Boston Sports Medicine and Performance Group, LLC Blog

Question: A strength coach, an athletic trainer and a physician are in a car driving through the Arizona desert.  They get a flat tire.  Whose fault is it?

Answer: It doesn’t matter. They are all going nowhere together.
You can argue that the flat tire can be blamed on the strength coach for not ensuring the tires were made to withstand the rigors of the desert, or the athletic trainer for not checking the air pressure prior to the trip, or even the physician for giving the nod to drive over the speed limit even though the engine was never tested to perform at that speed.  The fact remains that each professional is stuck together going nowhere.  

Sound familiar?

When we work with our athletes who are unable to play for whatever reason we often end up blaming the flat tire on someone else when in fact we are all now stuck in the same car going nowhere. Prior to your next road trip, let’s make sure we all meet in the garage together and develop a plan for our athletes before taking “the car” out for a zip around town.

Remember, if you’re looking to go nowhere, any road will take you there.

Art Horne the Coordinator of Care and Strength & Conditioning Coach for the Men’s Basketball Team at Northeastern University, Boston MA.  He can be reached at a.horne@neu.edu.

When did hard work go out of style?
When did squatting, pull-ups, and heavy sled pushes become bad for you?
Athletes now more than ever are always looking for a secret answer from above. Something to swoop down and give them the advantage that they need to become bigger, faster and stronger (as long as it doesn’t require actual work mind you).  Even in the athletic training room you’ll find it. Athletes would rather wear organic blueberry filled “pain patches” on their patellar tendons rather than complete an uncomfortable eccentric single leg squat program for their knee pain.
“I saw such and such pro-athlete use these/do this, it will help me too.”
Deus ex machina!

Even some strength coaches and athletic trainers have gotten into the mix. You’ll always know if your colleagues have gone to a course taught by a “guru” over the weekend.  Suddenly on Monday morning, every athlete needs this or can be treated with that.
Deus ex machina!

Literally translated, Deus ex machina means “God from the machine” and is used to describe the sudden and miraculous appearance of an unexpected way out of a very difficult situation.  In Roman and Greek plays, a “god” was lowered onto the stage via mechanical device to resolve a complicated situation in the plot. A divine intervention if you will.  A God sent from above to rescue you from your very poor predicament! Too good to be true, right?  But in modern Hollywood films and movies, this is frowned upon because it undermines the story’s internal logic… unless you are directing a silly comedy like Dumb and Dumber or Tommy Boy which requires a lack of logic and the more dues ex machina, the funnier it gets.

So this summer, as you prepare your off-season training programs, don’t let a guru who yells the loudest, or your athletes who just logged off youtube undermine your logic.  Let’s all agree to leave deus ex machina to those that that need it most, and get back to programming rehab and strength programs based off of sound evidence.  If a place as crazy as Hollywood understands this simply concept, we should too.

 

Art Horne is the Coordinator of Care and Strength & Conditioning Coach for the Men’s Basketball Team at Northeastern University, Boston MA.  He can be reached at a.horne@neu.edu.

As strength and conditioning coaches, it is imperative that we have a good understanding of what fatigue really is. A dictionary definition might be a decrease in energy, but most of us would say that fatigue is a decrease in force production. That might be acceptable to tell your athletes, but do you really understand what is going on? Let’s take a close look into what fatigue really is and it’s untapped potential.

There are two classes of fatigue: “peripheral” and “central”. The more commonly known and understood is peripheral fatigue. Peripheral fatigue is what is happening in the extremities, more specifically the muscles. This is usually due to action potential failure or impairment in the cross-bridge cycle. Studies have shown that there is an increase in lactic acid concentration and a decrease in pH, ATP, and creatine phosphate. Also, there is a decrease in muscle or liver glycogen stores during sub maximal exercise which is all believed to cause fatigue. These metabolic processes add up together to prevent the muscle from a forceful contraction. Essentially, you can look at peripheral fatigue as the muscle no longer capable of producing the force that it is being asked to produce. An example would be doing 1,000 bicep curls and getting the “BURN”.

