(This article was published in the February 2008 edition of the American Chiropractic Association News)

Last month, we discussed ways to improve lumbopelvic stability to help young athletes prepare for sports participation. This month’s article addresses other areas of sports readiness.

Minimizing ACL Injuries
Let’s look at how we can reduce the incidence of ACL injuries, especially in girls’ basketball. Research shows that it is not their hormones causing all these injuries, nor is it the exaggerated “Q” angle; it is their inability to decelerate the adduction and internal rotation of their femur in relation to their tibia. Preston Wolin, MD, director of the Sports Medicine Program at the Neurologic and Orthopedic Hospital of Chicago, believes a general naivete about good strengthening and conditioning practices is a major reason young women are injuring themselves far too frequently in competitive sports. Dr. Wolin remarks that females typically overwork their quadriceps muscles more than males and tend to land more flat-footed. In addition, excessive movement in either the frontal plane (adduction) or transverse plane (internal rotation) will result in knee caving and, ultimately, wear and tear on the ACL. The knee is stuck between the foot and the hip. “Smart” feet and buttocks will ensure that the tibia and femur are driven into good alignment.

“Smart feet” are proprioceptively rich feet. If the proprioceptors of the foot/ankle complex are ineffective at stabilizing the lower kinetic chain, we will see a “bottom up” driver problem, with the tibia driving the knee into the caved-in position. It is a good idea to examine the athlete’s feet. If the athlete presents an arch in the non-weight-bearing position, but not in the weight-bearing position, you’ve got work to do. Sometimes simply performing exercises barefoot will wake up the proprioceptors in the foot/ankle. Cue your athlete to maintain a neutral foot position: Do not let the arch collapse.

It is fairly easy for the athletes to show good alignment when they are standing on two feet as in their “ready” stance. But what happens when they maintain their “ready” stance, but transfer all their weight to one leg? Are they still able to maintain the alignment necessary to ensure good patella tracking? If a patellar tracking disorder is detected, rule out the cause, which can range from femoral anteversion (internal femoral torsion) and patella alta (high small patella) to increased Q-angle. In addition, soft-tissue tightness of the muscles (gastrocnemius, hamstrings, rectus femoris and iliotibial band) and lateral structures (lateral retiniculum, IT band and vastus lateralis) could be the cause of the patella tracking being too far laterally. Once abnormal biomechanics and soft-tissue tightness are ruled out as potential causes, look to muscular dysfunction as the root of the problem.

If the core/buttocks musculature is ineffective at stabilizing the trunk, we will see a “top down” driver problem with the knee. In addition to addressing lumbopelvic stability, focus on the gluteus medius. The gluteus medius decelerates adduction and internal rotation of the femur, especially when the hip is flexed at approximately 45 degrees. Single-leg stance work is crucial to training the gluteus medius because all athletes run, cut, leap and often jump from a one-legged stance to another one-legged stance.

A simple single bent-leg balance activity is an extremely effective way to begin establishing good patella-femoral tracking. The athlete must “own” this position. It is very easy to challenge this exercise and keep it interesting. Balance is a function of the PVV system: proprioception, vestibular mechanism and vision. We can increase the stimulus to the proprioceptors by changing the surface the athletes are standing on, using, for example, an Airex mat or BOSU ball. Or we can have them dribble a basketball or perform a chest pass while maintaining their single bent-leg balance. Another “tweak” is to have them close one or both eyes. A final modification, and one particularly appropriate for sports, challenges their vestibular mechanisms. Simply having the athletes shake their heads while holding the static single bent-leg balance once again mimics what we so often see in sports. Rarely does the court athlete have his or her head still, with eyes focused straight ahead. The athlete is always scanning the court.

A more dynamic way to train patella-femoral tracking is by performing two-legged and one-legged box jumps. Begin by jumping up onto the box and stepping down from the box. Once you are confident in the athlete’s landing mechanics, allow him or her to jump down, as well.

Multi-directional skaters are an extremely functional way to train the entire neuromuscular system to react with agility. An additional element of reaction training can be built in by asking the athletes to shadow your movements as you sporadically change direction and pace.

Incidentally, the above exercises can also help significantly reduce the incidence of shoulder injuries. The more we recognize that the site of pain is rarely the source of pain, the more effective we are at helping these athletes prevent and overcome injury.

Preventing Overuse Injuries in the Rotator Cuffs
By nature, an overuse injury is the result of the structures being overworked. Certainly, there are cases when an athlete is performing with good technique but the work-to-rest ratio is out of balance. Ensure that the balance of the training doesn’t continue loading that shoulder joint. How often have you had athletes present with an inflamed supraspinatus or bicep tendon, and they have had shoulder exercises prescribed? That tissue might need rest. It most likely needs treatment, not more work! In the meantime, we can get busy working the rest of the kinetic chain and hopefully identify the original mechanism of injury.

Let’s look at a couple of the major causes of rotator cuff strains. First, observe how the athlete “loads” for the throw. Essentially they begin by accelerating a D2 pattern (drawing the sword from the scabbard) and then they transition into decelerating a D1 pattern (returning the sword to the scabbard). If the anterior oblique subsystem (adductor, internal oblique and contra-lateral external oblique) has not been properly trained to decelerate the weight of the trunk moving backward, the athlete will excessively load the shoulder joint into a hyper-flexed position, compromising the joint. Remember, it is the thoracic spine that drives the scapula, which ultimately drives the humerus. If the athletes are unable to get into thoracic extension due to a weak anterior oblique sub-system or tight hip flexors (i.e. restricted hip extension), they will be putting the structures of the shoulder joint under too much strain as they load for a throw. A single-leg posterior reach effectively trains the musculature of the anterior oblique sub-system while putting the athlete in hip extension, which ultimately encourages thoracic extension.

How does the athlete “unload” from the throw? In this case, the athlete transitions from accelerating the D1 pattern to decelerating the D2 pattern. Is the rotator cuff entirely responsible for the deceleration of the humerus on the follow-through? What structure is decelerating the trunk as the athlete moves into hip flexion? Review the role of the posterior oblique subsystem (latissimus dorsi and contra-lateral gluteus maximus) and bicep femoris in decelerating the trunk and humerus moving forward. Single-leg anterior reaches performed with both a relatively straight leg and bent leg effectively trains the posterior oblique subsystem to decelerate hip flexion, trunk flexion and internal rotation of the humerus.

A final word on the source of power development with overhead throws. An athlete who hasn’t learned how to utilize the core as a routing system, essentially connecting the lower body to the upper body, will undoubtedly fail to use ground reaction force effectively and therefore will try to create all the power for the throw from the shoulder. The musculature of the shoulder and upper back isn’t designed for power development.

In conclusion, there are far too many unprepared young athletes whose hopes and dreams can be shattered because their bodies are not prepared for the physical demands of competitive sports. We can help with training programs designed to teach athletes to react to a stimulus with agility, accelerate to where they need to be on the court or field and, finally, decelerate their body mass to a balanced position.

Kym Burke, a certified personal trainer and health and fitness instructor, is the co-owner of One on One, Fitness Consultants Inc. (www.StateCollegeFitnessConsultantsInc.com). Established in 1985, One on One provides customized fitness training programs, from post-rehabilitation to enhanced sport performance.

To view a five-minute video demonstrating the exercises described in the article, go to www.youtube.com and search for “Preventing Injuries with Youth Athletic Readiness Training” or http://www.youtube.com/watch?v=pwkpGm4HJsQ&feature=channel.

View this article on the ACA website.