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Slide 1
Jason M. Mensinger MEd, LAT, ATC, PES, CES
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Slide 2
Review healing process and core goals of rehabilitation
To enhance knowledge of strength and conditioning principles and how they can be applied throughout the rehabilitation process.
Provide a framework to categorize physical preparation activities based on how they stress the central nervous system.
Discuss the importance of central nervous stimulation through movement activities from the acute stage of rehabilitation through functional return to play
Provide information related to strength related to sporting activity, along with progressions for movements utilized in training.
Discuss phases of a sprint and activities that can be used during rehabilitation to maintain or enhance them
Provide progressions related to speed and strength development activities and how they can be used during all stages of rehabilitation for sprint-based athletic activities.
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Slide 3
Inflammatory
Fibroblastic-repair
Remodeling
WHAT IS THE FUNCTION OF THE TISSUE?
Many times what gets left out of discussion?
“Just because biological healing has occurred, it does not mean that the athlete
is prepared for performance.”1
Neurophysiologic dysfunction
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Slide 4
Structural integrity
Pain-free joints and muscles
Joint flexibility
Muscular Strength
Muscular Endurance
Muscular Speed
Motor Skill
Muscular power
Agility
Cardiorespiratory endurance
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Slide 5
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Slide 6
All training has general and specific effects
Structural
Neural
Rate of Force Development
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Slide 7
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Slide 8
CNS Impact dependent upon3
o Speed of movement
o Magnitude of resistance
o Amplitude of movement
o Number of working muscles
o Size of working muscles
o Volume and density
Activities3
o Sprinting at Max Velocity
o Explosive sport maneuvers
o Explosive jumps, push-ups, lifts
o Max Effort Strength training
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Slide 9
1. Total Body/Global Movements
2. Compound Regional
3. Single Joint/Local
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Slide 10
Increased somatosensory activation
Decreased motor cortex excitability
Increased intracortical inhibition
Altered cortical activation in task execution
IMPORTANCE OF CNS
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Slide 11
Load compromised athletes cannot take more than two weeks off from strength
training or risk neuromuscular “switching off”1
Arthrogenic muscle inhibition occurs bilaterally after a unilateral knee injury6
o Apply cross-education concept
o Unilateral strength training enhances performance in contralateral limb7
o Eccentric contraction
o Earlier onset of hamstring activity on both the injured and non-injured side of patients with
hamstring strains8
Diminished ability of the motor system to send action potentials following
chronic injury9
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Slide 12
General
General Specific
Specific
*Rehabilitation connection
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Slide 13
Use strength as a means to activate motor units3-4,13-15
Basic movement patterns13
o Push
o Pull
o Quad Dominant
o Hip Dominant
o Rotation/Anti-Rotation
o Carry/Drag/Push
o Grip
Strength Movements
o Bench Press
o Squat
o Deadlift
o *General & Local Effects
Supplemental/Accessory
o Support movements and single joint activities
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Slide 14
Bottom-Up
Body weight
Loaded- KB (Goblet)
Barbell Back on Box
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Slide 15
Greater neural adaptation16
o Increased activity in brain17
Higher stress level per motor unit18
Preferentially recruit fast twitch fibers16,19
Greater Cross Education18
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Slide 16
Greatest activation of motor units18
Increase primarily at angle worked
o Greater transfer for muscle lengthened than shortened during movement11
Isomiometrics
Iso-ballistic
Can be used to facilitate more intense work12,18,20
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Slide 17
Study Cal Dietz21
Pro Agility vs. Ecc, Iso, Con
3 Components of a multi-directional movement
Need to focus initial efforts on deceleration
o Landing
o Split Stance
o Athletic Stance
o Multidirectional Hops
o Split Squat Eccentric Quasi-Isometric
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Slide 18
Important SKILL for non-track athletes
High neuromuscular demand- intermuscular and intramuscular coordination.
