Mobility, Stability and Movement

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TheNationalStrengthandConditioningAssociation
Presents
Mobility,StabilityandMovement:
Mobility,StabilityandMovement:
The Risk of Conditioning
TheRiskofConditioning
with
GrayCook,
MSPT
MSPT,OCS,CSCS,RKC
,OCS,CSCS,RKC
OCS CSCS RKC
October07,2009
www.nsca
www.nscalift.org
1
800
800815.6826
TheRiskofConditioning
Conditioningdoesnotseemtoprevent
injuries.
injuries
Sometimesitactuallycreatesfalse
confidence.
fid
Usedincorrectlyitevencanincreaserisk.
Copyright2009NSCAAllRightsReserved
Why
Whydohighlytrained
do highly trained
athletessustainnon
contactinjuries?
Andwhyisprevious
i j
injurythenumber#1risk
h
b #1 i k
factorinsports?
Whocanweblame?
TheTrainer
TheStrengthCoach
ThePhysicalTherapist
Whatdoweknow
actuallyknowabout
InjuryRisk?
Flexibility
Two prospective
studies in soccer
players implicate
hamstring and
quad flexibility as a
risk factor
(Sodermann 2001,
Witvrouw 2003)
Flexibility
2 studies found no association
Krivickas 1996 (all collegiate sports)
Arnason 1996 (soccer)
Flexibility
Flexibility Inconclusive
Why???
Because...
Its not movement oriented.
Intent on discussing the remedy with out
actually
y discussing
g the p
problem.
Theseguysmayhavethesame
flexibility scores but they dontthave
flexibilityscoresbuttheydon
have
thesamemovementscores
Double-click to edit
10
Consider
Flexibility...
incontrastto
MovementPatterns
11
What Just happened?

WhatJusthappened?
12
Is this a bad movement or have

we just
j
become bad squatters??
Argue ffor a cultural

A
lt
l
weakness and you will
soon own it!
13
The Solution...
TheSolution...
We
Weneedbetter
need better
biomarkersforthe
risk of injury
riskofinjury.
14
What the Heck is a Biomarker

WhattheHeckisaBiomarker
TheofficialNIHdefinitionof
abiomarkeris:
bi
k i
Acharacteristicthatis
objectively measured and
objectivelymeasuredand
evaluatedasanindicator
ofnormalbiologic
processes,pathogenic
h
processes....
15
Biomarkers for injury Risk!!!!!!!!!!!

BiomarkersforinjuryRisk!!!!!!!!!!!
PreviousInjury
Asymmetry
MotorControl
BMI
Stupidity
16
Previous Injury
PreviousInjury
23 Prospective
Studies
Increased Injury Risk
2
2-19x
19x greater risk
of injury
17
Previous Injury
PreviousInjury
Either we are not fully rehabilitating these

athletes / fitness clients / and patients...
18
Previous Injury
PreviousInjury
or
Something fundamentally changes
after injury...
19
Previous Injury
PreviousInjury
OrBoth
20
Asymmetries
Strength
St
th
Flexibility
Alignment
ROM
Joint Laxity
Nadler et al 2001, Myer 2008, Soderman 2001, Baumhauer 1995, Rauh 2007
Ekstrand 1983, Knapik 1991, Plisky 2006, Yeung 2008
21
Asymmetries
YBalanceTest IdentifiesAthletesat
Increased Risk of LE Injury
IncreasedRiskofLEInjury
cmright/leftanteriorreachdifference(3x
morelikely)
lik l )
Bottom1/3ofpeers
(Women6timesmorelikelytogetinjured)
Plisky etalJOSPT2006
et al JOSPT 2006
www.ybalancetest.com
22
Knapik indicated that no clear evidence was identified

to implicate tightness or weakness of a particular
muscle group with injury, but a significant amount of
injuries were noted in athletes with right to left sided
strength and flexibility imbalances (asymmetries).
23
Motor Control
MotorControl
Balance
Balance
Dynamic Neuromuscular Control
Proprioception
Proprioception
24
Poor balance as a risk factor

