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Thanks!
8.18.2016
7.17.2016
Hip Thrusts: Are they All That?
A friend sent me an essay that makes an argument for Hip Thrusts being better than squats for the purpose of improving running speed. This defines and discusses something called the Force Vector Theory of Transfer
[Below is copy and pasted from https://www.strengthandconditioningresearch.com/promotions/horizontally-directed-exercises/]
Typically, these are referred to as “vertical” and “horizontal” although strictly the correct terms are axial (for vertical) and anteroposterior (for horizontal), as these refer to force directed from the feet towards the head, and force directed from the back of the body to the front of the body, respectively.
So the squat has an axial (vertical) force vector, like this:
Force is applied by the feet into the ground, and the direction of the force is from the feet towards the head.
If the force vector is important, we should therefore expect the squat to transfer better to athletic abilities involving axial (vertical) movements, like vertical jumping. We might expect it to transfer less well to athletic abilities involving anteroposterior (horizontal) movements, like broad jumps and sprinting.
On the other hand, the hip thrust exercise has an anteroposterior (horizontal) force vector, like this:
Force is applied by the feet into the ground and by the back into the bench, and the direction of the force is from the back of the body towards the front of the body.
If the force vector is important, we should therefore expect the hip thrust to transfer better to athletic abilities involving anteroposterior (horizontal) movements, like broad jumping and possibly even sprinting. We might expect it to transfer less well to athletic abilities involving axial (vertical) movements, like vertical jumps.
- - - - - -
The writing goes on to site a recent study that found hip thrusts to be superior to front squats in horizontally directed movements. The hip thrust group improved their horizontal jump distance and sprint times SLIGHTLY as compared to almost no improvement in the squat group.
Effects of a six-week hip thrust versus front squat resistance training program on performance in adolescent males – a randomized controlled trial, by Contreras, Vigotsky, Schoenfeld, Beardsley, C., McMaster, Reyneke, & Cronin, in The Journal of Strength & Conditioning Research (2016)
Okay. Never mind that. Let's NOT do the Time Warp again...
[Below is copy and pasted from https://www.strengthandconditioningresearch.com/promotions/horizontally-directed-exercises/]
What is the force vector theory of exercise transfer?
The force vector is the direction in which force is applied with respect to the body.Typically, these are referred to as “vertical” and “horizontal” although strictly the correct terms are axial (for vertical) and anteroposterior (for horizontal), as these refer to force directed from the feet towards the head, and force directed from the back of the body to the front of the body, respectively.
So the squat has an axial (vertical) force vector, like this:
Force is applied by the feet into the ground, and the direction of the force is from the feet towards the head.
If the force vector is important, we should therefore expect the squat to transfer better to athletic abilities involving axial (vertical) movements, like vertical jumping. We might expect it to transfer less well to athletic abilities involving anteroposterior (horizontal) movements, like broad jumps and sprinting.
On the other hand, the hip thrust exercise has an anteroposterior (horizontal) force vector, like this:
Force is applied by the feet into the ground and by the back into the bench, and the direction of the force is from the back of the body towards the front of the body.
If the force vector is important, we should therefore expect the hip thrust to transfer better to athletic abilities involving anteroposterior (horizontal) movements, like broad jumping and possibly even sprinting. We might expect it to transfer less well to athletic abilities involving axial (vertical) movements, like vertical jumps.
- - - - - -
The writing goes on to site a recent study that found hip thrusts to be superior to front squats in horizontally directed movements. The hip thrust group improved their horizontal jump distance and sprint times SLIGHTLY as compared to almost no improvement in the squat group.
Effects of a six-week hip thrust versus front squat resistance training program on performance in adolescent males – a randomized controlled trial, by Contreras, Vigotsky, Schoenfeld, Beardsley, C., McMaster, Reyneke, & Cronin, in The Journal of Strength & Conditioning Research (2016)
But I think the much more pertinent question is "Are hip thrusts necessary and more beneficial than deadlifts or other hinge variations?" Instead, we should compare hip thrusts to dead lifts and kettle bell swings.
My opinion is that dead lifts probably "win."
When you visualize the bottom of a DL or KB swing, the hips are moving front to back and even though the weight is moving vertically there is a substantial (relative to torso) horizontal component to it.
