Category — Injury Prevention

The splenii musculature helps to extend the head/neck, as well as perform ipsilateral (same side) rotation and lateral flexion.  Addressing these muscles as well as the tissue in the cervical-thoracic region in people who are limited in cervical spine range of motion can be extremely helpful and can have an impact on the movement of the entire body.

Here are three ways to address this musculature.

Patrick
patrick@optimumsportsperformance.com

In my last blog entry on stress, Carson Boddicker asked about some ways to quantify stress without getting to extreme.  I offered a few “low-tech” methods which work very well and at the end of the article mentioned some of the more ”high-tech” methods that people can use when sufficient funds allow.

In the comments section of the blog article, track coach Carl Valle mentioned an app available for the iPhone or iPad to evaluate HRV called ithlete.  I heard that they may be making one compatible with the Droid, however nothing for the Blackberry at this moment (which is unfortunate for me).  This seems to be a reasonably priced product and cheaper than some of the Polar watches which can be used to measure HRV.

What is HRV and how can it be used?

Heart Rate Variability (HRV) is one method being used to evaluate the stress of the athlete and determine if they are in a more sympathetic or parasympathetic state, which would then guide the training program for that day. 

HRV assess the interval of time between heart beats by measuring the time between R’s in a QRS wave.  Having a high HRV corresponds with a high Vo2max, while having a low HRV can be an indicator of increased mortality and possible cardiac events.  Additionally, when R-R intervals are plotted the frequency at which the length of time between them is measured – very low frequency power (VLFP), low frequency power (LFP), high frequency power (HFP) and finally a ratio of LFP to HFP.  Different frequencies have different influences on both the parasympathetic and sympathetic nervous system.

In a nutshell, when HRV is high, this can be taken as an indicator of a parasympathetic state and being well rested.  When HRV is low it suggest sympathetic domminance, high stress, and a potentially overtrained state.  Additionally, it should be noted that parasympathetic activity is a major contributor to HFP, while LFP is often accepted as a marketer of sympathetic modulation (however, LFP has been debated in the literature with some suggesting that LFP is a paramater of both sympathetic and parasympathetic influences).  Finally, when the ratio of LFP to HFP is high, this reflects sympathetic dominance.

If HRV is low, back off that day, lower the intensity and volume, or take an off-day and recover.  If HRV is high, then training today is business as usual.  Another interesting thing to evaluate is how well the athlete recovers following a high stress situation like competition.  Athletes who are better conditioned will return to a parasympathetic state faster than those with poor conditioning.  This information can be used to plan training the day after competition for individual athletes.

Trained athletes have higher HRV, HFP, and increased R-R interval times compared to untraied individuals.  Additionally, as noted above, athletes who are in better condition are often able to recover at a faster rate following intense bouts of training and competition.

One thing that I would like to investigate in future articles is the influence that soft tissue therapy and manual therapy can have on HRV and promoting a more sympathetic state, as this has important implications to both recovery from training/competition and rehabilitation from injury.

Patrick
patrick@optimumsportsperformance.com

In response to Monday’s blog post, Stress!!, the following question was asked

Getting into some of our conversation from yesterday, is there any way we can quantify this stuff without extreme ends? Have you used anything like the Profile of Mood States?

Regards,

Carson Boddicker

Carson, great question.  Quantifying whether or not the athlete is under high amounts of stress and ready for intense/high quality work that day can be done several ways.

First, on my general intake form there is a question regarding the clients own subjective stress levels.  This is something that I further enquire about when talking with the individual, as I want to try and determine where they are at before I start adding more stress.  I’ll ask them about their sleep, their overall daily mood, and times when they feel the most stress.

Having a stress profile as you suggested can be helpful.  Having the individual jot down and/or rate how well they slept the night before, how they feel today, are they sore, how hard would they rate the last workout, etc, can provide you with valuable information to plan training on a specific day.  Additionally, resting heart rate and blood pressure can be taken and compared to previous tests to determine if they are at or around their general norm.

