NATA D10: The Time Constrained Athelete

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The Time Constrained Athlete:

Developing a 15 Minute Rehabilitation Program

National Academy of Sports Medicine © 2011

Joshua Stone, MA, ATC, NASM-CPT, CES, PESSports Medicine Program Manager

National Academy of Sports Medicine

TMAgenda

1. Time constrained athlete

2. Introduction to the human movement system

3. Human movement dysfunction

4. Corrective Exercise Continuum

5. Case Studies - 15 minute rehabilitation programs x 2

6. Open discussion


TMThe Problem

Athlete Schedule

• Academic• Athletics• Life

Athlete Mentality

• Desire• Compliance• Priorities

Practitioner

• Availability• Flexibility• Creativity


Time CrunchSuboptimal care

TMBest Utilization of Time?

• Prioritization–What is the single best tool for the injury

• Modalities• Manual Therapy• Prophylaxis • Rehabilitation

– Injury dependent


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The Keys to Optimal Care

• Understanding Athletes’ needs– Treatment or rehabilitation

• Knowledge pertaining to human movement system• Flexibility in program design

– Willing to change mind-set

• Creativity in modality use


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Human Movement System• Human Movement System is a very complex, well-orchestrated system of

interrelated and interdependent myofascial, neuromuscular, and articular components

Muscular System

Neuromuscular Control

Sensorimotor Integration

Skeletal System Nervous System

Human Movement System


The Human Movement System

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Human Movement Impairments

• Human Movement Impairments– Static malalignments – Dynamic malalignments

• Foot/Ankle• Knee• Hip/Low Back• Shoulder

– Altered muscle activation patterns• Synergistic dominance• Altered Reciprocal inhibition• Relative strength and relative flexibility


TMStatic Malalignments

Static malalignments may alter normal length-tension relationships.• Common static malalignments include

– joint hypomobility (decreased range of motion)– myofascial adhesions– Poor static posture

• National Academy of Sports Medicine © 2008

Joint hypomobility is one of the most common causes of pain

Certain muscles become tight or hypertonic (tense) to prevent movement and prevent further injury.

TMDynamic Malalignments

Dynamic malalignment (movement impairment syndromes)• altered muscle recruitment patterns• multi-segmental human movement system impairment


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Altered Muscle Activation Patterns

• Altered Reciprocal Inhibition– muscle inhibition caused by a tight /overactive muscle decreasing neural drive of

its functional antagonist• Synergistic Dominance

– Occurs when synergists take over function for a weak or inhibited prime mover

Psoas Gluteus Maximus Hamstrings

This altered muscle recruitment pattern further alters alignment and leads to injury


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Human Movement Dysfunction


Dysfunction

Altered Length-Tension Relationships

(muscle tightness)

Altered Arthrokinematics

Altered Sensorimotor Integration

Altered Force-Couple Relationships

(muscle weakness)

Altered Neuromuscular Efficiency

Tissue Fatigue Tissue Breakdown

TMCommon Injuries

• Foot/Ankle– Plantar fascia– Ankle sprains– Sesamoiditis – Achilles tendonitis

• Lower leg– MTSS– Post tib. Tendonitis– Stress Fx

• Knee– PFPS– ACL– OCD– Patella tendonitis– Osgood-Schlatter / Larsen-Johansson– IT Band– Bursitis

• Low Back– Snapping hip– Chronic strains– SI joint pain– Osteitis Pubis– Facet syndrome

• Shoulder– Impingement syndrome– Biceps tendonitis– Rotator cuff tendonitis– Strain– Subluxation / dislocation

• Elbow– Epicondylitis / tendonitis– UCL– Pronator syndrome


TMWhy Do We See Imbalances?

MobilityMobility

StabilityStability


TMMovement Assessments


Determines what muscles are underactive and overactive and how that impacts a client’s ability to move properly

This information can then be correlated to subjective assessment findings, for a comprehensive representation of the client’s functional status.

A movement assessment allows a Health and Fitness Professional to observe Human Movement System impairments.

TMKinetic Chain Checkpoints


• When joint motion deviates from its normal or ideal path, it is considered a compensation • Presumes possible human movement system impairments or muscle

imbalances.

