injury risk reduction

Coaching the Forearm Wallslide

A deceptively simple exercise, the forearm wallslide delivers a huge ROI:

Volleyball Performance Training: The Other Skillz

Following the loose theme we've had this month of volleyball training (but really, let's be honest, all of this can apply to most sports), I thought it would be beneficial to highlight a few other athletic skills/movements that are woefully under-trained in volleyball players. It's all about the vertical!

But not really.

It drives me nutso that coaches and parents and the players focus singularly on improving the vertical jump. Yes, it's important, but how does one get to the net to jump? How does one move fast enough to get behind the ball to pass it well?

I've worked with dozens and dozens of volleyball players and I've seen terrible movement quality all the other planes of motion. Great volleyball players are more than their vertical jump heights! (tweet that) I've listed a handful of movements that would behoove any volleyball player, and coaches, to implement in a regular training rotation.

Side Shuffle

I can, without exaggeration, tell you that I've seen volleyball players side shuffle with the grace of a new-born giraffe. How in the world can a volleyball player move around the court while keeping their eyes on the game, without side shuffling? Answer: Not possible. Side shuffling is the most efficient and most strategic way to move around the court.

Transitional Movements

Above are just a few examples of transitional movement drills. Along with side shuffling, there are times when players need to sprint forward or backpedal quickly and then run in a completely different direction. The ability to change directions rapidly is essential in volleyball, especially if there's a wild pass or tip off the net.

Heidens

Yes, I know volleyball consists of jumping up and down, and not side-to-side, but reinforcing lateral movements is a boon for volleyball. Heidens also teach force absorption and production in the frontal (lateral) plane. Most of volleyball consists of lateral movements, so if a player is strong side-to-side, not only will it reduce injury risk but she will be more confident moving sideways and will thus do it more.

Rolls

There are a lot of opportunities to dive, roll, and fall on the ground in volleyball. Learning how to do so safely is imperative. Learning how to pop back up again after a quick "hello" to the floor is vital for scoring points. Because rolling and tumbling is not a part of our everyday lives (at least, most of us) the vestibular system might be a bit slow in re-orienting. However, if you train rolls, you're also training the vestibular system and strengthening its ability to readjust quickly.

Add these into your training arsenal and there will be a guaranteed bump in performance.

Oh Dem Hammies! Hamstring Info and Harry Potter Analogies Part 1

Do you have tight hamstrings? Do you stretch them only to find that you’re not any closer to the suppleness that you desire in those posterior hip extenders? Have you tweaked/pulled your hamstring (due to your tightness maybe...)? Do you feel they’re tighter than Gringotts Bank Security?

 Today, we’ll go over some of the reasons why the hamstrings might be tight and in part 2 we’ll go over some of the prevention/rehabilitation techniques to deal with hamstring tweaks.

You may be surprised to find that your tight hamstrings are not actually tight… That sounds like something Professor Dumbledore might say.

Below are some of the potential culprits of “tight” hamstrings. (You’ll see why I put “tight” in quotation marks at the end.)

1. Protective tension.

This is when the brain is telling the hamstrings to remain “on,” for one reason or another, and it creates a sensation of tightness when the hamstrings are stretched. Why does this happen? I’m actually a good example of this. I have congenital laxity (meaning my joints are loose and I’m rather flexible) but for a period of about 3 years, my hamstrings were constantly tight and I could feel them being tugged on every time I bent over, and because of my laxity -and a lifetime of NEVER feeling tight- this was as odd as Hagrid’s love for horribly frightening beasts.

Here’s what was happening: my pelvis tilted, wildly I might add, anteriorly (forward).

Hamstrings pull the pelvis posteriorly or down and backwards.
Hamstrings pull the pelvis posteriorly or down and backwards.

The hamstrings attach to the (posterior) bottom of the pelvis (your “sit” bones) and my brain sensed the constant pelvic tilt and was desperately trying to prevent me tilting forward anymore by firing my hamstrings continually in an attempt to pull my pelvis back into a neutral position. That pelvic tilt results in instability throughout the lower back and pelvis. The brain HATES it when the body is unstable and will do anything necessary to regain stability, which in this case was locking down those hamstrings tighter than a Full Body-Bind Curse.

How do you fix APT? Through lots of dedicated anterior core work (i.e. plank variations) and glute strength. Once my pelvic tilt  was in a more neutral position… voilaThe tightness was gone. So, if your hamstrings feel tight, check our your pelvic alignment.  Stretching the hamstrings will NOT improve your flexibility in this case; they're already stretched to the max!

