Paul and JJB.  I first witnessed this contract-relax-contract mastery at Northeastern University while working with a young kid from Puerto Rico named Jose Juan Barea as he sliced up defender after defender on his way to becoming an NBA champion with the Dallas Mavericks most recently in 2011. 


basketball seminarbasketball conference

The LA Lakers and Miami Heat found out firsthand just how important spine stiffness and relaxation is during the 2011 NBA Playoffs - courtesy of one JJB.


Torso stiffness is paramount in the game of basketball and a must for those looking to change direction quickly on their way to the basket but also for those absorbing repeated bouts of body blows down on the blocks.


2. More hip range of motion was linked to better  performance

Appropriate hip range of motion is another no-brainer.  Its impact on low back and anterior knee pain are well documented in the literature from an injury perspective and should be evaluated both on initial contact with your athletes but also periodically throughout the competitive season as a simple check to ensure healthy tissue qualities and cooperation from joints above and below (tibio-femoral rotation along with SI position).


3. Bench Press correlated with blocks per game (r=.0.59)

We’ve all beaten the Kevin Durant bench press story to death and know that his inability to push 185 pounds off his chest during the NBA combine hasn’t impacted his ability to perform on the court. Now, I’m not ready to suggest that basketball athletes need to bench press, but if you’ve ever played basketball or at least watched a game, you know that the contribution from the upper body is immense when it comes to establishing position on the blocks and fighting through screens.  Although the actual “block” needs minimal upper body strength, the ability to position yourself for said block usually takes some pushing and shoving – both of which are aided by some impressive upper body strength.


4. Long Jump distance and Lane Agility Test were the most closely linked performance tests to actual performance

  1. Long Jump scores correlated with: minutes, rebounds, and blocks per game
  2. Lane Agility time correlated negatively with minutes played, points, assists and steals per game (meaning that a faster time was linked to more performance)
  3. Vertical Jump did not correlate with any variable below


  • Long jump is related to one’s ability to produce force into the ground and forward acceleration (Holm, 2008)
  • Vertical jump conversely is related to top end speed (and of course those highlight dunks on ESPN Sports Center)
  • Basketball courts measure 94 feet long from end to end.  Plays that result in scoring or prevent scoring almost always take place within the half court, with the majority of those occurring within the 3-point arc.  Therefore, if you were to choose between an athlete with incredible top end speed or incredible acceleration abilities, knowing that the majority of his productive (scoring or preventing scoring) minutes will take place within the 3-point arc, which would you choose?  My money is with the acceleration guy!  Although highflying dunks are popular in warm-up and during your morning Sports Center show, the rate at which this quality is utilized during an actual game is far less than qualities associated with acceleration, and as such, traditional strength training programming must reflect this end. 
  • If you have to choose, pick the guy with a huge horizontal jump – he’ll be able to cover more space more quickly over short distances and will be more valuable within the context of the game overall.


5. Back injured group had, on average played more games and more minutes per game and had a greater number of rebounds and steals per game but NOT more assists or points scored.

Only 5 injures were observed – those getting injured however played many more minutes per game, had double the rebounds and fivefold more blocks.


BSMPG Summer Seminar

Oakafur was a beast in college, but battling bodies like Big Baby Davis' will take a toll on even the healthiest of backs.

Athletes that play more minutes simply have a greater chance of getting injured due to the higher exposure rate – plain and simple.  What’s interesting however is the number of rebounds and blocks tallied by those suffering more injuries, suggesting a willingness to get physically involved in the trenches and the not-so-glamorous side of the game.  These athletes in my opinion also have a much higher general risk behavior and are more often willing to take a charge or dive after a loose ball.  These are the guys that coaches and teammates love for their hustle play but usually end up injured more often.  Because of their increased opportunity for injury, these athletes should be evaluated more often throughout the season through physical examination, subjective questionnaires or other means such as HRV with appropriate recovery and treatment methods applied in an effort to keep nagging pains from becoming a missed games due to injury.


The next article will focus on how we can interpret these very preliminary results and address deficiencies in your athletes this fall prior to the start of the season in both the weight room and sports medicine clinic.


See the leaders in Sports Medicine and Performance at the BSMPG 2013 Summer Seminar including Stuart McGill, Marco Cardinale, Fergus Connolly and Adriaan Louw.

Register for the 2013 BSMPG  Summer Seminar Today



Dietz C, Peterson B. Triphasic Training: A systematic approach to elite speed and explosive strength performance. 2012.

Holm DJ, Stalbom M, Keogh JWL, Cronin J. Relationship between the kinetics and kinematics of a unilateral horizontal drop jump to sprint performance. J Strength Cond Res. 2008 Sept:22(5):1589-1596.

McGill SM, Chaimber JD, Frost DM, Fenwick CM. Evidence of double peak in muscle activation to enhance strick speed and force: an example with elite mixed martial arts fighters. J Strength Cond Res. 2010 Feb:24(2):348-57.

Topics: Basketball Related, Art Horne

The Wait is Over - Triphasic Training is HERE!

Posted by Boston Sports Medicine and Performance Group on Thu, Feb 23, 2012 @ 07:02 AM

The wait is finally over - Triphasic Training by Cal Dietz and Ben Peterson is finally here. 

