Part 3/3: Attention Soccer Players, Coaches, and Trainers!! Are you or your athletes at risk of an ACL injury?
If you struggled to land properly and displayed poor movement quality on any of the screening tests from Part 2 it is not the end of the world. Luckily for you I have provided exercises which I believe are some of the best for preventing non-contact ACL injury in soccer. Please note that I am solely focussing on landing exercises and these won’t make up the bulk of your strength and conditioning program.
The following 6 exercises can be implemented into your own soccer training sessions, for example during the warm-up, or before and between sets of your main strength exercises in the gym. The aim is to build a robust and resilient knee to reduce your risk of non-contact ACL injury (or any non-contact knee injury for that matter!). The big focus is on the movement quality of the landing, specifically the link between the trunk, hip, knee and ankle. Perform 2-3 sets of 4-8 repetitions and aim to stick/hold the landings for about two to three seconds. Don’t get left behind this soccer season and miss out because your knee was not prepared for the rigours of a soccer match.
1. Forward Hop (single leg):
2. Diagonal Hop and Stick:
3. Lateral Hop and Stick
4. Single Leg Drop and Stick
5. Jump and Land with Perturbation
6. Rotational Hop and Stick (double)
An exercise physiologist can take you through an ACL preventative program that is structured and individualised to give you and your players the best chance of staying injury-free this soccer season.
Want to learn more about how we can help you stay injury free this season? At MTP Health we take you through a full comprehensive ACL screening that is specific to soccer performance. This includes aforementioned tests shown in Part 2 plus many more. Following the assessment, we will provide a structured and individualised training program for you to have the best chance minimising your risk of non-contact ACL injury and optimising your on-field performance.
COACHES: Always remember that the athlete’s best ability is their availability.
Book in for an initial soccer risk assessment below a or enquire for more information.
Part 2/3: Attention Soccer Players, Coaches, and Trainers!! Are you or your athletes at risk of an ACL injury?
By David Maiolo
Following on from Part 1, I will take you through a few examples of tests that you can use in your athletic screening process. Note that these tests reflect the injury mechanisms for an ACL injury seen in part 1 (e.g. drop vertical jump [double & single leg] reflect landing after heading a ball), hence the relevance of these tests to athletic performance and injury prevention. The first one is the Single Leg Hop and Land for Distance which reflects the ability to land effectively on one leg when moving in a forward direction.
Test 1: Single Leg Hop and Land for Distance Test.
Stand on one leg and find your balance. Once ready, hop as far as you can forward and land on that same leg. Repeat 3 times each side and take the best of the 3 measures for each side. This will give you some objective data to work with when you reassess. However, for the purpose of this series, we are more concerned with the movement quality (e.g. kinematics) of the LANDING. What we are looking for in this test is the coordination between the trunk, hip, knee and ankle when the athlete lands. This means we want to see a soft landing with a 2 to 3 second hold/stick, good alignment of the knee (over the toes) and an upright trunk position. Below is a video of one of my soccer athletes performing this test in his pre-season this year:
As you can see in the Single Leg Hop and Land for Distance video, the athlete displays a stiff landing, knee collapses inwards, and the trunk bends to the side – all signs indicating an increased risk of non-contact knee injury due to undesirable kinematics.
Test 2: Drop Vertical Jump Test
To perform this test, set up and stand on a 30cm tall object. You can use a box, steps + risers or weight plates, depending on what you have in your current facility. Drop off this height with a jump, hit the ground and straight away jump as high as you can and then land on two legs. For the single leg variant of this, the procedure is exactly the same however on one leg.
Test 3: Crossover Hop and Land Test
This test assesses the cutting/sidestepping movement capability of the individual. To perform the crossover hop test stand on one side of a 15cm wide line on one leg and find your balance. Once ready, perform 3 consecutive hops as far as you can while crossing the line between each hop. Repeat 3 times each side and take the best of the 3 measures for each side. “The distance from the start line to the toe of the test leg following the third hop was measured” (Hopper et al., 2002). Again, this will give you some objective data for when you reassess. As mentioned in the Single Leg Hop and Land for Distance Test, the purpose of these tests are to look at movement quality of the landings. Below is a schematic diagram of how this test would be performed and a video of how you do this in practice:
Figure 7: Crossover Hop Test (Hopper et al., 2002)
There are many other screening tests that you should use with soccer players. I have only focussed on the 3 that best replicate the injury mechanisms that I've discussed in part 1. Other testing should involve range of motion, strength and endurance of the lower limbs.
