Pre-habilitation for the High

School Athlete

Patrick Jenkins MA, ATC, CES

Athletic Trainer

What is Pre-hab?

• Exercises done with the specific goal of preventing

injuries.

Why Should We Do Pre-hab?

• Can we really prevent injuries from occurring?

– Role of the physician, ATC, strength coach, & sport coach, student athlete

• How do we determine who is at risk for what?

– Physician & ATC responsibility

• Why should high school athletes do pre-habilitation exercises?

– To prep for intensity of college level athletics – IT IS VERY DIFFERENT!!!

Why?

• 1 of 6 „Domains of Athletic Training‟ is Prevention

• OVERTRAINING-extended playing seasons beginning at youth levels up through college/university

• 25% of Student Athlete Body are Freshmen

• Tested immediately for strength, speed, power, endurance, vertical, etc – Are they ready?

– “If they aren‟t ready now, when can they be ready?”

– Are we getting a true test of the athlete if they have recognizable dysfunctions?

Prevention

• What methods are currently in place to prevent

injuries?

– Pre Participation Exam

• Physician & ATC exam

– BP, HR, lungs, vision, basic musculoskeletal scan

– Helmets, mouth guards, padding, etc

– Taping & Bracing

– Acclimatization periods

– Strength & Conditioning

Limitations • PPE does not currently address athletic movements

• Helmets, mouth pieces, padding, taping & bracing are debatable & don‟t correct potential issues

• Strength & Conditioning can‟t focus athlete development without a functional “unit” – Early recognition for proper training accommodations

• Where does this leave us?

Movement Screens

• Evaluation tool that can

assess functional body

movements

– Over head squat - OHS

– Single leg squat - SLS

– Push up?

– Running, cutting,

jumping?

What do we see?

• General weakness

– Hips – flexors, glutes, abductors, adductors

– Hamstrings – flexion of knee & extension of hip

– “Core” – TA, lumbar extensors, internal/external obliques, lats

– Shoulder girdle – rhomboids, mid & lower trap, serratus anterior

• General ROM deficits

– Hips – IR/ER, hamstrings, hip flexors, glutes, abductors, adductors

– Ankles – calves

– Shoulder – pecs, lats, rotator cuff

Common Findings

• General Injuries

– LBP

– Patellar tendonitis

– Medial & lateral ankle

pain, repetitive sprains

– Shin splints

– Achilles tendonitis

– Repetitive muscle strains

– hamstring & hip flexor

– Stress fractures

Overhead Squat - OHS

• Knees – move in or out

• Feet – turn in or out

• Feet – do heels raise

• Trunk/hips – flexion

• Lumbar spine – curvature

• Arms – verticality

Overhead Squat – Baseline Subject

Example 1

• Freshmen men‟s

basketball player

• 6‟6”, 207#

• 18 month history of B

anterior knee pain

• Persistent low back pain

• History of B ankle

sprains & lateral ankle

pain

• Standing VJ – 29.5”,

Approach VJ – 37”

• ROM deficits – hip flex/ext/er/ir/abd; knee flexion; + B Thomas test

• MMT deficits – hip abd/ext 3+/5; 4/5 knee extension

• TTP at inferior pole of patella

• Pes planus (flat feet)

Example 2

• Junior basketball player

• 6‟4, 210#

• L periodic quadriceps

tendonitis

• Periodic LBP

• R lateral foot stress

fracture

• Standing VJ – 31.5”,

Approach VJ – 37”

• ROM deficits in hip

ext/flex/ir/er; L

quadricep – knee

flexion; adductors

• TTP at superior L

patellar border

OHS Assessment

OHS Rear View Assessment

• Knees move in slightly

• Feet flatten

• Feet turn out

SLS Assessment

• Trunk rotates towards

stance leg

• Knees move in

• Feet flatten

• Hip drops

OHS Modified w/ Heel Lift

• With 1.25” heel lift

• Improved knee alignment

• Deeper squat

• Feet don‟t turn out

• Arms don‟t fall as far

• Improved trunk & tibia alignment

• Low back still extends

• Improved balance

Modified OHS

What did we find?

• Weak or Underactive

– m. hamstring, m. gastroc,

glute max & med, VMO,

ant. tibialis, erector

spinae, intrinsic core,

post tibialis

• Tight or Overactive

– Soleus, l. gastroc, l.

hamstring, TFL,

adductors, hip flexors,

latissimus dorsi,

peroneals

Now What?

• After movement analysis determine which

areas could benefit from a pre-habilitation

program

• How to treat findings

– Which exercises for specific areas

– “inhibit, lengthen, active, integrate”

• Progression through plan

– f/u at 4 weeks, 8 weeks, 12 weeks, 6 months, 1 yr

MBB Plan

• Inhibit (foam roll) - Lateral calf, lateral hamstring, ITBand, TFL, latissimus dorsi, glute

• Lengthen (stretch) – lateral calf, lateral hamstring, TFL, hip flexor, glute, piriformis, latissimus dorsi

• Activate (strengthen) – medial calf, medial hamstring, glute medius/maximus, anterior tibialis, posterior tibialis, erector spinae, intrinsic core

• Integrate (multi joint movements) – athletic lifts & movements to facilitate firing patterns, stabilization, co-contractions

Inhibit – Foam Roller

Inhibit – Foam Roller

Lengthen - Stretching

Activate - Strengthen

Integrate – Dynamic Exercise

Considerations

• Do you have time to evaluate your athletes?

– If you don‟t should you make the time?

• Should athletes with movement screen weaknesses

perform high intensity combination movements

(squats, cleans, plyometrics, etc)?

• Vary exercises

• Incorporate Rest

• Don‟t sacrifice form for weight

– Youth soccer example

Conclusions

• An ounce of prevention

– Taping, bracing, equipment is not enough

• Incorporate movement screens and then basic exercises for overlooked muscles

• Preparation for next level intensity

• Relative rest