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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.
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Why
Whydohighlytrained
do highly trained
athletessustainnon
contactinjuries?
Andwhyisprevious
i j
injurythenumber#1risk
h
b #1 i k
factorinsports?
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Whocanweblame?
TheTrainer
TheStrengthCoach
ThePhysicalTherapist
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Whatdoweknow
actuallyknowabout
InjuryRisk?
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Flexibility
Two prospective
studies in soccer
players implicate
hamstring and
quad flexibility as a
risk factor
(Sodermann 2001,
Witvrouw 2003)
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Flexibility
2 studies found no association
Krivickas 1996 (all collegiate sports)
Arnason 1996 (soccer)
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Flexibility
Flexibility Inconclusive
Why???
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Because...
Its not movement oriented.
Intent on discussing the remedy with out
actually
y discussing
g the p
problem.
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Theseguysmayhavethesame
flexibility scores but they dontthave
flexibilityscoresbuttheydon
have
thesamemovementscores
Double-click to edit
Double-click to edit
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Consider
Flexibility...
incontrastto
MovementPatterns
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13
The Solution...
TheSolution...
We
Weneedbetter
need better
biomarkersforthe
risk of injury
riskofinjury.
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PreviousInjury
Asymmetry
MotorControl
BMI
Stupidity
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Previous Injury
PreviousInjury
23 Prospective
Studies
Increased Injury Risk
2
2-19x
19x greater risk
of injury
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Previous Injury
PreviousInjury
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Previous Injury
PreviousInjury
or
Something fundamentally changes
after injury...
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Previous Injury
PreviousInjury
OrBoth
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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
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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
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Double-click to edit
23
Motor Control
MotorControl
Balance
Balance
Dynamic Neuromuscular Control
Proprioception
Proprioception
Double-click to edit
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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.
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NeuromuscularControl
Hewett 2005
Increased knee
ABDuction angle was 8
degrees greater and
2.5x greater ABD
moment with landing in
ACL injured
Double-click to edit
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27
McHugh et al 2006
Tyler
y et al 2006
Gomez et al 1998
Lymann 2001 (baseball)
Q
Quarrie
i 2001 ((rugby)
b )
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Stupidity...Youcanproveit,
p y
p
butyoucantfixit!
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Injuryriskfactors
Injury
risk factors
(prospectivestudies)
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Nowyouknowwhat
Now
you know what
but not why
butnotwhy...
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Itisironic...
thatresearchand
goodoldcommon
sensearepointingin
thesamedirectionfor
achange orisit
commonsense
research.
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THEFUNCTIONALMOVEMENTSCREEN Amovementstandardsince1997
1. Squatting
2. Stepping
3. Lunging
4. Reaching
5. Leg raising
6. Push-up
7 Rotary
7.
R t
St bilit
Stability
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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
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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)
Kiesel, Plisky, Kersey ACSM Abstract (2008)
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FMSInterventionStudyy
The purpose of this
study was to
determine if an offseason intervention
program was effective
in improving FMS
scores in professional
football players.
39
Kiesel Plisky,
Kiesel,
Plisky Butler CSM Abstract (2009)
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41
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Responsevs.Adaptation
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Note
The
Thetrainingprogramsimprovedcore
training programs improved core
function.
Butcorefunctionwasnotthefocus.
Thefocuswasmovementpattern
p
correction.
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32 subjects
bj t improved
i
d their
th i score from
f
14 tto > 14
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20playersretainedasymmetries
p y
y
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51
Question
Canastandardizedrisk
managementsystembe
used by the nearly all
usedbythenearlyall
exerciseprofessionals?
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Question
Can
Canthesamesystembe
the same system be
usedtopromotebetter
communicationand
i i
d
transitionfrom
rehabilitationto
performance and fitness
performanceandfitness
programs?
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Question
Cancurrent
researchhelp
hh l
clarifyissuesofrisk
y
associatedwith
conditioning?
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Question
Cantheresearch
implications produce
implicationsproduce
practicalrisk
management
systems?
y
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Brent Grimes
BrentGrimes
FMS21
(aperfectscore)
W
Weight178
i h 178
pounds
KettleBell71
pounds
Double-click to edit
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Double-click to edit
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SSowhatdoyouplantodowiththis
h d
l
d
i h hi
information?
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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.
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Weneedtostopdebatingexerciseandtake
astandonpreexercisescreening
d
i
i
standards.Thestandardsandsystemswill
moldyourfutureprograms.
ld
f
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GrayCook
Gray Cook
,MSPT,OCS,CSCS,RKC
,MSPT
,OCS,CSCS,RKC
FunctionalMovementSystems
AverettUniversity
f ti
l
t
www.functionalmovement.com
QUESTIONS?
Copyright2009NSCAAllRightsReserved
www.nsca-lift.org
www.nsca62
800--815.6826
800