This wraps up part 2 of this series. Part 3 will take you some of the best exercises used to prevent knee injuries in soccer.
Part 1/3: Attention Soccer Players, Coaches, And Trainers!! Are you or your athletes at risk of an ACL injury?
By David Maiolo
In this 3 part series, I will discuss the Anterior Cruciate Ligament (ACL) and it’s relation to soccer performance. The ACL is one of the most common yet highly PREVENTABLE knee ligament injuries that occurs in soccer. I will cover the following topics and hope you can take away some practical relevance to your own sporting or coaching endeavours
- ACL background information and injury statistics in soccer (Part 1)
- Common ACL injury mechanism in soccer (Part 1)
- Specific athletic screening / testing protocol for the ACL you can and SHOULD use in soccer (Part 2)
- ACL injury prevention exercises to add into your gym routine and soccer training sessions (Part 3)
Background and Statistics
The knee joint requires an enormous amount of stability from passive structures such as ligaments but also requires incredible amounts of dynamic stability from surrounding musculature (e.g. the quadriceps). In soccer, the knee is subject to rotational and pivoting movements and as such is placed under a lot of stress. One of the passive structures that is vital for knee stability is the ACL. In short, its primary role is to prevent excessive forward translation and rotation of the tibia (on the leg bones) relative to the femur (thigh bone). The ACL is essential for control of the tibial translation and rotation during pivoting, jumping, or quick change of direction or deceleration movements (Brukner and Khan, 2006).
The annual incidence of ACL injuries in professional soccer is reported to range between 0.15-3.7% per person per year and between in 0.03-1.7% per person per year in amateur soccer (Moses et al., 2012). Unfortunately for females the incidence is a lot higher compared to men, with research reporting that female soccer players are 2 to 3 times more likely to suffer ACL injuries (Walden et al., 2010). Crucially, most ACL injuries are NON-CONTACT in soccer.
Common ACL injury mechanism in soccer
Soccer is a multidirectional and fast-paced sport involving numerous jumping, twisting, cutting and deceleration movements. A study by Walden et al., 2015 analysed videos of 39 fully torn ACL injuries in professional male soccer players. From this video analysis they found that 64% (25) of these ACL injuries were the result of 3 separate NON-CONTACT mechanisms. These mechanisms are summarised below:
1. PRESSING / SIDESTEPPING / CUTTING
In every case this involved a defending player running at a high speed who would make a cutting / sidestep movement in an attempt to get the ball / tackle the other player. This requires a fast deceleration (slowing down) combined with a change of direction placing the position of the hip, knee and ankle in a vulnerable position. Look at the right leg of the blue player in this photo where you can see that the entire weight of his body is on his right leg in outstretched position.
Figure 2: Walden et al., 201
2. RE-GAINING BALANCE AFTER KICKING
This mostly occurred when a player was clearing a ball. During this action the player was moving forward at a fast speed while being off balance. Again, look at the position of the right leg of the yellow player in this photo: the right leg and outstretched with minimal knee bend and the ankle and rotating outwards (eversion).
Figure 3: Walden et al., 2015
3. LANDING AFTER HEADING
During this situation, the individual jumps and competes with the opponent for the ball. Both players make contact in the air. Focus on the red and blue player in this instance. As he comes back to the ground he is out of balance (both backwards and sideways) and lands on an outstretched leg at a fast speed with minimal knee bend. This shifts the entire load of the body onto this leg forcing the knee to give way.
Figure 4: Walden et al., 2015
In all situations, the injured leg was always in a vulnerable position (e.g. outstretched leg, hip externally rotated – turned outwards – and the ankle in either a rolled in / out position). All of these situations shift the entire load of the body onto one leg in the described positions and consequently result in a full ACL tear.
Zlatan Ibrahimovic and Kurt Zouma (both professional footballers) both tore their ACLs landing after heading the ball. What you will notice is how unnatural the position of their legs are.
Check back for Part 2 where we will show you some athletic tests you can use to see whether you or your players are at risk of an ACL injury.
By Sarah Antico
The Commonwealth Games, like most sporting competitions, is a public forum for athletes to compete for their dreams. It an event where it doesn’t matter how you got there or who you are outside of your chosen sport, but rather what you do on that track/pool/field/pitch/court that counts.