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The Overhead Squat Assessment


ANTERIOR• Assesses the following:• Structural alignment• Dynamic flexibility• Neuromuscular control

• Position:• Feet shoulder width apart• Arms overhead

LATERAL POSTERIOR

TMA Few Common Compensations Seen

• Overhead Squat Assessment– Feet

• Flatten– Knees

• Move Inward– Back

• Excessive forward lean

Feet Flatten Knees move inward Excessive Forward Lean


TMThe Single-leg Squat Assessment

• Single-leg Squat Assessment – Designed to assess dynamic flexibility, core strength,

balance and neuromuscular control.

• Position– Place hands on the waist– The feet should be pointing straight ahead– The ankle, knee and the lumbo-pelvic-hip complex

should be in a neutral position.


TMA Few Common Compensations Seen

• Single Leg Squat Assessment– Knees

• Inward movement– Hips

• Inward/Outward Trunk Rotation

Inward Trunk Rotation Knee moves inwardOutward Trunk Rotation


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Double-leg Squat & Single-leg Squat


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National Academy of Sports Medicine • Movement Assessments

Assessment Modification

• Modifications to Overhead Squat:– Elevating the heels– Hands on the hips

TMPushing and Pulling Assessments

• Push-ups Assessment

• Standing Row Assessment


TMThe Corrective Exercise Continuum

Inhibit Activate Integrate

Inhibitory Techniques

Self-Myofascial Release

Manual Therapy

Activation Techniques

Isolated Strengthening

Positional Isometrics

Integration Techniques

Integrated Dynamic

Movement

Lengthen

Lengthening Techniques

Static Stretching

Neuromuscular Stretching

Manual Therapy


TMCase Studies


• Two Case Studies• Background Information

– Goals– Lifestyle– Medical history

• Video footage– Movement Assessments

• Identify Movement compensation• Design a CEx program

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Case Study 1: Rachel’s Bio

• Bio: Rachel

Age: Sophomore

Sport: Cross Country

Recreation/Hobbies: Running, dancing, movies

Problem: MTSS

Occupation: Student Athlete

Medical History: Good health, no previous surgeries or medication


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Case Study 1: Rachel’s Overhead Squat Assessment


Overhead Squat Assessment

View Checkpoints Movement Observation

Right -Yes Left - Yes

Anterior Feet Turns out

Knees Moves inward

Moves outward

Lateral LPHC Excessive forward lean

Low back arches

Low back rounds

Shoulder Complex Arms fall forward

Posterior Feet Flatten

LPHC Asymmetrical weight shift

TMRachel’s Overhead Squat


TMRachel’s Modified Overhead Squat Assessment


Modified Overhead Squat: Heels Elevated

YES No

Squat Improved:

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Case Study 1: Rachel’s Single-leg Squat Assessment


Single-leg Squat AssessmentView Checkpoints Movement Observation Right -Yes Left - Yes

AnteriorKnees Moves inward

LPHC Hip hike

Hip drop

Inward rotation

Outward rotation

TMRachel’s Single Leg Squat


TMRachel’s Movement Analysis



Checkpoints Movement Observation Left -Yes Right - Yes

Feet Turns out √ √

Knees Moves inward √ √

LPHC Low back arches √

Feet Flatten √ √Notes: Her left foot flattens and turns out more than the right foot from the posterior view. She has a slight excessive forward lean and arms fall forward, however, the primary dysfunctions appear to be in the lower extremities (feet turn out/flatten, knees cave-inward, and low back arches).

Modified Overhead Squat

Heels Elevated

Notes: Squat improved dramatically with feet and knees remaining in optimal alignment.

Single-leg Squat Assessment

Checkpoints Movement Observation Left -Yes Right - Yes

Knees Moves inward √ √

Notes: She compensates for a lack of balance and femoral control with slight tilting of the pelvis, however, her primary compensations include her knee caving inward and feet flattening.

