a leg to stand on - cook children's medical center · landing phase • eccentric loading...
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A Leg to Stand On
Knee & Ankle Injury Prevention
E. John Stanley, MSPT, PTCook Children’s SPORTS Rehab750 Mid-Cities Blvd. Hurst, TX(817)605-2925
Knee & Ankle Injury
Prevention
Objectives:
Participants will be able to identify the most common ankle
and knee injuries.
� Participants will be able to demonstrate 2 training
principles to prevent lower extremity injuries.
� Participants will be able to demonstrate 2 exercises to
improve ankle stability during cutting maneuvers.
� Participants will be able to demonstrate 2 exercises to
decrease knee valgus during dynamic loading activities.
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A Leg to Stand OnPictures courtesy of: http://www.foottrainer.com/index.html
A Leg to Stand On
Mechanics: Progressive Loading
�Foot
�Knee
�Hip
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A Leg to Stand OnInjuries: Traumatic
Fractures
Sprains/Ruptures (ACL,MCL, ATFL, CFL)
Strains (Quad, Hamstrings, Adductor (groin), Gastrocs,
Hip flexor)
A Leg to Stand OnInjuries: Overuse
• Shin Splints
• Sever’s
• Plantar Fasciitis
• Neuroma’s
• Anterior knee pain
• Osgood-Schlatter’s
• ITB syndrome
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A Leg to Stand OnBALANCE OF STRENGTH
AGONISTANTAGONIST
A Leg to Stand OnBALANCE OF MUSCLE LENGTH
EXTENSORS FLEXORS
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A Leg to Stand OnBALANCE OF FORCES
FLEXIBILITY STRENGTH
A Leg to Stand On
Prevention:
Where is the weakest link?
Keeping alignment in dynamic situations is
the key
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Athletic Stance
• Foundation for all movement
• Must allow for linear, lateral, and multi-directional movement
Lauren Arnold, PT, DPT Performance Enhancement, 2009
Correct Athletic Stance
� Shoulders
• Pushed forward, shoulder
blades retracted
� Arms
• Elbows bent, hands relaxed
� Knees
• Slightly inside of feet
� Feet
• Wider than shoulder width
• Pointed straight ahead
Lauren Arnold, PT, DPT Performance Enhancement, 2009
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Correct Athletic Stance
� Back
• In neutral
� Hips
• Pushed back
� Knees
• Pushed forward over toes for positive shin angle
Lauren Arnold, PT, DPT Performance Enhancement, 2009
A Leg to Stand OnBALANCE OF MUSCLE LENGTH
EXTENSORS FLEXORS
Stretching program:-Quads v. Hamstrings-Gastroc v. Ant. Tibialis-Adductor v. ITB/TFL
Static Stretching: -Improve length-Done POST- performance-Intensity
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A Leg to Stand OnBALANCE OF STRENGTH
AGONIST ANTAGONIST
Hypertrophy and/or Endurance-Weight Room
Neuromuscular Control-Proprioception-Deceleration-Core stability
Lauren Arnold, PT, DPT Performance Enhancement, 2009
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Teaching proper landing is
key!
Requires eccentric
strength
A Leg to Stand On
Teaching Control:
- Proximal to distal
- Even to Uneven
- Static to Dynamic
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A Leg to Stand On
CORE FIRST:
- Proper static activation
- Endurance
- Proper dynamic activation
A Leg to Stand On
• Sit back and keep weight on heels
• Keep chest up, upper/lower back arched and tight, feet shoulder width apart
• Descend slowly until tops of thighs are parallel to floor
• Keep knees over midfoot and drive heels into floor
Squats: Form for Landing
Lauren Arnold, PT, DPT Performance Enhancement, 2009
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Teaching proper landing is
key!
Box step offs
• Initially, teach athlete to land on outside of foot, rolling to inside to dissipate forces
• As strength increases, athlete can land only on ball of foot
Jump and Hop Progression
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Plyometric Sequence
� Landing phase
• Eccentric loading
� Amortization phase
• Time on the ground
• Time between eccentric loading and concentric contraction
� Take off phase
• Concentric contraction
Lauren Arnold, PT, DPT Performance Enhancement, 2009
Deceleration Training
� Proper position of the feet, legs, and upper
body to dissipate forces is crucial for the
prevention of injuries and for sports
performance!
� Injuries primarily occur during
deceleration and rotational
circumstances
Lauren Arnold, PT, DPT Performance Enhancement, 2009
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A Leg to Stand OnPutting it all Together
Components and
Length of warm up
� Based on objective of training session
� Range from 10-30 minutes
� Depends on environmental conditions and
intensity of practice
Lauren Arnold, PT, DPT Performance Enhancement, 2009
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Progression of warm
up
General to specific
Low intensity to high
intensity
Linear to lateral to multi-
directional movements
Lauren Arnold, PT, DPT Performance Enhancement, 2009
Sample Warm Up
� Ankling
� Walking knee hug
� Cradle walk
� Shin grabs
� Easy skip
� Soldier kicks
� Inchworms
� Spidermans
� High skipping
� Lateral shuffle
� Carioka
� Falling starts
� Get up and go
� Back Pedal
Lauren Arnold, PT, DPT Performance Enhancement, 2009
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Cutting Progression
� In place stabilization hop
� Walk → stabilization hop
� Jog → stabilization hop
� Run → stabilization hop
� In place cutting maneuver
� Walk → cutting maneuver
� Jog → cutting maneuver
� Run →cutting maneuver
Lauren Arnold, PT, DPT Performance Enhancement, 2009
Jump and Hop Progression
� Moving Hops
• Linear
� Forward
� Backward
� Medial/lateral
• Multi-directional
� Star pattern
� On command
Lauren Arnold, PT, DPT Performance Enhancement, 2009
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Components of a sound
strength training program
� Core strength
� Power exercises
� Knee dominant exercises
� Hip dominant exercises
� Horz. pressing movements
� Horz. pulling movements
� Vertical pressing movements
� Vertical pulling movements
Lauren Arnold, PT, DPT Performance Enhancement, 2009
Knee & Ankle Injury
PreventionBibliography: Arnold, Lauren, PT,DPT: Performance Training: Speed, Agility, & Quickness
Training. A review of the course presented by Brian Lawler, MS, PT, OCS,
ATC, CSCS, PES on behalf of North American Seminars on October 31-
November 1, 2009.
Mihalik, Jason P; Libby, Jeremiah J; Battaglini, Claudio L; McMurray, Robert G.
The Duration of the Inhibitory Effects with Static Stretching on Quadriceps
Peak Torque Production The Journal of Strength & Conditioning Research.
22(1):47-53, January 2008.
Faigenbaum, Avery D.; Bellucci, Mario; Bernieri, Angelo; Bakker, Bart; Hoorens,
Karlyn. Acute Effects of Different Warm-Up Protocols on Fitness
Performance in Children. The Journal of Strength & Conditioning Research.
19(2):376-381, May 2005