Click HERE to order Cal's Book.

Read a portion of Cal's Book by viewing a previous post HERE.






What the book is about:
The eBook contains over 350 pages, divided clearly into 2 parts: the why and the what.  The first section goes through the physiological basis for the Triphasic method, undulated block periodization, and general biological applications of stress. The authors will explain how to incorporate the Triphasic methods into existing programs, with complete descriptions on adapting it to virtually any scenario. Section 2 is devoted entirely to programming, with over 3,000 exercises hyperlinked to show you specifically how to perform every exercise. Included in this section are 5 separate 24-week training programs built for either 6 day, 5 day, 4 day, 3 day, or 2 day models. Also included is a complete 52 week training program for football. Cal and Ben show you why and how to peak football lineman or skill players, baseball, swimming, volleyball, and hockey players (among others). By reading this book, you will learn how to take the principles of Triphasic Training and apply it in the correct context for YOUR needs and YOUR athletes! 
What is Triphasic Training?
It is the pinnacle of sports performance training. By breaking down dynamic, athletic movements into their three components (eccentric, isometric, and concentric), the Triphasic system maximizes performance gains by applying stress to the athlete in a way that allows for the continuous development of strength, speed, and power.
Who uses Triphasic Training:
Everyone! From elite level athletes to absolute beginners, the triphasic method of training allows for maximal performance gains in minimal time. For that reason professional athletes from all backgrounds seek out Coach Dietz each off-season to train with his triphasic system. Coach Dietz has worked with hundreds of athletes from the NFL, NHL, and MLB, as well as several dozen Olympic athletes in track and field, swimming, and hockey. 

Table of Contents

Authors's Note
Section 1
1.1 Basic Principles and Their Application to Training
1.2 Stress, Stress, Stress!
1.3 Five Factors for Success
1.4 Results Speak Louder than Words
1.5 Variation is Key
1.6 Summary and Review
Periodization And The Implementation of Stress
2.1 Microcyle: Undulating Model
2.2 Mesocycle: Block System
2.3 Comparison to Linear Periodization
2.4 Summary and Review
The Triphasic Nature Of Athletic Movement
3.1. The Importance of Triphasic Training
3.2. Eccentric Phase
3.3. Isometric Phase
3.4 Concentric Phase
3.5 Summary and Review
Section 4
High Force at Low Velocity(Above 80%)
4.1: Training Above 80 Percent
4.2: Loading Parameters
4.3: Above 80 Training Blocks
4.4: How to Read the Workout Sheet
4.5: Specialized Methods of Applying Training Means
4.6: Monday, Medium Intensity (Submaximal Effort)
4.7: Wednesday, High Intensity (Maximal Effort)
4.8: Friday, Low Intensity (High Volume)
4.9: Above 80 Percent Three-Day Program Overview
4.10: Triphasic Q & A
4.11: Above 80 Percent Four-Day Program
4.12: Above 80 Percent Five-Day Program
4.13: Above 80 Percent Six-Day Program
4.14: Above 80 Percent Two-Day In-Season Program
Section 5
High Force at High Velocity(55-80%)
5.1: Training Between 55 and 80 Percent
5.2: Loading Parameters
5.3: 55 To 80 Training Block
5.4: Specialized Methods of Applying Training Means
5.5: Monday, Medium Intensity (Submaximal Effort)
5.6: Wednesday, High Intensity (Maximal Effort)
5.7: Friday, Low Intensity (High Volume)
5.8: 55-80 Percent Three-Day Program Overview
5.9: 55-80 Percent Four-Day Program
5.10: 55-80 Percent Five-Day Program
5.11: 55-80 Percent Six-Day Program
5.12: 55-80 Percent Two-Day In-Season Program
Section 6
High Velocity Peaking(Below 55%)
6.1: Transfer of Training and Dynamic Correspondence
6.2: AFSM
6.3: Loading Parameters
6.4: Below 55 Percent Training Block
6.5: Specialized Methods of Applying Training means
6.6: How to Read The Workout Sheet: Part II
6.7: Monday, Medium Intensity (Sport-Specific Time: Ideal)
6.8: Wednesday, High Intensity (Sport-Specific Time: Below Ideal)
6.9: Friday, Low Intensity (Sport-Specific Time: Above Ideal)
6.10: Three-Day High Velocity Peaking Program Overview
6.11: Sport Specific Peaking Programs
6.12: Below 55 Percent Two-Day In-Season Program
Putting It All Together
7.1: The Big Picture
7.2: Wrap-Up

Topics: Basketball Related, athletic training conference, boston hockey conference, Cal Dietz, barefoot training

The NBA should have learned from the NFL - Injuries on the Rise

Posted by Boston Sports Medicine and Performance Group on Sun, Jan 22, 2012 @ 10:01 AM

by Art Horne



BSMPG basketball conference

Darrell Arthur suffered a season ending Achilles tear on December 18, 2011.


Eric Maynor

OKC Guard Eric Maynor after a torn ACL on Jan. 7th.



Only the Strong Survive.

We are approaching the one month mark of this current NBA season and there appears to be a terrible trend emerging..... Injuries! (lots of them). 