Less commonly known is central fatigue. Central fatigue is a decrease in neural drive or a disruption in the efferent fibers. In more simple terms, central fatigue originates in the brain. There is limited research on this phenomenon, but studies show that during exercise there is a change in neurotransmitters, such as increase in serotonin, which can regulate muscle contraction among other things, and a decrease in dopamine and acetylcholine which play a role in voluntary movement, motivation, attention, working memory, and learning; and then opens ligand-gated sodium channels in skeletal muscle to produce muscle activation, respectively. Now, I know neurology wasn’t my favorite class either so to develop the big picture, let's just say when there is increase in neural drive, there is an increase in neurotransmitter activity which results in a decrease in brain capacity to recruit motor neurons. This is that feeling of your body just not doing what you ask it to do although your muscles aren’t on fire, that “I just don’t have it today” feeling.

The debate on central fatigue is that I mentioned it being a disruption in efferent fibers. Proponents of peripheral fatigue will argue that it is just the opposite, and that it is the afferent fibers that cause a change in the neurotransmitters. Meaning that muscles, by way of the mentioned metabolic processes, are sending sensory information to the brain that then activate the change in the neurotransmitters to stop exercise. But then studies have shown that fatigue doesn’t start in the motor cortex but even further up in cortical regions, as in the prefrontal and cingulate cortex. So what comes first, the chicken or the egg?
No studies have shown a physiological change with no change on perceived fatigue. Actually, just the opposite has been shown.   Perceived fatigue has been expressed with no physiological change. Chronic fatigue syndrome is just that; patients express fatigue at rest when there is no impairment of the metabolic processes that we discussed. . Consider the fact you can produce more force during an eccentric lift than a concentric lift, which would suggest different neural drives. Studies show that at most during maximal voluntary contraction (MVC) one can only recruit 70% of motor units and some suggest that 100% recruitment would tear tendons right off the bone. On the other side perhaps central fatigue takes place as a protective mechanism. By changing neurotransmitter activity your brain will not allow 100% MVC. So what are your muscles actually capable of and what can you do about it?

Whether you believe it is the chicken or the egg that comes first, you can’t argue that they both have a role in fatigue. Metabolic processes do take place and your brain does prevent 100% MVC. So how do decrease the protective threshold? For the sake of this article, we will save the idea of over training for another time and just focus on a single training session. In order to get more out of our athletes, we need to engage their brain. Increase dopamine and acetylcholine. Studies have shown that verbal encouragement during activity will increase the duration of the contraction. Others have shown that yelling during a lift actually can increase force production. Another study showed that when subjects were asked to give maximal effort during a cycling sprint their power output decreased over the reps except it increased on their last rep, indicating a “reserve tank”. Perhaps the brain protects less knowing that it is your last rep. Perhaps this developed during the pre-historic era when our ancestors had to hunt for their food, but maintain a reserve tank of energy in case they became the hunted. Either way, we need to tap into that reserve tank. One way to achieve this is by including open looped activities. Doing 10 reps or sprinting for 1 minute is a closed loop activity because you know when it will stop allowing you to pace yourself. So including an open loop activity is one way to do short maximal effort without pacing yourself, such as having your athlete sprint for an unknown time stopping when you decide to blow the whistle. Challenge yourself to develop ways for the conscious brain to control the unconscious brain. Don’t allow your athletes to pace themselves. Training is not about surviving, it is about DESTROYING.

If a mother is able to lift a car to save her child, find a way for your athlete to lift a bus, because they can.


Keke Lyles is a DPT student at Northeastern University and has worked directly with both the Men’s and Women’s Basketball teams.

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Check out Brian McCormick’s interview with Ray Eady, Strength and Conditioning Coach from University of Wisconsin.  His interview can also be found on Brian’s Newsletter, “Hard2Guard Player Development Newsletter” a must read for all those that follow the game of basketball.  Ray talks about training and evaluating the basketball athlete along with special considerations for the female athlete.
 
