Slide 1. Slide 2. Slide 3

Transcription

1 Slide 1 Jason M. Mensinger MEd, LAT, ATC, PES, CES Slide 2 Review healing process and core goals of rehabilitation To enhance knowledge of strength and conditioning principles and how they can be applied throughout the rehabilitation process. Provide a framework to categorize physical preparation activities based on how they stress the central nervous system. Discuss the importance of central nervous stimulation through movement activities from the acute stage of rehabilitation through functional return to play Provide information related to strength related to sporting activity, along with progressions for movements utilized in training. Discuss phases of a sprint and activities that can be used during rehabilitation to maintain or enhance them Provide progressions related to speed and strength development activities and how they can be used during all stages of rehabilitation for sprint-based athletic activities. Slide 3 Inflammatory Fibroblastic-repair Remodeling WHAT IS THE FUNCTION OF THE TISSUE? Many times what gets left out of discussion? Just because biological healing has occurred, it does not mean that the athlete is prepared for performance. 1 Neurophysiologic dysfunction

2 Slide 4 Structural integrity Pain-free joints and muscles Joint flexibility Muscular Strength Muscular Endurance Muscular Speed Motor Skill Muscular power Agility Cardiorespiratory endurance Slide 5 Slide 6 All training has general and specific effects Structural Neural Rate of Force Development

3 Slide 7 Slide 8 CNS Impact dependent upon 3 o Speed of movement o Magnitude of resistance o Amplitude of movement o Number of working muscles o Size of working muscles o Volume and density Activities 3 o Sprinting at Max Velocity o Explosive sport maneuvers o Explosive jumps, push-ups, lifts o Max Effort Strength training Slide 9 1. Total Body/Global Movements 2. Compound Regional 3. Single Joint/Local

4 Slide 10 Increased somatosensory activation Decreased motor cortex excitability Increased intracortical inhibition Altered cortical activation in task execution IMPORTANCE OF CNS Slide 11 Load compromised athletes cannot take more than two weeks off from strength training or risk neuromuscular switching off 1 Arthrogenic muscle inhibition occurs bilaterally after a unilateral knee injury 6 o Apply cross-education concept o Unilateral strength training enhances performance in contralateral limb 7 o Eccentric contraction o Earlier onset of hamstring activity on both the injured and non-injured side of patients with hamstring strains 8 Diminished ability of the motor system to send action potentials following chronic injury 9 Slide 12 General General Specific Specific *Rehabilitation connection

5 Slide 13 Use strength as a means to activate motor units 3-4,13-15 Basic movement patterns 13 o Push o Pull o Quad Dominant o Hip Dominant o Rotation/Anti-Rotation o Carry/Drag/Push o Grip Strength Movements o Bench Press o Squat o Deadlift o *General & Local Effects Supplemental/Accessory o Support movements and single joint activities Slide 14 Bottom-Up Body weight Loaded- KB (Goblet) Barbell Back on Box Slide 15 Greater neural adaptation 16 o Increased activity in brain 17 Higher stress level per motor unit 18 Preferentially recruit fast twitch fibers 16,19 Greater Cross Education 18

6 Slide 16 Greatest activation of motor units 18 Increase primarily at angle worked o Greater transfer for muscle lengthened than shortened during movement 11 Isomiometrics Iso-ballistic Can be used to facilitate more intense work 12,18,20 Slide 17 Study Cal Dietz 21 Pro Agility vs. Ecc, Iso, Con 3 Components of a multi-directional movement Need to focus initial efforts on deceleration o Landing o Split Stance o Athletic Stance o Multidirectional Hops o Split Squat Eccentric Quasi-Isometric Slide 18 Important SKILL for non-track athletes High neuromuscular demand- intermuscular and intramuscular coordination. Largest forces in shortest amount of time o Forces up to 5 times bodyweight 14,22 High degree of CNS activity- More than just running fast Strength training can improve, but up to a point Most important factor is rate of force development Repeat sprint ability important for team sports o Alactic/Aerobic Recovery Introduce sprinting/running drills as early as possible o Toe over knee drill/power Speed Drills

7 Slide 19 Most team sports function in realm of 5-30 meters 13-15,23 Angle of lower leg/line of extension Don t force stride length Greater horizontal forces More quadriceps/anterior chain Strength development more relevant Slide 20 More upright posture Greater hamstring emphasis Greater vertical forces All sprint action affected by arms Swing phase- hamstrings do not actively contract 24 o More important in relation to hip extension Reactive ability more relevant 14,24-25 Slide 21 Push-Up Into Sprint Jump Back to Sprint Falling acceleration Hill Sprint Sled Sprints Jumps with deeper knee bend

8 Slide 22 Slide 23 More strength-based Pistol Squat Lunge Variations with hip flexion Split Squat Variations Step-Up with hip flexion Heavy Prowler and Sled Slide 24 Hip Extension Strengthening Upright sled walking Flying Sprints Increase sprint distances Jumps more elastic/reactive

9 Slide 25 Kinematic likeness to sprinting Elastic/Reactive Component (lower intensity) A series B series Lateral skips Backwards skips Butt-kickers (modified with hip flexion) Straight leg Bounds Ankling **Single leg variations Slide 26 Slide 27 Stationary Bike Application Acceleration vs. Max Speed Work Periods 14 o Acceleration <6 seconds o Max Velocity 6-8 seconds o Speed Endurance 8-15 seconds o Special Endurance I o Special Endurance II >45 seconds

10 Slide 28 Aerobic development and recovery in speed/power athletes 14-15, % Speed in interval fashion Distance based on sport demand Slide 29 Bike Tempo Pool Tempo Power Speed Drills MB Tempo Bike Example o second running tempo equivalent to approx 30 second bike o Shorter rest intervals Slide 30 Case- DI Football RB 14 Wrist surgery for damaged ligament All regular lower body workouts 10 days post wrist brace removal- Bench Press o 355 before/330 after For application purposes also think about the reverse

