As I mentioned in my article here, females are at a significantly higher risk for non-contact ACL injury than males across all age bands. Many of these injuries are preventable and I am hosting a clinic this month to help identify at-risk athletes and help reduce their risk while improving their athletic performance.

During this clinic, we will screen each athlete using clinically recommended tests to determine potential risk and examine athletes’ posture and movement abilities which may contribute to injury risk.

Who: Athletes ages 10-15
When: Saturday March 21st @ 12:00 noon – 1:30
Where: DR Fitness Systems
2428 Palumbo Drive #140
Lexington, KY 40509
Cost: $49 per athlete which includes video analysis, a foam roller, and a resistance band for exercises.

Sign up for the Screening and Clinic here.

Space is limited so sign up today! If you are a coach and would like to have your entire team screened (or would like to set up another time for a team screening) and receive a discounted rate, please contact me at drew@drfitnessystems.com.

**Let me preface this entry by saying that while this is mainly about females and ACL injury risk, I frequently see males demonstrate the same movement patterns that can lead to ACL injury, and males who play multi-directional sports should also be screened for risk factors.**

We got a glimpse of spring earlier this week with temps going above 50 degrees before we got hit with more than a foot of snow at our house last night and this morning. As spring approaches (hopefully soon) millions of kids will be taking to the soccer and lacrosse pitches, tennis courts and softball / baseball fields nationwide. With any sport, there is a risk of injury and this is especially true for female athletes and their risk of “non-contact” ACL injury. In fact, female athletes are at an increased risk of suffering an ACL injury when compared to male athletes in the same sport. Statistics vary depending on the study, but the rates are 2-10 times higher in female athletes!

So why are female athletes more prone to suffering ACL injury?

There are roughly 250,000 ACL tears each year in the United States and women are suffering them much more frequently than men. Part of the reason is that since Title IX was enacted female participation in high school sports has increased 10-fold and collegiate participation 5-fold. With the raw number of female athletes increasing, the number of ACL injuries has increased as well. I’m by no means saying that women should be at home cleaning and learning to cook instead of lacing up their cleats, but women DO need to address some important factors that predispose them to ACL injury.

There are several reasons for this phenomenon and I’ll try to explain them as plainly as possible.

1) Ligament dominance – An imbalance between the neuromuscular and ligament control of dynamic knee stability (relying heavily on the knee ligaments to control stability of the knee) (1)

2) Quad dominance – imbalance between quadriceps strength and hamstring strength, recruitment, and coordination (1)

3) Leg dominance – an imbalance between the two lower extremities in strength, coordination, and control (1)

4) Core dysfunction dominance – an imbalance between the inertial demands of the trunk and core control and coordination to resist it (lack of core control which can affect lower extremity alignment) (2)

5) Posture and alignment – One of the factors I battle on a daily basis at the gym is correcting bad posture. Whether it’s rounded shoulders, forward head posture, extreme lumbar extension, etc., our bones (ligaments) and muscles (tendons) dictate how we move. If there are restrictions in certain areas, the body will compensate with bad movement – which leads to overuse and injury.

As a side note, rapid growth associated with puberty can affect coordination, balance, strength, and neuromuscular control which also come in to play with the above factors. There are some other factors like Q-Angle and ovulation during the menstrual cycle which have shown a relationship to ligament knee injury as well. Many of these factors coexist which further multiplies the risk for injury.

Your daugher may demonstrate this faulty pattern.

Your daugher may demonstrate this faulty pattern.

Collateral damage from ACL Injury

In addition to the injury itself, there are many other things to consider when talking about ACL injuries. First, the average cost of an ACL reconstruction is roughly $25,000; not to mention pre-surgery consultations, rehabilitation and medication. Second are the emotional and physical problems. People who suffer ACL injuries tend to gain weight following the injury due to an abrupt decrease in their physical activity. Occasionally athletes can become depressed because their chance of playing college or professional sports may have been affected, which can negatively impact their academic performance. Additionally, those who suffer an ACL injury are at a 50%-100% higher risk to develop knee osteoarthritis later in life.