Poorbalanceasariskfactor
Trojian & McKeag 2006

Wang et al 2006
Plisky et al 2006
McGuine et al 2000
Watson 1999
Tropp et al 1984
25
NeuromuscularControland
Proprioception
Zazulak 2007
277 collegiate athletes (140 female and
137 male)
Trunk displacements (in response to
sudden unloading)
Proprioception (active repositioning
error) and a
History of low back pain, predicted knee
ligament
g
injury
j y with 91% sensitivity
y and
68% specificity.
26
NeuromuscularControl
Hewett 2005
Increased knee
ABDuction angle was 8
degrees greater and
2.5x greater ABD
moment with landing in
ACL injured
ACL injured had

increased ground
reaction force and
decreased stance time
27
Body Size / BMI

BodySize/BMI
McHugh et al 2006
Tyler
y et al 2006
Gomez et al 1998
Lymann 2001 (baseball)
Q
Quarrie
i 2001 ((rugby)
b )
28
Stupidity...Youcanproveit,
p y
p
butyoucantfixit!
29
Injuryriskfactors
Injury
risk factors
(prospectivestudies)
Previous Injury (23) - loaded statistic

Asymmetries(8)
MotorControl(7)
BMI(5)
The studies on stupidity are ongoing in the athletic and fitness world
Thestudiesonstupidityareongoingintheathleticandfitnessworld
30
Nowyouknowwhat
Now
you know what
but not why
butnotwhy...
31
Dr. Kyle Kiesel

Dr.KyleKiesel
We think a motor control adaptation
p
occurs
following injury (likely pain driven) that many times
does not normalize with rehabilitation efforts.
the pain is gone - I must be well
We are trying to measure this with body relative
functional movement testing.
testing.
32
Itisironic...
thatresearchand
goodoldcommon
sensearepointingin
thesamedirectionfor
achange orisit
commonsense
research.
33
THEFUNCTIONALMOVEMENTSCREEN Amovementstandardsince1997
1. Squatting
2. Stepping
3. Lunging
4. Reaching
5. Leg raising
6. Push-up
7 Rotary
7.
R t
St bilit
Stability
34
FMS BestPossibleScore
FMS
Best Possible Score 21
Scoreathreeforcorrectmovementpattern
p
Scoreatwoformovementpatternwith
compensationorlackofcorrectness
Score a one for inability to perform the
Scoreaoneforinabilitytoperformthe
pattern
Scoreazeroforpainregardlessof
Score a zero for pain regardless of
correctness
35
FMS Injury Study

FMSInjuryStudy
81 Professional Football Players
Built a regression
g
model to predict
p
injury
j y (time
(
loss
due to musculoskeletal injury during the course of
training camp)
What was considered: FMS score, cut score, FMS
asymmetry, rookie/veteran status, upper body
power lower body power
power,
Kiesel, Plisky, Kersey ACSM Abstract (2008)
36
FMSInjuryStudy
j y
y
Players who were
14 were 11x (p<0
(p<0.05)
05)
more likely to be
injured (CI95 1.2
1.2-99.2)
99.2)
Players with an
asymmetry 3x
(p<0.05)) more likely
(p
y
to be injured (CI95
1.1-10.6)
37
FMS Injury Study

FMSInjuryStudy
Having both risk factors was highly specific
0.98 (CI95 .93-.99) LR+ = 13.4 (CI95 2.3-84.2)
TOAST!!!!
Rookie/veteran
/
and power measures were
not predictive.
38
FMSInterventionStudyy
The purpose of this
study was to
determine if an offseason intervention
program was effective
in improving FMS
scores in professional
football players.
Kiesel, Plisky, Butler CSM Abstract (2009)

39
FMS Intervention Study

FMSInterventionStudy
Pre-test/post-test design
62ProfessionalFootballPlayerswhohadnotbeen
previouslyscreenedwiththeFMS
Grouped:Linemanandnonlineman
Kiesel Plisky,
Kiesel,
Plisky Butler CSM Abstract (2009)
40

Underwent a standardized 7-week off-season
training program
ProgramwasbasedontheindividualathletesFMSscore
Includedmovementpreparationandcorrective
exercise
Kiesel, Plisky, Butler CSM Abstract (2009)

41

MovementPrep
StickWork
Isolated
Stretching
42

Movement
Pattern
Pattern
Corrective
Exercise
43
Responsevs.Adaptation
44
45
46
Note
The
Thetrainingprogramsimprovedcore
training programs improved core
function.
Butcorefunctionwasnotthefocus.
Thefocuswasmovementpattern
p
correction.
47