At MTP Health, we often hear stories about how athletes must overcome personal atrocities and adversity such as injury or illness in order to compete for their country. However, something that has surfaced in the media around this year’s games is the number of new mums bouncing back from giving birth 9-12months prior to competition and managing to stage a comeback at the highest level.
Australian netballer Laura Geitz
Australian hockey player Jodie Kenny
Kiwi shot putter Dame Valerie Adams
Vanuatu’s beach volleyball duo Miller Patu and Linline Matauatu
These are just a handful of mums who made the return to their respective sports after recently giving birth. The thing that strikes me most about these women is that their sports are both high intensity and high impact, elements that commonly deter women in the post-natal period.
For the 3 in 4 Australian mums who experience urinary incontinence or leakage at some point in their lives, the thought of repetitive running and jumping can be terrifying! To be able to overcome the physical and emotional toll of childbirth and then condition their bodies back to an elite competitive level is nothing short of extraordinary.
Not every new mum has the desire to return to the world of elite sport but there are a number of messages we can take away from these inspirational athletes:
The post-natal pelvic floor is often the biggest deterrent for women wanting to return to higher intensity exercise. There is so much information in circulation about when/if new mums should be returning to their pre-baby exercise regime and what exercises should be avoided (usually, heavy lifting and jumping). This information will apply to women who have experienced a pelvic organ prolapse or are at high risk of experiencing one, but they are by no means absolutes for everyone indefinitely.
There is no question about the importance of strengthening the pelvic floor after having a baby and it should be prioritised over other movements. Many physiotherapists and yoga studios offer tailored programs targeting pelvic floor exercise in the immediate 6-8 week postnatal period and these are fantastic kick-starters. However, the key to enabling athlete mums to return to competitive sport is that they learn to coordinate localised pelvic floor strength into globalised functional movements such as squats and deadlifts. This 6-8 week transition period is where women commonly develop problems if they aren’t able to integrate their pelvic floor contraction correctly and this is exactly where MTP Health can help!
We believe in the power of movement and we want to help you achieve the impossible. We have developed a post-natal program to help new mums get back into exercise by incorporating fundamental pelvic floor activation and stability into functional training in order to gain the confidence to transition back into their pre-baby activities. For the not so new mums who might be experiencing leakage or are worried about engaging in the higher impact exercises such as running and jumping, MTP Health can also assist by structuring an individualised program that will target the coordination of pelvic floor contractions during peak movements.
The post-natal period is an amazing time and is a great motivator for you to work towards achieving some fitness goals you never knew you could! If you would like to book in an initial assessment, follow the link below or else give us a call for some more information on 9437 9794.
By Sarah Antico | Exercise Physiologist
With the running season fast approaching, now is the optimal time to consider how best to approach the race of your choice. It is easy to get caught up in the buzz of training, especially if it’s your first big race so here are a few handy tips to help get your feet off the ground.
Tip 1: It’s a marathon, not a sprint!
Beginner running programs vary in length however, 12-14 weeks is the general guide for a novice half marathon. It’s important to start slow and gradually build up the distance you run each week so as not to burn out before the race. Aim to complete 2-3 running sessions per week: 1 x sprint/interval, 1 x short tempo run (working on your ideal ‘race pace’) and 1 x long slow run (where you build up the kilometres in your legs). If the thought of running 10km in the first week for your long run seems a bit daunting, try set time goals instead eg: 30-40mins continuous and build from here each week.
Tip 2: Don’t skip leg day!
Strength training is an important part of any training program, especially for runners and yet it is often forgotten about! 1-2 whole body strength sessions across the week has proven to be extremely beneficial in giving runners an edge come race day. Unilateral lower limb exercises such as split squats, calf raises, glute bridges and hip thrusts are more sport specific than their bilateral counterparts and require full body stabilisation in order to complete effectively. Maintaining good posture is another key component for long distance running. Incorporating some postural exercises such as band pull aparts and single arm rows into your strength sessions can help alleviate fatigue in the shoulders and upper back area, allowing for more ease of movement during your running arm motion.
Tip 3: When in doubt, stretch it out!