So with all the associated problems stemming from an ACL injury one would think that we have this trend under control, but we don’t. In fact it’s getting worse. What is interesting is that the frequency of ACL injury is increasing in 10-12 year olds! Why are girls so young tearing their ACL? Unfortunately, many parents and coaches are contributing unknowingly to this trend by encouraging their kids to specialize in one sport at a very young age in hopes that they’ll receive scholarships or maybe even play professionally. This “early specialization” is associated with increased injury risk, shorter athletic careers, and sport “burn out”. Studies actually show that kids who specialize early on have a decreased chance of playing college or professional athletics. A trend I’m particularly frustrated with is that kids today are less physically prepared for athletics. They might be great at soccer or baseball, but they are lousy athletes. THERE IS A DIFFERENCE. Kids spend too much time sitting at home and at school which has altered them physiologically and they only know how to play one sport which limits their exposure to movements and activities outside their single sport.

Additionally, some coaches or trainers have their athletes perform drills that are too advanced for their developed skill set which results in poor performance and sloppy technique. If they learn it incorrectly at this stage, it’s much more difficult to correct it years later! Females also add a disproportionate amount of muscle mass to body mass throughout puberty further reducing their strength and coordination. Subsequently, these advanced exercises become even more dangerous because they haven’t “grown in to their bodies yet.” Lastly, many coaches choose exercises which are downright dangerous but the parents and kids think they’re doing something good because they’re “sore” or “exhausted” after their workout. SORENESS AND EXHAUSTION DO NOT EQUAL QUALITY and college and professional training programs SHOULD NOT BE APPLIED to kids!

Unfortunately, females have the deck stacked against them in terms of risk for non-contact ACL injuries. However with smart exercise programming, attention to detail, and some effort, these risk factors can be mitigated while improving their overall strenght and athletcism.

How do you know if your daughter is at risk for an ACL injury? How can you help her reduce her risk?

The first thing to do is to have your daughter screened for risk factors. During the screening, we are able to identify possible factors and provide a game plan to reduce the risk. This may mean some basic exercises for pre-game and pre-practice warm-ups or a more advanced and thorough hands-on training program. (We recommend each athlete follow a year-round strength and conditioning program with us so we can work closely with them in order to produce a healthier athlete.) Finally, re-test weeks and months later to determine efficacy. EVERY strength and conditioning program we write is based on keeping (or getting) the athlete healthy while improving their strength, coordination, deceleration, acceleration, agility, (AKA athleticism). Certainly some females are more prone to injury and require an increased focus on correcting their imbalances before advancing, but every program is designed to address these numerous factors.

I am hosting an upcoming seminar for female (and male) athletes that will include:

-ACL Risk Screening
-Education for parents, coaches, and athletes
-Corrective exercises to implement on a daily basis to reduce injury risk

If you are interested in learning more about our sport performance training or would like to get details about the seminar, please email me at drew@drfitnessystems.com.

For details about the clinic click here.
If you would like to sign up for the clinic, click here.
Don’t wait until after an ACL tear to find out about ACL injury prevention!

1.Myer GD, Ford KR, and Hewett TE. Rationale and clinical techniques for anterior cruciate ligament injury prevention among female athletes. J Athletic Train 39: 352-364, 2004

2.Myer GD, Chu DA, Brent JL and Hewett TE. Trunk and hip control neuromuscular training for the prevention of knee joint injury. Clin Sports Med 27: 425-448, ix, 2008

As a side note, rapid growth associated with puberty can affect coordination, balance, strength, and neuromuscular control which also come in to play with the above factors. There are some other factors like Q-Angle and ovulation during the menstrual cycle which have shown a relationship to knee injury as well. Many of these factors coexist which multiplies the risk f, and the risk for injury is multiplied.

