NATA D10: The Time Constrained Athelete

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NATA D10: The Time Constrained Athelete

  1. 1. The Time Constrained Athlete:<br />Developing a 15 Minute Rehabilitation Program<br />National Academy of Sports Medicine © 2011<br />Joshua Stone, MA, ATC, NASM-CPT, CES, PES<br />Sports Medicine Program Manager<br />National Academy of Sports Medicine<br />
  2. 2. Agenda<br />Time constrained athlete<br />Introduction to the human movement system<br />Human movement dysfunction<br />Corrective Exercise Continuum<br />Case Studies - 15 minute rehabilitation programs x 2<br />Open discussion <br />National Academy of Sports Medicine © 2011<br />
  3. 3. The Problem<br />National Academy of Sports Medicine © 2011<br />Time Crunch<br />Suboptimal care <br />
  4. 4. Best Utilization of Time? <br />Prioritization<br />What is the single best tool for the injury<br />Modalities<br />Manual Therapy<br />Prophylaxis <br />Rehabilitation<br />Injury dependent<br />National Academy of Sports Medicine © 2011<br />
  5. 5. The Keys to Optimal Care<br />Understanding Athletes’ needs<br />Treatment or rehabilitation<br />Knowledge pertaining to human movement system<br />Flexibility in program design<br />Willing to change mind-set<br />Creativity in modality use<br />National Academy of Sports Medicine © 2011<br />
  6. 6. Human Movement System<br />Muscular System<br />SkeletalSystem<br />NervousSystem<br />Sensorimotor<br />Integration<br />Neuromuscular<br />Control<br />The Human Movement System<br />Human Movement System<br />Human Movement System is a very complex, well-orchestrated system of interrelated and interdependent myofascial, neuromuscular, and articular components<br />National Academy of Sports Medicine © 2011<br />
  7. 7. Human Movement Impairments<br />Human Movement Impairments<br />Static malalignments <br />Dynamic malalignments <br />Foot/Ankle<br />Knee<br />Hip/Low Back<br />Shoulder<br />Altered muscle activation patterns<br />Synergistic dominance<br />Altered Reciprocal inhibition<br />Relative strength and relative flexibility<br />National Academy of Sports Medicine © 2011<br />
  8. 8. Static Malalignments<br />Static malalignments may alter normal length-tension relationships.<br />Common static malalignments include <br />joint hypomobility (decreased range of motion)<br />myofascial adhesions<br />Poor static posture<br /> • National Academy of Sports Medicine © 2008<br />Joint hypomobility is one of the most common causes of pain <br />Certain muscles become tight or hypertonic (tense) to prevent movement and prevent further injury. <br />
  9. 9. Dynamic Malalignments<br />Dynamic malalignment (movement impairment syndromes)<br />altered muscle recruitment patterns<br />multi-segmental human movement system impairment<br />National Academy of Sports Medicine © 2011<br />
  10. 10. Altered Muscle Activation Patterns<br />Altered Reciprocal Inhibition<br />muscle inhibition caused by a tight /overactive muscle decreasing neural drive of its functional antagonist<br />Synergistic Dominance<br />Occurs when synergists take over function for a weak or inhibited prime mover <br />Psoas<br />Gluteus Maximus<br />Hamstrings<br />This altered muscle recruitment pattern further alters alignment and leads to injury<br />National Academy of Sports Medicine © 2011<br />
  11. 11. National Academy of Sports Medicine © 2011<br />Dysfunction<br />Altered Length-Tension Relationships <br />(muscle tightness)<br />Altered <br />Arthrokinematics<br />Altered Force-CoupleRelationships <br />(muscle weakness)<br />Altered Sensorimotor<br />Integration<br />Altered Neuromuscular <br />Efficiency<br />Tissue Fatigue <br />Tissue Breakdown<br />Human Movement Dysfunction<br />
  12. 12. Common Injuries<br />Foot/Ankle<br />Plantar fascia<br />Ankle sprains<br />Sesamoiditis <br />Achilles tendonitis<br />Lower leg<br />MTSS<br />Post tib. Tendonitis<br />Stress Fx<br />Knee<br />PFPS<br />ACL<br />OCD<br />Patella tendonitis<br />Osgood-Schlatter / Larsen-Johansson<br />IT Band<br />Bursitis<br />Low Back<br />Snapping hip<br />Chronic strains<br />SI joint pain<br />Osteitis Pubis<br />Facet syndrome<br />Shoulder<br />Impingement syndrome<br />Biceps tendonitis<br />Rotator cuff tendonitis<br />Strain<br />Subluxation / dislocation<br />Elbow<br />Epicondylitis / tendonitis<br />UCL<br />Pronator syndrome<br />National Academy of Sports Medicine © 2011<br />
  13. 13. What is Poor Movement?<br />National Academy of Sports Medicine © 2011<br />arching the low back<br />elevating the shoulders<br />knee valgus<br />
