Mental Performance

Overcoming Injury: The Mental Edge

  |   Injury Prevention and Care, Mental Performance, Performance Training, Photos   |   No comment

Many athletes experience injury during the course of their careers.

 

And recent research by Ardern, C., Taylor, N., Feller, J., & Webster, K. (2012) suggests that negative behavioral changes can occur from anxiety of re-injury during and post-recovery, including:

 

-impinged performance manifesting as hesitation
-reduced maximal effort
-a wariness in the athlete of both unfamiliar and familiar movement patterns similar to that from which the injury occurred.

 

This cycle of events, in some cases, can actually increase the risk of re-injury and lead to a vicious cycle of physical and mental uncertainty regarding performance.

 

Accelerate Sports Performance’s extensive physical and mental assessment and programming takes into consideration not only the physical demands of rehabilitation, but also the mental rigors of returning to competition, recreational exercise, and functional daily activity. ASP’s clients, once recovered, often perform more efficiently than prior to their injury.

 

In the next blog post, we’ll take a data-driven look at the progress of Kayla Coloyan, a high school basketball point guard, who is 6 months post-op from ACL surgery and looking to return to play stronger than before.

 

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Full Citation

 

Ardern, C., Taylor, N., Feller, J., & Webster, K. (2012). Fear of re-injury in people who have returned to sport following anterior cruciate ligament reconstruction surgery. Journal of Science and Medicine in Sport, 15 (6), 488-495.

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Flat Feet – Symptoms, Structures, and Management

  |   Injury Prevention and Care, Mental Performance, Nutrition, Performance Training, Photos, Video   |   No comment

With rising numbers of lower leg injuries, and the growing number of amateur runners both recreationally, and semi-competitively in marathons and triathlons, we decided to enlighten those interested with an introduction to a few simple structures, deficiencies, and rehab tools use with both our professional and amateur athlete populations.

 

Flat feet are a lowering or collapse of the medial longitudinal arch.  Left untreated, this structural condition can lead to pronation at the ankle joint.  Excessive pronation can cause pain and stress to several structures, including musculature and ligaments (Prentice, 2004).  Today’s blog will outline the visual symptoms, associated structures, and a management plan for flat feet.

Figure 1 displays a posterior view of the left foot and ankle.  On the right side, a collapse of the medial arch is shown indicating flat feet.  On the left side, there is a sign of “too many toes” which is associated with mid-foot abduction.  Also displayed in Figure 1, but not labeled, is an eversion of the calcaneus and a medial bulge of the talar head.  With repeated pronation during weight-bearing activities (standing, walking, running), increased stress will be placed along the medial aspect of the ankle.  As a result, Figure 2 shows swelling and edema posterior to the medial malleolus of the right foot.  These are all visual symptoms of flat feet or ankle pronation.

A common tendon injury associated with flat feet is the tibialis posterior tendon (Yuill, 2010).  The tibialis posterior originates at the adjacent margins of the tibia and fibula and runs posterior to the medial malleolus, then inserts at the navicular, medial cuneiform, and the 2nd-4th metatarsals (middle/inside of the foot).  With flat feet and ankle pronation, strain is placed on the tendon (as shown in Figure 3) and stress occurs on the deltoid  ligament of the medial ankle as displayed in Figure 4.  Both the tibialis posterior and the deltoid ligaments serve to protect the ankle from excess eversion.

 

There are a variety of ways to manage pain and prevent injuries.  On the path back to performance training or incorporated into performance training:

 

(1) The first step is to support the flattened arch through the use of orthotics.

 

(2) Next, we want incorporate a stretching program to ensure full range of motion in all planes.

 

(3) After an adequate level of range of motion has been established, a strength program can be added.

 

(4) Finally, proprioception and balance exercises will be trained to enhance neuromuscular control.

 

A primary aspect that we try to focus on is having the athlete train with a stable medial longitudinal arch. Although three distinct arches function to support the foot, the medial longitudinal arch has been found to be the arch of clinical significance in preventing injury due to flat feet (Franco, 1987).

ORTHOTICS

 

One way to manage flat feet is by using orthotics. The main function of an orthotic is to provide a combination of neuromuscular reeducation and a change in body mechanics in an attempt to readjust the foot into a more ideal weight baring position (Franco, 1987). A proper fitting orthotic provides mechanical support to the flattened medial longitudinal arch and prevents further tendon lengthening or ligament stress. The muscles that are constantly being stressed and lengthened are then, finally relaxed and shortened.

