A great slide. Would love to be able to credit it appropriately- but thanks to Strength and Conditioning Coach Michael Davie for this excellent summary slide.
Make sure you click on the image above to enlarge in your browser.
Sometimes, patients symptoms improve or resolve with unconventional treatments suggested by unqualified “advisors” or “gurus”. Despite all the research to the contrary, the patient or athlete will swear by this course of treatment. I recently assessed one such patient who attributed his absence of shoulder pain symptoms to the removal of milk from his diet. How to handle this? Tell the patient how wrong he is, and the absence of any research or valid theories to support his unconventional treatment? Its time’s like these that I smile to myself, reflect on this great placebo video and kindly pat the patient on the back and let them know I’m here next time if they need any help.
I’m always happy to share links and articles written by “thinking” clinicians who are happy to constantly evaluate “the whats and whys” of sports medicine. Very happy to run across this excellent blog article by Adam Rufa evaluating where we are at in our understanding of tendon pain. Nice reading, thoroughly recommended with a link to the relevant journal article. Thanks for sharing Adam.
Vern Gambetta is a gentleman whose work I respect immensely in the world of exercise, coaching and fitness. Although I have not had the pleasure of speaking with Vern one on one, I have attended some of his seminars and followed his writing’s and blog with much interest, and particularly like his ability to “cut to the chase”. Vern does not suffer fools, and anyone who spends time examining his work will soon realize that training and exercise without function or purpose has little place in his coaching.
Recently Vern has posted on a topic for which I have much interest, namely ACL injury prevention in the female athlete.The consequences of ACL injury to a young female athlete cannot be underestimated.
Vern’s most recent post discusses his thoughts and illustrates several excellent exercises which assist hip and knee control. As an addition I would encourage the reader to consider research and activities designed to assist the athlete with hip and knee control in more dynamic landing/cutting activities, which does require progression in the complexity of the exercise prescription – however only after the athlete has demonstrated appropriate control in the pre-requisite exercises so nicely documented in Vern’s post. Indeed, as all good coaches will agree- advancement or progression is only after the athlete has “earned the right” by displaying competency at less complex exercises. In my experience progression is often prescribed on a recipe approach, where the athlete is advanced to more complex exercises on the basis of time at previous level rather than any degree of assessment of competency.
Clear Illustration of various lower limb landing postures demonstrating the difference between good (A,B,C) and poor (D,E,F) neuromuscular control of hip and knee during landing.
In my experience it is at this time when athletes are performing activities or exercises beyond their level of competence , where they are “out of control” that injury occurs. Interestingly, it is not just exercise competence (or lack of) that may result in an athlete competing or undertaking activities where control is compromised- I have observed an increase in musculoskeletal (not only knee) injuries in the weeks post an athlete suffering concussion. These observations, and my reading of the literature have reinforced to me the importance of neuromuscular control as an essential element of injury prevention, rather than the oft cited but poorly defined “core stability”.
Given the many competing time demands on coaches and athletes, when does one find time for neuromuscular control exercises aimed at assisting injury prevention? My solution to this difficulty has been to include these activities as part of the sports specific dynamic warm up for training. This ensures athletes get time to practice landing and cutting maneuvers in an appropriate environment- however the athlete must be aware of correct technique, and offered relevant and appropriate feedback along with instruction on how to achieve appropriate control. In this regard- the foundational exercises illustrated in Vern’s blog go a long way towards providing the athlete with the necessary pre-requisite strength and control to be able to practice and achieve dynamic neuromuscular control.
During the last decade, training the “core” for treatment of back pain, prevention of injury and performance enhancement has been promoted endlessly within fitness and the media. However have we been sold a false promise by incorrect interpretation and application of the research?
The term “core” has many meanings depending on the literature one reads. As such there are a wide variety of “core exercises” that have been proposed for treating and preventing low back pain, and indeed improving performance. But how robust is the evidence for these approaches promoting “isolated core activation” and stability over general principles of exercise prescription. In other words- what we have seen is the emergence of a system where exercise is prescribed “for muscle, not movement”.
An excellent review/ commentary article in Arch Phys Med Rehabil Vol 88, December 2007 by C Standaert and S Herring “Expert Opinion and Controversies in Musculoskeletal and Sports Medicine: Core Stabilization as a Treatment for Low Back Pain”provides some very interesting insights into some of the many presumptions around core or segmental stabilization exercise programs. This article identifies that exercise programs , varyingly referred to as lumbar stabilization, segmental stabilization, or core stabilization, among other terms, and are aimed at improving the neuromuscular control, strength, and endurance of a number of muscles in the trunk and pelvic floor that are believed to play important roles in the dynamic stability of the spine. Despite the tremendous degree “acceptance” and universal unquestioning of theory of these treatment concepts into the therapeutic arena, the medical literature, and the lay press there are few prospective studies on patients with LBP, and there is even more limited discussion of the concepts of patient selection, dose-response, and long-term outcome associated with these approaches. There also is a significant lack of uniformity regarding the meaning of “core stabilization” and what therapeutic exercises may be most effective.
Further this commentary identifies that research with moderate evidence that stabilization exercises are effective in improving pain and function in patients with low back pain but strong evidence that stabilization exercises are no more effective than a general exercise program administered within an activating treatment approach.
Indeed, it appears from a close examination of the research that we need to step back and take a broader look at the research and use of core stabilization exercises. Perhaps more appropriate and functional is the utilization of a kinetic chain approach, with this model leading into rehabilitation and training programs involving functional, multisegmental exercises progressing through physiologic loads and joint speeds. In this way prescribers of exercise can truly “train movement- not muscle”.