Perhaps the most neglected component in any training regime and yet it is arguably the most important. An increased training load on your body, often results in muscle stiffness and soreness especially in the first few weeks. Hip flexors, calves and hamstrings tend to be troublesome areas for runners so regular foam rolling and stretching of these areas can help alleviate stiffness. Tightness and pain at the bottom of the foot is also a common problem in runners. Regular release of the plantar fascia using a tennis ball, lacrosse ball or frozen water bottle can help alleviate this tightness. This can be achieved by finding a tight spot under the bottom of your foot and pressing down with your body weight. Hold this for 30secs-1min and then slowly work your way around the sole of your foot.
If you need some further advice on how to optimise your running performance, book in with one of our Exercise Physiologists at MTP Health. Train hard, run fast and have fun!!
One of the most common injuries suffered by athletes and gym-goers is tendinopathy, more commonly known as tendinitis, however this term is technically incorrect as 'itis' means inflammation and this is not thought to play a big role in most tendon issues.
Tendinopathy is an overuse injury of the tendon that results in degeneration of the tendon's collagen (main structural component of the tendon). It is believed to occur due to too much stress being placed on the tendon with inadequate time for it to recover/adapt positively to this stress. Often the pain from tendinopathy is worse in the hours after exercise or the next day rather than during exercise, where they tend to 'warm up'/become less painful as exercise continues.
Common areas for tendinopathy include the patellar tendon (knee), Achilles tendon, hamstrings, biceps, wrist flexors/extensors (which attach proximally on the inside and outside of the elbow, respectively), and rotator cuff. In this article we will focus on patellar tendinopathy.
Patellar tendon runs from the bottom of the knee cap onto the top of the tibia (shin bone)
***Probably the most important thing to understand about these injuries is that COMPLETE REST DOES NOT HELP, AND NEITHER DOES JUST PUSHING THROUGH THE PAIN***
This is very different to most other injuries which tend to improve over time with rest. Tendons on the other hand MUST BE LOADED TO IMPROVE. The tricky part is getting the amount of loading right! Too much load and they often flare up and pain increases. Too little load and they don't get better.
So in this blog I want to outline a guide to tendon loading that is both based off the research and one that I've found works well in my clinical experience.
*Note - this does NOT have to be followed like a bible; there are many different ways to load tendons, and some people will respond better to certain methods than others, and quicker/slower than others too - every person/case is different! This is just one protocol that I've found has worked well for myself and my patients.
It can be applied to tendinopathy in any area of the body. You just need to pick an exercise where the muscle/tendon in question is the main one being worked. In terms of the patellar tendon, the squat is a good example of a movement that stresses it well.
Here is the loading guide:
1. Start with isometric holds in the mid range position for whatever muscle/tendon is the issue (e.g. wall squat hold quarter to half way down for the patellar tendon). Hold for 30-45 seconds. Do 2 sets, twice a day (e.g. 2 in the morning and 2 in the evening). Use a level of resistance which allows you to do the hold with pain less than a 3/10.
Don't push through the pain any more than that. This might mean doing the wall squat on two legs or one leg depending on how much load you can tolerate. Do this for a week and increase the resistance as able within those pain limits. Isometrics are great early on in tendon rehab as they have been shown to be very useful for pain relief (1).
2. Progress to eccentric contractions (lowering phase of any movement). Start at the top of the movement and lower over 5-6 seconds then help up/do the concentric (lifting phase) with the other arm/leg or on two legs. For the patellar tendon this would involve doing the lowering phase of a squat on one leg onto a bench, then standing back up with 2 legs.
Do this for 1-2 weeks and progress weight as able within the same pain limits (3/10). Eccentric rehab protocols have been shown to be very effective for rehabilitation of patellar tendinopathy (2).
Lower over 5-6 seconds, then stand back up with both legs
3. Progress back to normal isotonic squats on two legs (isotonic = lowering and lifting phases together) but using higher rep ranges (>15 reps). Slowly increase the weight/lower the reps over time as symptoms allow, keeping in mind to monitor how you pull up the day after making adjustments to the loads used.
Pull up really sore in the tendon? Probably best to regress a bit and build back up.
-Pull up with a bit of awareness/minimal pain? Try the same loading again and see if it feels better the next time.
-Pull up absolutely fine? Green light to progress!
In terms of evidence behind this type of approach, a recent study showed that isotonics are beneficial for patellar tendon rehab (3).
