Thank you for attending NSCA’s Webinar today.

The
Webinar will begin soon. For audio, dial into the conference
line provided via e-mail received at the time of registration.

For technical difficulty, please call

866.229.3239

The National Strength and Conditioning Association

Presents

Mobility, Stability and Movement:

with
Gray Cook,
, , ,

www.nsca‐lift.org
1
October 07, 2009 800‐815.6826
 The Risk of Conditioning
• Conditioning does not seem to prevent
.
• Sometimes it actually creates false
con ence.
• Used incorrectly it even can increase risk.

Copyright © 2009 NSCA All Rights Reserved 2

 athletes sustain non‐
contact injuries?

• And……why is previous
n ury t e num er #1 r s
factor in sports?

Copyright © 2009 NSCA All Rights Reserved 3

 Who can we blame?

• The Trainer

• The Strength Coach

• The Physical Therapist

Copyright © 2009 NSCA All Rights Reserved 4

 What do we know
actually know about
Injury Risk?

Copyright © 2009 NSCA All Rights Reserved 5

• Two prospective
studies in soccer
players implicate
hamstring and

risk factor
(Sodermann 2001,
Witvrouw 2003)

Copyright © 2009 NSCA All Rights Reserved 6

• 2 studies found no association

• Krivickas 1996 (all collegiate sports)

• Arnason 1996 (soccer)

Copyright © 2009 NSCA All Rights Reserved 7

–

Copyright © 2009 NSCA All Rights Reserved 8

• It’s not movement oriented.

• Intent on discussing the remedy with out

actuall discussin the roblem.

Copyright © 2009 NSCA All Rights Reserved 9

These guys may have the same
’
the same movement scores

Double-click to edit Double-click to edit

Copyright © 2009 NSCA All Rights Reserved 10

 Consider
Flexibility...

in contrast to
Movement Patterns

Copyright © 2009 NSCA All Rights Reserved 11

Copyright © 2009 NSCA All Rights Reserved 12
Is this a bad movement or have
we ust become bad squatters?

rgue or a cu ura
weakness and you will
soon own it!
Copyright © 2009 NSCA All Rights Reserved 13
biomarkers for the
.

Copyright © 2009 NSCA All Rights Reserved 14

• The official NIH definition of
a omar er s:
– “A characteristic that is

evaluated as an indicator
of normal biologic
processes, pat ogenic
processes....

Copyright © 2009 NSCA All Rights Reserved 15

• Previous Injury
• A mm tr
• Motor Control
•
• Stupidity

Copyright © 2009 NSCA All Rights Reserved 16

• 23 Prospective

• Increased Injury Risk

– -
of injury

Copyright © 2009 NSCA All Rights Reserved 17

athletes / fitness clients / and patients...

Copyright © 2009 NSCA All Rights Reserved 18

• Something fundamentally changes
after injury...

Copyright © 2009 NSCA All Rights Reserved 19

• Or Both

Copyright © 2009 NSCA All Rights Reserved 20

 • reng
• Flexibility
• Alignment
•
• Joint Laxity

Nadler et al 2001, Myer 2008, Soderman 2001, Baumhauer 1995, Rauh 2007
Ekstrand 1983, Knapik 1991, Plisky 2006, Yeung 2008

Copyright © 2009 NSCA All Rights Reserved 21

 Asymmetries
• Y Balance Test ‐ Identifies Athletes at

• cm right/left anterior reach difference (3x

more e y

Bottom 1/3 of peers

(Women 6 times more likely to get injured)

Plis
Plisk
k et al JO
JOSP
SPT
T 2006
2006

www.ybalancetest.com

Copyright © 2009 NSCA All Rights Reserved 22

• Knapik indicated
indicated that no clear evidence
evidence was identified
identified

muscle group with injury, but a significant amount of

injuries were noted in athletes with right to left sided
strength and flexibility imbalances (asymmetries).

Double-click to edit Copyright © 2009 NSCA All Rights Reserved 23

• “ ”
• “ Dynamic
ynamic Neuromuscu
urom uscula
larr Control”
• “ ”

Double-click to edit
Copyright © 2009 NSCA All Rights Reserved 24
• Trojian & McKeag 2006
• Wang et al 2006
• Plisky et al 2006
• McGuine et al 2000
• Watson 1999
• Tropp et al 1984

Copyright © 2009 NSCA All Rights Reserved 25

 Neuromuscular Control and
Proprioception
• Zazulak 2007
• 277 collegiate athletes (140 female and

• Trunk displacements (in response to

sudden unloading)
•
error) and a
• History of low back pain, predicted knee
ligament injury with 91% sensitivity and
68% specificity.

Copyright © 2009 NSCA All Rights Reserved 26

Neuromuscular Control

• Hewett 2005

• Increased knee
ABDuction angle was 8
degrees greater and Double-click to edit

2.5x greater ABD

ACL injured

•
increased ground
reaction for ce and
decreased stance time

Double-click to edit
Copyright © 2009 NSCA All Rights Reserved 27
 B iz BMI

• McHugh et al 2006
• T ler et al 2006
• Gomez et al 1998
• Lymann 2001 (baseball)
• uarr e rug y

Copyright © 2009 NSCA All Rights Reserved 28

Stu idit ... You can rove it,
but you can’t fix it!