11 Slide 31 Early Phase (Days 2-5) (Based off of Smith 14 & Mach 27 ) Power Speed/Drills Single Leg o A Drills first Short Submax accelerations o Distances of 5-10m o Extend to 15-20m Jumping exercises- No explosive hip extension affected side Abdominal exercises MB work Eccentrics Slide 32 Power Speed Drills- Both legs o A drills (Hill or stairs if possible) 30 m runs o 2X30m, 4X30, 6X30, 8X30, 10X30 and back down Eccentric (Hip extension variants) o Reverse bands Trap Bar Deadlift? Slide 33

12 Slide 34 Protocol summarized from Brotzman and Wilk 29 Average return to play about 10 days Passive modalities Bracing WB as tolerated Quad sets/slr Eccentric Quads Hip movements Mini-squats Slide 35 Squat pattern- bottoms up Day 1-2 Single leg A march (Double leg?) Single leg A skip (3-5 days?) Submax acceleration/prowler? Acceleration work on bike Stiff Leg KB Swings (3-5 days out?) Deceleration- Double to single leg landing CONTINUE WITH REHABILITATION AFTER RETURN TO PLAY Slide 36 Type of injury- Acute vs. Chronic? Body part/joint/tissue Contraindications Contralateral limb/general Organism Strength Home exercise Athlete motivation to begin to train the right way Regional Interdependence What is sport demand o Repeat-sprint o Throw o Jump

13 Slide Knowles B. Reconditioning: A performance-based response to an injury. In: Joyce D, Lewindon D, ed. Sports Injury Prevention and Rehabilitation. Kindle ed. New York, NY: Routledge, Knight KL, Draper D. Therapeutic Modalities: The Art and Science. 2 nd ed. Baltimore, MD: Lippincott Williams & Wilkins; Smith, J. The Governing Dynamics of Coaching. Publisher: Author; Francis, C. Training for Power and Strength in Speed. Publisher: Author; Kindle edition. 5. Needle AR. Neuroplasticity after musculoskeletal injury: The central nervous system & clinical outcomes. Oral presentation at: National Athletic Trainers Association Clinical Symposia & AT Expo, 2016; Baltimore, MD. 6. Palmieri-Smith RM, Thomas AC. A neuromuscular mechanism of posttraumatic osteoarthritis associated with ACL injury. Exercise and Sport Science Review. 2009;37(3): Fimland MS, Helgerund J, Solstad GM, Iversen VM, Leivesth G, Hoff J. Neural adapatations underlysing cross-education after unilateral strength training. Europoean Journal of Applied Physiology. 2009;107: Sole G, Milosavlijevic S, Nicholson H, Sulivan JS. Altered muscle activation following hamstring injuries. British Journal of Sports Medicine. 2012;46: Slide Lepley AS. Neural origins of dysfunction following joint injury. Oral Presentation at: National Athletic Trainers Association Clinical Symposia & AT Expo, 2016; Baltimore, MD 10. Bondarchuck AP. Transfer of Training in Sports, Vol. 2. Ultimate Athlete Concepts; Kurz T. Science of Sports Training: How to Plan and Control Training for Peak Performance. 2 nd ed. Island Pond, VT: Stadion; Verkhoshansky Y, Verkhoshansky N. Special Strength Training Manual for Coaches. Rome, ITA: Verkhoshansky SSTM; Defranco J, Smith J. Special Strength for Team Sports: Transforming Strength, Power, and Speed into Athletic Performance Smith J. Applied Sprint Training Hansen D. Successfully translating strength into speed. In: Joyce D, Lewindon D, ed. High-Performance Training for Sports. Kindle ed. Champaign, IL: Human Kinetics; Hortobagyi T, Hill JP, Houmand JA, Frasier DD, Lambert NJ, Israel RG. Adaptive responses to muscle lengthening and shortening in humans. Journal of Applied Physiology. 1996;80(3): Slide Grooms D. The clinical implications of neuroplasticity after musculoskeletal injury: Targeting the brain during rehabilitation. Oral presentation at: National Athletic Trainers Association Clinical Symposia & AT Expo, 2016; Baltimore MD. 18. Thibadeau C, Schwartz T, ed. Therapy and Application of Modern Strength and Power Methods Nardone A., Romanò C., and Schieppati M Selective recruitment of high threshold human motor units during voluntary isotonic lengthening of active muscles. J. Physiol. 409: Siff M. Supertraining. 4 th ed. Denver, CO: Supertraining Institute; Dietz C, Peterson B. Triphasic Training: A Systematic Approach to Elite Speed and Explosive Strength Performance. Hudson, WI: First Bye Dietz: Coh M, Babic V. Biodynamic characteristics of maximum speed development. Physical Education and Sport. 2010;8(2): Kraaijenhof H, Thome M, ed., Mann B, ed. What We Need is Speed: Scientific Practice of Getting Fast. Ultimate Athlete Concepts; Harrison, A. Biomechanical factors in sprint training: where science meets coaching. International Symposium of Biomechanics in Sports: Conference Proceedings Archives. 2010;28:36-41.

14 Slide Francis, C. The Charlie Francis Training System Kindle Edition. 26. Josse C. Advanced Special Strength Protocols. Diesel Strength and Defranco s Training; Hansen D. Optimal tempo training concepts for performance and recovery. Published: August 14, Accessed: May 19, Mach G. Sprints and Hurdles. Vanier, ON: Canadian Track and Field Association; Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation. 2 nd ed. Philadelphia, PA: Mosby; Slide 41 mensingj@neumann.edu