2. Neural tension.

I know this will sound similar to the above reason, but this particular tension generally results from an injury. The most likely answer is an injury to a lower back disc. (since the nerve for the hamstrings runs through that region.) If there’s damage to a disc in the L1-S1 region, there’s potentially compression on the nerve for the hamstrings which could result in mishaps in the neural messages (communication between brain and muscles) causing hamstring tightness. Usually this type of tension is accompanied by other symptoms such as tingling, shooting pain, electric pain or numbness. Two common tests to check for spinal issues are the slump test and the heel drop test (which consists of standing on your toes then dropping to you heels. If pain occurs, congratulations! You might have a compression issue.)

3 and 4. Nasty fibrotic tissue or tendonosis in the hamstring.

Sometimes muscle fibers get junky and gunky, from poor movements, overuse, or prior injury, -or all of the above- which changes the length and function of the muscle. Instead of the muscle fibers running parallel and working harmoniously, they’re twisted up like spaghetti noodles (and work as well together and a plate of spaghetti). Soft tissue work such as SMR or possibly work by a professional is in order to help restore the tissue quality.

adductor
adductor

Other areas to target for soft tissue would would be the adductors (since they attach to the pelvis as well) and those fellas are Gunk-City in a lot of folks.

5. The hamstring muscles are truly short.

Yep, they're are people out there either because of their genes (not their jeans. Ha!) or a surgery where the hamstring was immobilized in a shortened position (though this is not common), their hamstrings are physically shorter than they should be. This can happen over time (but to a small-ish degree) in folks who sit down a lot during the day because the pelvis is tilted posteriorly (tucking your butt under) which does shorten the hamstrings a bit. However, this probably isn’t the main source of tightness since they are only short at the very end range of motion.

So what have we learned? If your hamstring is tight, it’s not necessarily it’s fault nor will endless hamstring stretches change anything (even if you’re drew the genetic short stick. Stretching won’t do that much. Sorry.).  Soft tissue work in the hamstrings, adductors, and glutes as well as some dedicated anterior core work and glute training (*cough* swings *cough*) can help to solve some tight hamstring issues.

Check back in next week for some hamstring injury causes and care.

Off-Season Training: Overhead Athletes

kiss
kiss

Last week, we laid out some general guidelines for athletes heading into their off-seasons. You should read it, if you haven't already. Today, we'll delve into some specifics for overhead athletes (i.e. baseball, softball, javelin, shot put, swimmers (though it seems as if they never have an off-season), etc.). Shoulders are rather complicated and annoyingly fickle joints that can develop irritation easily which is why proper attention MUST be paid to shoulder mechanics and care during the off-season. There is nothing "natural" about throwing a heavy object (or a light one really, really fast) and shoulders can get all kinds of whacky over a long, repetitive season. I'm going to keep it sweet and simple.

1. Restore lost mobility and improve stability

- Hips: they get locked up, especially on athletes that travel a lot during the season (helloooo long bus rides). Restoring mobility will go a long way in preventing hip impingements, angry knees, and allow for freer movements in general. Locked up hips will prevent safe, powerful throws and batting, thus, now is the time, Padawans, to regain what was lost!

- Lats: Usually tighten up on the throwing side and create a lovely posture that flares the rib cage and makes breathing not-so-efficient. Loosen up these bad boys!

- Breathing patterns: Those need to be re-trained (or trained for the first time), too. Breathing affects EVERYTHING. Learning proper breathing mechanics will do a lot to restore mobility (T-spine, shoulder, and hips), increase stability (lower back and abdominal cavity), and create a more efficient athlete (more oxygen with less energy expended to get it). I've written about it before HERE.

- Pecs and biceps: These guys are gunky and fibrotic and nasty. Self-myofacial release is good, finding a good manual therapist would be even better, to help knead that junk out! One caveat: make sure that as you release these two bad boys, you also add stability back into the shoulder. This means activating lower and mid-traps and the rotator cuff muscles to retrain them to work well again. Why? Most likely, the pecs and biceps are doing a LOT of stabilization of the shoulder (which they shouldn't be doing so much) so if you take that away through releasing them, one of two things will happen: 1) injury will occur since there's nothing holding stuff in place, 2) no injury, but the pec and/or bicep will tighten right back up again as your body's way of producing stability. So, mobilize then stabilize!

