Evidenced Based Functional Rehabilitation Is it becoming stronger? May 10 th 2014 MAATA, Virginia Beach Michael Higgins PhD, ATC/PT, CSCS Towson University What is Functional Rehabilitation/Training? Is it Becoming Faster? FUNCTIONAL? Is it Becoming More Powerful?
Is it Becoming More Flexible? Is it Reproducing the Desired Motion? Is it Improving Balance? Is it a Combination of Them All? Stronger Faster/quicker Powerful Flexible Improving balance? Improving neuromuscular control? Reproducing the desired motion? Is it Improving Neuromuscular Control? We Have the Technology
Functional Training Defined All functional movement patterns involve deceleration, stabilization and acceleration, which occur at every joint in the kinetic chain and in all three planes of motion. Functional Training Defined An exercise continuum involving balance and proprioception, performed with the feet on the ground and without machine-assistance, such that strength is displayed in unstable conditions and body weight is managed in all movement planes. National Academy of Sports Medicine Gray G. (1995) Following a functional path. Functional Training Simply stated, the primary goal of functional training is to transfer the improvements in strength achieved in one movement to enhancing the performance of another movement by affecting the entire neuromuscular system. Functional Training Defined Multi-joint, multi-planar, proprioceptively-enriched activity that involves deceleration (force reduction), acceleration (force production) and stabilization; controlled amounts of instability; and management of gravity, ground reaction forces and momentum. Boyle M. (2003) Functional Training for Sports Chek Institute Functional Training In functional training, it is as critical to train the specific movement as it is to train the muscles involved in the movement. The brain, which controls muscular movement, thinks in terms of whole motions, not individual muscles. Functional Training Defined It must be remembered that functional training is not an all-ornothing concept. A continuum of functionality exists. The only entirely functional exercise is the actual activity one is training for. Vern Gambetta American Council on Exercise
Functional Training Training to improve functional strength involves more than simply increasing the force-producing capability of a muscle or group of muscles. Rather, it requires training to enhance the coordinated working relationship between the nervous and muscular systems. Functional Exercise (Gray) Non-Functional Functional Isolated Integrated Rigid Flexible Limited Unlimited Artificial Physiological Fake Real Link action Chain reaction Gravity confused Gravity user Lab-like Life-like Mechanical Biomechanical Deceptive Proprioceptive 1 dimensional Multi-dimensional Alternate Definition Functional training involves movements that are specific in terms of mechanics, coordination and/or energetics to one s activities of daily living (ADLs). When considered in these terms, the range of functional activities may be broader than commonly thought. Plisk, S. NSCA Functional Training. Hot Topic Specific functional vs. Non functional Exercises: (Chek) Non-Functional Bench press Lat pull down Seated triceps extension Leg extension Leg press Functional Push up Pull up Dip Lunge Squat Functional Training Some individuals believe that by mimicking the explosive, ballistic activities of high-level competitive athletes, they are training in a functional manner. Functional Training Full spectrum work, in multiple planes, using multiple joints, incorporating full range of motion that is proprioceptively demanding. Training that incorporates a full spectrum of training methods, designed to elicit optimum adaptive response appropriate for the sport or activity being trained for. No one system of the body is emphasized to the exclusion of another.
Functional Training Quarterbacks vs. Pitchers No one training method or physical quality becomes an end unto itself. Each athlete is a case study of one respect the individual. Be real Avoid artificial restraints and positions. The goal of functional training is to develop Athleticism, the ability to perform athletic movements (Run, Jump, Throw, & Lift) with sound technique at optimum speed, with precision, style and grace within the context of the sport or activity Everyday and Athletic Activity Involve skillful application of ground reaction forces. Transmit forces through the body s segments. Are performed in multiple planes of motion, often with no machine to guide one s movement (unlimited degrees of freedom). Football and Pitchers Upright position of the quarterback causes: Decreased contribution from the trunk and legs result in decreased arm velocity No complete follow-through Decreased forward trunk tilt. Consequently, we must control, direct and stabilize the mass of our own bodies as well as other objects. Tasks, while often repetitive, are usually brief in nature. In fact, rapid spikes in force output are the rule rather than the exception. In order to achieve the balance and leverage needed to perform these tasks, we regularly get into certain positions. And the more habitually we do so, the more this reinforces corresponding motor programs and functional adaptations. Plisk S, NSCA Funtional Training So What do we do? Rotator Cuff Strength (1-6) Let research, experience and common sense guide the way. 1. Side-lying ER at 0 degrees of abduction 2. Standing ER at 0 degrees of abduction with a towel roll 3. Standing ER at 45 degrees in the scapular plane 4. Open can exercise 5. PNF D2 6. Standing ER at 90 degrees of abduction 7. Prone ER at 90 degrees of abduction All of these exercises have produced high amounts of EMG activity in the supraspinatus muscle.