4. The final stage of tendon rehab is returning to plyometrics, if this is a part of your regular training or is needed for your sport (which is the case for most field sports). By no means do you NEED to do this type of training for tendon healing if it's not.
Before starting plyometrics it's a smart idea to reach pain-free strength levels within 10% of what they were pre-injury, so that the tendon has re-established good load tolerance.
This is important as plyometrics are the most stressful type of activity for the tendon. It is important to gradually increase the volume of plyometric activities, and not jump straight back into a full plyometric program (4).
A good idea would be to start with double leg jumps and progress to single leg hops which will be more stressful on the tendon.
Single leg bounds – a type of plyometric exercise
5. For team/field sport athletes – once you can perform full plyometric training pain-free, a gradual return to full training should begin where the athlete progressively returns to usual volumes of running (both total distances and high speed distances), and eventually, a return to competition!
Throughout this rehab process, avoid or modify your gym exercises that cause more than a 3/10 pain. For example, for patellar tendinopathy try switching from normal back/front squats to box squats or low bar back squats, or from walking lunges/split squats to reverse lunges.
Following this process should help clear up most tendon issues. Tendons are often annoyingly slow to work with but normally respond well to sensible load progressions.
Finally, I would also recommend thinking about what may have contributed to the injury in the first place so that it's less likely to come back (which unfortunately happens all too often with tendinopathys).
Most of the time it's a tendon load management issue caused by either:
- too rapid a build-up in training volumes
- poor technique that places abnormally large stress on the tendon in question, e.g. squatting with excessive forward knee travel well past (>10-15cm) your toes for patellar tendinopathys; or jerky/bouncy movements at the bottom of the exercise when the tendon is being compressed
- not having enough variety in your training program (e.g. If you've high bar back squatted heavy for months on end maybe it's time to change up the exercise or rep range)
Here is a nice summary of what we have spoken about, in infographic form! Picture credit to the running physio.
Patellofemoral pain (PFP) has a high prevalence in general practice, orthopaedic, and sports settings. Pain is exacerbated by tasks which increase patellofemoral joint (PFJ) loading including running, squatting and stair negotiation, with occupational and physical capacity often reduced. The condition affects a wide range of ages, often beginning in early adolescence. Between 71 and 91% of individuals report chronic ongoing pain up to 20 years following initial diagnosis. PFP may also increase the risk of developing patellofemoral osteoarthritis.
Numerous biomechanical factors have been linked to PFP and these are discussed in more detail later in this article. As a result, various conservative interventions have been proposed and evaluated, including education, exercise, taping, braces, foot orthoses, soft tissue manipulation and acupuncture.
PFP is typically characterized by a dull, achy pain around or behind the kneecap that begins without a known incident, and is aggravated by anything that loads the knee while it is flexed – squatting, step up/stairs, running, jumping and even prolonged sitting. Among runners, it is the most common overuse injury, and unfortunately, becomes a chronic issue for many that experience it, regardless of the preferred activity. Needless to say, this can have a huge impact on training.
There are numerous research studies attempting to explain the causes and most effective treatments for this mysterious, but all too common ailment, including the most recent consensus statement from the British Journal of Sports Medicine.
Like many research topics, the information available on PFP seems to be, at times, contradictory and unclear. The purpose of the article is to translate what seems like a jumbled mess of research into something reasonably digestible and applicable, regarding the causes and possible treatment of PFP.
Causes (Or Effects) of Patellofemoral Pain
Excessive loading or varied and rapid increases to physical activity which your knee cannot cope with are thought to contribute to pain development. Poor biomechanics (movement) can also contribute, with the knee cap thought to move toward the outside of the knee, stopping it from tracking normally in its groove. A number of factors can lead to this poor tracking. There are numerous other contributing factors to patellofemoral pain including the structure of your knee, trauma, surgery and systemic disease, which you may wish to speak to your therapist about.
What exercise principles are important?
What exercises should I be completing?
How else can my therapist help?
Q: What is the most important movement in CrossFit/Weightlifting/Sports/Life.....?
Not the squat.
Not the deadlift.
Not the clean.
Not the snatch.
Not the swing.
Not a box jump.
None of these are the most important movement in CrossFit or in any form of fitness for that matter. However, they do all contain THE most important movement as part of their execution.