Largest forces in shortest amount of time
o Forces up to 5 times bodyweight14,22
High degree of CNS activity- More than just running fast
Strength training can improve, but up to a point
Most important factor is rate of force development
Repeat sprint ability important for team sports
o Alactic/Aerobic Recovery
Introduce sprinting/running drills as early as possible
o Toe over knee drill/Power Speed Drills
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Slide 19
Most team sports function in
realm of 5-30 meters13-15,23
Angle of lower leg/Line of
extension
Don’t force stride length
Greater horizontal forces
More quadriceps/anterior chain
Strength development more
relevant
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Slide 20
More upright posture
Greater hamstring emphasis
Greater vertical forces
All sprint action affected by arms
Swing phase- hamstrings do not
actively contract24
o More important in relation to hip
extension
Reactive ability more relevant14,24-
25
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Slide 21
Push-Up Into Sprint
Jump Back to Sprint
Falling acceleration
Hill Sprint
Sled Sprints
Jumps with deeper knee bend
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Slide 22
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Slide 23
More strength-based
Pistol Squat
Lunge Variations with hip flexion
Split Squat Variations
Step-Up with hip flexion
“Heavy” Prowler and Sled
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Slide 24
Hip Extension Strengthening
Upright sled walking
Flying Sprints
Increase sprint distances
Jumps more elastic/reactive
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Slide 25
Kinematic likeness to sprinting
Elastic/Reactive Component (lower intensity)
A series
B series
Lateral skips
Backwards skips
Butt-kickers (modified with hip flexion)
Straight leg Bounds
Ankling
**Single leg variations
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Slide 26
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Slide 27
Stationary Bike Application
Acceleration vs. Max Speed
Work Periods14
o Acceleration <6 seconds
o Max Velocity 6-8 seconds
o Speed Endurance 8-15 seconds
o Special Endurance I 15-45
o Special Endurance II >45 seconds
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Slide 28
Aerobic development and recovery in speed/power athletes14-15,25-26
60-75% Speed in interval fashion
Distance based on sport demand
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Slide 29
Bike Tempo
Pool Tempo
Power Speed Drills
MB Tempo
Bike Example
o 15- 20 second running tempo
equivalent to approx 30 second
bike
o Shorter rest intervals
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Slide 30
Case- DI Football RB14
Wrist surgery for damaged ligament
All regular lower body workouts
10 days post wrist brace removal- Bench Press
o 355 before/330 after
For application purposes also think about the reverse
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Slide 31
Early Phase (Days 2-5) (Based off of Smith14 & Mach27)
Power Speed/Drills Single Leg
o A Drills first
Short Submax accelerations
o Distances of 5-10m
o Extend to 15-20m
Jumping exercises- No explosive hip extension affected side
Abdominal exercises
MB work
Eccentrics
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Slide 32
Power Speed Drills- Both legs
o A drills (Hill or stairs if possible)
30 m runs
o 2X30m, 4X30, 6X30, 8X30, 10X30 and back down
Eccentric (Hip extension variants)
o Reverse bands
Trap Bar Deadlift?
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Slide 33
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Slide 34
Protocol summarized from Brotzman and Wilk29
Average return to play about 10 days
Passive modalities
Bracing
WB as tolerated
Quad sets/SLR
Eccentric Quads
Hip movements
Mini-squats
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Slide 35
Squat pattern- bottoms up
Day 1-2 Single leg A march (Double leg?)
Single leg A skip (3-5 days?)
Submax acceleration/Prowler?
Acceleration work on bike
Stiff Leg KB Swings (3-5 days out?)
Deceleration- Double to single leg landing
CONTINUE WITH REHABILITATION AFTER RETURN TO PLAY
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Slide 36
Type of injury- Acute vs. Chronic?
Body part/Joint/Tissue
Contraindications
Contralateral limb/General Organism Strength
Home exercise
Athlete motivation to begin to train the right way
Regional Interdependence
What is sport demand
o Repeat-sprint
o Throw
o Jump
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Slide 37
1. Knowles B. Reconditioning: A performance-based response to an injury. In: Joyce D, Lewindon D, ed. Sports Injury Prevention and Rehabilitation. Kindle ed. New York, NY: Routledge, 2016.