The Ballistic Six (7) Latex tubing external rotation. Latex tubing 90/90 external rotation. Overhead soccer throw using a medicine ball. 90/90 external rotation side-throw using a medicine ball. Deceleration baseball throw using a 2 lb medicine ball. Baseball throw using a 2-lb medicine ball. Shoulder Hurdle Walk Overs Exercises for Throwers Glut/Ham I,Y,T Scapular stabs/serrattus Anterior Shoulder slides (slide board/suspension) Glut ham I,Y,T & prone row press Trunk Single leg squat to overhead press Rotator cuff Triceps off bar No monies/w s Prone Row Rotation Press Glut/Ham Row Press
D 2 squat Slide Board Runs Basketball Single Leg Squat to Press Jump training Medicine ball throws Overhead squat Cleans Snatches Single Arm DB Snatch Swimming Phases Swimming produces less stress and eccentric loading to the joint BUT the continuous nature of swimming allows less opportunity for muscular recovery Greater risk of fatigue- induced microtrauma to the joint Pink MM, Tibone JE. The painful shoulder in the swimming athlete. Orthop Clin North Am 2000; 31 (2): 247-61
Exercises for Swimmers Fall Outs Trunk Shoulder Lats (inverted and incline pulls) Med ball Prone row press Strap flutters Strap fallouts Incline Pull Up (Beginner) Flutter Fall Outs Incline Pull Up Short Flutters
Volleyball Mechanics Important to Remember Leg drive and trunk rotation (forward/shoulder-over shoulder/twist) = shoulder speed Muscle Activity in Volleyball serve and spike Volleyball / Tennis Med ball jump slam Slide board running Tubing push up Cone walkovers for shoulders Rokito et al.j. Shoulder Elbow Surg,1998 Tennis Tubing Push -up The players with a better leg-drive uses the inertial transfer from the trunk to upper limb to move the upper arm into a position of MER. Increased leg drive less internal rotator torque to stop the external rotation. Less effective drive primarily use the external rotators to achieve MER, requires a greater internal rotator torque to reverse the rotation of the upperarm.
Jump Medicine Ball Slam Overhead Band Squat Medicine Ball Floor Slam Medicine Ball Warm-Up Overhead Medicine Ball Exercises for Lineman Hip assault Sled Med ball burpee Barbell corner squat to calf raise to press
Corner Barbell Squat Press Lunge with Press Stability Push-Up Hold Knee/Hip Patellofemoral Single leg squat Clam shell Lunge Cable extension Jospt Stability Push Up Hip Over
Hip Under Glut Medius Side-lying hip abduction 81% Single limb squat 64% Lateral band walk 61% Single-limb deadlift 58% Single Leg Squat Single Leg RDL Glut activation Glut ham raise Single leg bridge Single leg RDL Hamstring Glut Max Single-limb squat 59% Single-limb deadlift 59% Sideways, front, and transverse lunges 41-49% DiStefano, L. (2009). Gluteal Muscle Activation During Common Therapeutic Exercises Journal of Orthopaedic and Sports Physical Therapy DOI: 10.2519/jospt.2009.2796
Trunk Two Band Planks Med ball Planks Cable planks Tricep Extensions Cable Planks Band Planks References 1. McCabe, R.A., K.F. Orishimo, et al. Surface electromyographic analysis of the lower trapezius muscle during exercises performed below ninety degrees of shoulder elevation in healthy subjects. North American Journal of Sports Physical Therapy 2 no. 1 (2007): 34-43. 2. Reinold, M.M., Escamilla, R, Wilk, K. Current Concepts in the Scientific and Clinical Rationale Behind Exercises for Glenohumeral and Scapulothoracic Musculature. Journal of Orthopaedic & Sports Physical Therapy 39 no. 2 (2009): 105-117. 3. Blackburn T, McLeod W, White B, Wofford L. EMG analysis of posterior rotator cuff exercises. J Athl Train. 1990:25:45. 4. Reinold, M.M., L.C. Macrina, et al. Electromyographic analysis of the supraspinatus and deltoid muscles during 3 common rehabilitation exercises. Journal of Athletic Training 42 no. 4 (2007): 464-469. 5. Reinold, M.M., K.E. Wilk, et al. Electromyographic analysis of the rotator cuff and deltoid musculature during common shoulder external rotation exercises. Journal of Orthopaedic & Sports Physical Therapy 34 no. 7 (2004): 385-394. 6. Takeda, Y., S. Kashiwaguchi, et al. The most effective exercise for strengthening the supraspinatus muscle: evaluation by magnetic resonance imaging. American Journal of Sports Medicine 30 no. 3 (2002): 374-381. 7. Carter, A, Kaminski, T, Douex, A et al. Effects of high volume upper extremitymplyometric training on throwing velocity and functionalmstrength ratios of the shoulder rotators in collegiate baseball players. J. Strength Cond. Res. 21(1):208 215. 2007.