“Recovery. That’s the name of the game in sport. Whoever recovers the fastest does the best”
Lance Armstrong, 7x Consecutive Tour de France Winner
Introduction Recovery strategies are widely promoted within the media leading to a general acceptance by both the lay public and athletes that these strategies aid in post -exercise recovery. In basic terms, appropriate recovery results in the restoration of physiological and psychological processes, so that the athlete can compete or train again at an appropriate level. Recovery from training and competition is complex and involves numerous factors and is typically dependent on the nature of the exercise performed and any other outside stressors that the athlete may be exposed too. Recovery is one of the most neglected principles of competition and training, with coaches and athletes often needing to be reminded that adaptations to the demands of daily games and workouts only occur when an athlete is NOT training. Historically there has been limited research on recovery protocols, particularly those for power/speed/strength-based sports. Recovery protocols have been largely employed on the basis of “anecdotal” evidence rather than well constructed research. This leads to the practical problem- does one wait for the research to validate recovery processes, or does an organization/coach/therapist embrace these practices whole heartedly and evaluate the results in light of research as it comes to date. Fortunately, the last 2 years has seen increased interest in “recovery” as a research area. This article reviews some of the recent research with respect to “Ice baths” What does the research say? An excellent review from http://www.australiansportsconditioning.com/articles/?article5/cold-water-immersion (accessed 19.10.09) reveals the following: Roswell et al. (2009) submersed athletes in water at 10 degrees centigrade and 34 degrees centigrade after each match during a simulated football tournament of four days. Players showed no difference in test of physical performance but players in the cold-water immersion group did report less leg soreness and less feelings of general fatigue. This study concluded that cold-water immersion does not decrease inflammatory response or muscle damage but it does lead to decreased perceptions of fatigue and leg soreness. These conclusions are similar to the study on cyclists by Halson et al. (2008), which demonstrated that athletes undertaking cold-water immersion post exercise did not show any difference in physiological markers of fatigue compared with participants who were not immersed in cold water. However once again subjective reporting by the participants indicated decreased muscular soreness and less feelings of general fatigue. Montgomery (2008) looked at cold-water immersion during a basketball tournament and examined the effect of various recovery protocols performance tests. All subjects showed decreased performance in the tests but the subjects who used cold-water immersion showed the least performance decrement. Crawley (2009) found that cold water immersion was more effective in recovery than contrast (alternated warm cold) bathing. With cold-water immersion resulting in lower perceptions of muscular soreness, less time to achieving baseline sprint performance. Vaile et al. (2008) found that cold-water immersion and contrast water immersion were more effective in enhancing recovery than either hot-water immersion or passive recovery. In a second study Vaile et al. (2008) looked at performance recovery using a series of water immersion techniques. They was found that cold water immersion was an effective way reduce the physiological symptoms of delayed onset muscle soreness and also showed that subjects who used cold water immersion recovered force and power production better than subjects who did not use cold water immersion. Bailey et. al (2007) looked at the effect at the of cold water immersion after prolonged exercise (90min shuttle run test). The testing resulted in extreme muscle soreness and cold-water immersion was shown to reduce some but not all indicators of fatigue. Cold-water immersion improved ratings of muscle soreness and improved muscle force generation compared with subjects who did not participate in the cold-water immersion. In this study creatine kinase was not reduced for the cold-water immersion group. Morten (2007) looked at the effect of cold-water immersion on recovery from intense anaerobic exercise. It was found that after an intense cycling test designed to produce a significant amount of lactic acid that submersion in cold significantly improved lactic acid recovery levels during the 30-minute period post exercise. They concluded that cold-water immersion was a valid way of speeding recovery from intense anaerobic activity.
References Bailey, D.M., Erith, S.J., Griffin, P.J., Dowson, A., Brewer, D.S., Gant, N., & Williams, C.,(2008).Influence of cold-water immersion on indices of muscle damage following prolonged intermittent shuttle running. J Sports Sci, 25(11).1163-70. Halson, S.L., Quod, M.J., Martin, D.T., Gardner, A.S., Ebert, T.R. & Laursen, P.B.,(2008). Physiological responses to cold water immersion following cycling in the heat. Int J Sports Physiol Perform, 27(6).565-73. Ingram, J., Dawson, B., Goodman, C., Wallman, K. & Beilby, J.(2009). Effect of water immersion methods on post-exercise recovery from simulated team sport exercise. J Sci Med Sport, 12(3).417-21. Montgomery, P.G., Pyne, D.B., Hopkins, W.G., Dorman, J.C., Cook, K., Minahan CL. (2009). The effect of recovery strategies on physical performance and cumulative fatigue in competitive basketball. Journal of Sports Science, 26(11).1135-45. Morton, R.H. (2008).Contrast water immersion hastens plasma lactate decrease after intense anaerobic exercise. J Sci Med Sport, 10(6).467-70. Rowsell. G.J., Coutts. A.J., Reaburn. P. & Hill-Haas, S.,(2009). Effects of cold-water immersion on physical performance between successive matches in high-performance junior male soccer players. Journal of Sports Science, 27(6).565-73. Vaile, J., Halson, S., Gill, N. & Dawson, B.(2008). Effect of hydrotherapy on recovery from fatigue. Int J Sports Med, 29(7).539-44. Vaile, J., Halson, S., Gill, N. & Dawson, B.(2008). Effect of hydrotherapy on the signs and symptoms of delayed onset muscle soreness. Eur J Appl Physiol, 103(1).121-2.