I think DLs and to a slightly lesser extent KB swings provide a much better over-all training effect. I could type all fancy about neurological and proprioceptive benefits, but suffice to say that there is great value when the brain has to learn how to hinge the hips front to back -while- stabilizing the spine and working in an upright position. I see hip thrusts as a great alternative to dead lift variations for individuals who cannot deadlift due to pain or other issues.
To briefly summarize:
To briefly summarize:
Squat variations = better than hip hinge exercises for building leg size and vertically oriented power movements like jumping.
Hinge variations = better than squat variations for building hip and torso (lower and upper back) size and horizontally oriented power movements like horizontal jump and sprinting.
In the real world there definitely should be room for BOTH!
***Also of note:
Bret Contreras seems like a good guy. I really like his work and tone. But he sales these hip thrust devices and is constantly talking about how great they are. I'm not saying his research or research reviews are intentionally misleading...maybe hip thrusts truly are THAT great. But it could -possibly- be biased in some ways. Like experimental design comparing hip thrusts to squats rather than dead lift variations.
7.13.2016
What you should be eating
Do you know that weird diet thing going on, where so many people simply CANNOT eat this and HAVE to eat that, in the name of health or fitness? ...I mean, how do you really explain the continued existence of detoxes and cleanses, strict ratios and meal-plans, and Whole Foods and it's spin-offs...
Well - here's an odd collision of readings for tonight. Head nutritionist of Olympic athletes Louise Burk, and Frank Zappa
I read quite a bit RE training and nutrition. Everyone needs to hear this:
"The modern trajectory for most popular diets is that they burst onto the scene and gain huge publicity via support from traditional and social media, and uptake by celebrities and other people with popular influence. The rules are tightly adhered to by the first wave of followers, and because the rules of What Can’t Be Eaten typically make it difficult to eat as much as normal, weight loss and associated benefits are a common experience. Unfortunately for the diet, its next phase involves the take up by wider set of people and spinoffs by the food industry, hospitality industry and the secondary book/cookbook industry. Suddenly, there is a proliferation of Paleo cafes, Paleo dessert books, Paleo food products etc. And the next wave of devotees isn’t so committed to marching to the drum. They are Paleo-ish—choosing the bits and pieces of the diet that appeal to them. Or just replacing chocolate bars with Paleo Bars full of contrived ingredients. Usually, by this stage, many of the benefits of the diet, especially around weight loss, start to flee because the opportunity to overeat is restored."
-Louise Burk
-Louise Burk
I don't know much about Frank Zappa. But tonight while doing the dishes I came across and listened to an interview. I'm not suggesting that we take everything he says at face value. But this did get me thinking.
"I think that’s a reasonable way to look at it because [the U.S.] doesn’t have any real sort of values, you know? And a fad provides you with a temporary occupation for your imagination. Really, [America] doesn’t have any real culture. It doesn’t have any real art. It doesn’t have any real anything. It’s just got fads and a gross national product and a lot of inflation."
This when the real solution for diet is surprisingly simple (notice that I did not say easy).
-Eat minimally processed foods
-Load up on fruits and vegetables
-Limit (but don't altogether quit) treating yourself.
-Stay generally active and include some free weight resistance exercise in order to improve and maintain your strength, balance, and general physical abilities.
But instead we have a perfect storm for confusion on how we should eat.
We have a lot of people who are not fit or less-than-satisfied with their level of health and fitness.
We have a lot of people eager for something new, easy, or the next big thing (fads).
We have a of people well schooled in pseudo science and ready to cash in.
7.05.2016
Twinkie Eating Contest
So I won an eating contest. This is not exactly something I would put on a Bucket List, if I had one. I'm still not sure whether to celebrate with pride or hang my head in shame and quietly ponder the depths to which a competitive spirit may drive a person.
This was The Second Annual Stoddard Community Group (Living Hope Church) Twinkie Eating Extravaganza. It began innocently enough, in July of 2015, when someone in the group joked "We should make it a typical July 4th party and include an eating contest." But then...
There was trash talk and posturing. There were sermon notes with key words replaced by Twinkie. There is video evidence.
The competition was fierce and various strategies were employed.