This week, I have an interview with Ray Eady, the strength and conditioning coach for the women’s basketball program at the University of Wisconsin. Previously, he was the head strength and conditioning coach for men’s and women’s basketball at the University of Akron and Northeastern University. Eady holds a Masters degree in Exercise Physiology form the University of Akron and is a Certified Strength and Conditioning Specialist (NSCA – CSCS) and a Performance Enhancement Specialist (NASM – PES).

BM: What assessments or evaluations do you use with your players in the pre-season?
Eady: During the pre-season, the athletic trainer and I will assess and evaluate the players in a couple of areas. First, we will do a functional movement screen. I like doing the movement screens because it allows me to asses an array of total body movement mechanics.  As you know, proper movement mechanics is needed to perform efficiently, effectively, and injury free on the basketball court.  The screens we typically use are:

1.    Overhead squat test
2.    Hurdle test
3.    Active hamstring test
4.    In-line lunge test

In addition to the screens, we will do the hop and stop test and the leap and stop test to assess a player’s ability to produce, absorb, and stop force on one leg.

We will also do some performance evaluations to measure leg power and strength.  To measure power, we will do a series of vertical jump test.  

1.    Static jump test to measure starting strength
2.    Countermovement jump test to measure speed-strength
3.    4-jump test to measure how efficient a player is using their power repeatedly

We perform these jumps on a just-jump mat while the athletes are holding a dowel on the back of their shoulders (as if they were going to do a back squat). The goal is to eliminate the action of the arms to really determine leg power. I like performing these tests because they can help you determine if certain players need more strength work or more speed/elastic work.

For conditioning, we will do the standard 300 yard shuttle test which is a great test to measure anaerobic capacity. This year, I will test the players in the 150 yard shuttle because the energy system demands are bit different (anaerobic power).

Lastly, we will do body composition assessments to determine body fat and lean muscle tissue.  I want our players to be at an optimal body weight for increased performance and to reduce the chances of injury.  

I must say the most overrated test when evaluating basketball players has to be the bench press test. So many coaches put a premium on the results. I am not saying basketball players don’t need upper body pushing strength but the relevance it has on basketball performance is minimal. When the bench press can prevent a female player from tearing her ACL then I will put more emphasis on the test.

Let’s make it clear, performance evaluations will never truly tell you if a player will have some success on the court. It merely predicts future performance.  All the strength and power in the world won't make you a successful athlete unless you're able to apply it in sport-specific contexts and integrate it with finer motor qualities.

I don’t try to re-invent the wheel when it comes to testing. I want to make my evaluations meaningful for my athletes and to make it applicable for what they will most likely be doing on the court.

BM: Do you have any good/different drills that you use with women’s players to teach proper landing and cutting techniques to prevent ACL injuries?
Eady: First, I don’t think we can ever prevent ACL injuries in female basketball players.  We all know that female players are two to eight times more likely to sustain an ACL tear when compared to males. Anatomical and physiological characteristic such as pelvis width (Q-angle), femoral notch, poor glute and hamstring recruitment, and joint and ligament laxity during the menstrual cycle puts the female player at risk. However, we can reduce the rate of occurrences by having female players participate in a well designed and progressive strength training program that focuses on improving maximal strength development. The stronger females can become, the less likely they will get injured.

Second, strength is the foundation for improving movement efficiency, central nervous system efficiency, nervous system efficiency, neuromuscular control, balance, coordination, stability, deceleration, and reaction.  All of these attributes are needed to reduce the rate of ACL injuries. With these non-contact injuries, poor lower body eccentric strength is usually at the root of the problem.  

Also, many jump programs tend to emphasize landing with correct technique but don’t address the ability to get into a safe landing position. If a player lacks the ankle, hip and T-spine mobility (and once again, strength) to get into a safe landing position with just her body weight, how are they ever going to do it when the forces are higher?  If you are going to address landing and cutting mechanics it is important that mobility and strength (most specifically isometric and eccentric strength) are addressed concurrently. The ability to decelerate, absorb and stop the forces a player creates on the court is the key.

