Current Concepts in Balance and Postural Stability for...

ESSA ROADSHOW 2014

Current Concepts in Balance and Postural Stability

for Athletic and Clinical Populations

LECTURE NOTES

Presented by

Elite Performance Intl. Web: http://eliteperformanceintl.com

Peter Woodgate BHMvt (Ex Sci) CSCS, AEP, AES, ESSA, MASCA, MNSCA Dr Stephen Bird BHMvt (Hons), PhD CSCS, AEP, AES, RNut, ESSA, MASCA, MNSCA

http://eliteperformanceintl.com/

2014 ESSA ROADSHOW

Current Concepts in Balance & Postural Stability of 18

Contents

Balance and postural stability (BAPS) 3

Overview 3

Functional anatomy related to BAPS and athletic performance 4

Review of functional anatomy 4

Lumbopelvic stability and sports performance 5

Key considerations 6

Current concepts in the application of BAPS exercises 7

BAPS - Definition 7

Pre-elite youth athletes 8

Elite athletes 8

Program design and progression 9

Integrating BAPS for use in athletic and clinical rehabilitation 11

Case Study 1. 11

Case Study 2. 12

Graded BAPS exercise prescription 14

What must precede the initial design? 14

Key aspects in BAPS program design 15

An exercise sequence for progression in balance training 15

Interactive learning activities 17

Reference List 18

2014 ESSA ROADSHOW


Overview: What is Balance and Postural Stability (BAPS)? Beginnings

De Motu Animalium, the vertical of gravity in the human body, Borelli (1679)

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BAPS Neurology & Practical Reasoning:

Sensory Input Afferent neurons

Senses to CNS

Movement Efferent Neurons

CNS to SkM

Proprioception

Interneurons Sensory to Motor

Joint Stability Flexibility

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Functional anatomy related to BAPS and athletic performance

Akuthota, V., & Nadler, S. F. (2004). Core strengthening. Archives of Physical Medicine and Rehabilitation, 85(Supplement 1), 86-92.

Review of Functional Anatomy

Lumbo-pelvic-hip complex ↔

Muscular scaffolding ↔ ↔

Key component:

Three muscle slings:

Self-locking mechanism:

Weaknesses usually found in 3 key areas.....

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2.

3.

Critical thought questions

VCP Learning Activity: 1


2014 ESSA ROADSHOW


Neuromuscular efficiency Model of Lumbopelvic Stability

Willardson, J. M. (2007). Core stability training: applications to sports conditioning programs. Journal of Strength and Conditioning Research, 21(3), 979-985.

Lumbopelvic stability and sports performance: Requires efficient transfer of force

Sports where this transfer of forces is critical Sports where balance between left and right sides is crucial

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Sports that depend almost exclusively on an athlete’s dynamic balance

Sports that require athletes to stay balanced while moving in relation to a moving object (a ball) or team mates

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What about the Postural environment?

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Key considerations

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Athletes with smaller multifidus have higher lower limb injury rates

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Lumbopelvic muscle size and identification of AFL players at risk of injury

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Unit Summary (Think → Pair → Share)

In pairs, discus what are the most important points from this lecture?

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2014 ESSA ROADSHOW


Current concepts in the application of BAPS exercises

Bird, S.P., & Stuart, W. (2012). Integrating balance and postural stability exercises into the functional warm up for youth athletes. Strength and Conditioning Journal, 34(3), 73-79.

ACL injury involves complex interaction of modifiable and non-modifiable factors:

Balance and Postural Stability (BAPS): Definition.

BAPS is a integrative neuromuscular training method that develops core stability in a way that contributes to a heightened sense of lumbar spine position and pelvic orientation during dynamic movements, thereby enhancing the ability to regain stability in athletic contexts

BAPS exercise =


2014 ESSA ROADSHOW


Published surveys indicate that S&C coaches often prescribed BAPS exercise....

% % %

Pre-Elite Youth Athletes

What we know:

• Challenging an athlete’s centre of gravity within their base of support may enhance ability to regain stability in athletic context:

1. heightened sense of lumbar spine position/pelvis orientation during dynamic movements ;

2. enhancing movement preparation and functional strength characteristics

3. most effective strategy for reducing sports related injuries in young athletes

Force interplay: ↔ ↔ ↔

Elite Athletes

Did you know?