The cram and choke.
The nibble.
The cram and drown.
The laugh and blow chunks on women and children spectators (grounds for disqualification).
But one victor emerged.
It wasn't a mere standard Twinkie. It was a limited edition yellow sponge cake packed with fluorescent green Key Lime Slime filling. Yes, these are real and approved by the FDA.
Gary, a wise friend of the group who would not stoop to those depths, read the ingredients before the competition. I covered my ears.
"LA-LA-LA-LA-LA-LA-LA..."
Before and after the event, I reasoned with myself:
"ALL competitive eating is obnoxious and plain gross."
"It's okay. It's just for fun. And downing two Twinkies for time is a much more dignified eating contest as compared to seeing how many Twinkies can be packed into one's GI tract."
Yes, those were my actual thoughts. This is never, under any circumstance, a reasonable use of the word "dignified."
And so I went ahead with my second (ever) eating contest, and pounded 440 calories worth of Key Lime Slime Twinkies in 37.40 seconds. This took place in the exact location where I regularly preach and practice the finer details of performance training and dietary moderation.
The Bonny Lane Club has been defiled by Christians, a competitive band of brothers and sisters who understand the tremendous value of lighthearted fun.
We laughed at all the ridiculousness until our faces and stomachs hurt. We talked and ran around in the back yard well past dusk. For (mostly) better and worse, our memories, and likely that of our children, will never be the same.
And Lord willing, in the same time and location next year, The Champ will be granted an opportunity to defend his title.
7.01.2016
Beast Mode OFF: Training versus Testing
Any fitness and athletic related goal can be yours if you're willing to sacrifice. Practice or play the game every day. Run and stretch and hit the weights. Go hard or go home. Give 110% each and every workout. Pain is weakness leaving the body and sleep is for babies.
Truth is:
For serious athletes (and definitely their parents and coaches), the pendulum has swung too far. The all things high intensity approach is absolutely not ideal for long-term health and athletic development.
Everyone needs a test. And a rest.
An objective goal or considerable challenge makes the pursuit of health and fitness immeasurably more interesting than simply showing up to "workout" or having a desire that your team will "win the division."
Run a 5K or 40 yards in under X minutes or Y seconds.
Throw 85 mph.
Perform 5 strict pull-ups.
Gain 15 pounds of muscle.
A 3-minute "Fran" [Recognized in Crossfit circles]
Deadlift twice your body weight.
20 Rep Squat your body weight.
I'm all for goals and tests. But herein lies a common mistake.
There are problems with making the workout the test and the test the workout, especially for high level athletes.
AMRAP (as many reps as possible) or as many ANYTHING as possible is fine for a test. But it's not a great idea in terms of physical preparation, especially for a particular sport that demands a specific fitness and skill set.
Newbies get away with pushing full tilt multiple times per week. They can add resistance to their one- or 10-rep max lifts without running themselves into the ground. But that lasts only for a while. When intermediate and advanced athletes push themselves in a test too frequently, progress stagnates or they get injured.
Once you are reasonably fit and strong, the best way to get faster and stronger is not simply adding more weight, more mileage, more reps, more more more. Progress is rarely linear in any facet of life. Strength training and conditioning is not rocket science. But the pursuit of high level performance demands a little tact and planning.This is especially important for athletes who are looking to use the weight room in order to improve on the athletic field. Hard work is certainly in order! But going full throttle too frequently and treating each workout like a competition will work against you in terms of performance and being prone to injury.
Learn from my mistakes:
For years I did one intense set of 20 REP SQUATS on every Saturday. Week in, week out, it was a few warm-up sets, then one horrifically awesome set of 20 reps.
If one set does not sound like a big deal to you, then you need to get acquainted with 20-rep squats HERE.
The weekly Squatting Deathmarch ritual would continue until I faced an interruption like vacation or some type of injury. Did 20-rep squats "work?" Yes. I built up to some fairly ridiculous weights in this feat. And they were a big part of how a busy professional maintains a fit and strong physique with only two workouts per week. The experience wasn't all bad.
But in time, Saturday nights became relatively worthless and Sundays were hangover day even though I drink very little. I realized that this 20 Rep Squat routine had became a test and I was pushing my limits far too frequently.
