How do we analyze movement? FMS and Y-Balance are among some of the more popular screening tools. McGill et al published an interesting study that brings up some food for thought.....
- We often evaluate using body weight functional tasks (squats, gait, SL squat, functional reach, etc). Do we need to add more load and/or speed to see how movement changes? (we do this with scapular movement by adding weight) Granted, often our patients come to us after injury and this study was using healthy individuals but it begs the question: Is our movement assessment lacking if we do not induce a load and/or change of speed upon the movement?
- What about return to sport? Should we train our athletes with a weighted vest for agility and jumping tasks? It would be a relatively cheap investment in a clinic.
- This study shows some movement adaptations when load and speed are induced. Intuitively, we know this and train for this in some ways even if its not agility or jumping. Do we not induce load for training if they are in some pain? My thoughts are that our athletes go through some pain regardless during seasons, etc, so why not? Now, that being said- we don't want to encourage or strengthen in a dysfunctional position/compensation due to pain, but are we doing a disservice to our athletes if we do not prepare them for that external load they are going to get in a game anyway? Lastly, if we do decide to re-train them with increased load or increased speed (since this study shows different movement adaptations for both), how do we cue? Similar to how we may cue our throwing athletes, throwing "hard" vs increasing throwing distance and having them throw may change their respective velocities depending on the type of cue.
I think we need to really consider load and speed a little more with our screenings, evaluations, and return to sport testing/training.
Mcgill S et al. The influence of load and speed on individuals’ movement behavior. Journal of Strength & Conditioning. October 2013.
What is considered the "terminal" phases of rehabilitation and what should we as sports clinicians do in that time frame? This is arguably a time frame that many sports clinicians think about and struggle with, as authors Dan Lorenz and Mike Reiman allude to in the following article.
So what gives? Do we work on power/agility/strength/speed? What about sports biomechanics? How do we achieve this? This article serves as a starting point for those questions.
Clinical Point #1: "The terminal phases of a rehabilitation protocol should be a hybrid of sports physical therapy and strength and conditioning"
Clinical Point #2: "The terminal phase of rehabilitation is defined as the time frame from when the athlete is completing an algorithm- based progression (anthropometric measures, range of motion, strength, isokinetic testing, functional tests) to when he or she is released to participate in sports"
One of the important points of this article is that it discusses the current thoughts on how to improve performance. Those thoughts included: traditional weight training, plyometric training, and dynamic weight training. The rest of this article breaks down definitions, examples, and ideas when training for strength, power, speed, endurance, and training using energy systems/metabolic capacity.
1. Eccentric exercise- Evidence points to eccentric strengthening being superior to concentric strengthening for increasing total and eccentric strength, in addition to muscle mass. The authors also point to eccentric training being found to be more effective than concentric training for improving rate of force development.
2. Variable resistance training- using elastic bands or heavy chains. It is important to understand that using these tools, load increases when the muscle has increased leverage during early phases of the lift and decreased during later phases of lift. The authors point out that while chains may not be realistic in the clinical setting, bands may be used with dumbbells (DB bench press, push jerks, split jerks, etc).
1. Complex Training- alternating biomechanically similar high load weight training with plyometric exercises. Theoretically this should build in the postactivation potentiation. Postactivation potentiation is based on the contractile history of a muscle influencing the mechanical performance of subsequent muscle contractions.
2. Contrast Training- using high and low loads in the same training session. Example used: "The athlete may perform 6-repetition sets with loads between 60% and 80% of 1 RM, alternating with 6- repetition loads between 30% and 50% 1 RM at maximum speed to increase power".
** Evidence has supported increased VJ, sprint performance, and agility in soccer players with complex & contrast training. **
3. Plyometric Training- most well known power type training. Full recovery recommended in between sets if using plyometrics alone to allow maximum power production.
4. Olympic Weightlifting- maximizes power and requires full body coordination, strength, and balance. Authors note: requires a longer time to teach athlete. Authors recommend breaking down movements with PVC or wooden dowel for teaching purposes. Additionally, dumbbells may be more realistic than barbells and useful from the unilateral and neuromuscular control points of view.
1. Varied pace sprints- running relaxed at high intensities and "recharging" the nervous system between maximal bouts
2. Resisted sprints- recruit increased muscle fibers and increase neural activation. Can use weighted sleds or running with tethered resistance.
3. Assisted sprints- improves stride rate and elastic energy production.
*** "With fatigue, sprinting form is potentially sacrificed, thereby negating the positive effects of speed training" ***
1. General endurance- trained by low loads (30% of 1RM), short rest periods (10-30s), and reps (20-150).
2. Specialized endurance- speed endurance and strength endurance
a. Speed endurance- generating tension over long periods of time without a decrease in efficiency
b. Strength endurance- developed with 25% to 50% of 1RM, with a moderate tempo of repetition performance (6-120 rep/min)
3. Mixed intensity interval training- to facilitate sport specific endurance in soccer: 30-90 second intervals of varying intensity over 6 minutes.
Metabolic Capacity/Energy System Specificity
1. Using the essential 3 energy systems (ATP-PC, lactic acid, aerobic system) for specificity with training athletes. Football example: average play runs 7-10 seconds with about 20-60 seconds rest. Ways to improve metabolic capacity= using heavy duty ropes (alternating arms, chop pattern, see-saw pattern, etc)
Additional Clinical Pearls
1. Backward medicine ball throw is a reliable indicator of upper body power
2. Performance enhancement techniques should be highly specific to the athlete's sports demands.
3. Power relates directly to agility and speed
Overall, this article can give the sports clinician a review of different components of athletic performance, definitions of strength, power, speed, and endurance, and examples of ways to increase each component. Physical therapists in general do not get specific strength and conditioning training but the sports clinician needs to understand and know how to implement those principles. Additionally, sports clinicians must adequately understand the importance of mimicking the biomechanics of the athlete's desired sport, position, and function (jump, run, kick, etc) while including performance enhancement in the terminal phases of an athletes rehabilitation.
Objective: Functional performance testing can determine physical limitations that may affect sporting activities.
Great article by Manske and Reiman on the importance of functional testing. The make a statement early in the article that set the tone: "Functional performance testing (FPT) may objectively measure progress and determine rehabilitation effectiveness as well as whether the athlete is safe to return to full sports participation."
One of the key points to this article was that the best type of tests are the ones that mimic the sporting activity. As sports physical therapists this is are bread and butter. We work on joint mobility/stability, flexibility, ROM, strength, power, etc, but how do we mimic the sporting activity? Experience, research, and creativity all play a role in functional testing. Another important takeaway from this article is the sequencing of the functional testing. Remember to consider the energy systems when planning functional testing (ex: power before endurance testing).
The last section of the article explained different power testing. The tests described include trunk power tests, lower extremity power tests, and an upper extremity power test. With pictures and descriptions available, it was a useful segment.
Functional testing in sports physical therapy is very important. Too often are athletes returned to sport without any type of test that mimics their sport/position in sport. As sports physical therapists we must be conscience of why, how, and when we implement functional testing. We need to make sure we provide our athletes with the best interventions to be successful in their return to sport (and hopefully improve performance).