America is obsessed with soreness, pain, and exhaustion as it pertains to training. We think that we have to train “all-out” all the time in order to make progress. However the human body doesn’t perform this way and attempting to push harder for extended periods of time can result in pain, injury, sickness or even death (okay maybe I exaggerated a little).
In fact, we need to look at our training in the context of our whole lives. As an example, I have two clients training for two separate marathons – one an elite professional runner, the other a recreational runner. As their running volume increases, our training volume has to be reduced / altered in order not to totally exhaust them. EVERY exercise I choose in our sessions is done to make their running better, easier, faster, etc. If I push them with more sets, higher reps, less rest, their running would suffer, their risk for injury and / or sickness increases dramatically.
Additionally, if you are losing sleep due to stress, work, a child, etc., training with a high intensity might make your problem worse while compromising your immune system. Rather than push harder (or further) take it easy and do some restorative work with lower intensity and focus on the little things like technique and high quality reps with plenty of rest. Work on correcting the sleep / stress issue first and subsequently your body will be able to recover better which means you can train harder. See how this works??
There is only so much of you. Spend it wisely. Train smart, train hard (when applicable), eat well, recover.

 

 

It’s Father’s Day Weekend and there is no shortage of sports to watch! The World Cup, U.S. Open, College World Series, NBA Finals, and the Stanley Cup Finals are all going on. I’m thrilled because one of my athletes is playing in the CWS this weekend for Vanderbilt. My buddy Aaron and I went to Nashville to see Walker pitch against cross-town (cross-the-street) rivals Belmont University. He recorded a then career-high strikeouts that night and it was worth it even though Aaron and I froze our butts off. Looking forward to watching Vandy this weekend in the CWS! ANCHOR DOWN!

Walker and I after he picked up a win against Belmont.

Happy Father’s Day to all the dad’s out there!

I started training others in 1999 and over the course of 15 years, I’ve seen lots of trends in abdominal training come and go. Back then, if someone told me they wanted a six-pack (which was just about every client), I told them to clean up their eating and we would hammer their abs for 15-20 minutes at the end of each session with sit-ups, 374 different crunch variations, side crunches, hanging leg raises, and anything else I could dream up. I even created a group class called “Hard Core” which would challenge your balance, endurance, and abdominal strength in any way I could dream up (I used Swiss balls in every class). During the past 5-7 years however, through lots of reading articles, books, and research publications from people much smarter than me, and coaching hundreds more people I’ve changed my approach. I understand more about the true role of our core musculature and some of the mechanisms of pain and injury.

Low back pain (LBP) is the most common complaint I hear from people who come to me interested in training. I’d imagine than anyone reading this knows several people who have suffered through LBP or required some type of medical treatment to resolve it. Much of this can be attributed to the fact that as a population, we sit more than ever and we adopt faulty sitting, standing, and breathing patterns. Unfortunately though we all want six-pack abs and think that the best way to achieve them is to do lots of sit-ups, crunches, side crunches, hanging leg raises, etc. There are many other “ab” exercises that I have neither the time nor interest to type which you might be performing and might be detrimental to your spine health resulting in low back pain in the future. I’ll discuss some of them and if possible, I’ll post videos of them at some point.