  14. 14. Why Do We See Imbalances?<br />Stability<br />Mobility<br />National Academy of Sports Medicine © 2011<br />
  15. 15. Movement Assessments<br /> • National Academy of Sports Medicine © 2011<br />A movement assessment allows a Health and Fitness Professional to observe Human Movement System impairments. <br />Determines what muscles are underactive and overactive and how that impacts a client’s ability to move properly<br />This information can then be correlated to subjective assessment findings, for a comprehensive representation of the client’s functional status.<br />
  16. 16. Kinetic Chain Checkpoints<br /> • National Academy of Sports Medicine © 2011<br /><ul><li>When joint motion deviates from its normal or ideal path, it is considered a compensation
  17. 17. Presumes possible human movement system impairments or muscle imbalances.</li></li></ul><li>The Overhead Squat Assessment<br /> • National Academy of Sports Medicine © 2011<br /><ul><li>Assesses the following:
  18. 18. Structural alignment
  19. 19. Dynamic flexibility
  20. 20. Neuromuscular control
  21. 21. Position:
  22. 22. Feet shoulder width apart
  23. 23. Arms overhead</li></ul>ANTERIOR<br />LATERAL<br />POSTERIOR<br />
  24. 24. Movement Compensations<br />
  25. 25. Lower Extremity Movement Impairment Syndrome <br />National Academy of Sports Medicine © 2011<br />Lower Extremity Movement Impairment Syndrome <br /><ul><li>Foot pronation (flat feet)
  26. 26. Knee valgus (Knock Kneed)
  27. 27. Increased movement at the LPHC (extension and/or flexion) </li></ul>Typical Injury <br /><ul><li>plantar fasciitis
  28. 28. posterior tibialis tendinitis (shin splints)
  29. 29. anterior knee pain
  30. 30. low back pain</li></li></ul><li>Upper Extremity Movement Impairment Syndrome<br />National Academy of Sports Medicine © 2011<br />Upper extremity movement impairment syndrome<br /><ul><li>rounded shoulders
  31. 31. forward head posture
  32. 32. improper scapulothoracic and/or glenohumeral kinematics</li></ul>Common in individuals who:<br /><ul><li>sit for extended periods of time
  33. 33. develop pattern overload by performing repetitive motions</li></ul>Typical injury<br /><ul><li>rotator cuff impingement
  34. 34. shoulder instability
  35. 35. biceps tendinitis
  36. 36. thoracic outlet syndrome
  37. 37. headaches </li></li></ul><li>A Few Common Compensations Seen<br />Overhead Squat Assessment<br />Feet<br />Flatten<br />Knees<br />Move Inward<br />Back<br />Excessive forward lean<br />Feet Flatten <br />Knees move inward<br />Excessive Forward Lean<br />National Academy of Sports Medicine © 2011<br />
  38. 38. The Single-leg Squat Assessment<br />Single-leg Squat Assessment <br />Designed to assess dynamic flexibility, core strength, balance and neuromuscular control.<br />Position<br />Place hands on the waist<br />The feet should be pointing straight ahead<br />The ankle, knee and the lumbo-pelvic-hip complex should be in a neutral position.<br />National Academy of Sports Medicine © 2011<br />
  39. 39. A Few Common Compensations Seen<br />Single Leg Squat Assessment<br />Knees<br />Inward movement<br />Hips<br />Inward/Outward Trunk Rotation<br />Inward Trunk Rotation<br />Knee moves inward<br />Outward Trunk Rotation<br />National Academy of Sports Medicine © 2011<br />
  40. 40. Double-leg Squat & Single-leg Squat<br />National Academy of Sports Medicine © 2011<br />
  41. 41. National Academy of Sports Medicine • Movement Assessments<br />Assessment Modification<br />Modifications to Overhead Squat:<br />Elevating the heels<br />Hands on the hips <br />
  42. 42. Pushing and Pulling Assessments<br />Push-ups Assessment<br />Standing Row Assessment<br />National Academy of Sports Medicine © 2011<br />
  43. 43. Inhibit<br />Activate<br />Integrate<br />Lengthen<br />Inhibitory Techniques<br />Self-Myofascial Release<br />Manual Therapy<br />Activation Techniques<br />Isolated Strengthening<br />Positional Isometrics<br />Integration Techniques<br />Integrated Dynamic Movement<br />Lengthening Techniques<br />Static Stretching<br />Neuromuscular Stretching<br />Manual Therapy<br />The Corrective Exercise Continuum<br />National Academy of Sports Medicine © 2011<br />
  44. 44. Case Studies<br />Two Case Studies<br />Background Information<br />Goals<br />Lifestyle<br />Medical history<br />Video footage<br />Movement Assessments<br />Identify Movement compensation<br />Design a CEx program<br />National Academy of Sports Medicine © 2011<br />