Copyright © 2009 NSCA All Rights Reserved 29

 (prospective studies)

• Previous Injury (23) - “ loaded statistic”

• Asymmetries (8)
• Motor Control (7)
• BMI (5)
•

Copyright © 2009 NSCA All Rights Reserved 30

 ...

Copyright © 2009 NSCA All Rights Reserved 31

• “

Copyright © 2009 NSCA All Rights Reserved 32

 It is ironic...

• that research and

good old common
sense are pointing in
the same direction for
a change ‐ or is it
common sense
research.

Copyright © 2009 NSCA All Rights Reserved 33

 THE FUNCTIONAL MOVEMENT SCREEN ‐ A movement standard since 1997

1. Squatting
2. Stepping
3. Lunging

5. Leg raising
6. Push-up
. o ary a y

Copyright © 2009 NSCA All Rights Reserved 34

 ‐ ‐
• Score a three for correct movement pattern
• Score a two for movement pattern with
compensation or lack of correctness
•
pattern

correctness

Copyright © 2009 NSCA All Rights Reserved 35

• 81 Professional Football Players

• Built a re ression model to redict in ur 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 b ody
,

Kiesel, Plisky, Kersey ACSM Abstract (2008)

Copyright © 2009 NSCA All Rights Reserved 36

FMS In ur Stud
• Players who were ≤
.
more likely to be
. - .

•
asymmetry 3x
(p<0.05) more likely
to be injured (CI95
1.1-10.6)
Kiesel, Plisky, Kersey ACSM Abstract (2008)
Copyright © 2009 NSCA All Rights Reserved 37
• Having both risk factors was highly specific
0.98 (CI95 .93-.99) LR+ = 13.4 (CI95 2.3-84.2)

• Rookie/veteran and power measures were

not predictive.

Kiesel, Plisky, Kersey ACSM Abstract (2008)

Copyright © 2009 NSCA All Rights Reserved 38

 FMS Intervention Stud

• The purpose of this

study was to
determine if an off-
season intervention
program was effective

scores in professional
football players.

Kiesel, Plisky, Butler CSM Abstract (2009)

Copyright © 2009 NSCA All Rights Reserved 39
• Pre-test/post-test design

• 62 Professional Football Players who had not been

previously screened with the FMS

• Grouped: Lineman and non‐lineman

, ,

Copyright © 2009 NSCA All Rights Reserved 40

• Underwent a standardized 7-week off-season
training program

• Program was based on the individual athletes FMS score

• Included “movement preparation” and “corrective

exercise”

Kiesel, Plisky, Butler CSM Abstract (2009)

Copyright © 2009 NSCA All Rights Reserved 41
• Movement Prep
– Stick Work
– Isolated

Copyright © 2009 NSCA All Rights Reserved 42

• Movement

Corrective

Double-click to edit

Copyright © 2009 NSCA All Rights Reserved 43

 Response vs. Adaptation

Double-click to edit Double-click to edit

Double-click to edit Double-click to edit

Copyright © 2009 NSCA All Rights Reserved 44
Copyright © 2009 NSCA All Rights Reserved 45
Copyright © 2009 NSCA All Rights Reserved 46
•
function.

• But core function was not the focus.

• The focus was movement attern

correction.

Copyright © 2009 NSCA All Rights Reserved 47

• ≤ 14 has been established as a cut point

• su ec s mprove e r score rom o>

• -

Copyright © 2009 NSCA All Rights Reserved 48

• As mmetr

• 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

Copyright © 2009 NSCA All Rights Reserved 49

• 23 sub ects failed to im rove be ond the
threshold of ≤14

• Scoring lower on the Deep Squat was associated with

failure
. . ‐ .

• 20 players retained asymmetries

Copyright © 2009 NSCA All Rights Reserved 50

•
standardized system.

correction, but the screen seemed to

.
• Some potential suggestions are more
nvo ve assessment an more a vance
soft tissue work.

Copyright © 2009 NSCA All Rights Reserved 51

• Can a standardized risk
management system be

exercise professionals?

Copyright © 2009 NSCA All Rights Reserved 52

•
used to promote better
commun cat on an
transition from
rehabilitation to

programs?
Copyright © 2009 NSCA All Rights Reserved 53
• Can current
researc e p
clarify issues of risk
associated with

Copyright © 2009 NSCA All Rights Reserved 54

• Can the research

practical risk
management
s stems?

Copyright © 2009 NSCA All Rights Reserved 55

• YES

Copyright © 2009 NSCA All Rights Reserved 56

 ‐

• FMS‐21
– (a perfect score)

• eg t
pounds
• Kettle Bell 71
pounds

Double-click to edit

Copyright © 2009 NSCA All Rights Reserved 57

 Double-click to edit

Copyright © 2009 NSCA All Rights Reserved 58

o w at o you p an to o w t t s

Copyright © 2009 NSCA All Rights Reserved 59

• The skeptics said give us data... DONE

• The pessimists said we don’t have time to

• e o s sa e screen con uses us ‐ us

give us your exercises... THE EXERCISES ARE

GREATEST DYSFUNCTION.

Copyright © 2009 NSCA All Rights Reserved 60

• We need to stop debating exercise and take
a stan on pre‐exercise screening
standards. The standards and systems will
mo your uture programs.

Copyright © 2009 NSCA All Rights Reserved 61