Injury

December 4, 2013

Is Your Athlete Hypermobile?

Contributed by expert, Dr. Jon Herting.

Can your athlete do any of the following things?

Hyperextend their elbows  > 10° on either side Hyperextend their knees > 10° on either side Flex their thumbs to contact their forearm on either side Extend their pinky to a > 90° angle to the rest of the hand on either side Place both palms flat on the floor without flexing the knees  

Beighton_Score

If so they may be hypermobile. Joint hypermobility is estimated to occur in 10-15% of children and is often a benign condition. Also known as double jointed or “loose joints,” these children may be at increased risk for joint subluxations/dislocations and ligament sprains.

The above scale is called the Beighton Hypermobility Scale and it is scored out of 9 points. If your athlete scores > 4 points, among other things, then they are most likely hypermobile and this should be taken into account when a coach, trainer, therapist, or physician assesses your athletes injury or writes their rehab or strength and conditioning program.

Just as joint hypomobility, decreased range of motion, may affect an athlete’s movement patterns and performance, joint hypermobility can also influence their program in a variety of ways which we will discuss.

I was recently speaking at a seminar and presented the audience with the following picture.

hypermobile

I followed this picture up with the question, Do you think this level of mobility is good or bad? One of the parents in the group answered good with several of those around her nodding in agreement. My response to her is that the above level of hypermobility is not necessarily a good thing and that it may actually be setting up her young athlete for injury and should certainly be taken into account when they are being assessed for an injury or prior to a strength or rehab program.

While you may think that being hypermobile may mean that you are more flexible, it doesn’t. Often hypermobility, certainly to the degrees of the above person, is more based in hypermobile joints as opposed to flexible muscles. These joints may be hypermobile for a variety reasons including but not limited to increased laxity and weakness through their ligaments, misaligned joints and abnormally shaped ends of bones.

Many times the “flexibility” is not due to muscle length changes, but increased joint mobility. As a result stretching these athletes who do not need to be stretched will only lead to further joint instability in turn placing your athlete at increased risk for ligamentous tears, sprains and arthritis further down the road. These athletes may still feel tight and have palpable knotting throughout their muscles or they may feel like they can never fully stretch their muscles even though they can touch their palms to the floor during a hamstring stretch. For these athletes foam rolling and other forms of soft tissue release may be more beneficial so that they can increase muscle extensibility for improved performance without further compromising joint stability.

Instead of stretching prior to a workout or competition another option may be to perform various band or joint stability circuits to promote more stable joints prior to competition. By using band exercises and circuits to “activate” your joint stabilizers they can prepare the muscles to stabilize a joint during exercise or competition helping to promote improved body mechanics with the goal to be to improve joint integrity and reduce the risk of injury. An example of a quick band circuit for the hips is below. This circuit is comprehensive in addressing hip movement through multiple movement patterns and all planes of motion. Addressing the hips prior to training or competition can also help to influence knee and ankle position during the activity in order to prevent injuries in these areas.

https://www.youtube.com/watch?v=qlmRhRE-ybA

Maintaining joint integrity is paramount especially if you play a contact sport or participate in dance and gymnastics related activities where you are routinely asked to perform movements or are forced into movements beyond normal joint ROM. A good general rule of thumb is to limit your time and the number of repetitions that you perform into joint hyperextended positions and to strengthen the opposing muscle groups that will help to counteract the stressful motion. For example gymnasts and dancers are often asked to routinely hyperextend their backs. These athletes may benefit from anterior core and trunk stabilizer activities prior to over-extending in order to help support their spine in these compromised positions. This way you may be able to help prevent common injuries including spondylolysis which is often too common in these athletes.

As described in the opening the below scale is used to asses joint hypermobility. If you suspect you or your child may be hypermobile you can use this test to confirm your suspicions. Overall a score of 4 or more and pain for greater than 3 months among other points can help to confirm.