  45. 45. Case Study 1: Rachel’s Bio<br />Bio: Rachel<br />Age: Sophomore<br />Sport: Cross Country<br />Recreation/Hobbies: Running, dancing, movies<br />Problem: MTSS<br />Occupation: Student Athlete<br />Medical History: Goodhealth, no previous surgeries or medication <br />National Academy of Sports Medicine © 2011<br />
  46. 46. Case Study 1: Rachel’s Overhead Squat Assessment<br />National Academy of Sports Medicine © 2011<br />
  47. 47. Rachel’s Overhead Squat<br />National Academy of Sports Medicine © 2011<br />
  48. 48. Rachel’s Modified Overhead Squat Assessment<br />National Academy of Sports Medicine © 2011<br />
  49. 49. Case Study 1: Rachel’s Single-leg Squat Assessment<br />National Academy of Sports Medicine © 2011<br />
  50. 50. Rachel’s Single Leg Squat<br />National Academy of Sports Medicine © 2011<br />
  51. 51. Rachel’s Movement Analysis<br />National Academy of Sports Medicine © 2011<br />
  52. 52. Analysis of Rachel: Program Design<br />Overactive/Tight<br />Lateral Gastrocnemius / Soleus<br />Biceps femoris (short head)<br />TFL<br />Hip flexors (rectus femoris, psoas)<br />Adductor complex <br />Peroneals<br />Vastus Lateralis<br />Underactive/Weak<br />Medial Gastrocnemius<br />Anterior & posterior tibialis<br />Medial hamstrings<br />Vastus Medialis oblique<br />Gluteus Medius / Maximus<br />CEx Goal:<br />Prioritize issues<br />Regain LE muscle balance<br />Relieve lower extremity pain<br />National Academy of Sports Medicine © 2011<br />
  53. 53. 15 Minute Corrective Exercise Program<br />National Academy of Sports Medicine © 2011<br />
  54. 54. 15 Minute Corrective Exercise Program<br />National Academy of Sports Medicine © 2011<br />
  55. 55. 15 Minute Corrective Exercise Program<br />National Academy of Sports Medicine © 2011<br />
  56. 56. 15 Minute Corrective Exercise Program<br />National Academy of Sports Medicine © 2011<br />
  57. 57. Case Study 2: Jeff’s Bio<br />Bio:<br />Age: Senior<br />Sport: Baseball<br />Recreation/Hobbies: Hiking, working out, fishing<br />Goal: Biceps tendinitis, impingement syndrome<br />Occupation: Student Athlete<br />Medical History: Goodhealth, previous rotator cuff repair <br />National Academy of Sports Medicine © 2011<br />
  58. 58. Case Study 2: Jeff’s Overhead Squat Assessment<br />National Academy of Sports Medicine © 2011<br />
  59. 59. Jeff’s Overhead Squat<br />National Academy of Sports Medicine © 2011<br />
  60. 60. Analysis of Jeff’s Movement<br />National Academy of Sports Medicine © 2011<br />
  61. 61. Analysis of Jeff: Program Design<br /><ul><li>Overactive/Tight
  62. 62. Latissimus Dorsi
  63. 63. Pectoralis Major
  64. 64. Pectoralis Minor
  65. 65. Subscapularis
  66. 66. Lateral gastrocnemius / soleus
  67. 67. Hip flexors
  68. 68. (TFL, rectus femoris, psoas)
  69. 69. Underactive/Weak
  70. 70. Middle/Lower Trapezius
  71. 71. Serratus Anterior
  72. 72. Rhomboids
  73. 73. Posterior Rotator Cuff
  74. 74. Gluteus medius/maximus
  75. 75. Intrinsic core stabilizers</li></ul>CEx Goal:<br />Prioritize issues<br />Regain muscle balance in the upper<br />Alleviate shoulder pain<br />National Academy of Sports Medicine © 2011<br />
  76. 76. 15 minute Corrective Exercise Program<br />National Academy of Sports Medicine © 2011<br />
  77. 77. 15 minute Corrective Exercise Program<br />National Academy of Sports Medicine © 2011<br />
  78. 78. 15 minute Corrective Exercise Program<br />National Academy of Sports Medicine © 2011<br />
  79. 79. 15 minute Corrective Exercise Program<br />National Academy of Sports Medicine © 2011<br />
  80. 80. 15 minute Corrective Exercise Program<br />National Academy of Sports Medicine © 2011<br />
  81. 81. Summary<br />Inhibit<br />Activate<br />Integrate<br />Lengthen<br />Inhibit:<br />Myofascial Release to Overactive Muscles<br />Activate: Strengthening of Underactive Muscles<br />Integrate: <br />Dynamic /Functional Strengthening Movement<br />Lengthen:<br />Stretching or Manual Therapy to Overactive Muscles<br />Perform an integrated assessment to identify dysfunction<br />Utilize rehab vs. biophysical modalities if possible<br />Develop focused corrective exercise program based on assessment with given time frames<br />National Academy of Sports Medicine © 2011<br />
  82. 82. Thank You!<br />National Academy of Sports Medicine © 2011<br />Questions & Answers<br />BOC Approved for 37 CEUs!! <br />Contact Information<br /><ul><li>joshua.stone@nasm.org
  83. 83. facebook.com/NASMJosh
  84. 84. facebook.com/correctiveexercise</li>

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