2. Improve scapula movement and stability

Along the lines of restoring mobility everywhere, the scapula need particular attention in overhead athletes as they are responsible for pain-free, overhead movements. Below is a handy-dandy chart for understanding scapula movements:

shoulder-scapular-motions
shoulder-scapular-motions

Now, over the course of the season, an overhead athlete will often get stuck in downward rotation therefore at in the early off-season (and throughout really) we want to focus on upward rotation of the scapula. Exercises like forearm wallslides are fantastic for this.

Eric Cressey notes that the scapula stabilizers often fatigue more quickly than the rotator cuff muscles. This means the scapula doesn't glide how it should on the rib cage, which leads to a mechanical disadvantage for the rotator cuff muscles, which leads to impingements/pain/unstable shoulders.

We need a freely gliding scapula to get overhead pain-free.
We need a freely gliding scapula to get overhead pain-free.

As we increase the upward rotation exercises, we want to limit exercises that will pull the athlete back into downward rotation, i.e. holding heavy dumbbells at their sides, farmer walks with the weight at sides, even deadlifts.(whoa now, I'm not saying don't deadlift, but limit the volume on the heavy pulls for a few weeks, and like I said in the last post, training speed work will limit the amount of load yanking down on those blades.) Instead, athletes can lunge or farmer carry in the goblet position (aka, one bell at their chest). 

There is more to be said, but let us move on, shall we?

3. Limit med ball work

At SAPT, we back off on aggressive med ball throwing variations for the first couple weeks post season as the athletes have been aggressively rotating all season. Instead, we'll sub in some drills that challenge the vestibular such as single-leg overhead medicine ball taps to the wall. (I don't have a video, sorry.)

Or, stability drills such as this:

If we do give them some low-intensity throws, we'll have them perform one less set on their throwing side than on the non-throwing side.

4. Limit reactive work

We don't usually program a lot of sprint work or jumps the first few weeks. If we do program jumps, we'll mitigate the deceleration component by adding band resistance:

5. Keep intensity on the lower end

As mentioned in the last post, instead of piling on weight, we enjoy utilizing isometric holds, slow negatives, and varying tempos to reap the most benefit from the least amount of weight. We also maintain lower volumes over all with total program.

There you have it! Tips to maximize the off-season and lay a strong, stable foundation for the following season!

Early Sport Specialization: Why This Needs to Stop (with a capital "S")

Here in northern Virginia, and in other hub-bub places too, it's not uncommon for an athlete to play a sport during the high school season, and then transition straight into the club season (which lasts f-o-r-e-v-e-r), leaving the athlete with maybe 2-3 weeks rest before try-outs for the next year's high school season start. Does this sound familiar? Does this sound healthy? Today we're going to address a growing (alarmingly so) problem with youth athletics: early sport specialization. As a strength coach, I see some messed up kids when it comes to movements, joint integrity, and muscle tissue quality (all = poop) who play year-round sports at young ages (that is, under 16-17 years old). I see year-round volleyball players who can't do a simple medicine ball side throw. Why? Because they spend ALL YEAR moving in the saggital (forward/backward) plane with a little bit of the frontal plane (side to side shuffling, but even that is dominated by their inability to actually move sideways; they tend to fall forward and/or move as if they're running forward, just facing a little bit to the side.) They have limited movement landscape (remember this?) and therefore are limited athletes.

I see young baseball players with chronic elbow or shoulder pain. Why? Because they throw a ball the same way ALL YEAR ROUND. And they're not strong enough to produce the force needed to throw it properly, (because, heaven forbid, they take some time off to actually weight train and get stronger) so they rely on their passive restraints (ligaments, tendons, and joint capsules) to throw.

This topic gets me fired up because I see SO MANY injuries and painful joints in kids who shouldn't have injuries or painful joints. I see kids who can't move like a normal human being because they're locked up and, worse, don't even have the mind-body connection to create movements other than those directly related to their chosen sport.

There's this pervasive myth that if a kid doesn't play year round or get 10,000 hours of practice, then he/she will never be a good athlete. Parents get caught up in chasing scholarships and by golly, if Jonny doesn't play travel ball he'll fall behind, then he won't make varsity, then he won't get into a good college... and on and on. My friends, we need to take a step back and think about what's best for the athlete. Do the aforementioned afflictions sound good to you?