If you don’t want to have the athletes fill out paper work every time, you can also just talk to them and observe them during the warm up.  Being a good observer is an important aspect of being a good coach.  Notice how the athlete(s) look when walking into the gym.  Are they looking sluggish?  Do they look down?  What is their overall posture like (this can tell a lot about a persons general mood)?  From there, during the warm up, you may notice the athlete(s) moving in a slower or uncharacteristic manner.  When I see things like this, I immediately start asking more questions.  If I feel that the athlete is not prepared for intense/high quality training that day, based on what I see and the feedback I am getting, then we go ahead and do a back off day or we just do some soft tissue work and mobility exercises.  I have also sent people home on certain occasions when I felt that taking a full day of rest would be the best thing for them.  Additionally, knowing when stressful periods of the year are coming up can help you plan training.  For example, you work with several collegiate athletes.  Midterms and finals time would be a good time to turn down the training stress as the athletes are usually staying up late to study or write papers, and under high amounts of stress from taking tests all week.

Finally, performance measures can be used if you have a base to measure them against.  A vertical jump or a broad jump (following a good warm up of course) can help to determine if the athlete is ready for strength or power work on a given day.  I believe in Fleck and Kraemer’s Optimizing Strength Training, they recommend taking the average of three jumps.  That number should be roughly 90% or greater than their normal vertical or broad jump if you are going to train power or strength that day.  If it is below 90%, then the athlete is not prepared for high quality work that day and should take a back off day to allow for more recovery to ensure they are ready for the next intense workout.

Those are a few “low-tech” ways of evaluating the athlete, others may have additional ideas, so hopefully they leave the in the comments section.  Of course you can also try and go more “high-tech” with things like the Omega Wave (which I confess I don’t know much about at this time) or even a Polar watch/heart rate monitor that can take your heart rate variability (HRV).

Patrick
patrick@optimumsportsperformance.com

The debate about whether or not to do lumbar flexion exercises (sit ups, knee ins, bicycles, v-ups, etc) is a heated one.  To tell you the truth, it probably wont ever end as professionals will always reside on one side of the fence (lumbar flexion isn’t that bad!) or the other (stabilize, stabilize, stabilize!).

Dr. Stuart McGill has done a great job conducting research on the topic and lecturing around the world regarding appropriate training strategies for strength coaches, fitness professionals, and rehabilitation specialists.  However, one of the common debates that often comes up is, “Competitive fighting athletes go through lumbar flexion (sometimes very aggressive lumbar flexion) in their sport and thus we must train that movement to ensure that they are adequately prepared for competition.”

Sounds good, right?  After all, the role of the strength coach is to prepare the athlete for their competitive endeavors! 

The only problem I see with this argument is that as the strength coach, we need to ensure that the athletes are healthy and injury free.  If we know that the mechanism of disc injury is repeated flexion, and we know that the athletes go through this movement in their sports training and competition, is this a movement that we really need to do more of in the gym?  To me, that sounds like the same as doing a high volume plyometric program for an inseason basketball or volleyball athlete.  They are already getting a lot of contacts in practice and games, why do we need to load that up more?  In fact, we should unload that and do something with less impact that sufficiently addresses the strength needs of those athletes.  Speaking of basketball, when taking a jump shot, athletes will typically go into knee valgus.  With this same mentality, shouldn’t we train that movement it so that they are prepared for it when it happens in a dynamic environment like competition?  Obviously I don’t expect anyone to answer “yes” to that question.

The next point that is always brought up is “Athletes who fight competitively all over the world train using lumbar flexion exercises and then go and practice and compete and do more lumbar flexion and don’t seem to have problems.  Maybe it isn’t such a big deal.”

One of the things science does is helps us to remove our assumptions of what we think is going on based on our observations.  Our assumptions are brought about by several factors including the sample size of people we are working with and our own personal bias towards what we are doing.  Basically, we put it in the hands of a neutral third party who tests these assumptions and then comes back to us an either says, “Yep, you were right!  It looks like that is happening”, or “Actually, we tested your assumption and we found the opposite to be true.”  This of course leads to more research and more questions and eventually theories are developed to help give us a larger explanation of what is taking place.

While the idea that, “Training these movements is essential because they happen in sport” may sound good on paper, are the programs being created really helping these athletes compete without incident?

A 2007 study conducted by Okada et al, looked at the prevalence of nonspecific low back pain and lumbar radicular abnormalities in 82 male judo athletes in three different weight classes – light, middle, and heavyweight. 