14 has been established as a cut point
32 subjects
bj t improved
i
d their
th i score from
f
14 tto > 14
23 failed to improve beyond 14

pre test scores were > 14
7 subjects pre-test
48

Asymmetry
y
y
31 subjects had at least 1 asymmetry at pre-test
and 31 had no asymmetry at pre-test
Following the intervention, 42 players were free
of asymmetry and in 20 players asymmetries
remained
49

23
3 subjects
j
failed to improve
p
beyond
y
the
threshold of 14
ScoringlowerontheDeepSquatwasassociatedwith
failure
OR5.2CI95(1.518.6)
OR 5 2 CI95 (1 5 18 6)
20playersretainedasymmetries
p y
y
50

All
Alloftheimprovementswerefroma
of the improvements were from a
standardizedsystem.
Someindividualswillneedgreaterlevelsof
Some individuals will need greater levels of
correction,butthescreenseemedto
identify those individuals
identifythoseindividuals.
Somepotentialsuggestionsaremore
i
involvedassessmentandmoreadvanced
l d
d
d
d
softtissuework.
51
Question
Canastandardizedrisk
managementsystembe
used by the nearly all
usedbythenearlyall
exerciseprofessionals?
52
Question
Can
Canthesamesystembe
the same system be
usedtopromotebetter
communicationand
i i
d
transitionfrom
rehabilitationto
performance and fitness
performanceandfitness
programs?
53
Question
Cancurrent
researchhelp
hh l
clarifyissuesofrisk
y
associatedwith
conditioning?
54
Question
Cantheresearch
implications produce
implicationsproduce
practicalrisk
management
systems?
y
55
Answer to all four...

Answertoallfour...
YES
56
Brent Grimes
BrentGrimes
FMS21
(aperfectscore)
W
Weight178
i h 178
pounds
KettleBell71
pounds
57
Which came first?

Whichcamefirst?
58
SSowhatdoyouplantodowiththis
h d
l
d
i h hi
information?
59
Theskepticssaidgiveusdata...DONE
Thepessimistssaidwedonthavetimeto
screen... IT TAKES 10 min.
screen...ITTAKES10min.
Th
Theidiotssaidthescreenconfusesus
idi t
id th
f
j t
just
giveusyourexercises...THEEXERCISESARE
LIKED TO THE TEST THAT DEMONSTRATES THE
LIKEDTOTHETESTTHATDEMONSTRATESTHE
GREATESTDYSFUNCTION.
60
Weneedtostopdebatingexerciseandtake
astandonpreexercisescreening
d
i
i
standards.Thestandardsandsystemswill
moldyourfutureprograms.
ld
f
61
GrayCook
Gray Cook
,MSPT,OCS,CSCS,RKC
,MSPT
,OCS,CSCS,RKC
FunctionalMovementSystems
AverettUniversity
f ti
l
t
www.functionalmovement.com
QUESTIONS?
E-mail questions to jdawes@nsca

jdawes@nsca--lift.org
This presentation was recorded and all registrants will have access
to download the session. You will receive an e-mail regarding its
availability by close of business tomorrow or sooner.
October 07, 2009
www.nsca-lift.org
www.nsca62
800--815.6826
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Mobility, Stability and Movement

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Thank you for attending NSCAs Webinar today.

What Just happened?

Is this a bad movement or have

Argue ffor a cultural

What the Heck is a Biomarker

Biomarkers for injury Risk!!!!!!!!!!!

Either we are not fully rehabilitating these

Knapik indicated that no clear evidence was identified

Poor balance as a risk factor

Trojian & McKeag 2006

ACL injured had

Body Size / BMI

Previous Injury (23) - loaded statistic

Dr. Kyle Kiesel

FMS Injury Study

FMS Injury Study

Kiesel, Plisky, Butler CSM Abstract (2009)

FMS Intervention Study

FMS Intervention Study

Kiesel, Plisky, Butler CSM Abstract (2009)

FMS Intervention Study

FMS Intervention Study

FMS Intervention Study

23 failed to improve beyond 14

FMS Intervention Study

FMS Intervention Study

FMS Intervention Study

Answer to all four...

Which came first?

E-mail questions to jdawes@nsca

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