Anterior cruciate ligament injuries are very common injuries and one of the most debilitating injuries that an athlete can suffer. These injuries are even more common in female athletes. Studies have shown that females are between 2 and 3 times more likely to suffer an ACL tear, with female basketball players up to 6 times more likely to suffer a non-contact ACL injury than males with similar exposure hours to the sport (Ireland).
This particular athlete is returning from an ACL repair in her right knee. She is performing a Keiser resisted vertical jump with minimal load. We want her to execute this vertical jump without a countermovement to familiarize her with the correct biomechanics/firing pattern of the jump. We’re also eccentrically loading her back into the correct position again on the landing before we have her add a stretch-reflex component with a countermovement.
In the beginning phase of this athlete’s program, she exhibits many of the patterns that increase the risk of an ACL injury. On the ascent of the jump, her right femur internally rotates at the hip and the tibia is externally rotated as she pronates at the ankle. This valgus position of the knee and pronation of the ankle puts the ACL in a vulnerable position. This is due to the hip extensors, abductors, and or external rotators not firing properly or staying dormant, therefore the femur falls into an internally rotated position. After time, this becomes a learned neuromuscular movement pattern.
Subconsciously, the pictured athlete utilizes a stretch-reflex with a countermovement change of direction before her jump (although not instructed to do so) without sound biomechanics. In this particular case, the issue is not due to a lack of strength, but a firing pattern issue of the hip extensors, external rotators and abductors. Our goal is to continue improving her jumping/landing biomechanics as reduce risk of reinjury through better kinesthetic awareness.
Here is an image of the biomechanical etiology of an ACL tear as we described in this instance, (as there are other mechanisms) in a more gross form followed by an image of the actual injury on the field of play by NFL athlete and QB of the washington Redskins, Robert Griffin III.
In week three of our athlete’s program, we can see significant improvement with a particular focus on queuing the loading pattern. In this video progression, the athlete executes the exercise with much more sound eccentric form, attacking the ground with her feet, readying herself to move in the other direction. In the first video from her first week of this phase, notice that her landing position is completely vertical and she is only “catching” herself into the landing, finding support in a structural fashion rather than an elastic fashion. She has gained the neuromuscular adaptations necessary to execute better, yet still not perfect, jumping and landing biomechanics.
We want to put the athlete in a more advantageous position utilizing her larger/stronger muscles, and stabilize with her smaller muscles; to not only strengthen, but prevent future ACL re-injury. By utilizing the vertical jump (in addition to other elements within her program) and tracking her progress over time, we will continue to work on her proprioceptive awareness, loading patterns, and dynamic strength and power development.
1.) Ireland, Mary Loyd MD, Anterior Cruciate Ligament Injury in Female Athletes: Epidemiology. Journal of Athletic Training. 1999, 34, 2, 150-154.
In this series, we have Bri performing the B March. This exercise is used to help develop proper sprint mechanics; specifically appropriate hip flexion and knee extension, plus the act of hip extension by pulling our foot through the ground strike phase. We coach the athlete to act as if they are trying to get gum off of their shoe to reinforce the concept of pulling through our sprint strides, as opposed to pushing off. This exercise is also geared to training the correct location for the foot strike, which is when the midfoot of the stride leg is even with the toes of the stabilizing foot. As with all other sprint techniques the strides are performed with all leg and arm movements in the sagittal plane without any lateral or medial deviations.
As we can see in her first attempt at the B March, there are considerable inefficiencies in the movement. Starting with the knee flexed during the initial stride phase, which prevents a full hamstring stretch. Ideally, we would see terminal extension at the knee, giving us a straight line from hip to heel. We also have passive foot striking. There is little to no hip extension to facilitate a dynamic pull of the foot as it makes contact with the ground. Lastly, the arm action becomes stagnant during the recovery phase. We would like to see both arms keep 90 degrees of flexion at the elbows during both the stride and recovery swings. Over weeks of practice this drill and general sprint mechanics will improve as seen below:
In this second video we can see Bri has increased in a couple of specific areas. First, the leg swing is initiated with better knee extension. With better knee extension comes a more dynamic hamstring stretch, and a more activated hamstring executes a more powerful stretch reflex to pull the leg through the ground strike and recovery phases. This is why we also see an improvement in the pull portion of this movement. The foot is now more dynamic when it makes contact with the ground and you can see the hip extension pulling her into each stride. Still the recovery hand tends to fall to the ground as opposed to seeing the elbow pull through the recovery swing while keeping both elbows flexed. In the next video we will see improvements in overall technique and tempo:
In this final video we see all of the desired components coming together after nearly one month of twice per week training of this specific movement pattern. With the continuous training Bri was able to synchronize her arm and leg movements and achieve a more dynamic tempo. Full leg extension paired with her feet attacking the ground when the strike the floor allow her to move more efficiently in her lower half. Proper arm swinging helps her to stabilize her upper body as well as assist her with pulling herself through each stride, which is the preferred sprint technique.