50% of collegiate football players report history of shoulder pain Laudner (2012). J Strength Cond Res, 26(3), 672-676

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What is the most effective warm-up protocol in terms of its effect on peak power production? Crow, J.F., Buttifant, D., Kearny, S.G., & Hrysomallis, C. (2012). J Strength Cond Res, 26(2), 438-442

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Motor control training effectively reduces injury rates in AFL players Hides, J.A., & Stanton, W.R. (2014). Med Sci Sports Exerc, 46(4), 762-768

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2014 ESSA ROADSHOW


Program Design and Progression

Guidelines for BAPS Training

1. Proprioceptively rich program

2. Incorporate multi-sensory environment

3. Activity specific

4. Progressive functional continuum

5. Goal oriented

BAPS– Movement Preparation


2014 ESSA ROADSHOW




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2014 ESSA ROADSHOW


Integrating BAPS for use in athletic and clinical rehabilitation

Paterno, M. V., Myer, G. D., Ford, K. R., & Hewett, T. E. (2004). Neuromuscular training improves single-limb stability in young female athletes.. Journal of Orthopaedic and Sports Physical Therapy, 34(6), 305-316.

Who do we prescribe BAPS for? _______________________

Case Study 1. Describe 3 functional neuro/anatomical implications of this patient due to the mechanism of injury:

1. ______________________________________________________

2. ______________________________________________________

3. ______________________________________________________

How does the implementation of the BAPS exercises demonstrated enhance the neuro/anatomical areas you have identified demands of the injured worker’s physical tasks?

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2. ______________________________________________________________________________________________________________

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3. ______________________________________________________________________________________________________________

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2014 ESSA ROADSHOW


Case Study 2. Identify 2 obvious areas of performance improvement from this Olympic athlete’s profile:

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2. ______________________________________________________

Describe how BAPS exercises assisted in enhancing the sport-specific performance markers you identified for improvement in this Olympic athlete?

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2. ______________________________________________________________________________________________________________

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Discuss

“Power training is to an athlete, as an _______ is to the race car, while __________________________ training to the athlete is as the suspension to the race car. __________ is limited unless force is directed ________ through the structure during dynamic motion, in the most __________ and _________ of postures.”

2014 ESSA ROADSHOW




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2014 ESSA ROADSHOW


Graded BAPS corrective exercise prescription

Muehlbauer, T., Roth, R., Bopp, M., & Granacher, U. (2012). An exercise sequence for progression in balance training. Journal of Strength and Conditioning Research, 26(2), 568-574.

What must precede the initial design of your first exercise design? ________________________________________________

Why? ____________________________________________________________

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… Here

There…


2014 ESSA ROADSHOW


Key aspects in BAPS program design

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2014 ESSA ROADSHOW


Interactive Learning Activities (VisualPRO)

Learning Activity 1

Using VisualPRO identify the 6 muscle groups above:

Learning Activity 2

Using the VCP anatomy tab find 5 of the muscle groups above. Develop a corrective exercise list, 1 exercise for each of the 3 key areas of weakness.

Learning Activity 3

Using VisualPRO find the 8 BAPS movement preparation exercises :

Learning Activity 4

Select a design and add two progressions and two regressions for each exercise.

Select a design and divide the prepared exercises

into Phase 1, Phase 2 & Phase 3 designs.