Not since the 1999 shortened season has teams been forced to play a "triple" (three games in three nights) and this year each team is for better or worse, guaranteed two such miserable stretches.  Add these 72 hour marathons onto a hasty preseason and you have a recipe for disaster.

This year's NBA season "officially" started on Dec 1st with teams allowing players to return for voluntary workouts a mere 24 days prior to the beginning of the season on Christmas day.  But is 24 days (many players including free agents had even less time as they reported to new teams) enough time for players to go from zero to sixty safely?


This past summer the NFL underwent a very similar lockout situation in which athletes were not allowed access to team training facilities, sports medicine services and strength professionals for treatment and training, and unfortunately, many athletes suffered from this lack of preparation.  In an article by Myer and colleagues, the incidence of Achilles tendon injuries following this most recent work stoppage is explored and contrasted against previous NFL seasons.

"Data from a prior report covering 20 NFL seasons (1980 to 2001) indicated an average of approximately 4 Achilles tendon ruptures per year that required surgical intervention." (Myer, p.702)

"This year, following the rapid transition to training camp and preseason practice from the NFL Lockout, 10 Achilles tendon injuries occurred over the first 12 days of training camp, with 2 additional injures occurring in the subsequent 17 days, which included the first 2 weeks of the preseason competition." (Myer, p.703)

".... While it is noted that the preseason rosters were increased from 80-90 players this year, this 12.5% increase in the number of players cannot fully account for a 4-fold increase  (from 3 to 12) Achilles tendon ruptures in the preseason.  Regardless of the previous data that are used, the number of Achilles tendon ruptures in NFL players this year (15 days of training camp and 2 weeks of preseason) has already exceeded all previously reported numbers of Achilles tendon ruptures that normally occur over an entire NFL season." (Myer, p.703)


It’s no secret that a well-planned off-season strength program along with an integrated pre-season preparation period can not only prepare athletes for the rigors of sport, but also have a protective effect against future injury, and the data supports this.

"Based on their dataset, it is clear that preseason training results in increased athlete safety during the first half of the competitive season.  A positive dose-response relationship has been demonstrated, and a minimum of 6-8 weeks of training appeared necessary for induction of positive changes toward enhanced injury prevention profiles." (Myer, p.704)


In a recent article featured on, Michael Wilbon explores this recent trend in NBA injuries:

"It's one thing to suspect injuries might have a big impact on the season, which we began to do the moment the labor lockout led to a shortened training camp, a barely existent preseason and a severely compressed regular season. But it's another to realize it, to see three-quarters of the teams scrambling already to cover for players of consequence missing in action, to see sprains and tears become such a dominant storyline that the team trainer is some nights better equipped than the coach to fill out the starting lineup.

Already, less than a dozen games in for some teams, the NBA could trot out an All-Injury Team of Dwyane Wade and Derrick Rose at guard, Carmelo Anthony and Zach Randolph at forward and Brook Lopez at center that could absolutely reach the NBA Finals. There's even a pretty good All-Injured International Team of Steve Nash and Manu Ginobili, Andrew Bogut, Andrea Bargnani and Luc Mbah a Moute that could finish fairly high up in the standings.

So here's the only prediction I'll boldly make for the rest of the regular season: The coach and staff that best manage their team's injuries will win the NBA championship in late June. Talent ultimately will matter less than health." (Wilbon, ESPN Article)

Continue to read Michael Wilbon's article on HERE


Looking to protect your team against the injury bug?

Come to the BSMPG annual summer seminar and learn what the best sports medicine, strength coaches and basketball professionals are doing to identify injury risk factors, manage injuries in-season and strengthen these athletes to avoid future injury. 

Click HERE for list of speakers and complete conference details.




Myer GD, Faigenbaum AD, Cherny CE, Heidt RS, Hewitt TE. Did the NFL Lockout Expose the Achilles Heel of Competitive Sports? J Orthop Sports Phys Ther 2011;41(10):702-705.

Topics: Basketball Related, Art Horne

We Do Not Have Body Parts. We Have Only A Body

Posted by Boston Sports Medicine and Performance Group on Thu, Dec 1, 2011 @ 07:12 AM

BSMPG summer seminar


by Art Horne


Still treating only the knee when your patients present with knee pain?

How about taking into consideration your athlete’s “stress” surrounding their upcoming exams as a contributor to their lack of “pop” in the weight room or their lingering back pain?

Although our undergraduate anatomy teachers would like to think that the human body can be pulled apart, segmented and discussed as individual parts, it’s impossible to ignore the relationship and influence that each segment and system has on the others.

Try this exercise: 

With your head straight forward, look to your left with only your eyes and then follow with your cervical spine rotating fully to the left.  Note the ease of motion and available range of motion.

Pretty good right?

Repeat by looking with your eyes to the left again but this time rotate your cervical spine to the right.

Notice anything?

I’m sure if you’re like everyone else, your cervical rotation the second time when you were NOT looking and turning in the same direction was a little less fluid and somewhat restricted.

Although not usually thought of, the eyes, tongue and breathing (to name only a few) have an incredible impact on either inhibiting or facilitating movement and thus adding or subtracting to the success of your treatment protocol.