With that being said, I am a fan of doing some yielding isometric (activation) work prior to our jump/landing drills. Yielding isometrics is great for re-enforcing how to control, absorb, and stop force production (which occurs when landing from a jump or changing directions). Studies have shown that a person can recruit 5% more motor-units/muscle fibers during a maximal isometric muscle action than during a maximal eccentric or maximal concentric action. This is great since we need our muscles to activate and fire eccentrically to decelerate force.  Of course, isometric work is not dynamic in nature but it’s also great for teaching, assessing and correcting body positioning. After our isometric work we will follow up with some dynamic work.  

For example, if we are doing double-leg jumps, we will do some partner resisted isometric squat holds to activate the musculature of the hips.  We will hold at three positions:

1.    Statically a few inches from the starting position
2.    Statically at mid range
3.    Statically at full contraction

Each position is held for approximately 10 seconds.  Following the isometric holds, we will perform maximum effort squat jumps with sticks (sticking the landing and holding for 5 seconds without any movement).  We do this set-up for the majority of our jump training/landing drills.  

Once again, the isometric work prior to our jumps just prepares our neuromuscular system for the dynamic action that is about to take place. It should be noted that the dynamic movement must mimic the isometric movement (i.e. squat holds for box jump downs, split squat holds for split squat jumps, single leg holds for single leg jumps, hops, leaps, etc.)

BM: Since girls/women tend to have poor hamstring strength compared to quad strength, what type of exercises (emphasis) do you do to correct imbalance or strengthen the weakness?
Eady: Of course, with most female basketball players, you will notice some lumbo-pelvis-hip postural distortion. This includes shortened and tight quads and hip flexors and lengthened and weak hamstrings and glutes. Therefore, our workouts always include some remedial and prehab work to correct these lower body imbalances. This will include soft tissue work, hip flexibility, glute activation, core stability and hip mobility.  

Some coaches are opposed to isolation work for specific musculatures but I think they have their role in training, especially when doing remedial work. With that being said, we will do a variety of isolation work for the posterior hip (glute max), lateral hip (glue medius), and the anterior hip (psoas).  

Within our strength training session, we will include more ground base posterior chain/hip extension exercises to re-enforce our remedial work.  On the days we squat, we will include more unilateral post-chain work. On the days we do single leg work (i.e. split squats, lunge variations), we will do more bilateral post-chain work.  My favorite exercise for posterior chain development and strength is actually the box squat.  There has been some debate about the squat especially for athletes that participate in movement based team sports.  However, I believe it’s a great exercise to strengthen the glutes and hamstrings and improve overall strength.  Of course, I would only prescribe this exercise if a player is capable and able to perform it proficiently.  Another favorite exercise is the one-leg squat to a bench or box. This is a great exercise to improve unilateral eccentric leg strength.

BM: Now that the season is over, how do you structure or periodize the players’ off-season? Do you use different training blocks emphasizing different things?
Eady: My goal for the off-season is to prepare our team for the upcoming competitive season by developing the physical qualities need to perform at a healthy and optimal level. Of course, this includes improving strength, power, sport-specific speed, quickness and conditioning. At the end of every competitive season, I will develop a yearly training plan based on a couple of factors (a few many include):

1.    The number of returning players.  Will we be a veteran or a rebuilding team?
2.    What type of playing style will we execute offensively and defensively?
3.    Are we a team that needs toughness?  More team unity?
4.    Are we skilled at all five positions? How many players do we have at each position?
5.    How will certain players be utilized offensively and defensively?
6.    Do some players need additional work (i.e. weight loss, weight gain, speed, etc.)?

Once these factors are identified, I can develop and implement a plan to meet our competitive needs.