2. Knight KL, Draper D. Therapeutic Modalities: The Art and Science. 2nd ed. Baltimore, MD: Lippincott Williams & Wilkins; 2013
3. Smith, J. The Governing Dynamics of Coaching. Publisher: Author; 2016.
4. Francis, C. Training for Power and Strength in Speed. Publisher: Author; 2014. Kindle edition.
5. Needle AR. Neuroplasticity after musculoskeletal injury: The central nervous system & clinical outcomes. Oral presentation at: National Athletic Trainers’ Association Clinical Symposia & AT Expo, 2016; Baltimore, MD.
6. Palmieri-Smith RM, Thomas AC. A neuromuscular mechanism of posttraumatic osteoarthritis associated with ACL injury. Exercise and Sport Science Review. 2009;37(3):147-153
7. Fimland MS, Helgerund J, Solstad GM, Iversen VM, Leivesth G, Hoff J. Neural adapatations underlysing cross-education after unilateral strength training. Europoean Journal of Applied Physiology. 2009;107:723-730.
8. Sole G, Milosavlijevic S, Nicholson H, Sulivan JS. Altered muscle activation following hamstring injuries. British Journal of Sports Medicine. 2012;46:118-123.
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Slide 38
9. Lepley AS. Neural origins of dysfunction following joint injury. Oral Presentation at: National Athletic Trainers’ Association Clinical Symposia & AT Expo, 2016; Baltimore, MD
10. Bondarchuck AP. Transfer of Training in Sports, Vol. 2. Ultimate Athlete Concepts; 2010.
11. Kurz T. Science of Sports Training: How to Plan and Control Training for Peak Performance. 2nd ed. Island Pond, VT: Stadion; 2016
12. Verkhoshansky Y, Verkhoshansky N. Special Strength Training Manual for Coaches. Rome, ITA: Verkhoshansky SSTM; 2011
13. Defranco J, Smith J. Special Strength for Team Sports: Transforming Strength, Power, and Speed into Athletic Performance. 2016
14. Smith J. Applied Sprint Training. 2014.
15. Hansen D. Successfully translating strength into speed. In: Joyce D, Lewindon D, ed. High-Performance Training for Sports. Kindle ed. Champaign, IL: Human Kinetics;2014.
16. Hortobagyi T, Hill JP, Houmand JA, Frasier DD, Lambert NJ, Israel RG. Adaptive responses to muscle lengthening and shortening in humans. Journal of Applied Physiology. 1996;80(3):765-772.
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Slide 39
17. Grooms D. The clinical implications of neuroplasticity after musculoskeletal injury: Targeting the brain during rehabilitation. Oral presentation at: National Athletic Trainers’ Association Clinical Symposia & AT Expo, 2016; Baltimore MD.
18. Thibadeau C, Schwartz T, ed. Therapy and Application of Modern Strength and Power Methods. 2006
19. Nardone A., Romanò C., and Schieppati M.. 1989. Selective recruitment of high‐threshold human motor units during voluntary isotonic lengthening of active muscles. J. Physiol. 409:451–471.
20. Siff M. Supertraining. 4th ed. Denver, CO: Supertraining Institute; 2000.
21. Dietz C, Peterson B. Triphasic Training: A Systematic Approach to Elite Speed and Explosive Strength Performance. Hudson, WI: First Bye Dietz: 2012.
22. Coh M, Babic V. Biodynamic characteristics of maximum speed development. Physical Education and Sport. 2010;8(2):141-148
23. Kraaijenhof H, Thome M, ed., Mann B, ed. What We Need is Speed: Scientific Practice of Getting Fast. Ultimate Athlete Concepts; 2016.
24. Harrison, A. Biomechanical factors in sprint training: where science meets coaching. International Symposium of Biomechanics in Sports: Conference Proceedings Archives. 2010;28:36-41.
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Slide 40
25. Francis, C. The Charlie Francis Training System. 2012. Kindle Edition.
26. Josse C. Advanced Special Strength Protocols. Diesel Strength and Defranco’s Training; 2016.
27. Hansen D. Optimal tempo training concepts for performance and recovery.
http://www.strengthpowerspeed.com/optimal-tempo-training/. Published: August 14, 2014. Accessed:
May 19, 2017.
28. Mach G. Sprints and Hurdles. Vanier, ON: Canadian Track and Field Association; 1980.
29. Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation. 2nd ed. Philadelphia, PA: Mosby; 2003.
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Slide 41
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