The integration of breathing for example has been ingrained within yoga poses and the martial arts since the inception of these practices yet many health care providers neglect its powerful contribution during stretching and tissue lengthening in an effort to maximize their effectiveness.  Simple breathing connections can be seen during extension of the thoracic spine and exhalation or movement into flexion of the cervical or lumbar spine being assisted by exhalation for example.

Although many clinicians already use complementary body systems during rehabilitation (verbal cueing, tactile encouragement or modality based biofeedback), consideration should be given to other internal systems to maximize the effectiveness of your treatment protocols.


SAVE THE DATE: May 19-20th, 2012. Boston MA. BSMPG Summer Seminar 

Topics: Basketball Related, Art Horne

Everything & Anything

Posted by Boston Sports Medicine and Performance Group on Fri, Nov 25, 2011 @ 08:11 AM



You can do anything that you want.
But you cannot do everything that you want.
To be successful, you must decide between the two.

- Art Horne


Just imagine how special your services could be if you simply stopped sabotaging yourself.

Just imagine the athletic assessments you could provide, the data tracking and trending of injuries and performance, or the complementary services that you and your staff could be involved in if you just stopped doing everything.

The problem with anything and everything is that everything is simply a lot more comfortable.

It’s a lot easier for example to check your email every 20 minutes than it is to visit and learn from a world class therapist during your off day or apply the usual ice and e-stim treatment after an ankle sprain than it is to assess for dorsiflexion prior to injury.

“Everything” gets you and the people you provide services to absolutely nowhere. Of course, you will look busy and everyone will pat you on the back for spending so much time in the office, but those that do everything seldom accomplish “anything” great.

The best way to starting doing anything, is to first starting saying no to everything.




Topics: Basketball Related, Art Horne

Ankle Dorsiflexion and Positional Faults

Posted by Boston Sports Medicine and Performance Group on Tue, Nov 1, 2011 @ 07:11 AM

by Art Horne





In a previous post we discussed how restrictions within the soft tissue surrounding the ankle joint may limit the ever so important motion of dorsiflexion.  However, soft tissue dysfunction or tissue adhesions may not be the only limitation when it comes to you and your ankle joint moving freely.  In fact, many times a gross reduction in motion may be caused by only a miniscule restriction in one of the surrounding foot and ankle bones, especially after injury.

This concept of “positional faults” was first made famous by Australian physiotherapist, Brian Mulligan in which he described an actual anterior translation of the fibula on the tibia after the typical inversion ankle sprain, rather than a disruption of the ATF ligament which so many athletic trainers and physical therapists focus their post-injury treatment protocol on.



“I believe that when the foot is forcibly plantar flexed and inverted beyond the natural range the lateral ligament usually suffers minor injury. The fibula gets wrenched forward on the tibia and positional faults occur.” (pg. 96 Manual Therapy by Brian Mulligan)

Mounting evidence is beginning to support this notion in some patients after the common ankle sprain as well as those with lateral ankle instability as indicated by the article summaries below.  As with all your patient cases, a proper and  methodical assessment is critical to determining if in fact a “positional fault” has occurred versus the previously discussed restriction within the soft tissue surrounding the ankle complex .  In the event that a patient has difficulty after a “simple” ankle sprain, consideration should be given to Mulligan’s concepts with manual therapy techniques employed to correct these faults.


Fibular Position in Individuals with Self-Reported Chronic Ankle Instability

by Hubbard, Hertel and Sherbondy


It has been reported that 55% of individuals who sprain their ankle do not seek treatment and up to 70% suffer from repetitive sprains. Chronic Ankle Instability (CAI) may also lead to increased risk of osteoarthritis and articular degeneration. “Altered arthrokinematics lead to abnormal physiologic motions, distorted state of ligamentous structure and altered joint function” (pg.4), with the combination of these possibly leading to an increased risk of re-injury.

Purpose: The purpose of this study was to assess the position of the distal fibula in individuals with chronic ankle instability CAI. 
Study Design: Thirty subjects with unilateral CAI and 30 subjects with no previous history of ankle injury participated in this study, completing a pair of subjective functional scales and fluoroscopic lateral images for both ankles with the distance from the anterior margin of the distal tibia to the anterior margin of the distal fibula measured.
Results: There were statistically significant differences in fibular position for the subjects with unilateral CAI compared to their non-injured limb as well as the control group, suggesting an anterior positional fault was present in those with unilateral CAI. 
Conclusion: the fibula was positioned significantly more anterior in relation to the tibia in subjects with unilateral CAI but further research is needed to determine if repetitive bouts of ankle instability caused the anterior fibula position or if the position was a predisposing factor to injury.
Clinical Pearl: Suspicion of fibula position fault should be high in lateral ankle sprains with longer than usual symptoms despite traditional treatment, especially in those ankles with swelling that remains despite treatment and is supported by Hubbard and Hertel 2008 in which they found, “a strong positive correlation between fibular position and swelling.” In addition, “those ankles with more swelling had the most anteriorly positioned fibulae. The fibulae in sub-acutely sprained ankles appear to be positioned more anteriorly compared to the contralateral ankles. This positional fault may be maintained acutely by swelling.” (pg. 63)



