1. The Time Constrained Athlete: Developing a 15 Minute Rehabilitation Program National Academy of Sports Medicine © 2011 Joshua Stone, MA, ATC, NASM-CPT, CES, PES Sports Medicine Program Manager National Academy of Sports Medicine

2. Agenda Time constrained athlete Introduction to the human movement system Human movement dysfunction Corrective Exercise Continuum Case Studies - 15 minute rehabilitation programs x 2 Open discussion National Academy of Sports Medicine © 2011

3. The Problem National Academy of Sports Medicine © 2011 Time Crunch Suboptimal care

4. Best Utilization of Time? Prioritization What is the single best tool for the injury Modalities Manual Therapy Prophylaxis Rehabilitation Injury dependent National Academy of Sports Medicine © 2011

5. The Keys to Optimal Care Understanding Athletes’ needs Treatment or rehabilitation Knowledge pertaining to human movement system Flexibility in program design Willing to change mind-set Creativity in modality use National Academy of Sports Medicine © 2011

6. Human Movement System Muscular System SkeletalSystem NervousSystem Sensorimotor Integration Neuromuscular Control The Human Movement System Human Movement System Human Movement System is a very complex, well-orchestrated system of interrelated and interdependent myofascial, neuromuscular, and articular components National Academy of Sports Medicine © 2011

7. Human Movement Impairments Human Movement Impairments Static malalignments Dynamic malalignments Foot/Ankle Knee Hip/Low Back Shoulder Altered muscle activation patterns Synergistic dominance Altered Reciprocal inhibition Relative strength and relative flexibility National Academy of Sports Medicine © 2011

8. Static Malalignments Static malalignments may alter normal length-tension relationships. Common static malalignments include joint hypomobility (decreased range of motion) myofascial adhesions Poor static posture • National Academy of Sports Medicine © 2008 Joint hypomobility is one of the most common causes of pain Certain muscles become tight or hypertonic (tense) to prevent movement and prevent further injury.

9. Dynamic Malalignments Dynamic malalignment (movement impairment syndromes) altered muscle recruitment patterns multi-segmental human movement system impairment National Academy of Sports Medicine © 2011

10. Altered Muscle Activation Patterns Altered Reciprocal Inhibition muscle inhibition caused by a tight /overactive muscle decreasing neural drive of its functional antagonist Synergistic Dominance Occurs when synergists take over function for a weak or inhibited prime mover Psoas Gluteus Maximus Hamstrings This altered muscle recruitment pattern further alters alignment and leads to injury National Academy of Sports Medicine © 2011

11. National Academy of Sports Medicine © 2011 Dysfunction Altered Length-Tension Relationships (muscle tightness) Altered Arthrokinematics Altered Force-CoupleRelationships (muscle weakness) Altered Sensorimotor Integration Altered Neuromuscular Efficiency Tissue Fatigue Tissue Breakdown Human Movement Dysfunction

12. Common Injuries Foot/Ankle Plantar fascia Ankle sprains Sesamoiditis Achilles tendonitis Lower leg MTSS Post tib. Tendonitis Stress Fx Knee PFPS ACL OCD Patella tendonitis Osgood-Schlatter / Larsen-Johansson IT Band Bursitis Low Back Snapping hip Chronic strains SI joint pain Osteitis Pubis Facet syndrome Shoulder Impingement syndrome Biceps tendonitis Rotator cuff tendonitis Strain Subluxation / dislocation Elbow Epicondylitis / tendonitis UCL Pronator syndrome National Academy of Sports Medicine © 2011

13. What is Poor Movement? National Academy of Sports Medicine © 2011 arching the low back elevating the shoulders knee valgus

14. Why Do We See Imbalances? Stability Mobility National Academy of Sports Medicine © 2011

15. Movement Assessments • National Academy of Sports Medicine © 2011 A movement assessment allows a Health and Fitness Professional to observe Human Movement System impairments. Determines what muscles are underactive and overactive and how that impacts a client’s ability to move properly This information can then be correlated to subjective assessment findings, for a comprehensive representation of the client’s functional status.

18. Structural alignment

19. Dynamic flexibility

20. Neuromuscular control

21. Position:

22. Feet shoulder width apart

23. Arms overheadANTERIOR LATERAL POSTERIOR

24. Movement Compensations

26. Knee valgus (Knock Kneed)

28. posterior tibialis tendinitis (shin splints)

29. anterior knee pain

31. forward head posture

34. shoulder instability

35. biceps tendinitis

36. thoracic outlet syndrome

38. The Single-leg Squat Assessment Single-leg Squat Assessment Designed to assess dynamic flexibility, core strength, balance and neuromuscular control. Position Place hands on the waist The feet should be pointing straight ahead The ankle, knee and the lumbo-pelvic-hip complex should be in a neutral position. National Academy of Sports Medicine © 2011