When a person is missing the capacity to effectively complete this movement their risk of back injury increases, their efficiency of force production decreases, their postural endurance decreases, their technique progression is limited, their chance of knee pain and hip impingement increases. So what is this crazy risk factor and performance limiting movement?
A: The Hip Hinge.
The ability to stabilise your spine, flex and extend [close and open] the hip at great speed and under no load or large load is the most fundamental performance indicator of an athlete’s potential. It can be applied to just about any lower body dominant movement and a great deal of upper body movements
Without an effective hinge movement at the hip, a couple of things occur:
1. Force production is usually created by driving through a quad dominant extension pattern.
The repeated shearing stress that is transferred through the patella tendon as a result of the knees translating straight out over the toes commonly leads to anterior knee pain and issues such as; patella femoral pain syndrome (irritation of the surfaces of the knee cap and femur) and patella, and quadriceps tendon aggravation/inflammation/ tears. Furthermore, the extra stress that is taken by the quadriceps when you dip straight into the knees, makes it very difficult to maintain or improve your range of motion through the front of the thigh and hip.
2. Full extension is achieved by compromising the lumbar spine control and over extending.
If this occurs, your lower back will start to hurt after training or worse still, you will sustain an actual injury. This occurs because the back is so damn helpful. It just starts doing extra work to make up for the poor loading mechanics at the hip. The high repetition of bending and extending that needs to happen at the lower back to make up for a sub-standard hip hinge, commonly results in injuries such as facet joint aggravations, disc aggravations/ bulges/tears, ligament sprains, SIJ aggravation or just excessive muscle soreness and spasm, particularly around the top of the glutes and quadratus lumborum (QL).
3. Finally, your performance suffers!
You just can’t produce as much power. Also the efficiency of the movement is impacted which leads to performance blocks and plateaus... Which nobody wants.
So what to do about this?
Ideally the hip hinge should be viewed by the fitness/strength/CrossFit/athletic coaching community as a foundation movement. If the athlete can master control of this movement, all subsequent movements taught to the athlete or built on top of this will be more stable, more efficient and safer in the long run. Unfortunately, I rarely see this. In the rush to get people into high intensity exercise and make them feel like they have worked hard, it either gets brushed over or not addressed at all.
To help you get started with identifying where you or your client are in terms of their hinge control, I have put together a progression framework that is very simple but allows you to identify at what level you need to spend the time working on the hinge. For instance, if you can't do it lying down, then there is no point doing it standing, because you will just be compensating your way through. Likewise, if you can do it in standing with two feet on the floor you are not going to do it properly in single leg stance or with weight.
So have a look through the progressions, try them and be honest with yourself. Identify where your postural control or stability starts to break down. And spend some time working on THAT position. Once you have established your level of control then you can work in that position ensuring your corrective exercise or movement education training is challenging enough to stimulate a response that will carry over to your high intensity training.
Disclaimer: There are hundreds of exercises and progressions out there for hip hinging, so listing them all would not be feasible. This is not meant to be an exhaustive list, it is just a recommendation for a broad starting point to identify at what level of stability, support, stance you can safely move through a hinge.
Note: A band can be added to this movement to add some hip drive feedback with lighter weight.
By Nick Burrows, MTP Exercise Physiologist
Pain is a long studied and misunderstood concept, however recent insights have led to greater understanding of what pain is and how it comes about. The first thing we need to realise is that pain is an output of the brain, not an input from the tissues of the body. What the tissues do is send a danger signal to the brain which it then decides what to do with. This is a difficult concept for some people to comprehend so it is best explained through the use of a few examples.
Person A is perfectly healthy with no existing issues or injuries. They inadvertently put their hand on a hot saucepan. The cells in the hand send a danger signal to the brain which then assesses the situation. The brain gets information from the eyes, seeing a saucepan over a flame, thinks back to the recent memory of you turning on the stove and thinks further back to previous experiences. It knows that fire is hot, heat can damage the skin and cause injury so it sends out a pain signal they move their hand away from the saucepan. In this scenario, pain has served its purpose as a protective mechanism.
The brain does not always follow this process. For example, Person B is an elite athlete playing in an important game. They suffer a traumatic injury, one that would normally leave them lying on the ground in agony. Despite this, they shake it off and continue playing, and it’s not until after the game that it begins to hurt and they realise they’ve injured themselves. What’s happened here is that in the state of excitement about the game, the brain has received the danger signal but processed everything else that is going on and decided that the injury is not a priority (and the same is true of soldiers in battle, or other people in life threatening circumstances). The priority is to finish the game (or get out of the battle) and once that is done, then the brain will send out pain signals for Person B to deal with the injury.