Immediate Effects of Anterior-to-Posterior Talocrural Joint Mobilization after Prolonged Ankle Immobilization: A Preliminary Study

by Landrum, Brent, Kelln, Parente, Ingersoll and Hertel



Ankle dorsiflexion ROM typically decreases after prolonged immobilization and thus is a central focus for many clinicians during the rehabilitation process.  Interventions such as static stretching and joint mobilizations are often employed as an effort to restore this very motion. “Passive mobilizations consist of gentle oscillating movements of the articular surfaces that create the movement of joints by a means other than the musculotendinous units that normally act on those particular segments. Joint mobilizations are purported to relieve pain and improve range of motion of injured joints.  Such  improvements can in turn lead to an increase in functional activities.” pg. 100. 

Purpose: “The purpose of this study was to determine if a single bout of Grade anterior-to-posterior talocrural joint mobilizations immediately affected measures of dorsiflexion ROM, posterior ankle joint stiffness, and posterior talar translation in ankles of patients who have been immobilized at least 14 days.”
Study Design: The study used 10 subjects 5 male and 5 female each who had been previously immobilized following lower extremity injuries with at least a 5 degree deficit in ankle dorsiflexion. Immobilization ranged from 2 weeks to 9 weeks. All subjects underwent three series of measurements of ankle dorsiflexion ROM, posterior talar mobility, and posterior joint stiffness. ROM was measured using a bubble inclinometer and talar mobility and joint stiffness were measured using an ankle arthrometer. The subjects were split into two groups one receiving the intervention and one control group. All subjects received both the joint mobilization and control (no intervention) in their crossover design.
Results: Ankle dorsiflexion ROM increased significantly at each assessment period. A possible reason for this increase in dorsiflexion ROM could be due to correction of an anterior positional fault of the talus after joint mobilizations. It is possible that these faults were corrected via either the joint mobilization and/or the arthrometer testing.
Conclusion: “After a single application of Grade III anterior-to-posterior talocrural joint mobilization, dorsiflexion ROM and posterior ankle joint stiffness were significantly increased.  There was also a trend toward less posterior talar translation immediately after immobilization.”  This result may be related to correction of a positional fault at the talocrural joint.

Interesting Note: “Mulligan’s positional fault theory may help explain our findings. Residual loss of the posterior glide may be representative of an anterior positional fault of the talus on the tibia and may result in an abnormal axis of talocrural rotation.  Through an acute mechanism of injury, such as ankle sprain, the talus may anteriorly subluxate and become stuck, thus resulting in restricted posterior glide and compromised ankle function.  It is possible that the patients in our study who were immobilized for a prolonged period of time also developed positional faults of the talus and that these positional faults were corrected via either the joint mobilizations and/or the arthrometer testing.” pg. 104




Predicting Short-Term Response to Thrust and Nonthrust Manipulation and Exercise in Patients Post Inversion Ankle Sprain

By Witman et al.



“It has been estimated that the reinjury rate following a lateral ankle sprain may be as high as 80% suggesting the need to identify the most effective management strategies for this condition.”

Purpose: The purpose of this study was to develop a clinical prediction rule (CPR) to identify patients who had sustained an inversion ankle sprain who would likely benefit from manual therapy and exercise.
Study Design: Consecutive patients with a status of post inversion ankle sprain underwent a standardized examination to determine baseline data followed by a treatment program consisting of ankle/foot thrust and non-thrust manipulation, general mobility exercises (including ROM and stretching), advice to maintain usual activity within the limits of pain, and instruction in the use of ice and elevation. Thrust manipulations included a rearfoot distraction technique and a proximal tibiofibular joint posterior-to-anterior thrust manipulation. Nonthrust manipulation techniques used included anterior-to-posterior talocrural technique, lateral glide/eversion rearfoot technique and a distal tibiofibular technique. Of the 85 patients enrolled in the study, 64 or 75%, experienced a successful outcome as reported on the Global Rating of Change scale. Of those who experienced success, 35 or 55%, experienced a successful outcome at the time of the second visit and the remaining 29 experienced success at the 3rd visit. 
Conclusion: The study developed a CPR to identify patients with a status of post inversion ankle sprain who would most likely benefit rapidly and dramatically from manual therapy and general exercise. If 3 of the 4 variables (symptoms worse when standing, symptoms worse in the evening, navicular drop >5 mm, or distal tibiofibular joint hypomobility), were present, the accuracy of the rules was maximized and the post-test probability of success increased to 95%. 
Interesting Note: Athletes/patients who have suffered ankle sprains in high school and did not seek medical help but instead left their ankle trauma to resolve on its own, often present years later with limited ankle range of motion with associated knee or other foot pain for which they usually present.  It is this author’s experience that athletes with previous ankle sprains, but otherwise “healthy” benefit greatly from the following mobilization techniques (described in this article) as part of their comprehensive treatment in an effort to regain normal ankle dorsiflexion regardless of their initial presentation. 

Appendix A – page 199

• Lateral Glides and Eversion Mobilization/Manipulation to the Subtalar Joint
• Talocrural joint Anterior-to-Posterior mobilization/manipulation with patient supine and ankle off end of treatment table
• Talocrural joint Anterior-to-Posterior mobilization/manipulation (mobilization with movement utilizing belt for assistance)

** This is true for both acute ankle inversion sprains as well as for athletes with residual restrictions from prior injury.  In a study by Green et al., in 2001 the addition of talocrural mobilizations to traditional RICE protocols necessitated fewer treatments to achieve pain-free dorsiflexion.



Initial Changes in Posterior Talar Glide and Dorsiflexion of the Ankle After Mobilization With Movement in Individuals With Recurrent Ankle Sprain

By Vicenzino et al.




“Physiotherapists frequently use mobilization with movement (MWM) techniques as a physical treatment to improve range of motion, alleviate pain, and promote earlier return to function following lateral ankle sprain.”

Purpose: Test current contention that mobilization with movement (MWM) to the talocrural joint in both weight bearing and non–weight bearing positions improve posterior talar glide as a means to increasing ankle dorsiflexion
Study Design:  8 females and 8 males ages 18-27 recruited from Queensland’s student population
• Inclusion Criteria: “history of recurrent ankle sprain with at least 2 ankle sprains, more than 20 mm asymmetry on the weight-bearing lunge test for ankle dorsiflexion, no history of lateral ankle sprain on the contralateral side, and not receiving any other physiotherapy treatment during the study”
• Exclusion Criteria: “acute ankle sprain within past 6 months, previous injury or surgery in the back, hip or knee, or major fracture to the ankle or distal leg”

Results:  “weight-bearing and non-weight-bearing MWM treatment techniques both produced significant changes in posterior talar glide that were not evident in the control condition”

- Non-weight-bearing: “reduced posterior talar glide deficit by 50%”
- Weight-bearing: reduced posterior talar glide deficit by 55%

- Control: “reduced posterior talar glide deficit by 17%”
- Weight-bearing and nonweight-bearing MWM treatment improved weight-bearing dorsiflexion by 26%, compared to 9% by the control group.

Conclusion: “application of MWM treatment techniques improved posterior talar glide and talocrural dorsiflexion immediately after application in subjects with chronic recurrent lateral ankle sprain.”


“Approximately 44% of all sprained ankles go on to have further problems and although the factors that predispose to injury or reinjury are not conclusively evidence based, they are reported to involve proprioceptive deficits of the ankle, lack of ankle dorsiflexion, and reduced posterior glide of the talus in the ankle mortice.” (pg. 465)

“Denegar et al found a reduction in posterior glide of the talus in the ankle mortise in asymptomatic fully functional subjects in the 6 months following ankle sprain. It was postulated that because the talus lacks muscular attachments, it might subluxate anteriorly following disruption to the ligaments that attach to it. The talus then remains malpositioned anteriorly until it is passively returned to its ‘normal’ position. To an extent, the findings of reduced posterior talar glide and dorsiflexion range of motion appear congruent, as posterior talar glide is an accessory motion component of ankle dorsiflexion.” (pg. 465)


Conclusion: Whether you are treating an acute ankle sprain, or addressing knee pain secondary to restricted ankle dorsiflexion a detailed evaluation which involves ALL contributing factors, both bony and soft-tissue, associated with a decrease in ankle dorsiflexion as outlined here and our previous post is the only way to ensure your patient will receive the best possible outcome and the fastest track back to normal function and high performance activities.  Positional faults are impossible to find if you never look for them - assessment of all ankle sprains or ankles with limited motion should include a detailed examination of all bones related to the foot and ankle including the distal tib-fib joint and talus for appropriate accessory motions. In a future post I’ll discuss why the all so common,  “ice and e-stim approach” to ankle sprain management only works for so long and why hip strength may actually be more important.





Collins N, Teys P, Vicenzino B. The initial effects of a Mulligan’s mobilization with movement technique on dorsiflexion and pain in subacute ankle sprains. Manual Therapy 2004; 9:77-82

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.

Hubbard T, Hertel J, Sherbondy P. Fibular position in individuals with self-reported chronic ankle instability. J Orthop Sports Phys Ther. 2006;36(1):3-9.

Hubbard TJ, Hertel J. Anterior positional fault of the fibula after sub-acute lateral ankle sprains. Manual Therapy.  2008;13:63-67.

Landrum E, Kelln B, Parente W, Ingersoll C, Hertel J. Immediate effects of anterior-to-posterior talocrural joint mobilization after prolonged ankle immobilization: a preliminary study. J Manual Manip Ther. 2008;16(2):100-105.

Whitman J, Cleland J, McPoil T, et al. Predicting short-term response to thrust and nonthrust manipulation and exercise in patients post inversion ankle sprain. J Orthop Sports Phys Ther.  2009;39(3):188-200.

Vincenzino, B., Branjerdporn, M., Teys, P., Jordan, K.  Initial Changes in Posterior Talar Glide and Dorsiflexion of the Ankle after Mobilization With Movement in Individuals with Recurrent Ankle Sprain.  J Orthop Sports Phys Ther. 2006;36(6):464-471.