I divide the training year into blocks (off-season I, off-season II, pre-season I, pre-season II, and in-season). Each block focusing on a specific physical quality.  For example, off-season I is typically dedicated to teaching and re-educating the players on how to perform certain “technical” lifts, as well as improving posture, balance, coordination, movement, core stability, and GPP (work capacity). These are the physical qualities that are needed to successfully complete summer workouts.

Our main goal for off-season II is to improve sub-maximal and maximal strength which is extremely important. Strength is one of the catalysts for enhancing athleticism.

We still train other qualities such as strength-speed, speed-strength, general conditioning, etc. but our number one priority is to get strong. This particular block is the best time to achieve this quality because of a couple of reasons:

1.    On-court activity is usually reduced during the summer. Players can give more energy and mind share to weight room activities.
2.    I don’t believe you can continue to improve strength at an optimal rate during the pre- or competitive seasons because players are now being exposed to stressors that can negatively impact strength gains.  (i.e. individual workouts with coaches, team practices, conditioning sessions, pick-up games, late night study sessions, early classes, etc.)

During pre-season I our goal is to prepare for the start of official practice.  The physical qualities that are highly emphasized are basketball specific movement/endurance, power, and strength. Our training tends to be more specialized to the demands of the sport.

The goal for pre-season II is to prepare for the beginning portion of our non-conference game schedule. At this point in time, on-court activity has increased dramatically.  Weight training frequency and volume will decrease but when we train the focus is to maintain strength gains achieved during the off-season and pre-season I. We tend to do more therapeutic work during these sessions to facilitate the recovery process as well.

Finally, the goal for the in-season is to keep the players healthy and competitive. Like most strength coaches, I understand the importance of in-season strength training but I also understand that practice takes priority. You can’t put too much physical and mental stress on your players that they are unable to perform efficiently on the court.  Eventually, you will have overtrained players and not so happy coaches.

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Whether it is a 2 hour practice or 45 minute weight training session, proper movement prep (MP) is an essential part of our basketball routine.  This short session of stretches can have a big impact on your team’s physical and mental well-being.  There are many factors that need to go into devising your MP.  I will explain 4 Elements of MP along with other factors to take into consideration when designing your MP plan.  In my case I have to specifically come up with a plan for basketball.  Now the needs for my basketball team and are very different from what another team or sport may need.  Therefore, it’s vital to identify what my needs are.

When I design a MP, the first thing I ask myself is, what are we doing it for?  Well that’s easy, basketball, duh!  True, but I need to get more in depth than that.  Some days we will practice for 2 or more hours and it will be at a high intensity.  Another day may be getting shots up for an hour.  We may do individual work in a ¼ court setting with moderate intensity.  The MP may be after we got off a plane or bus!

Now that I know what I’m using the MP for I can ask myself a few more questions.  How long do I have for MP?  Coach usually gives me a timeframe to work with, it’s important to know.  If I have 5 minutes, I have to use exercises that give me the most bang for my buck.  If I have longer, I better know what to do with my time.  I can’t exhaust the team with my 10-15 minutes.

Where are the players at mentally?  If I have great exercises but mentally the players have cashed out on me, it’s something I need to take into consideration.  The great MP I designed won’t do its job, unless I get them doing it with some level of alertness and focus.  Over the course of a basketball season the mental part is huge!  After talking with a colleague this year, he calculated all of the movement preps over the course of a year at over 300!  Your players may lose some interest; the question to yourself is what can I do to get them ready today?

How many players will I be warming up?  If I have the entire team, how specific and difficult can I get with exercise?  It’s difficult to view 15 players trying to do a split stance lunge with 3-way uni-lateral upper body drivers with 3 angulations.   At another time I may have a 4 man group, who moves well and understands exactly what I want.  Timing is important for whatever you’re flowing into.

Will I have any implements?  It can be a very specific piece of equipment such as a tri-stretch or something much more basic as a box.  You can get very creative and expand your toolbox of exercises with implements.  Something else to consider are your resources when you travel.  It may be wise to travel with some equipment but size is an issue.  I’ve also found bleachers and railings are hidden gems when looking for implements on the road.