39. A Few Common Compensations Seen Single Leg Squat Assessment Knees Inward movement Hips Inward/Outward Trunk Rotation Inward Trunk Rotation Knee moves inward Outward Trunk Rotation National Academy of Sports Medicine © 2011

40. Double-leg Squat & Single-leg Squat National Academy of Sports Medicine © 2011

41. National Academy of Sports Medicine • Movement Assessments Assessment Modification Modifications to Overhead Squat: Elevating the heels Hands on the hips

42. Pushing and Pulling Assessments Push-ups Assessment Standing Row Assessment National Academy of Sports Medicine © 2011

43. Inhibit Activate Integrate Lengthen Inhibitory Techniques Self-Myofascial Release Manual Therapy Activation Techniques Isolated Strengthening Positional Isometrics Integration Techniques Integrated Dynamic Movement Lengthening Techniques Static Stretching Neuromuscular Stretching Manual Therapy The Corrective Exercise Continuum National Academy of Sports Medicine © 2011

44. Case Studies Two Case Studies Background Information Goals Lifestyle Medical history Video footage Movement Assessments Identify Movement compensation Design a CEx program National Academy of Sports Medicine © 2011

45. Case Study 1: Rachel’s Bio Bio: Rachel Age: Sophomore Sport: Cross Country Recreation/Hobbies: Running, dancing, movies Problem: MTSS Occupation: Student Athlete Medical History: Goodhealth, no previous surgeries or medication National Academy of Sports Medicine © 2011

46. Case Study 1: Rachel’s Overhead Squat Assessment National Academy of Sports Medicine © 2011

47. Rachel’s Overhead Squat National Academy of Sports Medicine © 2011

48. Rachel’s Modified Overhead Squat Assessment National Academy of Sports Medicine © 2011

49. Case Study 1: Rachel’s Single-leg Squat Assessment National Academy of Sports Medicine © 2011

50. Rachel’s Single Leg Squat National Academy of Sports Medicine © 2011

51. Rachel’s Movement Analysis National Academy of Sports Medicine © 2011

52. Analysis of Rachel: Program Design Overactive/Tight Lateral Gastrocnemius / Soleus Biceps femoris (short head) TFL Hip flexors (rectus femoris, psoas) Adductor complex Peroneals Vastus Lateralis Underactive/Weak Medial Gastrocnemius Anterior & posterior tibialis Medial hamstrings Vastus Medialis oblique Gluteus Medius / Maximus CEx Goal: Prioritize issues Regain LE muscle balance Relieve lower extremity pain National Academy of Sports Medicine © 2011

53. 15 Minute Corrective Exercise Program National Academy of Sports Medicine © 2011

54. 15 Minute Corrective Exercise Program National Academy of Sports Medicine © 2011

55. 15 Minute Corrective Exercise Program National Academy of Sports Medicine © 2011

56. 15 Minute Corrective Exercise Program National Academy of Sports Medicine © 2011

57. Case Study 2: Jeff’s Bio Bio: Age: Senior Sport: Baseball Recreation/Hobbies: Hiking, working out, fishing Goal: Biceps tendinitis, impingement syndrome Occupation: Student Athlete Medical History: Goodhealth, previous rotator cuff repair National Academy of Sports Medicine © 2011

58. Case Study 2: Jeff’s Overhead Squat Assessment National Academy of Sports Medicine © 2011

59. Jeff’s Overhead Squat National Academy of Sports Medicine © 2011

60. Analysis of Jeff’s Movement National Academy of Sports Medicine © 2011

62. Latissimus Dorsi

63. Pectoralis Major

64. Pectoralis Minor

65. Subscapularis

66. Lateral gastrocnemius / soleus

67. Hip flexors

68. (TFL, rectus femoris, psoas)

69. Underactive/Weak

70. Middle/Lower Trapezius

71. Serratus Anterior

72. Rhomboids

73. Posterior Rotator Cuff

74. Gluteus medius/maximus

75. Intrinsic core stabilizersCEx Goal: Prioritize issues Regain muscle balance in the upper Alleviate shoulder pain National Academy of Sports Medicine © 2011

76. 15 minute Corrective Exercise Program National Academy of Sports Medicine © 2011

77. 15 minute Corrective Exercise Program National Academy of Sports Medicine © 2011

78. 15 minute Corrective Exercise Program National Academy of Sports Medicine © 2011

79. 15 minute Corrective Exercise Program National Academy of Sports Medicine © 2011

80. 15 minute Corrective Exercise Program National Academy of Sports Medicine © 2011

81. Summary Inhibit Activate Integrate Lengthen Inhibit: Myofascial Release to Overactive Muscles Activate: Strengthening of Underactive Muscles Integrate: Dynamic /Functional Strengthening Movement Lengthen: Stretching or Manual Therapy to Overactive Muscles Perform an integrated assessment to identify dysfunction Utilize rehab vs. biophysical modalities if possible Develop focused corrective exercise program based on assessment with given time frames National Academy of Sports Medicine © 2011

83. facebook.com/NASMJosh

84. facebook.com/correctiveexercise