Green., T., Refshauge, K., Crosbie, J., Adams, R.  A randomized controlled trial of a passive accessory joint mobilization on actue ankle inversion sprains. Phys Ther. 2001;81(4):984-994.

Mulligan BR. Manual therapy: “NAGS,” “SNAGS,” “MWMS,” etc. 3rd ed. Wellington, New Zealand: Plane View Services LTD; 1995.




Topics: Basketball Related, Art Horne

Free Online Training for Health Care Professionals - Concussion Management

Posted by Boston Sports Medicine and Performance Group on Mon, Oct 17, 2011 @ 07:10 AM



"Heads Up to Clinicians: Addressing Concussion in Sports among Kids and Teens" is a free, online course, developed by CDC through support from the CDC Foundation and the National Football League, available to health care professionals. It features interviews with leading experts, dynamic graphics, and case studies and provides an overview of what you, as a health care professional, need to know about concussion among young athletes.




Topics: Basketball Related, BSMPG, athletic training conference, athletic training, athletic trainer

Integrated Care - Part VI: Getting Everyone To Squat

Posted by Boston Sports Medicine and Performance Group on Tue, Sep 27, 2011 @ 07:09 AM


by Art Horne

Since squatting and the decision to squat or not comes up more often than any other subject when it comes to sports medicine and performance professionals, we decided to tackle this subject head on in this latest post.  Everyone should be able to squat - there I said it. So whether you'll be teaching it after surgery, or training it in the weight room it's important that the beliefs and concepts that you have pertaining to the squat is the same as those that you work with in order to achieve the highest level of athlete success. 

Below is an outline which we have used in a staff journal club to finalize our teaching progressions and teaching cues for the squat pattern while also getting everyone on the same page and on board with the importance of squatting.

sports medicine


Squat Goal: all athletes should be constantly working towards a score of three on their OH Squat test. Whether they initially present to Sports Medicine with back, knee, hip or other LE injury or pain, all care and performance training providers should be able to look at this movement pattern and address any movement concerns IN ADDITION to their traditional rehab or performance program regardless of initial pain or injury presentation.

FMS Squat Test:  see  for complete details
(Have a staff member certified or familiar with the FMS review testing criteria, followed by staff members from both staff’s testing and evaluating each other).


What if the student-athlete describes PAIN during the squat test?


sports medicine


Only qualified medical professionals should deal with pain and painful movement patterns.  If a student-athlete experiences pain they should be referred to the athletic trainer coordinating their care at the college level or another health care professional if you are working in the private sector.  Although many “painful” maneuvers are often neglected and played down by the student-athlete, seldom do those with pain during a simple bodyweight squat ever go on to compete at a high level without future injury and time loss.

Since PAIN is complicated, multifactorial and often unpredictable, a painful pattern should be “broken down” to its component parts so to find the underlying pain generator or limiting factor.  The Selective Functional Movement Assessment TM offers health care providers a systematic approach and a common movement language among all staff members.

(Have a staff member certified or familiar with the SFMA squat breakout present this algorithm to the remainder of your staff and then follow up by having individuals from both groups evaluate each other while identifying the limiting factor within each individual’s squat pattern.

SFMA Squat Breakout:

1. Overhead deep squatting pattern

2. Fingers interlocked behind neck into deep squat position
a. This position lowers the difficulty by not having the shoulders flexed vertical
b. Removes the upper body components and reduces the level of dynamic stability needed to perform the squat.

3. Assisted Squat from ATC into deep squat
a. Athlete holds hands of evaluator while performing squat.
b. Looks at the true symmetrical mobility of the lower body (hips, knees, ankles) without the requirement of dynamic stability.

4. Half kneeling Dorsi-flexion (test for ankle ROM)
a. Place foot on weight bench and lean forward over the foot as far as possible without the heel coming off the bench.
b. The knee should move forward out past the toes at around 4 inches.
c. Repeat for both sides.

5. Supine Knees-to-chest – test for anatomical limitations at hip in non-weight bearing position.
a. Looks at mobility of the hips, knees and spine in a non-weight bearing position.
b. Can help differentiate a mobility vs. stability problem
c. Have the patient grab both shins and attempt to touch their thighs to their lower rib cage.
d. If they can’t get their calves to touch their thighs due to knee tightness, have them grab their thigh instead and repeat thin maneuver. (This will help differentiate between hip and knee mobility issues. If in this position they still can’t get their thighs to touch their rib cage, then there is a potential hip dysfunction).

What’s Next?

Since so many of us sit on our butts all day it’s no surprise that our butts are rarely working to the level they should be. 

(Unless of course you use your butt for a simple paper weight – then your butt works just fine).

Because the squat is the end goal for all athletes in terms of both health and performance, it’s important for athletic trainers and other health care professionals to begin grooving this pattern early on in the rehabilitation process so that there is not only a seamless transition from one Sports Medicine to Performance Training, but also a clear message when it comes to cueing and technique among all professionals on staff.  In order to have everyone speaking the same squat language, starting everyone back on the ground and building a solid and logical progression from post-surgical all the way to high performance only makes sense while the entire staff is playing nice together.