    Some of the common culprits

  • The sit-up – If you’re doing sit-ups, you should probably stop. The sit-up imposes approximately 3300 N (730 lbs) of compression on the spine (Axler and McGill 1997). The National Institute for Occupational Safety and Health set the action limit for low back compression at 3300 N, yet every time you do a sit-up you are subjecting your spine to this high compression with each repetition. In his book, Low Back Disorders, 2nd Edition, world-renowned spine specialist Stuart McGill says, “Those who are training for health never need to perform a sit-up; those who are training for performance may get better results by judiciously incorporating them in to their routine.” Essentially, the risk isn’t worth the reward.
  • Straight Leg Raises or straight leg holds – Most people have performed a straight leg raise at least once in their lives. Our high school soccer coach would make us hold them for maximum time at the end of practice to see if our abs were in shape. I vaguely remember my longest hold being somewhere in the neighborhood of five minutes. Did we use good form? I think not. The straight leg raise with feet a few inches off the floor (or hold) engages the hip flexors which forces the pelvis in to anterior tilt thus pulling the lumbar spine in to extension and compressing the spinous processes and nerve roots. Most of the clients I work with or see in our gym “live” in extension and training them in a way which exacerbates this pattern isn’t a good idea. As you raise your legs (mainly a hip flexor action) your lumbar spine will tend to flatten or even flex, right before returning to an extended position. And during the Straight Leg Raise the flexion / extension cycle is repeated often until exhaustion. The problem is that the overwhelming majority of people lack the core control to pull off the Straight Leg Raise.
  • The crunch – Crunches came about as a way to alleviate the problems created by the sit up, yet still “feel the burn” of abdominal training but crunches have created an entirely new set of problems because of our excessive thoracic kyphosis (hunched over) and neck posture namely; anterior head carriage and cervical spine extension. I see some pretty bad crunch technique, most of which includes pulling forward on the head and using the arms to help perform the exercise. So yes your abs will burn from doing 100 crunches, but at what cost? You could further damage your already hunched-over upper back and shoulders and create problems in the neck and head. (The number of people who come to me complaining about neck pain and headaches is almost as many as those who come to me with low back pain.)
  • Planks – I know what you’re thinking, “Wait, planks are supposed to be safe for your back and good for the core, and I can hold a plank for 17 minutes!” First of all, planks CAN BE good for your core and safe for your spine, but they are more often than not performed with less than optimal technique. Secondly, if you can hold a plank for more than a couple minutes, I’d venture to say that you’re doing something wrong. As we fatigue, our bodies compensate. And when we compenate, we make alterations to proper movement / position. For example: try to stay up a couple nights straight and don’t take naps during the day then see what happens. Chances are, you will start making silly mistakes, dozing off, or hallucinating. THAT is your body’s way of compensating for your lack of sleep. It’s shutting down the systems that should be running properly in favor of simply keeping you alive. (Why do you think the FAA has time-out regulations for flight crews?)

So what CAN you do for your core that will not hurt your low back, upper back, neck, etc?

It starts with the ability to control your core with very subtle but important breathing and bracing technique. Fundamental exercises that allow you to control spine position while moving are first.
Hip extensions (glute bridge) – This a great warm-up exercise that can serve as a primer for the rest of your workout or if you have poor core control, it may constitute part of your workout. Most people get this wrong by driving their low back up in to greater extension (remember most people live in extension) rather than driving from the glutes while keeping the lumbar spine neutral. Lie on your back with your feet 12 inches from your butt. Brace your core and pull your low back to the floor. Press your heels to the floor and drive through your glutes lifting your hips. Hold for one full breath, lower and repeat. Perform 10-15 reps.

Plank – I test the plank for all my new clients to determine if they tend to fall in to one or more of these faulty positions (low back sags, head falls forward, hips up too high). As you can see, this client sets up with a couple positions which need correction. A plank should look like a plank of wood. Straight.

Bad Plank

If you cannot hold a good posture in the plank, you have no business moving on to more advanced exercises. Sorry. I know you saw this crazy cool exercise on Youtube, but you’re not ready for it. Don’t put the cart before the horse. It’s easy to tell you how to fix it, but it’s better to teach you. Essentially, I would like the hips lower (by actively turning on the glutes) and posteriorly tilting the pelvis which will bring the lumbar spine to neutral. Then we want the chin tucked in and back to created a more neutral cervical spine as well. All this is easier said than done however, because some people whose hip flexors dominate their pelvis cannot effectively activate their glutes (distance runners and desk jockeys).

Side Plank – A side plank should look like a plank…on your side. Hips extended with glutes squeezed, lumbar spine neutral, and head in line with the spine. I usually start with a kneeling side plank or a side plank up on the wall to master the position before going to a full side plank.

This is only a very basic introduction to this idea and I will have many more posts, pictures, and videos to follow which will take us deeper down the rabbit hole. But until then, remember this. The function of the core is to control movement of the spine and to transfer power from lower to upper extremity and vice versa. Train it accordingly, and you will feel better, move better, and be stronger.

Always a student, sometimes a teacher, never a master.

Quote  —  Posted: May 21, 2014 in Uncategorized