The diaphragmatic breathing pattern is one of the many aspects of health that we really focus on correcting at ASP. I say “correcting” because most don’t know that chances are, they have probably been breathing incorrectly for most of their lives. This is important because breathing with an optimal Zone of Apposition can effect many different things including: posture, strength, muscle flexibility, joint range of motion, fatigue and recovery, neck pain, and lower back pain. While reading this, go ahead and take the deepest breath possible by inhaling through your nose while either standing or sitting up straight. If you noticed your chest/ribs rise, or expand you are probably breathing with a sub-optimal Zone of Apposition. If this is the case, don’t worry because you are among the majority.
The Zone of Apposition (ZOA) refers to the cylindrical dome-shape of the diaphragm and its relation to the rib cage. Along with the diaphragm, the muscles used in an optimal breathing pattern and in spinal stability are the transversus abdominis and the muscles of the pelvic floor. When breathing with a sub-optimal ZOA the transversus abdominis and the pelvic floor musculature are weakened due to under usage and in some cases are nearly dormant. The muscles that are then forced to pick up the slack (main ones include: the pectoral muscles, upper trapezius, scalenes, SCM) become severely overactive and tight. This causes the ribs to elevate and/or externally rotate.
The average person breathes somewhere between 17,000 and 24,000 times per day. So when breathing using a sub-optimal ZOA, muscles that where not designed for breathing are doing thousands of repetitions of ribcage elevations each day.
Postural and Range of Motion Effects:
Tightness in the upper traps, scalenes and SCM can lead to lack of ROM in the cervical spine, neck pain, and in severe cases migraines.
With the pectoral muscles, upper traps, scalenes, and SCM being overused during Sub-optimal breathing, they become tight and shortened. Posturally, this causes the shoulders to have anterior rounding. With anterior rounding of the shoulders, ROM is limited especially external rotation.
Each ribcage elevation during Sub-Optimal ZOA breathing often activates paraspinal muscles causing slight thoracic extension. This increases lordosis and creates spinal instability and extra compression on the lumbar spine. The overactive paraspinal muscles also limits thoracic rotation.
An excessive lordotic posture continues to create more dysfunction down the kinetic chain. Adding to an anterior pelvic tilt that will cause tightness/ lack of ROM/ and sometimes pain in the Hip Flexors, TFL, IT band, and quadriceps.
Clients at ASP start with a 90-90 supine breathing corrective exercise to remind him or her of an optimal breathing pattern heading into their workout. This is also why we emphasize this breathing technique with every exercise as well. We also encourage that our clients practice an optimal breathing pattern when away from the gym as well; while sitting in traffic or standing in line for coffee for example. In order to correct a muscle dysfunction that has been misused constantly for 10, 20, maybe 30 years takes a lot of practice and thought.
Laying supine with knees and hips bent at 90 degrees and hands in prescribed position.
Chin tucked in
Inhale through the nose
Fill the thorax with breath expanding upward and outward in 360˚ of direction
Exhale through the mouth contracting belly button towards the spine, internally rotating the rib cage and pulling it down and back with the internal obliques.
During inhalation allow for expansion the ribs or chest in a 360˚ fashion
During exhalation draw the belly button to the spine, and ribs, down, back and internally rotated
During exhalation do not allow substitutions such as “sucking in,” lifting the rib cage or shoulders, or pelvic tilts.
Initial contraction should be gentle to activate transversus abdominus and not override with contraction of the internal obliques primarily.
Instruct proper breathing techniques
Initiate breaths with the diaphragm
Carry proper breathing techniques to exercise and life
Decrease back pain
Mobilize and stabilize spine/posture
Breaths will subconsciously and reflexively engage the core and postural muscles that help in our lifts/sport and every day life.
We want to squash the habit of chest breathing that leads to poor lifting form/lack of core activation and postural support, and as a result the potential for postural dysfunction and back pain.