But enough of my opinion, let's look at some hard science to support the Stop-Early-Specialization-Theory.

Playing multiple sports and playing just for the sake of running around like a kid builds a rich, diverse motor landscape, especially during the years before late adolescence. Diversifying the motor landscape, or movement map, or the bag-o-skillz, or whatever you want to call it, is essential to human development and especially valuable to athletes. I'm going to sound like a broken record, but kids need a broad and varied map to:

1. Understand how to move their bodies through space

2. Create and learn new movements

3. Learn how to adapt to their environment

4. Develop better decision making and pattern recognition based on their circumstances (i.e. being able to find the "open" players in a basketball game helps in finding one on the soccer field. )

Matter fact, this really smart fellow, Dr. John DeFirio MD, who is the President of the American Medical Society for Sports Medicine, Chief of the Division of Sports Medicine and Non-Operative Orthopaedics at the David Geffen School of Medicine at UCLA and Team Physician for the UCLA Department of Intercollegiate Athletics (that's quite the title, eh?) says this:

"With the exception of select sports such as gymnastics in which the elite competitors are very young, the best data we have would suggest that the odds of achieving elite levels with this method [early sport specialization] are exceedingly poor. In fact, some studies indicate that early specialization is less likely to result in success than participating in several sports as a youth, and then specializing at older ages"

And, Dr. DiFiori encourages youth attempt to a variety of sports and activities. He says this allows children to discover sports that they enjoy participating in, and offers them the opportunity to develop a broader array of motor skills. In addition, this may have the added benefit of limiting overuse injury and burnout.

You can read his full article here. The article also notes two studies in which NCAA Division 1 athletes and Olympic athletes were surveyed regarding what they did as children. Guess what? 88% of the NCAA athletes played 2-3 sports as kids, and 70% of them didn't specialize until after age 12. The Olympians also all averaged 2 sports as kids  Are you picking up what he's putting down? Specialization doesn't make great athletes, diversification does!

Side bar: Check out Abby McCollum, who played 4 sports for a Division 1 school. The article says that she was recruited last minute... probably because she was such a great all-around athlete that she could play any sport.

Next up: injuries rates.

Dr. Neeru Jayanthi, a sports medicine physician, in conjunction with Loyola University published a few studies using a sample set of 1,026 athletes between ages 8-18 who came into the Lurie Children’s Hospital of Chicago for either sports physicals or treatment for sports-related injuries. The study ran from 2010 to 2013.  Dr. Jayanthi and her collegues recorded 859 injuries, of which 564 of them were overuse injuries (that's well over HALF). Of those 564 injuries, 139 of them were serious injuries concerning stress fractures in the back or limbs, elbow ligaments or injuries to the cartilage. All of these injuries are debilitating and can side line and athlete for 6 months or more. The broad study is reviewed here and a more specific cohort (back injuries, which carry into later in life) is here. I highly recommend reading both as the data are eye opening.

To sum up Dr. Jayahthi and co.'s recommendations on preventing overuse injuries (I took it directly from one of the articles in case you don't have time to read them both):

• If there's pain in a high-risk area such as the lower back, elbow or shoulder, the athlete should take one day off. If pain persists, take one week off. (though I think it should be more)

• If symptoms last longer than two weeks, the athlete should be evaluated by a sports medicine physician. (and go get some strength training! There's a reason that pain is occurring; something is overworking for something else that's NOT working.)

• In racket sports, athletes should evaluate their form and strokes to limit extending their backs regularly by more than a small amount (20 degrees). (this should also apply to any overhead sport like volleyball, baseball, softball, etc.)

Enroll in a structured injury-prevention program taught by qualified professionals. (hey, like SAPT? Lack of strength is a common denominator among injured athletes.)

• Do not spend more hours per week than your age playing sports. (Younger children are developmentally immature and may be less able to tolerate physical stress.) (10 year-olds don't need 12 hours or soccer! Also check out Dr. Jayahthi's injury prediction formula.)

• Do not spend more than twice as much time playing organized sports as you spend in gym and unorganized play. (Kids, go play tag, get on the playground, play capture the flag, anything; JUST PLAY!)

• Do not specialize in one sport before late adolescence.

Do not play sports competitively year round. Take a break from competition for one-to-three months each year (not necessarily consecutively).

Take at least one day off per week from training in sports.