Through reading and experience (learning the hard way), I realized that there is a better way.
These days, I squat with a fair amount of intensity, awfully hard by the standard of an average gym-goer. But 20-rep Squats come up only once every three to four weeks. Or we do them for a span of 8 to 10 weeks and then take time altogether away from it.
Right now I'm in the middle of a different squat challenge that I hereby label the Mazel Tov Squat Challenge. I'll leave the details for another time. The important note is that the intensity work has been cycled and will peak to achieve a near superhuman physical feat. I will train for the test, do the test, then back off for a while.
And the fitness journey and high intensity work is absolutely fun when you feel like a beast instead of a wet wash rag because you planned intelligently. The few clients that I train and I attempt to pin this down to a science.
There are a few important steps:
-Invite some friends along on the journey.
-Trash talk
-Plan (lay out the short and mid-term goals) and then implement the build-up.
-For a few days before the test, taper outside and other training activities.
-On the day of the event, wear your p.r. shirt, warm-up well, put on the -right- song, and let her rip full throttle!
Do you see how much more fun this is than droning through workout DVDs or mind-numbing "cardio?" Can you imagine what it's like to arrive on "game day" feeling prepared and eager instead of banged-up and flat?
Athletes and fitness-minded people need to remember that the magic is in the process.
-Value the process.
-Be systematic in your training (rather than random).
-Be consistent.
-Be patient.
-Give it your all and go HARD on the day of the test.
For better or worse - there will be some degree of transformation. In the mean time, whether or not the initial goal is actually achieved, you will have learned about yourself and achieved something remarkable to apply toward your event and your life.
But in time, Saturday nights became relatively worthless and Sundays were hangover day even though I drink very little. I realized that this 20 Rep Squat routine had became a test and I was pushing my limits far too frequently.
Through reading and experience (learning the hard way), I realized that there is a better way.
This wet wash rag is precisely what it feels like to have
Beast Mode On for too long, too often.
|
These days, I squat with a fair amount of intensity, awfully hard by the standard of an average gym-goer. But 20-rep Squats come up only once every three to four weeks. Or we do them for a span of 8 to 10 weeks and then take time altogether away from it.
Right now I'm in the middle of a different squat challenge that I hereby label the Mazel Tov Squat Challenge. I'll leave the details for another time. The important note is that the intensity work has been cycled and will peak to achieve a near superhuman physical feat. I will train for the test, do the test, then back off for a while.
There are a few important steps:
-Invite some friends along on the journey.
-Trash talk
-Plan (lay out the short and mid-term goals) and then implement the build-up.
-For a few days before the test, taper outside and other training activities.
-On the day of the event, wear your p.r. shirt, warm-up well, put on the -right- song, and let her rip full throttle!
Do you see how much more fun this is than droning through workout DVDs or mind-numbing "cardio?" Can you imagine what it's like to arrive on "game day" feeling prepared and eager instead of banged-up and flat?
Athletes and fitness-minded people need to remember that the magic is in the process.
-Value the process.
-Be systematic in your training (rather than random).
-Be consistent.
-Be patient.
-Give it your all and go HARD on the day of the test.
For better or worse - there will be some degree of transformation. In the mean time, whether or not the initial goal is actually achieved, you will have learned about yourself and achieved something remarkable to apply toward your event and your life.
6.22.2016
Plyometrics for Conditioning
Today I finished treating a runner who had been struggling to recover from a foot injury. She is back on the road again, hoping to complete her first marathon in early 2017.
In order to run faster and stay healthy, she began an on-line strength training routine for runners. The injury she sustained while doing the program set her back at least six months. This is not the first or last occasion of treating an injury caused by an on-line or DVD program like P90X. This is not even the first time that IronStrength For Runners has brought business to my office.
This particular program was created by a "nationally known sports medicine physician" and sponsored by Runners World magazine. The workouts are not terrible if you consider the mode of delivery. But they're not good, either.
I assume that Dr. Metzi, the creator, ignored or does not know what I'm about to tell you. I have mixed feeling about saying it outright. After all, injuries keep me gainfully employed. But here goes:
--- DO NOT PERFORM PLYOMETRICS FOR CONDITIONING (i.e. what most people call burning calories or generally getting in shape). ---
Inappropriate use and progression of plyos are some of the top reasons for active young- and middle aged people to require physical therapy.