Beighton Hypermobility Test. The screen consists of five tests (four of which are unilateral), and is scored out of 9:

1. Elbow hyperextension > 10° (left and right sides) 2. Knee hyperextension > 10° (left and right sides) 3. Flex the thumb to contact with the forearm (left and right sides) 4. Extend the pinky to >90° angle with the rest of the hand (left and right sides) 5. Place both palms flat on the floor without flexing the knees

Please feel free to leave a comment below if you have any questions or suspect your athlete may be hypermobile.

 

June 25, 2013

Are you teaching your athletes the best way?

Contributed by Coach Ron McKeefery, http://ronmckeefery.com

Most of us coaches were once athletes, try to remember back to when you learned a new skill.  Chances are that you learned one way, while one teammate learned differently, and another teammate learned a third way.  As coaches we know that all athletes are not the same, but yet we often use one method of teaching.  Typically it goes something like this:

Coach – “Have you ever squatted before?”

Athlete – “No”

Coach – “Grab the bar and then squat down”.

box-squat-2

Sound about right?  Maybe we get crazy and actually just get in and show them.  The reality is that there are three ways athletes learn: Auditory, Visually, and Kinesthetically.  When teaching our athletes we make sure to use all three methods when introducing them to a new stimulus.

Sticking with our squat example, we first use verbal information.

Non-Verbal-Communication

We break down exercises into their most basic elements “Ready, Set, Go”.  We tell the athlete to grab a 45lb Bar like they would grab it to do a Bench Press, and pull the bar back towards them to feel the shelf they create with your shoulder blades and traps.  Duck under the bar and place it on that shelf.  In a good athletic position, lift the bar off the hooks and walk out 1-2 steps.  This is the ready position.  Set, place your feet slightly wider than shoulder width and take a deep breath squeezing your shoulder blades together keeping your chest up and head neutral.  Go, hinge your hips first and descend to two inches below parallel, brief pause and then forcefully return to the start position exhaling as you do.

Once they are able to talk through the “Ready”, “Set”, “Go” steps we have them call out the commands as the coach visually demonstrates the lift.  This serves to reinforce what they heard as well as allow them to see the lift.  Most athletes are visual learners.  It is what is reinforced from an early age.  Coaches even at the little league level will practice and then have film sessions to teach.  We can then take it a step further by introducing video analysis as they require more information or advanced coaching.

df_squat

Lastly we use touch and feel to teach them kinesthetically.  Where there body is in space.  This could be as simple as applying pressure to their back and chest (shoulders for female athletes) to keep their chest up.  Hands on the hips and a little pull to make sure the hinge at the hip first, or a tap on the forehead to keep their head up.  If they are having trouble with valgus/varus knees we can use bands to provide the same information.  An athlete must feel the correct position to best understand it.

coaching-the-squat-300x294

For all you die hard squatters out there this is not intended to be a thesis on squat technique, rather demonstrating how you can use Auditory, Visual, and Kinesthetic coaching cues to better your athletes understanding when teaching them a new skill.  Once you have introduced the lifts and they have effectively learned the basics then you can proceed with more advanced coaching cues and techniques.  Additionally, the three methods outlined are not an either/or.  Rather they should be used in conjunction to identify the best method to use with each of your athletes.  By using all three methods you will give your athletes the best chance at success.

                                                                                                                                                                                                                                                                                                                      

June 24, 2013

The Biggest Mistake a Coach Can Make…

Similar to Coach Vern Gambetta’s Facebook post a couple of months ago Speed Coach Lee Taft posted something along the same lines. He has allowed me to share his thoughts below. You can find out more information from Coach Taft at www.speedinsiders.com.

‘Biggest mistakes a coach can make is to not understand the maturation process of kids. Some athletes develop much later while other develop real early. How many times have you seen phenoms at the age of 10, 11, 12 years old and they are labeled the next “Great Player”….than they fade away because everyone catches and passes them up. Then there is the young athlete that coaches push to the sideline because they can’t “Keep Up” due to being smaller, weaker, slower…. Then when they are 17, 18 years old they blossom into a great athlete. These are the athlete that stay competitive for years to come. DON’T GIVE UP ON KIDS!!! Coach beyond the end of your nose.’

Interested to hear your thoughts. Please post them in the comments session.