The highlights and comments are mine. Do you see the RISK involved in specializing in a sport early in life? Not only does the risk of injury skyrocket, and the ability to move fluidly and easily plummet, but there's a lot of external pressure on the athlete to perform. Stressed athletes don't perform well. I don't know how many times I've asked my year-round players what they're doing on the weekends, it's always "tournament" or "practice." They have NO LIFE outside of sports. To me, that seems unhealthy and frankly, a recipe for burn-out.

Parents, athletes, and coaches, in light of all this research, I urge you to strongly reconsider year-round playing time for kids under 16 or 17. I urge you to allow athletes time off, to play other sports besides they're favorite, and to just be a kid. I urge you to keep the long-term development of our athletes in mind; do you want to risk a permanent injury, hatred of sport (because of burn out), or development of weird compensations and movement patterns?

Let's build strong, robust athletes that can do well in the short- and long-term instead of pigeon-holing them into a particular sport and limiting their athletic potential.

Why Train In-Season?: Strength and Power Gains

Hopefully by now, you've read about the signs and reversal of overtraining. Now let's look at why and how to train intelligently in-season. A well-designed in-season program should a) prevent overtraining and b) improve strength and power (for younger/inexperienced athletes) or maintain strength and power (older/more experienced lifters).

First off, why even bother training during the season?

1. Athletes will be stronger at the end of the season (arguably the most important part) than they were at the beginning (and stronger than their non-training competition).

2. Off-season training gains will be much easier to acquire. The first 4 weeks or so of off-season training won't be "playing catch-up" from all the strength lost during a long season bereft of iron.

I know that most high school (at least in the uber-competitive Northern VA region) teams require in-season training for their athletes. Excellent! However, many coaches miss the mark with the goal of the in-season training program. (Remember that whole "over training" thing?) Coaches need to keep in mind the stress of practice, games, and conditioning sessions when designing their team's training in the weight room. 2x/week with 40-60 minute lifts should be about right for most sports. Coaches have to hit the "sweet spot" of just enough intensity to illicit strength gains, but not TOO much that it inhibits recovery and negatively affects performance.

Goldilocks-Principle-640x480
Goldilocks-Principle-640x480

The weight training portion of the in-season program should not take away from the technical practices and sport specific. Here are a couple of things to keep in mind about the program, it should:

1. Lower volume, higher intensity-- this looks like working up to 1-2 top sets of the big lifts (squat or deadlift or Olympic lift), while maintaining 3-4 sets of accessory work.  The rep range for the big lifts should be between 3-5 reps, varied throughout the season. The total reps for accessory work will vary depending on the exercise, but staying within 18-25 total reps (for harder work) is a stellar range. Burn outs aren't necessary.

2. Focused on compound lifts and total body workouts-- Compound lifts offer more bang-for-your buck with limited time in the weight room. Total body workouts ensure that the big muscles are hit frequently enough to create an adaptive response, but spread out the stress enough to allow for recovery. Note: the volume for the compound lifts must be low seeing as they are the most neurally intensive. If an athlete can't recover neurally, that can lead to decreased performance at best, injuries at worst.

3. Minimize soreness/injury-- Negatives are cool, but they also cause a lot of soreness. If the players are expected to improve on the technical side of their sport (aka, in practice) being too sore to perform well defeats the purpose doesn't it? Another aspect is changing exercises or progressing too quickly throughout the program. The athletes should have time to learn and improve on exercises before changing them just for the sake of changing them. Usually new exercises leave behind the present of soreness too, so allowing for adaptation minimizes that.

4. Realizing the different demands and stresses based on position -- For example, quarterbacks and linemen have very different stresses/demands. Catchers and pitches, midfields and goalies, sprinters and throwers; each sport has specific metabolic and strength demands and within each sport, the various positions have their unique needs too. A coach must take into account both sides for each of their positional players.

5. Must be adaptable --- This is more for the experienced and older athletes who's strength "tank" is more full than the younger kids. The program must be adaptable for the days when the athlete(s) is just beat down and needs to recover. Taking down the weight or omitting an exercise or two is a good way to allow for recovery without missing a training session.

A lot to think about huh? As a coach, I encourage you to ask yourself if you're keeping these in mind as you take your players through their training. Athletes: I encourage you to examine what your coach is doing; does it seem safe, logical, and beneficial based on the criteria listed above? If not, talk to your coach about your concerns or (shameless plug here, sorry), come see us.