[Plyometrics are explosive powerful training exercises (usually variations of jumping, hoping, and throwing) that effectively activate a quick response and elastic properties of muscles and joints. Here is the Wikipedia entry.]
Plyometrics are included in most home-based programs because they are challenging, require very little equipment, and they produce results.
I'm not against them. Plyometrics are actually great...so long as they don't destroy you.
Almost every single DVD or on-line fitness guru will have you doing plyometrics inappropriately:
-You will be doing plyometrics without feedback on your form.
-You will be doing plyometrics without even knowing if your body possesses the flexibility and strength to achieve proper form.
-You will often be jumping into plyometrics without systematically increasing the resiliency of the muscles and connective tissue.
-You will often be jumping and thrusting around until you're blue in the face (in a state of high fatigue).
Each one of these factors -alone- is enough to cause injury, even in young people. Sorry, but it's the nature of the beast. On-line and DVD fitness programs simply cannot be custom tailored to assess and coach each person on the other side of the screen. And some of them are downright bad (poorly designed).
People of all fitness levels and walks of life make errors in their training. We go too hard or heavy, for too long, too often. We perform exercises incorrectly. We assume that what is healthy or "worked" for someone else is necessarily going to "work" for us. A fitness program or DVD simply cannot navigate the details of where you fit in.
I've made my share of training errors and experienced (and continue to experience) the consequences. Injuries...they happen. But the risks are often manageable, and well worth the benefit (and fun!) of leading an active lifestyle.
So put some thought into your plyometric training:
-While plyometrics impose various amounts of impact on the joints, the target body part is the nervous system. Plyos teach the brain to control and coordinate the entire body to be powerful and quick. If 20 minutes once or twice per week is good, more is NOT better.
-Seek instruction from someone who knows what they are doing. Ask questions like "Why am I doing this?" and "What does that certification mean?" If the answers sound like fitness jargon b.s., it is.
-Ideally, you should go through a basic movement screen to see that you pass the known prerequisites to beginning plyometric exercise.
-If you do stand to benefit from and tolerate plyometric activities, do not perform them in a state of fatigue. Keep the rest periods long and the work periods short and powerful. You should never feel completely gassed from these activities.
-For conditioning (getting in shape, calorie burning for weight loss, etc), find lower impact, grinding alternatives like variations of sled push, kettlebell swings and carry, farmer walk, rowing and stationary bike intervals, battling ropes, hill walks, jogs, and sprints, etc.
-If you are a serious runner or other endurance based athlete, see the above points AND do not confuse your resistance and plyometric training with just adding more endurance work. Your muscular endurance is already stellar, and you will benefit most from increasing your strength and power. So "lift" relatively heavy, leap and bound in short, powerful blasts, and be smart about exercise selection.
Again, find a guide for six or 8 weeks. This is usually plenty of time for you to ...
lose 30 pounds and gain huge amounts of strength and vertical jump and rock hard 12 pack abs
...you to TRULY LEARN how to best fit an effective exercise program to the structure of your body and the demands of your activity.
My apologies to Insanity. I want to thank them for the referrals. And if I spared you an injury, please direct your friend, uncle, or cousin who sustained an Insanity injury to my office.
In order to run faster and stay healthy, she began an on-line strength training routine for runners. The injury she sustained while doing the program set her back at least six months. This is not the first or last occasion of treating an injury caused by an on-line or DVD program like P90X. This is not even the first time that IronStrength For Runners has brought business to my office.
This particular program was created by a "nationally known sports medicine physician" and sponsored by Runners World magazine. The workouts are not terrible if you consider the mode of delivery. But they're not good, either.
I assume that Dr. Metzi, the creator, ignored or does not know what I'm about to tell you. I have mixed feeling about saying it outright. After all, injuries keep me gainfully employed. But here goes:
--- DO NOT PERFORM PLYOMETRICS FOR CONDITIONING (i.e. what most people call burning calories or generally getting in shape). ---
Inappropriate use and progression of plyos are some of the top reasons for active young- and middle aged people to require physical therapy.