 

EXERCISES

 

While the orthotic passively creates an arch for the athlete and may help prevent overuse injuries, it is also important for the athlete to actively train and strengthen muscles that are underactive during over pronation. A program that incorporates the strengthening of the anterior and posterior tibialis is important because they help maintain a proper arch. Without the use of an orthotic, the athlete can work towards biomechanical betterment by practicing “bilateral short foot position.”

 

https://www.youtube.com/watch?v=oxU9uC5FHF4#t=7

 

Other exercises that should be incorporated into the athlete’s program to build strength in the ankle and lower leg include isometric exercises against all planes of motion. After that, the athlete can progress to concentric and eccentric movements using tubing or resistance bands and onward.

 

Kinesthetic awareness can be regained through multiple balance training exercises. One balance exercise that we may incorporate into the rehab training is a single leg RDL. While a main objective of this exercise is to strengthen the posterior chain, performing an RDL on one leg also forces the athlete to focus on balance, thus improving neuromuscular control at the ankle, lower leg, hip, and torso. Another way we improve balance is by having the athlete stand on a soft, unstable pad while throwing a ball for them to catch. When the athlete reacts to catch the ball, they must stabilize the foot and lower leg.

 

While these are general exercises for ankle and lower leg rehabilitation, athletes respond to treatment and exercises differently, so modifications should be made accordingly.

 

In the next blog post, we will talk about the effects of over pronation up the kinetic chain.

References

  1. Howitt S, Jung S, Hammonds N. Conservative treatment of a tibialis posterior strain in a novice triathlete: a case report. Journal of the Canadian Chiropractic Association Mar2009, Vol. 53 Issue 1, p23 9p.
  2. Yuill E, MacIntyre I. Posterior tibialis tendonopathy in an adolescent soccer player: a case report. Journal of the Canadian Chiropractic Association Dec2010, Vol. 54 Issue 4, p293 8p.
  3. Kulig K, Reischl SF, Pomrantz AB, Burnfield JM, Mais-Requejo S, Thordarson DB, Smith RW. Nonsurgical Management of Posterior Tibial Tendon Dysfunction With Orthoses and Resistive Exercise: A Randomized Controlled Trial. Physical Therapy Jan2009, Vol. 89 Issue 1, p26 12p.
  4. Mattacola, Carl & Dwyer, Maureen. Rehabilitation of the ankle after acute sprain or chronic instability. Journal of Athletic Training. 2002 Oct.; 37 (4); 413-429.
  5. Prentice W. Rehabilitation Techniques for Sports Medicine and Athletic Training Fourth Edition 2004.
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Anterior Cruciate Ligament Injuries

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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).

 

http://youtu.be/lSqBhDgT4b0

 

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.

 

 

Robert Griffin

 

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http://youtu.be/lSqBhDgT4b0

 

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.

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PURPOSEFUL PROGRAMMING

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What is the goal of your program? Why are you doing what you’re doing? What are the adaptations your program is creating if adhered to? If you don’t have answers to these questions then you may be guilty of just making things up randomly, having ineffective programs, or underachieving in your programs results.

 

Training adaptations can be physical, mental, sociological, and the like. The best training programs bring about a combination of adaptations. At Accelerate Sports Performance, before any program is written and implemented the question is asked by the coaching staff “What is the purpose of this program? What adaptations are we trying to create?” From here it is simply a matter of measuring your success over time and adjusting the approach based on the best results attained and the latest scientific research.

 

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Training Environment Is Key!

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At Accelerate Sports Performance we have a specific culture we are continually developing. It is one of motivation and awareness.

 

Each and every athlete develops a strong affinity for the surroundings of ASP during their training sessions. This is key because a training program is so much more than what is written on paper. It is entirely as much a unique experience associated with various emotions as it is simply an exercise prescription on paper. At ASP, we pride ourselves in our programming while at the same time taking as much pride in the environment and culture the program is carried out in. Having a positive and motivating training environment can bring out the best effort in many athletes.

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EDUCATION IS FOUNDATION

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At Accelerate Sports Performance, not only is the coaching staff formally educated in sports science and sports medicine but we continually impart that knowledge deeply into our athletes.

 

Elucidating the “Why’s” while doing the “How’s” help to create buy-in from athletes of all levels. We have found that athletes who are empowered with knowledge not only reach their fullest training potential but lay down a foundation that will guide them throughout their training careers.

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At ASP, whether you are a 7th grade athlete or a recurrent Olympic champion we’ll meet you at your level and give you a solid appreciation for how any why your training program is producing such amazing results. For ASP and its athletes – knowledge is power.

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