Back pain:

• 10 out of 29 lightweight athletes had nonspecfic low back pain (34.5%)
• 10 out of 31 middleweight athletes had nonspecific low back pain (32.3%)
• 9 out of 22 heavyweight athletes had nonspecific low back pain (40.9%)

Lumbar radicular abnormalities:

• 19 out of 29 lightweight athletes exhibited lumbar radicular abnormalities (65.5%)
• 28 out 31 middleweight athletes exhibited lumbar radicular abnormalities (90.3%)
• 20 out of 22 heavyweight athletes exhibited lumbar radicular abnormalities (90.9%)

With lumbar radicular abnormalities and WITH low back pain:

• 50% in the lightweight group
• 100% in the middle weight group
• 88.9% in the heavy weight group

With lumbar radicular abnormalities and WITHOUT low back pain:

• 73.7% in the lightweight group
• 85.7% in the middleweight group
• 92.3% in the heavyweight group

The researchers concluded that the prevalence of low back pain in this group ranged from 30-40% and that the prevalence of lumbar radicular abnormalities with nonspecific low back pain (79.3%) and without nonspecific low back pain (83%) suggest a lack of association between back pain and imaging (this should come as no surprise since it has been indicated in previous research). While medical imaging didn’t give us the full picture as some athletes had pain without positive imaging and others with positive imaging did not have pain, low back pain appears to be a problem in this group of athletes and Okada et al state, “Because nonspecific low back pain is a common complaint among athletes, it is important that the athletes and their coaches work towards prevention so that athletes can continue their sports activities.”

In the wrestling community, reports of low back pain have been shown to be as high as 69%.  Wrestlers are a group who spend a lot of time on the mat getting into and (hopefully) out of a variety of positions. Iwai and colleagues (2004) evaluated trunk muscle strength and functional disability of chronic low back pain in 53 college wrestlers.  The wrestlers were evaluated for radiological abnormalities and isokinetic trunk muscle strength.  They found that 14 of the subjects with radiological abnormalities had low back pain (40%) and 8 of the subjects without radiological abnormalities had low back pain (44%).  Similar to the study by Okada et al, we see that the percentage of those with low back pain and with or without radiological findings is relatively close.  Iwai et al, concluded that low trunk extensor strength may be a potential factor in chronic nonspecific low back pain in this population of athletes.  Which would be in contrast to those supporting more lumbar flexion training for these types of athletes. 

Just looking at these two studies, we see that maybe the assumptions being made regarding lumbar flexion training and competitive fighting athletes is not a good one.  Perhaps the anecdotal information that we get from other coaches is not valid?  In other parts of the world, how much pain/injury goes undocumented or maybe the athletes don’t even bring it to the coach’s attention?  How well is the record keeping of these coaches?  Everyone seems to remember the “hits”, “This is how we’ve have always done it and we have had 10 world champions.”  However, they failed to remember the 30 other athletes that were sidelined with injury.  Are we missing people?

Conclusions

Low back pain is common in sports and the training program should be comprehensive and well thought out in a manner that helps to prevent or reduce the incidence of injury.  While some potentially injurious movements happen in sport that doesn’t necessarily mean that we need to further train those movements in the gym.  Rather, it may be more advantageous to prepare athletes to handle the loads and forces placed upon them in competition with a strength and conditioning program that teaches healthy movement and does not seek to overtrain/overuse patterns that are commonly performed in both sports preparation and competition.

Patrick
patrick@optimumsportsperformance.com

References

Okada T., Nakazato K. Iwai K., Tanabe M., Irie K., Nakajima H. Body Mass, Nonspecific Low Back Pain, and Anatomical Changes in the Lumbar Spine in Judo Athletes. JSOPT 2007;37(11):688-693.

Iwai K., Nakazato K., Irie K., Fujimoto H., Nakajima H., Trunk muscle strength and disability level of low back pain in collegiate wrestlers. Med Sci Sport Exer 2004;36(8):1296-1300.

I was recently interviewed by my friend and colleague Zack Lush on the topic of arm care for high school baseball players.  I talked mainly about soft tissue therapy and recovery strategies.  While there is a question or two that are specific to baseball, most of what is in the interview can be applied to high school athletes in any sport.

Hope you enjoy it!

Patrick
patrick@optimumsportsperformance.com