[Plyometrics are explosive powerful training exercises (usually variations of jumping, hoping, and throwing) that effectively activate a quick response and elastic properties of muscles and joints. Here is the Wikipedia entry.]
Plyometrics are included in most home-based programs because they are challenging, require very little equipment, and they produce results.
I'm not against them. Plyometrics are actually great...so long as they don't destroy you.
Almost every single DVD or on-line fitness guru will have you doing plyometrics inappropriately:
-You will be doing plyometrics without feedback on your form.
-You will be doing plyometrics without even knowing if your body possesses the flexibility and strength to achieve proper form.
-You will often be jumping into plyometrics without systematically increasing the resiliency of the muscles and connective tissue.
-You will often be jumping and thrusting around until you're blue in the face (in a state of high fatigue).
Each one of these factors -alone- is enough to cause injury, even in young people. Sorry, but it's the nature of the beast. On-line and DVD fitness programs simply cannot be custom tailored to assess and coach each person on the other side of the screen. And some of them are downright bad (poorly designed).
People of all fitness levels and walks of life make errors in their training. We go too hard or heavy, for too long, too often. We perform exercises incorrectly. We assume that what is healthy or "worked" for someone else is necessarily going to "work" for us. A fitness program or DVD simply cannot navigate the details of where you fit in.
I've made my share of training errors and experienced (and continue to experience) the consequences. Injuries...they happen. But the risks are often manageable, and well worth the benefit (and fun!) of leading an active lifestyle.
So put some thought into your plyometric training:
-While plyometrics impose various amounts of impact on the joints, the target body part is the nervous system. Plyos teach the brain to control and coordinate the entire body to be powerful and quick. If 20 minutes once or twice per week is good, more is NOT better.
-Seek instruction from someone who knows what they are doing. Ask questions like "Why am I doing this?" and "What does that certification mean?" If the answers sound like fitness jargon b.s., it is.
Has some work to do before hitting the plyos |
-Ideally, you should go through a basic movement screen to see that you pass the known prerequisites to beginning plyometric exercise.
-If you do stand to benefit from and tolerate plyometric activities, do not perform them in a state of fatigue. Keep the rest periods long and the work periods short and powerful. You should never feel completely gassed from these activities.
-For conditioning (getting in shape, calorie burning for weight loss, etc), find lower impact, grinding alternatives like variations of sled push, kettlebell swings and carry, farmer walk, rowing and stationary bike intervals, battling ropes, hill walks, jogs, and sprints, etc.
-If you are a serious runner or other endurance based athlete, see the above points AND do not confuse your resistance and plyometric training with just adding more endurance work. Your muscular endurance is already stellar, and you will benefit most from increasing your strength and power. So "lift" relatively heavy, leap and bound in short, powerful blasts, and be smart about exercise selection.
Again, find a guide for six or 8 weeks. This is usually plenty of time for you to ...
...you to TRULY LEARN how to best fit an effective exercise program to the structure of your body and the demands of your activity.
My apologies to Insanity. I want to thank them for the referrals. And if I spared you an injury, please direct your friend, uncle, or cousin who sustained an Insanity injury to my office.
6.16.2016
Should Football Players do Neck Exercises?
Today this question came in:
Football players are one of the few athletic population where direct neck exercises are absolutely warranted. Football imposes demands in this area and it makes sense that athletes should train to build some resiliency there.
I have a question that is somewhat controversial. What is your professional opinion about doing neck exercises for football players? If so, what do you recommend for exercises, reps
volume etc...
Football players are one of the few athletic population where direct neck exercises are absolutely warranted. Football imposes demands in this area and it makes sense that athletes should train to build some resiliency there.
Here are a few guidelines and caveats:
-The reps and resistance do not need to be extreme to derive benefit. Direct neck work should be done two to (at most) three times per week. Two to three moderate intensity sets of 6 to 8 reps in all planes (front, back, side) is plenty.
-The reps should be completed in the middle of the range of motion. This means that the athlete should NOT take their head as far as it should go. Take, for example, this training video found at NFL.com. It hurts my head to see guys cranking their cervical spine into maximum side bend, flexion and extension under load!
