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NATA D10: The Time Constrained Athelete
- 1. The Time Constrained Athlete: Developing a 15 Minute Rehabilitation Program National Academy of Sports Medicine © 2011 Joshua Stone, MA, ATC, NASM-CPT, CES, PES Sports Medicine Program Manager National Academy of Sports Medicine
- 2. Agenda Time constrained athlete Introduction to the human movement system Human movement dysfunction Corrective Exercise Continuum Case Studies - 15 minute rehabilitation programs x 2 Open discussion National Academy of Sports Medicine © 2011
- 3. The Problem National Academy of Sports Medicine © 2011 Time Crunch Suboptimal care
- 4. Best Utilization of Time? Prioritization What is the single best tool for the injury Modalities Manual Therapy Prophylaxis Rehabilitation Injury dependent National Academy of Sports Medicine © 2011
- 5. 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 National Academy of Sports Medicine © 2011
- 6. Human Movement System Muscular System SkeletalSystem NervousSystem Sensorimotor Integration Neuromuscular Control The Human Movement System Human Movement System Human Movement System is a very complex, well-orchestrated system of interrelated and interdependent myofascial, neuromuscular, and articular components National Academy of Sports Medicine © 2011
- 7. 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 National Academy of Sports Medicine © 2011
- 8. Static 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.
- 9. Dynamic Malalignments Dynamic malalignment (movement impairment syndromes) altered muscle recruitment patterns multi-segmental human movement system impairment National Academy of Sports Medicine © 2011
- 10. 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 National Academy of Sports Medicine © 2011
- 11. National Academy of Sports Medicine © 2011 Dysfunction Altered Length-Tension Relationships (muscle tightness) Altered Arthrokinematics Altered Force-CoupleRelationships (muscle weakness) Altered Sensorimotor Integration Altered Neuromuscular Efficiency Tissue Fatigue Tissue Breakdown Human Movement Dysfunction
- 12. Common 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 National Academy of Sports Medicine © 2011
- 13. What is Poor Movement? National Academy of Sports Medicine © 2011 arching the low back elevating the shoulders knee valgus
- 14. Why Do We See Imbalances? Stability Mobility National Academy of Sports Medicine © 2011
- 15. Movement Assessments • National Academy of Sports Medicine © 2011 A movement assessment allows a Health and Fitness Professional to observe Human Movement System impairments. 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.
- 21. Position:
- 22. Feet shoulder width apart
- 23. Arms overheadANTERIOR LATERAL POSTERIOR
- 26. Knee valgus (Knock Kneed)
- 28. posterior tibialis tendinitis (shin splints)
- 38. The 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. National Academy of Sports Medicine © 2011
- 39. A Few Common Compensations Seen Single Leg Squat Assessment Knees Inward movement Hips Inward/Outward Trunk Rotation Inward Trunk Rotation Knee moves inward Outward Trunk Rotation National Academy of Sports Medicine © 2011
- 40. Double-leg Squat & Single-leg Squat National Academy of Sports Medicine © 2011
- 41. National Academy of Sports Medicine • Movement Assessments Assessment Modification Modifications to Overhead Squat: Elevating the heels Hands on the hips
- 42. Pushing and Pulling Assessments Push-ups Assessment Standing Row Assessment National Academy of Sports Medicine © 2011
- 43. Inhibit Activate Integrate Lengthen Inhibitory Techniques Self-Myofascial Release Manual Therapy Activation Techniques Isolated Strengthening Positional Isometrics Integration Techniques Integrated Dynamic Movement Lengthening Techniques Static Stretching Neuromuscular Stretching Manual Therapy The Corrective Exercise Continuum National Academy of Sports Medicine © 2011
- 44. Case Studies Two Case Studies Background Information Goals Lifestyle Medical history Video footage Movement Assessments Identify Movement compensation Design a CEx program National Academy of Sports Medicine © 2011
- 45. 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: Goodhealth, no previous surgeries or medication National Academy of Sports Medicine © 2011
- 46. Case Study 1: Rachel’s Overhead Squat Assessment National Academy of Sports Medicine © 2011
- 47. Rachel’s Overhead Squat National Academy of Sports Medicine © 2011
- 48. Rachel’s Modified Overhead Squat Assessment National Academy of Sports Medicine © 2011
- 49. Case Study 1: Rachel’s Single-leg Squat Assessment National Academy of Sports Medicine © 2011
- 50. Rachel’s Single Leg Squat National Academy of Sports Medicine © 2011
- 51. Rachel’s Movement Analysis National Academy of Sports Medicine © 2011
- 52. Analysis 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: Prioritize issues Regain LE muscle balance Relieve lower extremity pain National Academy of Sports Medicine © 2011
- 53. 15 Minute Corrective Exercise Program National Academy of Sports Medicine © 2011
- 54. 15 Minute Corrective Exercise Program National Academy of Sports Medicine © 2011
- 55. 15 Minute Corrective Exercise Program National Academy of Sports Medicine © 2011
- 56. 15 Minute Corrective Exercise Program National Academy of Sports Medicine © 2011
- 57. Case Study 2: Jeff’s Bio Bio: Age: Senior Sport: Baseball Recreation/Hobbies: Hiking, working out, fishing Goal: Biceps tendinitis, impingement syndrome Occupation: Student Athlete Medical History: Goodhealth, previous rotator cuff repair National Academy of Sports Medicine © 2011
- 58. Case Study 2: Jeff’s Overhead Squat Assessment National Academy of Sports Medicine © 2011
- 59. Jeff’s Overhead Squat National Academy of Sports Medicine © 2011
- 60. Analysis of Jeff’s Movement National Academy of Sports Medicine © 2011
- 62. Latissimus Dorsi
- 63. Pectoralis Major
- 64. Pectoralis Minor
- 65. Subscapularis
- 66. Lateral gastrocnemius / soleus
- 67. Hip flexors
- 68. (TFL, rectus femoris, psoas)
- 69. Underactive/Weak
- 72. Rhomboids
- 75. Intrinsic core stabilizersCEx Goal: Prioritize issues Regain muscle balance in the upper Alleviate shoulder pain National Academy of Sports Medicine © 2011
- 76. 15 minute Corrective Exercise Program National Academy of Sports Medicine © 2011
- 77. 15 minute Corrective Exercise Program National Academy of Sports Medicine © 2011
- 78. 15 minute Corrective Exercise Program National Academy of Sports Medicine © 2011
- 79. 15 minute Corrective Exercise Program National Academy of Sports Medicine © 2011
- 80. 15 minute Corrective Exercise Program National Academy of Sports Medicine © 2011
- 81. Summary Inhibit Activate Integrate Lengthen Inhibit: Myofascial Release to Overactive Muscles Activate: Strengthening of Underactive Muscles Integrate: Dynamic /Functional Strengthening Movement Lengthen: Stretching or Manual Therapy to Overactive Muscles 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 National Academy of Sports Medicine © 2011