Below is a starting point with a few teaching cues to get the conversation started and a solid progression built between the two groups.   (I have purposefully not included a complete progression below so to force the issue with your own staff.  People tend to complete tasks fully if they have had an opportunity to contribute to so be sure to ask for feedback from both staffs – Sports Medicine and Strength & Conditioning).


Back to Basics: (Supine Table Series)

1. Teach Glute Max w/ Bridge
2. Supine Bridge w/ Thera-band
3. Supine Bridge w/ Marching
4. Single Leg Hip Bridge

Teaching Points:

a. Squeeze Glutes to hold “gold coin” between butt cheeks or pretend to “crack a walnut” while bridging
b. brace core musculature as taught by Stu McGill
c. Ensure hamstrings are not dominate during exercise by palpating medial tendons.
d. Add a theraband around knees or create an ADDuction force to the knees to facilitate additional glute max contraction


Teaching Progression for the Troubled Squat




1. Goblet Squat: hold Kettlebell by the horns and squat to depth (providing a weight to the anterior portion of body balances the athlete and gives an additional point of stability

2. Descend squat so that elbows touch VMO of each knee.

3. If depth is a problem “wedge” elbows inside of knees to mobilize the hips.

4. In the early stages be sure to stand behind your athlete to ensure safety – encourage thoracic extension and a flat back

5. ** use clinical judgment based on patient presentation and injury. If unsure, REGRESS activity and PERFECT – OWN THE MOVEMENT before progressing to more advanced alternatives.


READ:  Squatting - An Expression Of Health


Next week: Bringing both staffs together to learn and master the hip hinge – a must for avoiding and rehabilitating back pain and also pulling big deadlift numbers!



Topics: Basketball Related, Art Horne, basketball resources, BSMPG, athletic training conference, athletic training, FMS, Barefoot in Boston

Art Horne Interviews with Joe Heiler on

Posted by Boston Sports Medicine and Performance Group on Wed, Sep 7, 2011 @ 07:09 AM




Click HERE to listen to this interview.

In this interview, Art discusses his new book, "Barefoot in Boston: A Practical Guide to Achieving Injury Resolution and Enhancing Performance", as well as discussing some research on barefoot walking and training versus wearing shoes, what to look for in minimalist shoes, how he has incorporated barefoot training with his basketball team, and much more..(including how to take a hack saw to a basketball shoe!)

Topics: Basketball Related, Art Horne, BSMPG, functional movement screen, boston marathon, foot pain, foot fracture, barefoot strength training, Barefoot in Boston, achilles pain, barefoot running, barefoot training

Sue Falsone and The Cervicothoracic Junction

Posted by Boston Sports Medicine and Performance Group on Sat, Sep 3, 2011 @ 11:09 AM

BSMPG Announces Sue Falsone & The Cervicothoracic Junction


BSMPG is proud to announce Sue Falsone to speak at Northeastern Univeristy on Sept. 22nd from 12-2 pm.  


Sue Falsone



Speaker: Sue Falsone

Topic: Cervicothoracic Junction: How the Head, Neck and Shoulders Inter-relate

When: Septemeber 22, 2011

Time: 12:00 noon - 2:00 pm

Cost: There is not cost associated with this program. In lieu of a program fee, attendees are encouraged to donate to InnerCity Weightlifting.

Location: Newly Renovated Cabot Physical Education Building (see Map HERE).  Building #41, enter main doors of building across from Building #42.

Continuing Education: 2 hours of continuing education is awarded for this event for both Certified Athletic Trainers and Strength & Conditioning professionals.

Continuing Education: The Boston Sports Medicine and Performance Group is recognized by the Board of Certification, Inc. to offer 2 hours of continuing education for Certified Athletic Trainers. Provider Number P8108.

athletic training resources


Contact Information:  For additional details please contact us at 

Listen to Sue on by clicking HERE.   


Additional Information on InnerCity Weightlifting

inner city weightlifting


The mission of InnerCity Weightlifting is to reduce violence and promote professional, personal and academic achievement among urban youth. We serve young people on a direct path to gang involvement, former and active gang members, and young victims of domestic abuse through the sport of Olympic Lifting. We work to empower young people with the confidence to say no to violence and yes to opportunity.  We provide our students with career opportunities working for InnerCity Weightlifting and in the field of personal training. We provide frequent adult mentorship, and academic support. Counseling services are offered through several of our partnering organizations. The training not only assists sport performance, but also increases confidence, motivation, and may increase learning skills through cognitive development.

These students want to become bigger, stronger, and faster. They want to participate in weightlifting. The sport, coaches, and training atmosphere, however, facilitate positive change. As a student attempts to set a new personal record (PR) for weight lifted, everyone stops and watches. The lifters help 'pump up' the student's morale and something unexpected happens: children, who have been given limited support outside of a gang, are now encouraging each other. They bond and a team is formed. They gain the confidence needed to succeed despite the odds.

Read this Blog by Sarah Cahill, Strength & Conditioning Coach at Northeastern University, on her experiences volunteering at Inner City Weightling

Interested in supporting Inner City Weightlifting or volunteering your time? Contact Sarah Cahill at


Topics: Basketball Related, BSMPG, athletic training conference, athletic training, Sue Falsone, innercity weightlifting