Our final example is the other of the spectrum. Person C has a bad back. They injured it 15 years ago and have had intermittent flare ups ever since. Every time it does flare up, they are in pain for a while, sometimes missing out on work and are unable to play their favourite sports. Due to this constant reinforcement, anytime a danger signal comes from their lower back, their brain is so wound up about the prospect of another flare up that it sends excessive amounts of pain out to stop them moving their back. However, this becomes counter-productive because not moving their back means it gets tight and weak and when they do need to use it they are at increased risk of re-injury. Further the brain’s pain signals are not helping so the brain increases its output of pain, to the point where any signal from the back is interpreted as dangerous and elicits a pain response. This wind-up in the pain process is known as chronic pain and can be extremely debilitating.
So what can we do about it?
What is required is actually the opposite of what the brain wants. Person C needs to move their back, get it stronger and retrain the brain that any movement of the back does not equal danger. However, we do need to be aware of the pain process and more importantly realise what is appropriate and inappropriate pain. This is explained in the graph below. The vertical axis represents pain, whilst the horizontal axis represents time as we exercise. The green line represents appropriate or good pain.
As we start exercise the pain will increase. This is normal even for someone who is uninjured. However, the pain should plateau at a manageable level and once we finish exercising the pain should decrease. Maybe not to baseline but it should go down. The red line is inappropriate or bad pain. This is where the pain continues to worsen and becomes unmanageable. If this is the case then we need to stop what we’re doing and either take a break or change exercise. Recognising the difference between appropriate and inappropriate pain is crucial to retraining the pain pathway and recovering from chronic pain issues.
Image 1: http://www.theneuroethicsblog.com/2013_04_01_archive.html
Image 2: http://www.dailymail.co.uk/news/article-3114252/Female-rugby-player-gets-nose-broken-makes-crushing-tackles.html
Image 3: http://www.orangecountyneckandbackpainrelief.com/no-spine-surgery-blog/
Does your lower back stiffen up as soon as you see deadlifts in your WOD? Do you pull up stiff and sore after a deadlift workout, and struggle to get out of bed the next day? Maybe deadlifts don't scare you that much, but they do receive a bad rep in the gym and amongst health care professionals. That’s why it is always important to find the right therapist for you who understands the specific demands of the sport/exercise.
The deadlift is the epitome of strength, it is a reasonably simple looking lift, where a weight is lifted from the ground, but can be difficult to get right and is regarded as one of the greatest test of brute strength exercises along with the bench press.
The humble deadlift is so much more than just a show of strength, it is a movement pattern we use a hundred times a day and a thousand times in a lifetime. Everytime you are picking the bub up off of the floor, taking the dishes out of the dishwasher or picking up a ball to play fetch with the dog, you are essentially doing a deadlift in one way or another.
It targets the entire posterior chain from the glutes, hamstrings and lower back, to the abs, quads, upper back, shoulders and forearms. This is why it is such a powerful exercise, not only does it target all the major muscle group, but it is the original function movement exercise as it teaches us good biomechanics to carry through into our everyday life.
The most common movement impairment for lower back patients seen in clinic, is the inability for people to "hip Hinge" properly. We end up breaking at the lower back, excessively flexing (bending forward) and Extending (bending backwards) our backs whilst under load. It has been well researched that placing high compressive and shear forces through the lower back leads to early degeneration of the spine. When the Deadlift is muscled up with movement coming through the lumbar spine instead of the hips it places both shear and compressive forces on the lower back (this is bad). It places increased loads through the smaller muscles in our back usually responsible for stabilization (the multifidi, the rotatores and the iliocostalis, or erector spinae group) along with our ligaments.
If we hip hinge and ensure the motion of lifting the weight from the floor comes from the hips then the compressive and shear loads are dispersed into a joint which is built to handle them. When the back rounds during a deadlift, we are putting all that force of lifting something heavy off the ground into the muscles and ligaments of the lower back. Although the lower back is designed to be able to carry us around all day and can handle compressive loads, it does not handle the shear loads so well.
When higher loads go through these muscles, joints and ligaments, injuries and pain are sure to follow.
If you experience: