Is the Squat a Good Exercise? LETS TALK ABOUT FUNCTION Is it - PDF document

5/29/2019 DISCLOSURE – STEVE KENNELLY FUNCTIONAL KNEE REHABILITATION CONSIDERATIONS FOR RETURN  Relevant Financial Disclosures TO SPORT  Co‐Author of Plyometric Anatomy book for which I receive publisher royalties from Human Kinetics Steve Kennelly, M.Ed., ATC, CSCS Assistant Head Athletic Trainer New York Football Giants Is the Squat a Good Exercise? LETS TALK ABOUT FUNCTION Is it Functional? How About the Deadlift? What About These Exercises? Hold that thought for a moment You get the idea here! 1

5/29/2019 What is Functional Let’s Get Back To This Training/Rehabilitation?  Good Question!  Many Opinions  After 30+ years, I haven’t quite figured this one out yet. But for me . . . IT’S ALL FUNCTIONAL!!  Everything I do with an athlete, or have an athlete perform, is relevant to how well they FUNCTION on the field FUNCTIONAL? FUNCTIONAL? When Are Athletes ‘Ready to Return?’  Back to Normal Symmetry? Biomechanical ACL REHABILITATION REMAINS A CHALLENGE IN TERMS OF RE‐INJURY AND RETURN TO SPORT Variables Remain More Asymmetrical Than Normal During Jump and Change‐of‐Direction Testing 9 Months After Anterior Cruciate Ligament Reconstruction. King E, et al. Am J Sports Med. 2019  Low rates of patients meeting return to sport criteria 9 months after ACL reconstruction. Welling et. al., Knee Surg Sports Traum, Arthoscopy 2018. Are Young Athletes At Risk? Re‐Injury Risks Are Very Real  ACLR in athletes: function, return to sport rates,  Young athletes after ACL reconstruction with quadriceps strength asymmetry at the time of return‐to‐sport demonstrate decreased and re‐injury rates. Failla M, et. al., Delaware‐Oslo ACL cohort study. knee function 1 year later., Ithurburn, Knee Surg Sports Traumatol Arthrosc. 2018 Orthop J Sports Med. 2015  Young athletes after ACL reconstruction with single‐leg landing  Risk of secondary injury in younger athletes after asymmetries at the time of return to sport demonstrate decreased knee function 2 years later., Ithurburn 2017. Am J Sports Med anterior cruciate ligament reconstruction: a  Young Athletes With Quadriceps Femoris Strength Asymmetry at systematic review and metaanalysis. Wiggins AJ, et. al. Am J Return to Sport After ACL Reconstruction Demonstrate Asymmetric Sports Med., 2016 Single‐Leg Drop‐Landing Mechanics. , Ithurburn MP, et al. Am J Sports Med. 2015  Incidence of second ACL injuries 2 years after  Young Athletes Cleared for Sports Participation After Anterior primary ACL reconstruction and return to sport. Cruciate Ligament Reconstruction: How Many Actually Meet Paterno MV, et. al. Am J Sports Med. 2014 Recommended Return‐to‐Sport Criterion Cutoffs?, Toole AR et. al., J Orthop Sports Phys Ther. 2017 2

5/29/2019 How Many Actually Return? Psychological Readiness  Fifty‐five per cent return to competitive sport following anterior  Psychological Readiness to Return to Sport Is Associated With Second Anterior Cruciate Ligament Injuries. McPherson AL, et al. Am J cruciate ligament reconstruction surgery: an updated systematic Sports Med. 2019 review and metaanalysis including aspects of physical functioning  How Is Psychological Outcome Related to Knee Function and and contextual factors. Ardern CL et al., Br J Sports Med. 2014 Return to Sport Among Adolescent Athletes After Anterior Cruciate  Return to high school‐ and college‐level football after anterior Ligament Reconstruction? Beischer S, et al. Am J Sports Med. 2019 cruciate ligament reconstruction: a Multicenter Orthopaedic  Progression of the Psychological ACL‐RSI Score and Return to Sport After Anterior Cruciate Ligament Reconstruction: A Prospective 2‐ Outcomes Network (MOON) cohort study. McCullough KA, et. al., Am J Year Follow‐up Study From the French Prospective Anterior Sports Med, 2012 Cruciate Ligament Reconstruction Cohort Study (FAST). Sadeqi M, et al.  Return to play and future ACL injury risk after ACL reconstruction in Orthop J Sports Med. 2018 soccer athletes from the Multicenter Orthopaedic Outcomes  Self‐Reported Fear Predicts Functional Performance and Second Network (MOON) group . Brophy RH, et al. Am J Sports Med. 2012 ACL Injury After ACL Reconstruction and Return to Sport: A Pilot Study. Paterno MV, et al. Sports Health. 2018  Return to Play After Anterior Cruciate Ligament Reconstruction in National Football League Athletes , Shah VM, et. al. Am J Sports Med 2010 Criteria for Return to Sport (RTS)  Battery of tests may provide a more robust assessment of the WHERE TO WE BEGIN? rehabilitation status than single‐test assessment  Movement  Mobility  Hip Flexion, Hip IR, Ankle Dorsiflexion WITH  Strength  Isokinetics THE END  Isometrics: Mid‐Thigh Rack Pull IN MIND!  Power: Rate of Force Development  Vertical: Force Decks or Counter Movement Jumps  Horizontal: Single Hop for Distance Criteria for Return to Sport (RTS) What’s Missing?  Biomechanical Analysis  Sport  3D Motion: Gold Standard in measuring multi‐joint, multi‐planar, high level movement and forces  2D Motion: limited, cannot measure joint forces  Cutting Kinematics  Decision and Indecision Cuts  Psychological Profile  IKDC Score  Position  ACL‐RSI Scale 3

5/29/2019 Does Fatigue Play A Role? Could This Be The Key?  Optimising the Late‐Stage Rehabilitation and  Energy Demands Return‐to‐Sport Training and Testing Process After  Goal it to return the athlete ACL Reconstruction. Buckthorpe M. Sports Med. 2019. to his/her sport to SUSTAIN the demands of the sport  Return to play following anterior cruciate ligament  Two Critical Factors reconstruction: incorporating fatigue into a return  The rate of energy to play functional battery. Part A: treadmill production  Power: how fast the athlete running. Connell R, et al. BMJ Open Sport Exerc Med. 2019 can produce energy  The duration of energy production  Endurance: how long the athlete can produce energy Functional Reconditioning Model WE MUST TAKE A WHOLISTIC APPROACH *Adapted from Al Vermeil’s Hierarchy of Athletic Development MetLife Stadium FOUNDATIONAL PATTERNS / MOVEMENT SKILL 4

5/29/2019 MetLife Stadium Construction Foundational Movement Patterns PRIMITIVE HINGE (LOWER BODY PULL ) UPPER BODY PULL SQUAT (LOWER BODY PUSH) CORE GAIT LUNGE (SINGLE LEG) UPPER BODY PUSH What Is the Common Theme Here? WHAT IS THE FOUNDATION OF ATHLETIC MOVEMENT? Universal Athletic Position (UAP) How About Now? SQUAT and HINGE Patterns  Work to improve the pattern, then challenge it with volume, intensity, speed, etc. 5

5/29/2019 Work Capacity (STAMINA)  Ability to maintain or increase effort over a long period WORK CAPACITY / STRENGTH of time  Stamina = Endurance + Economy  Endurance = ability to complete a task over time  Economy = ability to make the same task feel easier over time  Build endurance with volume  Low aerobic level: 70‐75% MHR or 180‐Age (Maffetone Method)  Build economy with intensity  Heavy resistance training, sprints, plyometrics, sport‐ specific practice Endurance vs Economy ‘GO TO’ Work Capacity Exercises  Stephen Seiler ‘Polarized Training’ Model Walking Medicine Ball Throws  Analyzed the training methods of world class rowers and cross country skiers  Quantifying training intensity distribution in elite endurance athletes: is there evidence for an "optimal" distribution? Seiler KS, Scand J Med Sci Sports. 2006  Training methods and intensity distribution of young world‐class rowers. Guellich A, Seiler S, Emrich E. Int J Sports Physiol Perform. 2009  80% of training occurs at low intensity  20% of training occurs at high intensity  Further research found that elite cyclists, swimmers, triathletes and runners trained the same way Example of Low Intensity Training ‘GO TO’ Work Capacity Exercises High Intensity Continuous Bike 6

5/29/2019 ‘GO TO’ Work Capacity Exercises ‘GO TO’ Work Capacity Exercises Aerobic Strength Escalated Density Training ‘GO TO’ Strength Exercises ‘GO TO’ Strength Exercises Squat Deadlift ‘GO TO’ Strength Exercises ‘GO TO’ Strength Exercises  Add Tippy Twist Reverse Lunge 7

5/29/2019 ‘GO TO’ Explosive‐Rate of Force Development Exercises EXPLOSIVE‐ELASTIC Hang Power Clean ‘GO TO’ Explosive‐Rate of Force ‘GO TO’ Elastic‐Plyometric Exercises Development Exercises Explosive Medicine Ball Throws Single Leg Hops ‘GO TO’ Explosive‐Elastic‐Plyometric ‘GO TO’ Elastic‐Plyometric Exercises Exercises Explosive Repeats Aerobic Plyometrics 8

5/29/2019 ‘GO TO’ Speed Exercises ‘GO TO’ Speed Exercises Tempo Runs Acceleration to Lunge Stop ‘GO TO’ Agility‐Quickness Exercises ‘GO TO’ Agility‐Quickness Exercises Shuffle to Cut Stop Lateral Bound to Acceleration ‘GO TO’ SARC Drills ‘GO TO’ Sport Specific Exercises Decision or Closed Loop Skills  Position Specific Drills ‐ Linebacker  Athlete chooses when and direction of cut. Predetermined start and finish  Reestablishes proper mechanics  Agility drills, position specific drills  Goal is to “memorize” or “groove” the pattern Indecision or Open Loop Skills   Time and direction are determined by an external stimulus. Athlete reacts to an external stimulus  Well documented as increased risk for ACL tears  Process the stimulus and produce movement patterns to effectively deal with the stimulus  Mirror drills, O‐Line vs. D‐Line drills, WR vs. CB drills 9