After you’ve answered those it’s time to get into the actual MP.  With each MP I believe you need to incorporate 4 Elements into its design.  I did not create these 4 categories but I was fortunate to study under, Matt Herring at the University of Florida for nearly 3 years and take away these organized ideas about MP from him.

1.        Increase muscle temperature (Warm-Up)

·         Dynamic flexibility
·         Multiple joints & muscles
·         3-planes

2.       Clear dysfunctions and improve mobility

·         Identify dysfunctions & issues
·         Mobility vs Stability – what needs what
·         3-planes
·         The big 3 – Ankle, Hip, T-Spine

3.       Turning on the CNS

·         3-planes
·         Ground based
·         Gravity
·         Proprioception

4.        Movement

·         Basic movement patterns
·         Basketball movement patterns

There is a 5th category I have as well but I don’t include it with the previous 4 elements.  The last one is a needs category.  This category is unique from the others.  Most often it turns out to be an energy and enthusiasm category.   I don’t always use it but if I can see we need it, I’ll include it.  These exercises are sometimes very specific to basketball but not always.  I may view the need for communication and incorporate that into a drill.  There have been days where the staff has gotten involved with category 5.  This category is always last; so it is right before the guys are handed over to coach.

Below is an example of a pre-practice warm-up that will last for 2+ hours at a high intensity.  It is done in the pre-season so the guys are fresh mentally.    The entire team will be involved and I’ll have all of my normal implements.  Coach has given me 10-12 minutes.

Muscle Temperature - 4 Dynamic Flexibility
    Knee Hug
    Heel to Butt
    Straight Leg March
    Sumo Squats

Dysfunction/Mobility- The Big 3
     Ankle – Tri-Stretch
     Hip – Hip Rockers w/ 3 stances
     T-Spine – T-Hugs/T-Swings

CNS
     Jump Matrix or Pivot Matrix w/ Arm Drivers

Movement
     High Knees/Butt Kicks – Forward/Retro
     Skip Matrix – Forward/Retro
     S-Pattern Runs/Shuffles

Category 5         
     Star Passing

Here are a few other things to consider:

·         Recording and dating each session
·         Creating an encyclopedia of exercises
·         Grading the MP, ex. too long, confusing, lost focus
·         Reuse a MP, probably not every day but maybe once every few weeks
·         When Coach says, “We won’t go hard today, do we need to stretch?”  Say yes, 5 minutes won’t hurt!
·         In-Season this is the only thing you may get to do with them for a week or 2 stretch (hopefully not)
·         It’s ok to ask the players what they need, they’ll often tell you.  Doesn’t mean you have to conform!  They’re mental needs of, “I Feel It,” are important
·         If you can get a copy of the practice plan, it can help with design.  It helps to know if practice will start with a 5 on 5 full court or defensive skill work

Andy Weigel is the Strength and Conditioning Coach for the Men’s Basketball team at the University of Alabama and can be reached at aweigel@ia.ua.edu.

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Uncle Sam did it again.

After another year of working countless hours, waking up early every weekend, and of course working on Christmas day… Uncle Sam showed no compassion.

I just returned from doing my taxes at the local HR Block where I get them done each year. It’s just a block away which I guess makes the pain of writing that check to the government a wee bit easier.

Reviewing my W-2 sheet made me think about one of Seth Godin's articles and exactly what I make.

I make kids better,

I make kids walk after surgery and I make parents feel good about the care their kid gets when they’re a thousand miles away,

I make push-ups feel easy,

I make shy kids walk with pride and I make bike sprints enjoyable,

I make spin, glide and roll move as they should,

I make slap shots harder, jump shots easier and high jumping higher.

So the next time your Wall Street brother-in-law rubs his thumb and fingers together and asks, “what do you make?”, just smile and say, “I make athletic dreams come true.”

Now get back to work.

Art Horne is the Coordinator of Care and Strength & Conditioning Coach for the Men’s Basketball Team at Northeastern University, Boston MA.  He can be reached at a.horne@neu.edu.

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