TMAnalysis of Rachel: Program Design

• Overactive/Tight– Lateral Gastrocnemius / Soleus– Biceps femoris (short head)– TFL– Hip flexors (rectus femoris, psoas)– Adductor complex – Peroneals– Vastus Lateralis

• Underactive/Weak– Medial Gastrocnemius– Anterior & posterior tibialis– Medial hamstrings– Vastus Medialis oblique– Gluteus Medius / Maximus

CEx Goal:1. Prioritize issues

2. Regain LE muscle balance

3. Relieve lower extremity pain


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15 Minute Corrective Exercise Program


Integrate Time Needed

Inhibit: Gastrocnemius / Soleus, Biceps Femoris (short head), TFL/IT-Band

3 min

Lengthen: 3 min

Activate: 1-2 sets10-15 reps 4/2/2 tempo 6 min

Integrate: 1-2 sets 10-15 reps slow tempo3 min

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3 min

Lengthen: Gastrocnemius / Soleus, Biceps Femoris (short head), TFL/IT-Band

3 min

Activate 1-2 sets10-15 reps 4/2/2 tempo 6 min


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3 min


3 min

Activate: Intrinsic Core Stabilizers, Gluteus Medius, Medial Gastrocnemius, Medial Hamstrings

1-2 sets10-15 reps 4/2/2 tempo 6 min


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3 min


3 min

Activate: Intrinsic Core Stabilizers, Gluteus Medius, Medial Gastrocnemius, Medial Hamstrings


Integrate: Ball Squat with Overhead Press 1-2 sets 10-15 reps slow tempo3 min

TMCase Study 2: Jeff’s Bio


Bio:Age: SeniorSport: BaseballRecreation/Hobbies: Hiking, working out, fishingGoal: Biceps tendinitis, impingement syndromeOccupation: Student AthleteMedical History: Good health, previous rotator cuff repair

TMJeff’s Overhead Squat


TMAnalysis of Jeff’s Movement



Checkpoints Movement Observation Left-Yes Right – Yes

Shoulder Arms Fall √

LPHC Excessive forward lean √

LPHC Low back arch √

Feet Turns out √ √

Feet Flatten √ √

Notes:Primary dysfunctions appear to present themselves at each Kinetic Chain Checkpoint. Consistent with the athlete’s shoulder pain, we see compensation at the shoulder. Specifically right greater than left.

TMAnalysis of Jeff: Program Design

• Overactive/Tight− Latissimus Dorsi− Pectoralis Major− Pectoralis Minor− Subscapularis− Lateral gastrocnemius / soleus − Hip flexors − (TFL, rectus femoris, psoas)

• Underactive/Weak− Middle/Lower Trapezius− Serratus Anterior− Rhomboids− Posterior Rotator Cuff− Gluteus medius/maximus− Intrinsic core stabilizers

CEx Goal:1. Prioritize issues

2. Regain muscle balance in the upper

3. Alleviate shoulder pain


TM

15 minute Corrective Exercise Program



Inhibit: Latissimus Dorsi, Thoracic Spine, Pectoralis Major, Subscapularis

3 min

Lengthen: 3 min



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3 min

Lengthen: Latissimus Dorsi, Pectoralis Minor, Pectoralis Major, Subscapularis

3 min



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3 min


3 min

Activate: Middle / Lower Trapezius, Rhomboids, Serratus Anterior, External Rotators



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3 min


3 min

Activate: Middle / Lower Trapezius, Rhomboids, Serratus Anterior, External Rotators


Integrate: Single Leg squat w/ PNF pattern 1-2 sets 10-15 reps slow tempo3 min

TMSummary

• Perform an integrated assessment to identify dysfunction• Utilize rehab vs. biophysical modalities if possible• Develop focused corrective exercise program based on

assessment with given time frames

Inhibit Activate Integrate

Inhibit:Myofascial Release to Overactive

Muscles

Activate: Strengthenin

g of Underactive

Muscles

Integrate: Dynamic

/Functional Strengthening Movement

Lengthen

Lengthen:Stretching or

Manual Therapy to Overactive

Muscles


TMThank You!


Questions & Answers

Contact Information

[email protected]

facebook.com/NASMJosh

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BOC Approved for 37 CEUs!!

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NATA D10: The Time Constrained Athelete

Health & Medicine

Transcript of NATA D10: The Time Constrained Athelete