-Direct neck work is a great time to integrate some thoracic extension and rotation mobility drills to make sure and ingrain neutral cervical and thoracic spine posture from which to work the neck out of. Just like any other "core" exercise, one of the most beneficial things an athlete can do is take the time to achieve proper resting alignment and to understand what this feels like before they load the movements.
-Not all athletes have access to expensive neck isolation training machines and wall mounts. Using manually resisted movements (like in the video) is likely just as beneficial and encourages the athlete to work at less than maximal load - this is a good thing!
So no extra credit for 1 rep max neck personal records!
6.11.2016
Heel pain in soccer players
Heel pain is a common problem in any "cleated" athlete, and something often treated at my physical therapy office. This essay will focus on the most common cause of heel pain in young soccer players.
-----
Differential diagnoses includes Achilles tendinitis, stress fracture, recurring ankle sprain, nerve entrapment, and plantar fasciitis. Just...don't assume that your Google degree has enabled you to reliably determine Severs disease from a stress fracture or achilles tendinitis.
-----
The problem is most often a condition known as apophysitis of the calcaneus (heel bone) or Sever's Disease. This label describes a repetitive overuse injury, with inflammation of the growth area of the calcaneus which has not completely closed together. It is most commonly seen in boys and girls between the ages of 10-15 who frequently participate in sports that involve running and jumping. The pain is usually present in the back and bottom surface of the heal.
Causes of Sever's Disease Include:
1. Training Errors
The issue often occurs abruptly when the athlete resumes running, cutting, and jumping activities too frequently or intensely after a period of relative inactivity. Other times, the condition develops gradually as the athlete continues to pound their joints with insufficient time for recovery between games and practices.
2. Footwear
Soccer cleats are intentionally created to minimize interference of the function of the foot. This is great for quick cuts and precision touches to a soccer ball, but leaves very little between the foot and the ground. Cleats that are too small are often a culprit, as are shoes with less than four cleats in the heel area.
3. Foot Structure and Function
Biomechanical imbalances such as high or low arches, or very stiff or loose joints, can be the root cause of the abnormal strain across the Achilles tendon insertion point on the heel bone.
Treatment: Beyond rest and heel cups
The most effective treatment usually includes measures to address some combination of the above problems.
1. Systematically apply stress to the body.
Plan ahead to gradually apply more stress the foot and ankle before jumping into a lot of repetitive agility and sprint work. At least initially, apply a limited number of high impact activities to build resiliency in the foot and ankle.
Wear cleats around the house for "everyday life" and light skill work before using them for more intense activities.
2. Address biomechanical issues.
The details of foot structure and function are beyond the scope of this essay. This is highly individual, and demands a thorough orthopedic evaluation of the entire athlete (not just the foot). Not all "low arch" feet need orthotics. They may respond well to a few exercises and shoe modification. But some athletes certainly do require an appropriate off-the-shelf or custom orthotic device.
3. Modalities
Applying ice and massaging the calf muscles and the area around (but not directly to) the tender area often helps. I've found Ultrasound treatment to be worthwhile to decrease pain and inflammation. While these do indeed help manage the symptoms, they don't address the root cause.
4. Taping Techniques
There are a few flexible (aka kinesiotape) and traditional taping techniques that effectively reduce the overload of the heel bone. Sometime this is enough to get the athlete outside of the threshold of injury. Which technique and type of tape may work best depends on the static and dynamic (movement) patterns the athlete displays.
5. The quick fix. ***
I've hit upon a quick fix (of sorts), and will usually try this in combination with a few targeted exercises and temporary activity modification prior to considering an orthotic or other more intensive intervention.
The quick fix is a 1/4" semi soft heel lift that runs from the heel and gradually tapers to the ball of the foot. This works far better than Dr. Scholls type insole because they don't take up room in the toe box area where the athlete is accustomed to a form fitting shoe. And unlike gel "cushion" heel cups, they don't slide around in the shoe. They also provide more lift than squishy gel. A quarter inch is usually enough to lift the posterior half of the foot just enough to allow for mitigating the Achilles tendon pull on the calcaneus.
I make these in the orthotic lab and they often do wonders for athletes stuck in a rut of heel pain.
Try these tips and let me know if you have any questions.
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