Learning Activity 5

2014 ESSA ROADSHOW


Reference List

Akuthota, V., & Nadler, S. F. (2004). Core strengthening. Archives of Physical Medicine and Rehabilitation, 85(Supplement 1), 86-92. Bird, S.P., & Stuart, W. (2012). Integrating balance and postural stability exercises into the functional warm up for youth athletes. Strength and Conditioning Journal, 34(3), 73-79. Crow, J. F., Buttifant, D., Kearny, S. G., & Hrysomallis, C. (2012). Low load exercises targeting the gluteal muscle group acutely enhance explosive power output in elite athletes. Journal of Strength and Conditioning Research, 26(2), 438-442. Granacher, U., & Gollhofer, A. (2011). Is there an association between variables of postural control and strength in adolescents? Journal of Strength and Conditioning Research, 25(6), 1718-1725. Hazime, F. A., Allard, P., Ide, M. R., Siqueira, C. M., Amorim, C. F., & Tanaka, C. (2011). Postural control under visual and proprioceptive perturbations during double and single limb stances: Insights for balance training. Journal of Bodywork and Movement Therapies, In Press. Hides, J. A., & Stanton, W. R. (2014). Can motor control training lower the risk of injury for professional football players? Medicine and Science in Sports and Exercise, 46(4), 762-768. Hubscher, M., Zech, A., Pfeifer, K., Hansel, F., Vogt, L., & Banzer, W. (2010). Neuromuscular training for sports injury prevention: a systematic review. Medicine and Science in Sports and Exercise, 42(3), 413-421. Klugman, M. F., Brent, J. L., Myer, G. D., Ford, K. R., & Hewett, T. E. (2011). Does an in-season only neuromuscular training protocol reduce deficits quantified by the tuck jump assessment? Clinics in Sports Medicine, 30(4), 825-840. Laudner (2012). Upper extremity sensorimotor control among collegiate football players. Journal of Strength and Conditioning Research, 26(3), 672-676. Leavey, V. J., Sandrey, M. A., & Dahmer, G. (2010). Comparative effects of 6-week balance, gluteus medius strength, and combined programs on dynamic postural control. Journal of Sport Rehabilitation, 19(3), 268-287. Muehlbauer, T., Roth, R., Bopp, M., & Granacher, U. (2012). An exercise sequence for progression in balance training. Journal of Strength and Conditioning Research, 26(2), 568-574. Myer, G. D., Faigenbaum, A. D., Ford, K. R., Best, T. M., Bergeron, M. F., & Hewett, T. E. (2011). When to initiate integrative neuromuscular training to reduce sports-related injuries and enhance health in youth? Current Sports Medicine Reports, 10(3), 155-166. Myer, G. D., Ford, K. R., Palumbo, J. P., & Hewett, T. E. (2005). Neuromuscular training improves performance and lower-extremity biomechanics in female athletes. Journal of Strength and Conditioning Research, 19(1), 51-60. Pasanen, K., Parkkari, J., Pasanen, M., Hiilloskorpi, H., Mäkinen, T., Järvinen, M., et al. (2008). Neuromuscular training and the risk of leg injuries in female floorball players: cluster randomised controlled study. BMJ, 337. Paterno, M. V., Myer, G. D., Ford, K. R., & Hewett, T. E. (2004). Neuromuscular training improves single-limb stability in young female athletes.. Journal of Orthopaedic and Sports Physical Therapy, 34(6), 305-316. Rasool, J., & George, K. (2007). The impact of single-leg dynamic balance training on dynamic stability. Physical Therapy in Sport, 8(4), 177-184. Romero-Franco, N., Martínez-López, E., Lomas-Vega, R., Hita-Contreras, F., & Martínez-Amat, A. (2012). Effects of proprioceptive training program on core stability and center of gravity control in sprinters. Journal of Strength and Conditioning Research, 26(8), 2071-2077. Verhagen, E., van der Beek, A., Twisk, J., Bouter, L., Bahr, R., & van Mechelen, W. (2004). The effect of a proprioceptive balance board training program for the prevention of ankle sprains. American Journal of Sports Medicine, 32(6), 1385-1393. Willardson, J. M. (2007). Core stability training: applications to sports conditioning programs. Journal of Strength and Conditioning Research, 21(3), 979-985. Zazulak, B., Cholewicki, J., & Reeves, N. P. (2008). Neuromuscular control of trunk stability: Clinical implications for sports injury prevention. Journal of the American Academy of Orthopaedic Surgeons, 16(9), 497-505. Zech, A., Klahn, P., Hoeft, J., Eulenburg, C., & Steib, S. (2014). Time course and dimensions of postural control changes following neuromuscular training in youth field hockey athletes. European Journal of Applied Physiology, 114(2), 395-403.

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